Types of Simulators
There are three general types of anesthesia simulators: realistic or hands-on simulators, screen-based simulators, and virtual reality simulators. In addition, part-task trainers are available for specific procedures, e.g., intravenous access, endotracheal intubation, CPR. The first realistic anesthesia simulator, Sim One, was produced in the late 1960's, based on work done by J.S. Denson and Stephen Abrahamson at the University of Southern California.
It was used mainly for the training of endotracheal intubation and the induction of anesthesia. The mannequin had outputs for peripheral pulses and heart sounds, but no outputs for electronic monitors. The system was clearly advanced for its time, but was eventually phased out. In the 1980's several independent groups developed anesthesia simulator systems. By this time personal computers were relatively inexpensive, and other types of simulation software were available (e.g., flight and driving simulators). The public became aware of simulation in a number of different fields, including military training, commercial aviation, nuclear power generation, and space flight. In the field of anesthesia, there was increased interest in the role of human factors issues such as ergonomics and human error. In the early 1990's, two realistic simulators were commercially produced, based on work at Stanford University (Dr. David Gaba) and University of Florida (Dr. Michael Good). Currently there are approximately 120 realistic anesthesia simulator installations around the world.
Simulation training: anesthesia and beyond!
Although realistic patient simulators were developed for use in anesthesia, they have been used to train a variety of health care providers. Medical students, anesthesia residents, emergency medicine residents, paramedics, and nurses are among the many groups receiving simulator training around the world. Although the exact role of simulation training in anesthesia resident education is not clear, it is likely to expand as more medical schools and residency programs purchase simulators.
Simulation at UCSF
The Center for Health Care Simulation was established in April 2000 by the Department of Anesthesia and Perioperative Care. A MedSim Patient Simulator was purchased by the department, and space was provided by San Francisco General Hospital. Dr. Manuel Pardo serves as the center's director and Adam Collins serves as the associate director. Tin-na Kan MD was instrumental in setting up the Simulator Center in a form similar to how it exists today. The UCSF Center for Healthcare Simulation presently services hundreds of learners a year, including medical students, residents and ICU fellows.
Gaba D. Human work environment and simulators. In Anesthesia. Miller RD, ed. 5th edition, Churchill Livingstone, 1999.
Denson JS and Abramson S. A computer-controlled patient simulator. JAMA 1969; 208: 504-508.