Fall and Rise of Simulation - UM Anesthesiology

Practical Updates in Anesthesiology
Dr. Mark Wigginton MB,BS FRCA
The Fall & Rise of Simulation
Anatomical models
• Anatomical stone sculpture from 24,000
years BC
• Egyptian
• Mayan
• 18th & 19th century memento mori
• Song dynasty – Wang Wei-Ye (987-1067)
De Humani Corporis Fabrica Libri Septum
by Andrea Vesalio 1543
Interactive models
• 1739 British maternity hospital opens with a promise,
– “all the inconveniences which might otherwise happen to women
from pupils practising too early on real objects will be entirely
prevented: for by this method and contrivance each pupil will
become in a great measure proficient in his business before he
attempts a real delivery.”
• Giovanni Antonio Galli
• Dr. Ozenne
• Marguerite Le Boursier du Coudray
Angélique Margeurite Le Boursier du Coudray
1714 -1789
‘The Machine’ – Musée Flaubert et
d'Histoire de la Médecine, Rouen
The Flexner Report
Facilities for teaching Obstetrics in
US Hospitals - 1909
• Southwestern University Medical College,
– “in the corner of one [lecture room] is an
abused manikin.”
• Georgia College of Eclectic Medicine &
Surgery, Georgia
– “limited to a tattered manikin.”
Commenting on medical training institutions
• Of the four institutions in the state of Texas only one was felt,
“capable of maintaining a medical school whose graduates deserve
the right to practice among its inhabitants.”
• “Those who deal with medical education in Tennessee are therefore
making the worst, not the best, of their limited possibilities.”
• Portland and Salem, Oregon, “Neither of these schools has either
resources or ideals; there is no justification for their existence.”
• University of Michigan Department of Medicine & Surgery, “There is
no question that if the entire state university were at Detroit, the
medical department would be better off.”
– “A faculty of distinction, with a hospital well equipped for the care
of the sick, and for teaching and research, can successfully
overcome the most serious difficulties of the situation.”
Sim One
Simulation manufacturers
CAE Healthcare (formerly METI)
• Improvised & local adaptations
Current Simulation Technology for
• Task trainers
• Low fidelity mannequins
• High fidelity mannequins
Blue Phantom
Pediatric HAL
Sim Man 3G
Quality CPR feedback
Bleeding wounds
Wireless monitor
Drug and event recognition
Eye signs
Vascular access
Chest decompression and chest drain
Airway complications
Human Patient Simulator
Train the trainers
• Being an expert in a field of medicine does not
qualify to teach simulation in that field
• Ensure consistency of teaching standards
• Ensure maximum use from simulators
• Ensure educational value of course/scenario
• Not all train the trainers are equal
• Insufficient trained trainers to support the amount
of simulation based medical education
International Societies
The Australian Model
• November 2010 – MONASH University report,
“Faculty development is a critical issue in
effective simulation based education.”
• Health Workforce Australia (SLE Program)
– Phase 1: Australian Simulation Education & Technical
training (AusSETT)
– Phase 2: National Health Education & Training in
Simulation (NHET-Sim)
Public interest
Proof of benefit
The Future
Standardise train the trainers
National strategy
Share ideas (for free) Standardise courses
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7(2): 102-116
Cooper J., Taqueti V. A brief history of the development of mannequin simulators for
clinical education and training. Qual Saf Health Care 2004; 13(Suppl 1): i11-i18
Daniels K., Parness A. Development and Use of Mechanical Devices for Simulation of
Seizure and Hemorrhage in Obstetrical Team Training Simulation in Healthcare 2008; 3:
McGaghie W., Draycott T., Dunn W., Lopez C. Evaluating the Impact of Simulation on
Translational Patient Outcomes Simulation in Healthcare Vol. 6, No. 7, August 2011
Supplement S42-47
McGaghie W., Issenberg S., Cohen E., Barsuk J., Wayne D. Does simulation-based
medical education with deliberate practice yield better results than traditional clinical
education? A meta-analytic comparative review of the evidence. Acad Med 2011;86:706
Issenberg S., McGaghie W., Hart I., et al. Simulation technology for health care
professional skills training and assessment. JAMA 1999; 282:861– 866
Draycott TJ, Sibanda T, Owen L, et al. Does training in obstetric emergencies improve
neonatal outcome? BJOG 2006;113:177–182.
Draycott TJ, Crofts JF, Ash JP, et al. Improving neonatal outcome through practical
shoulder dystocia training. Obstet Gynecol 2008;112:14–20.
Howard S, Gaba D, Fish K, Yang G, Sarnquist F. Anesthesia crisis resource
management training: teaching anesthesiologists to handle critical incidents. Aviat
Space Environ Med 1992; 63:763–70
Denson J., Abrahamson S. A Computer-controlled Patient Simulator. JAMA
Flexner A. Medical Education in the United States and Canada: A report to the Carnegie
Foundation for the Advancement of Teaching. New York,NY;1910 Available at
pdf (last accessed 01/01/2014)
Gelbert NR. The King’s Midwife: A History and Mystery of Madame du Coudray. Berkley,
CA: University California Press; 1998
Porter R. Blood and Guts: A Short History of Medicine. London: The Penguin Press;
Russell KF. Ivory Anatomical Manikins. Med Hist 1972;16:131-142

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