Mac, I wish I could write like that. I'm intending to paste that into my archive of ‘Prestigious Prose.'
Davaar
In short, I believe sims are a good systems trainer and they put the pilot to a good level of work-load while flying something resembling the aircraft type. I do not believe that they are a substitute for the real aircraft.
I guess the medical relevance is to do with stress loading, which can be achieved in the box, but it will never burden the candidate with the right type of fear.
Most base-checks are stressful, but it has little to do with the type of fear that I have talked about in the past. Some years ago I wrote about rational v irrational fear and talked of the type of symptoms that both could cause. For me, the peak stress in a base-check is just about the time I'm picking alternates for the first take-off. Everything after that is a free lunch by comparison...well, usually.
It's strange, but having all my ‘jet' training on a real airplane, I went into the work-place with no knowledge of sims at all. After about two years, some of our base checks were done courtesy of another airline. It was interesting to seen guys I had flown with for years, take off and spiral into the ground. One in particular was ex WWII and a line check captain on type. He just cussed at the ‘box' and blamed it for his violent over-corrections, he had the right mind-set for aviation. He would of course fly by the seat of his pants until retirement. However, another old-timer flew through all kinds of electronic hints, down to a landing somewhere below the ground. The box let him know in uncertain terms. He looked stunned to the point of needing medical assistance, but the point was that although it no doubt taught him some sort of lesson, the fear wasn't there before the ‘crash'.