['Photorealistic simulations may provide efficient transfer of certain skills to the real system, but by being opaque may fail to encourage deeper learning of the structure and function of the system. Schematic simulations that are more abstract, with less visual fidelity but make system structure and function transparent, may enhance deeper learning and optimize retention and transfer of learning. We compared learning effectiveness of these 2 modes of externalizing the output of a common simulation engine (the Virtual Anesthesia Machine, VAM) that models machine function and dynamics and responds in real time to user interventions such as changes in gas flow or ventilation.', "Undergraduate students (n = 39) and medical students (n = 35) were given a single, 1-hour guided learning session with either a Transparent or an Opaque version of the VAM simulation. The following day, the learners' knowledge of machine components, function, and dynamics was tested.", 'The Transparent-VAM groups scored higher than the Opaque-VAM groups on a set of multiple-choice questions concerning conceptual knowledge about anesthesia machines (P = 0.009), provided better and more complete explanations of component function (P = 0.003), and were more accurate in remembering and inferring cause-and-effect dynamics of the machine and relations among components (P = 0.003). Although the medical students outperformed undergraduates on all measures, a similar pattern of benefits for the Transparent VAM was observed for these 2 groups.'] Is understanding of anesthesia machine function enhanced with a transparent reality simulation?