Simulation training is a widely used educational modality for both technical and nontechnical skills and provides a safe environment for trainees to practise these skills. However, research into simulation training for communication in other institutional settings has found that simulations are not reflective of actual interactional or communicative practices. Clinical simulation research has also found that issues of authenticity impact on performance in simulations. Using conversation analysis, we compare what norms participants orient to in simulated versus actual surgeon- patient interactions. By doing so, we have identified differences between these interactions. In this article we focus on the ways actors present their problems differently to patients, how they manage the transition to history taking, and how they account for their visit to the doctor.