Before the application of virtual simulations and serious games for surgical education and training becomes more widespread, there are a number of open questions and issues that must be addressed including the relationship between realism, multi-modal cue interaction, immersion, and knowledge transfer and retention. Using the serious game surgical cognitive education and training framework developed specifically for cognitive surgical skills training, here we examine the effect of sound on visual realism perception and task completion time while performing a task within a virtual environment. Our preliminary experimental results indicate that the appropriate use of sound can lead to performance improvements when performing a task within a virtual environment without a corresponding decrease in the perception of visual realism.