Table 1 Use of simulators in emergency medicine.

Airway		Use of a simulator to teach airway skills to EM trainees. Simulator found to be ideal for teaching specific practical airway skills and demonstrating physiological responses in management of emergency airway6
Trauma		Use of a simulator within an ATLS course for teaching surgical airway and management of a pneumothorax7. Used as an adjunct to learning trauma skills after an ATLS course8
Crisis management		EMCRM course based on the ACRM course. Thirteen residents piloted the course, which concentrated on leadership and teamwork skills as well as anticipation and communication. Extremely positive response to the course in the small sample. The authors summarise that there should be further development and investigation of simulator based crisis management training for emergency medicine.9 Another pilot programme combined EM scenarios with the principles of the ACRM course. The paper highlights the proof of concept simulation workshop that was developed, and heralds the use of multiple simulators for teamwork education10
Medical error		Pilot study of 15 EM residents qualitatively assessing the use of simulation as an educational technique. Medical error was examined through cognitive forcing techniques. Students rated the technique as second only to direct patient care as a learning experience11
Ethics		Within the EMCRM course, a simulator was used to provide a scenario of an ethical dilemma to assess the professionalism of EM residents against performance checklists. Although the participants all worked in EM, the study was not specific to the use of simulators for EM, but was successful in demonstrating this use of simulation12
Team performance		A prospective, blinded controlled observational study on EM teams, determining if simulation based team training improves clinical team performance. Although no statistically significant results were found, there was a trend towards improvement in the quality of team behaviour as measured by a validated behavioural rating scale13
Review		Reznek et al highlight the likely future use of simulation and virtual reality in EM education. They summarise: “it will be important for academic emergency physicians to become more involved with this technology to ensure that our educational system benefits optimally”.14 McLaughlin et al proposed a 3 year EM curriculum for a US residency programme using human simulation for both teaching and assessment of the core competencies of patient care, interpersonal skills, communication, professionalism, and practice based learning.15 In a review article building on discussions from members of the Educational Technology Section of the 2004 Academic Emergency Medicine Consensus Conference for Informatics and Technology in Emergency Department Health Care, Vozenilek et al produce a recommendation that: “emergency medicine residency programmes should consider the use of high‐fidelity patient simulators to enhance the teaching and evaluation of core competencies among trainees”. This is based on strong face validity of the concept and the consulting members believing that EM is “uniquely positioned to take a leading role in the development, application and evaluation of simulation based training”16

ATLS, advanced trauma life support; EMCRM, emergency medicine crisis resource management; ACRM, anaesthetic crisis resource management.