Abstract
Simulation is a technique—not a technology—to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner. The diverse applications of simulation in health care can be categorised by 11 dimensions: aims and purposes of the simulation activity; unit of participation; experience level of participants; health care domain; professional discipline of participants; type of knowledge, skill, attitudes, or behaviours addressed; the simulated patient's age; technology applicable or required; site of simulation; extent of direct participation; and method of feedback used. Using simulation to improve safety will require full integration of its applications into the routine structures and practices of health care. The costs and benefits of simulation are difficult to determine, especially for the most challenging applications, where long term use may be required. Various driving forces and implementation mechanisms can be expected to propel simulation forward, including professional societies, liability insurers, health care payers, and ultimately the public. The future of simulation in health care depends on the commitment and ingenuity of the health care simulation community to see that improved patient safety using this tool becomes a reality.
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Selected References
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- Agutter James, Drews Frank, Syroid Noah, Westneskow Dwayne, Albert Rob, Strayer David, Bermudez Julio, Weinger Matthew B. Evaluation of graphic cardiovascular display in a high-fidelity simulator. Anesth Analg. 2003 Nov;97(5):1403–1413. doi: 10.1213/01.ANE.0000085298.03143.CD. [DOI] [PubMed] [Google Scholar]
- Barrows H. S. An overview of the uses of standardized patients for teaching and evaluating clinical skills. AAMC. Acad Med. 1993 Jun;68(6):443–453. doi: 10.1097/00001888-199306000-00002. [DOI] [PubMed] [Google Scholar]
- Beullens J., Rethans J. J., Goedhuys J., Buntinx F. The use of standardized patients in research in general practice. Fam Pract. 1997 Feb;14(1):58–62. doi: 10.1093/fampra/14.1.58. [DOI] [PubMed] [Google Scholar]
- Billings C. E., Reynard W. D. Human factors in aircraft incidents: results of a 7-year study. Aviat Space Environ Med. 1984 Oct;55(10):960–965. [PubMed] [Google Scholar]
- Bloom Matthew B., Rawn Chantal L., Salzberg Arnold D., Krummel Thomas M. Virtual reality applied to procedural testing: the next era. Ann Surg. 2003 Mar;237(3):442–448. doi: 10.1097/01.SLA.0000055279.50681.80. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Boulet John R., Murray David, Kras Joe, Woodhouse Julie, McAllister John, Ziv Amitai. Reliability and validity of a simulation-based acute care skills assessment for medical students and residents. Anesthesiology. 2003 Dec;99(6):1270–1280. doi: 10.1097/00000542-200312000-00007. [DOI] [PubMed] [Google Scholar]
- Cooper J. B., Barron D., Blum R., Davison J. K., Feinstein D., Halasz J., Raemer D., Russell R. Video teleconferencing with realistic simulation for medical education. J Clin Anesth. 2000 May;12(3):256–261. doi: 10.1016/s0952-8180(00)00148-3. [DOI] [PubMed] [Google Scholar]
- Cotin S., Dawson S. L., Meglan D., Shaffer D. W., Ferrell M. A., Bardsley R. S., Morgan F. M., Nagano T., Nikom J., Sherman P. ICTS, an interventional cardiology training system. Stud Health Technol Inform. 2000;70:59–65. [PubMed] [Google Scholar]
- Fletcher G., Flin R., McGeorge P., Glavin R., Maran N., Patey R. Anaesthetists' Non-Technical Skills (ANTS): evaluation of a behavioural marker system. Br J Anaesth. 2003 May;90(5):580–588. doi: 10.1093/bja/aeg112. [DOI] [PubMed] [Google Scholar]
- Gaba D. M., DeAnda A. A comprehensive anesthesia simulation environment: re-creating the operating room for research and training. Anesthesiology. 1988 Sep;69(3):387–394. [PubMed] [Google Scholar]
- Gaba D. M., Howard S. K., Flanagan B., Smith B. E., Fish K. J., Botney R. Assessment of clinical performance during simulated crises using both technical and behavioral ratings. Anesthesiology. 1998 Jul;89(1):8–18. doi: 10.1097/00000542-199807000-00005. [DOI] [PubMed] [Google Scholar]
- Good M. L., Gravenstein J. S. Anesthesia simulators and training devices. Int Anesthesiol Clin. 1989 Fall;27(3):161–168. doi: 10.1097/00004311-198902730-00005. [DOI] [PubMed] [Google Scholar]
- Helmreich R. L., Merritt A. C., Wilhelm J. A. The evolution of Crew Resource Management training in commercial aviation. Int J Aviat Psychol. 1999;9(1):19–32. doi: 10.1207/s15327108ijap0901_2. [DOI] [PubMed] [Google Scholar]
- Howard Steven K., Gaba David M., Smith Brian E., Weinger Matthew B., Herndon Christopher, Keshavacharya Shanthala, Rosekind Mark R. Simulation study of rested versus sleep-deprived anesthesiologists. Anesthesiology. 2003 Jun;98(6):1345–5A. doi: 10.1097/00000542-200306000-00008. [DOI] [PubMed] [Google Scholar]
- Krummel T. M. Surgical simulation and virtual reality: the coming revolution. Ann Surg. 1998 Nov;228(5):635–637. doi: 10.1097/00000658-199811000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Letterie Gerard S. How virtual reality may enhance training in obstetrics and gynecology. Am J Obstet Gynecol. 2002 Sep;187(3 Suppl):S37–S40. doi: 10.1067/mob.2002.127361. [DOI] [PubMed] [Google Scholar]
- Lighthall Geoffrey K., Barr Juliana, Howard Steven K., Gellar Eran, Sowb Yasser, Bertacini Edward, Gaba David. Use of a fully simulated intensive care unit environment for critical event management training for internal medicine residents. Crit Care Med. 2003 Oct;31(10):2437–2443. doi: 10.1097/01.CCM.0000089645.94121.42. [DOI] [PubMed] [Google Scholar]
- McLaughlin Steven A., Doezema David, Sklar David P. Human simulation in emergency medicine training: a model curriculum. Acad Emerg Med. 2002 Nov;9(11):1310–1318. doi: 10.1111/j.1553-2712.2002.tb01593.x. [DOI] [PubMed] [Google Scholar]
- Meier A. H., Rawn C. L., Krummel T. M. Virtual reality: surgical application--challenge for the new millennium. J Am Coll Surg. 2001 Mar;192(3):372–384. doi: 10.1016/s1072-7515(01)00769-4. [DOI] [PubMed] [Google Scholar]
- Miller G. E. The assessment of clinical skills/competence/performance. Acad Med. 1990 Sep;65(9 Suppl):S63–S67. doi: 10.1097/00001888-199009000-00045. [DOI] [PubMed] [Google Scholar]
- Mohr J. J., Batalden P. B. Improving safety on the front lines: the role of clinical microsystems. Qual Saf Health Care. 2002 Mar;11(1):45–50. doi: 10.1136/qhc.11.1.45. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Murray W. B., Foster P. A. Crisis resource management among strangers: principles of organizing a multidisciplinary group for crisis resource management. J Clin Anesth. 2000 Dec;12(8):633–638. doi: 10.1016/s0952-8180(00)00223-3. [DOI] [PubMed] [Google Scholar]
- Nelson Eugene C., Batalden Paul B., Huber Thomas P., Mohr Julie J., Godfrey Marjorie M., Headrick Linda A., Wasson John H. Microsystems in health care: Part 1. Learning from high-performing front-line clinical units. Jt Comm J Qual Improv. 2002 Sep;28(9):472–493. doi: 10.1016/s1070-3241(02)28051-7. [DOI] [PubMed] [Google Scholar]
- Pittini R., Oepkes D., Macrury K., Reznick R., Beyene J., Windrim R. Teaching invasive perinatal procedures: assessment of a high fidelity simulator-based curriculum. Ultrasound Obstet Gynecol. 2002 May;19(5):478–483. doi: 10.1046/j.1469-0705.2002.00701.x. [DOI] [PubMed] [Google Scholar]
- Reznek Martin, Harter Phillip, Krummel Thomas. Virtual reality and simulation: training the future emergency physician. Acad Emerg Med. 2002 Jan;9(1):78–87. doi: 10.1111/j.1553-2712.2002.tb01172.x. [DOI] [PubMed] [Google Scholar]
- Reznek Martin, Smith-Coggins Rebecca, Howard Steven, Kiran Kanthi, Harter Phillip, Sowb Yasser, Gaba David, Krummel Thomas. Emergency medicine crisis resource management (EMCRM): pilot study of a simulation-based crisis management course for emergency medicine. Acad Emerg Med. 2003 Apr;10(4):386–389. doi: 10.1111/j.1553-2712.2003.tb01354.x. [DOI] [PubMed] [Google Scholar]
- Salas E., Burke C. S., Bowers C. A., Wilson K. A. Team training in the skies: does crew resource management (CRM) training work? Hum Factors. 2001 Winter;43(4):641–674. doi: 10.1518/001872001775870386. [DOI] [PubMed] [Google Scholar]
- Satava R. M., Cuschieri A., Hamdorf J., Metrics for Objective Assessment of Surgical Skills Workshop Metrics for objective Assessment. Surg Endosc. 2002 Nov 20;17(2):220–226. doi: 10.1007/s00464-002-8869-8. [DOI] [PubMed] [Google Scholar]
- Satava R. M. Emerging medical applications of virtual reality: a surgeon's perspective. Artif Intell Med. 1994 Aug;6(4):281–288. doi: 10.1016/0933-3657(94)90033-7. [DOI] [PubMed] [Google Scholar]
- Satava R. M. Surgical education and surgical simulation. World J Surg. 2001 Nov;25(11):1484–1489. doi: 10.1007/s00268-001-0134-0. [DOI] [PubMed] [Google Scholar]
- Satava Richard M., Gallagher Anthony G., Pellegrini Carlos A. Surgical competence and surgical proficiency: definitions, taxonomy, and metrics. J Am Coll Surg. 2003 Jun;196(6):933–937. doi: 10.1016/S1072-7515(03)00237-0. [DOI] [PubMed] [Google Scholar]
- Schwid H. A. A flight simulator for general anesthesia training. Comput Biomed Res. 1987 Feb;20(1):64–75. doi: 10.1016/0010-4809(87)90019-x. [DOI] [PubMed] [Google Scholar]
- Schwid H. A., O'Donnell D. The Anesthesia Simulator Consultant: simulation plus expert system. Anesthesiol Rev. 1993 Sep-Oct;20(5):185–189. [PubMed] [Google Scholar]
- Schwid Howard A., Rooke G. Alec, Carline Jan, Steadman Randolph H., Murray W. Bosseau, Olympio Michael, Tarver Stephen, Steckner Karen, Wetstone Susan, Anesthesia Simulator Research Consortium Evaluation of anesthesia residents using mannequin-based simulation: a multiinstitutional study. Anesthesiology. 2002 Dec;97(6):1434–1444. doi: 10.1097/00000542-200212000-00015. [DOI] [PubMed] [Google Scholar]
- Sica G. T., Barron D. M., Blum R., Frenna T. H., Raemer D. B. Computerized realistic simulation: a teaching module for crisis management in radiology. AJR Am J Roentgenol. 1999 Feb;172(2):301–304. doi: 10.2214/ajr.172.2.9930771. [DOI] [PubMed] [Google Scholar]
- Small S. D., Wuerz R. C., Simon R., Shapiro N., Conn A., Setnik G. Demonstration of high-fidelity simulation team training for emergency medicine. Acad Emerg Med. 1999 Apr;6(4):312–323. doi: 10.1111/j.1553-2712.1999.tb00395.x. [DOI] [PubMed] [Google Scholar]
- Stefanich L., Cruz-Neira C. A virtual surgical simulator for the lower limbs. Biomed Sci Instrum. 1999;35:141–145. [PubMed] [Google Scholar]
- Stillman P. L., Swanson D. B. Ensuring the clinical competence of medical school graduates through standardized patients. Arch Intern Med. 1987 Jun;147(6):1049–1052. [PubMed] [Google Scholar]
- Sutnick A. I., Stillman P. L., Norcini J. J., Friedman M., Regan M. B., Williams R. G., Kachur E. K., Haggerty M. A., Wilson M. P. ECFMG assessment of clinical competence of graduates of foreign medical schools. Educational Commission for Foreign Medical Graduates. JAMA. 1993 Sep 1;270(9):1041–1045. [PubMed] [Google Scholar]
- Thompson S., Neal S., Clark V. Clinical risk management in obstetrics: eclampsia drills. Qual Saf Health Care. 2004 Apr;13(2):127–129. doi: 10.1136/qhc.13.2.127. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Tsai T-C, Harasym P. H., Nijssen-Jordan C., Jennett P., Powell G. The quality of a simulation examination using a high-fidelity child manikin. Med Educ. 2003 Nov;37 (Suppl 1):72–78. doi: 10.1046/j.1365-2923.37.s1.3.x. [DOI] [PubMed] [Google Scholar]
- Wang Y., Chui C., Lim H., Cai Y., Mak K. Real-time interactive simulator for percutaneous coronary revascularization procedures. Comput Aided Surg. 1998;3(5):211–227. doi: 10.1002/(SICI)1097-0150(1998)3:5<211::AID-IGS1>3.0.CO;2-6. [DOI] [PubMed] [Google Scholar]
- Wildavsky A. Doing better and feeling worse: the political pathology of health policy. Daedalus. 1977 Winter;:105–123. [PubMed] [Google Scholar]
- Ziv A., Ben-David M. F., Sutnick A. I., Gary N. E. Lessons learned from six years of international administrations of the ECFMG's SP-based clinical skills assessment. Acad Med. 1998 Jan;73(1):84–91. doi: 10.1097/00001888-199801000-00017. [DOI] [PubMed] [Google Scholar]