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Given a surgical context frame and a stream of robot kinematic actions, the model autoregressively generates the resulting future video in short blocks, streaming interactively on a single GPU. Unlike the bidirectional, offline [Cosmos-H-Surgical-Simulator](https://huggingface.co/nvidia/Cosmos-H-Surgical-Simulator), Cosmos-H-Dreams is a **causal, few-step self-forcing distilled student**: it is distilled from a bidirectional teacher into a streaming model that responds immediately to actions, turning a passive video generator into a controllable surgical simulator. The released checkpoint specializes the model to da Vinci Research Kit (dVRK) tabletop suturing. The model is intended for real-time surgical-skills rehearsal, interactive demonstration, closed-loop evaluation of surgical robotics policies, and synthetic data generation. 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