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The most effective screening for prostate cancer combines the prostate specific antigen blood test with the digital rectal examination (DRE). In performing a DRE, two sequential tasks are completed: ( task a) palpating the prostate to identify abnormalities and ( task b) linking identified abnormalities to a disease diagnosis. At present, clinicians find too few abnormalities and have variable rates of detection, due in part to the inadequacy of training simulators. The Virginia Prostate Examination Simulator (VPES) was designed, built, and tested to address the inadequacies of current simulators by incorporating the design requirements of the basic elements of accurate anatomy, multiple and reconfigurable scenarios of graded difficulty, and technique and performance feedback. We compared the training effectiveness of the VPES with two commercial simulators in an experiment of 36 medical and nurse practitioner students. Results indicate each type of training simulator-improved abilities, in general. Upon closer analysis, however, the following key patterns emerge: 1) Across all types of training, more deficiencies lie in skill-based rather than rule-based decision making, which improves only for VPES trainees; 2) only VPES training transfers both to other simulators and previously unencountered scenarios; 3) visual feedback may increase the number of abnormalities reported yet hinder the ability to discriminate; and 4) applied finger pressure did not correlate with the ability to identify abnormalities.