Much of the impetus for the development of simulators in anaesthesia came from the observed parallels between the environment that the anaesthetist works in and that found in the aviation industry. The aviation industry has a long history of using simulators for training and maintenance of skills, particularly in crisis management. The first aircraft simulator was built by Edwin Link in 1929. The current aircraft simulators are so realistic that pilots can be trained and certified to fly entirely on the aircraft simulator. These simulators address the importance of repeated practice, in order for responses to become automatic in the event of an emergency.
The first anaesthesia simulator, SIM1, was described in 1969 by Denson and Abrahamson. Its concepts and construction were ahead of its time. It was originally developed as an aid in learning to intubate, as well as to induce anaesthesia. It consisted of a mannequin comprising an intubatable airway and upper torso and arms. Despite its cutting-edge technology at the time, cost constraints greatly limited its practical use and further development was abandoned.
Computer simulators did not make a meaningful reappearance until the mid-1980s, starting with the computer screen-only versions such as SLEEPER and BODY simulators, as well as the Anesthesia Simulator Consultant (ASC). By this time,
technology had progressed to allow the widespread use of powerful personal computers, as well as the ability for complex programs of pharmacology and physiology to model appropriate responses to manipulation of clinical data input. These computer screen simulators (or microsimulators) displayed a realistic representation of the patient, the clinical data and the control panels of the work environment on the screen. They were inexpensive, flexible to use and can be adapted to present a variety of scenarios which test the anaesthetist’s ability to manage cases. SLEEPER and BODY were used mostly to teach pharmacological and physiological principles, whereas, ASC was used mostly to simulate crisis management.
In 1986, a team at Stanford, headed by Gaba and DeAnda, developed a full-scale simulator called the Comprehensive Anesthesia Simulation Environment (CASE)specifically to study the decision-making processes of anaesthetists during critical events. In aviation, a focused approach called Crew Resource Management (CRM) had been developed to assist pilots in understanding and dealing with the human factors involved in emergency situations. Taking their cue from the CRM model, Gaba, Fish and Howard subsequently refined CASE to be used in the development of the Anesthesia Crisis Resource Management (ACRM) course. At about the same time, a team at the University of Florida, lead by Drs Michael Good and JS Gravenstein developed the Gainesville Anesthesia Simulator (GAS), which later became the prototype for the Medical Education Teachnologies Inc (METI) simulator.
The highest level of simulation in the aviation model is the “Line Oriented Flight Training” (LOFT), in which all aspects of a flight are simulated and practised, including the paperwork, air traffic control and the duties of all primary and support staff. Team Oriented Medical Simulation (TOMS), developed in 1994 by Helmreich, Schaefer and colleagues at the University of Basel, is the medical equivalent of LOFT and emphasises the combined performance of the whole operating team during critical events.
Currently, full-scale simulators have evolved in their use beyond their specific use in teaching Crisis Resources Management to broader aspects of anaesthesia training and evaluation.
AUK would like to thank Dr Anne Wong M.D., M.Ed., F.R.C.P.(C), for her contribution to this section based on her work; Wong AK. Full scale computer simulators in anesthesia training and evaluation. Can J Anesth 2004; 51 (5): 455-464
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