The Virtual Anesthesia Machine (VAM) simulation is the flagship transparent reality simulation that led to the creation of the VAM web site.  First implemented in 1999, this simulation of a generic anesthesia machine with an oxygen-driven bellows ventilator now includes legends in 23 languages and 6 medical gas color codes.  Flow of gases is not only made visible but is also color-coded.  Users can interact with controls and settings of the anesthesia machine via a pointing device such as a mouse or trackball.  Audible cues are also provided to enhance the realism of the learning experience.