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Simulation in health care training has been used for decades. Since the late 60’s and early 70’s, the use of full body manikins for CPR and obstructed airway procedures have allowed skills and techniques to be taught to all levels of care providers. What is new today is the development of computer programs that can model physiology, combined with advances in plastics and other micro-technologies, to develop “lifelike” mannequins. Many colleges and universities have expanded skill labs to include the simulated patient and there are well over 20 “Virtual Hospitals” across the country where rooms are dedicated to simulation.
Advanced patient simulators combine multiple skill trainers in one “body,” such as realistic airways where tongues swell and cords spasm, plastic airways that have the ability to “swell” using pneumatic controls, an IV arm, and a chest that produce heart, lung, and bowel sounds. Blood flow can be simulated by pulsing of compressed air through tubing and controlling the pressure and volume to allow monitoring of changes in blood pressure. Some simulators can even analyze airflow for oxygen content or anesthesia gases. While state-of-the-art simulators makes for a more “real” experience, improvement and enhancement of training skills can also be realized using less expensive models.
Simulation is well suited for team training because to function as a team in an emergency, each member must have some knowledge of the strengths and abilities others bring to the event. Computer programmed simulation allows students to experience real time events and scenarios as well as variations in scenarios. The repeatability of computer programmed simulation enables the scenario to be repeated as many times as necessary to achieve the desired level of individual and/or team assessment and procedural skills.
Simulation training not only increases skill proficiency; it forces the student to deal with the real-time factor in completing the processes involved in various tasks. For instance, inserting an IV requires time to set-up, prepare the site, insert the IV, and secure it, as does medication administration or any other procedure. Students are prevented from “assuming” an IV or other procedure has been completed but must perform each step until the scenario has advanced to its logical conclusion, which may not always be the desirable outcome.
In the routine clinical setting, the instructor/mentor would “take over” in emergency cases to protect the patient. Simulation allows students to experience failure and the consequences of poor or incorrect choices without the harm factor.
Success teaches many things, but possibly not the point that needs to be learned.
Success can easily be an “accident,” done more as a list of steps rather than as a planned event. With simulation, weaknesses in approach and decision-making are easier to pinpoint and the repeatability feature of simulation readily highlights what would have been the correct or better decision.
Training with simulation works best when multiple members of the team are involved. In most schools, training usually involves students of one discipline, such as all nurses or physicians, or paramedics; however, health care teams of varying disciplines can benefit from this proactive approach toward improving the delivery of health care.
Both Shands Jacksonville and Shands UF campuses provide simulation training opportunities and you may contact the following individuals for further information:
Wayne Hodges, R.N., EMT-P Trauma Flight Services Education Coordinator
904-244-7573 (Jax Campus)
Dr. Andrew Godwin
R.C. Nuss Simulation Center 904-244-4106 (Jax Campus)
Dr. J. Gravenstein Simulation Center
352-846-0914 (UF Campus)
Bibliography
1. DeVita, MA; Schaefer, J; Lutz, J; Wang, H; Dingily, T. Improving medical emergency team (MET) performance using a novel curriculum and a computerized human patient simulator. Qual. Saf. Health care, 2005; 14: 326331.
2. Hamman, WR. The complexity of Team Training: What we have learned from aviation and its applications to medicine. Qual. Saf. Health care, 2004; 13: 72-79. Retrieved from: http://qhc.bmjjournals.com/cgi/content/ full/13/supl_1/i72. 
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