Simulations will be important in 21st-century medical education. However, several obstacles may prevent this teaching tool from being introduced to individual medical schools. Most medical schools cannot afford expensive full-scale simulators and do not have enough space for introducing simulation materials. Medical schools must also hire operators for extremely sophisticated computers. To solve these problems we propose to establish a medical simulation center in a large city. Trainees will come to the center from medical schools in Tokyo and learn fundamental techniques, such as intravenous injection and endotracheal intubation, with specialized partial simulators. In advanced courses, trainees can learn with fullscale simulations how to deal with serious situation. The establishment of a simulation center in a large city may popularize the use of expensive simulators and equipment. However, how to maintain the center financially remains a problem; raising funds from many sources is the key to success.