1 Project Summary 2 The objective of our current R01 project, “Surgical Simulator for Improving Skill Proficiency and Resilience”, is 3 to design, develop, and validate methods by which simulation technologies can be used by practicing surgeons. 4 This project is extending the interactive Medical Simulation Toolkit (iMSTK) by developing software templates 5 for rare and adverse event simulation including physiological modeling, automating skill assessment, and 6 performance management in surgical simulations, which are critical for building powerful simulation applications 7 for practicing surgeons. Physiology remains an aspect of interactive real-time simulation that is rarely dealt with. 8 In most instances physiological models are developed separately without coordination with interactive surgical 9 simulation. In our current grant, we are integrating Kitware’s open source Pulse Physiology Engine with iMSTK 10 to build a closed-loop physiology model that handles local physiology changes and global, systemic physiological 11 responses. We are demonstrating these new developments by building a virtual surgical simulator for 12 cholecystectomy with bile duct injury and other rare complications that occur in this type of surgery. The goals 13 of our supplement are to 1) improve the computational efficiency of Pulse, 2) advance the external interfaces for 14 Pulse, including the Unity Asset, and 3) engage and promote Pulse to expand the user community. These goals 15 will support the parent grant by 1) improving computational efficiency to ensure that Pulse does not engage 16 critical computational resources required for graphical render, displacement and force calculations, and haptic 17 interface integration and 2) making Pulse more readily accessible via external interfaces, such as Unity, which 18 is the simulator environment for our parent grant. The supplement will also have a significant impact on medical 19 simulation in general by improving the accessibility of the Pulse via additional external interfaces, such as an 20 Unreal Plugin and interface language support, including Python, C#, and Java. We plan to engage the community 21 via publications, software releases, blog posts, and a workshop at a computational modeling conference. We 22 will engage Kitware’s well-respected software development team with the Key Personnel of the parent grant to 23 advance the Pulse platform and engage with our community of users. 24 25