Biomedical Engineering Reference
In-Depth Information
accelerated in the late 1980s and early 1990s.
High-fidelity mannequin-based simulation training
remained, however, isolated to only a handful of
medical centers. The technology is exploding of
late and several simulator systems are now profes-
sionally manufactured and commercially avail-
able. The distribution of this technology, however,
is still in its infancy as is the incorporation of
this educational modality across the spectrum of
medicine. If one steps back and analyzes what
takes place around us, one would observe simu-
lation training in nearly every aspect of our lives.
The emergency personnel who provide police, fire,
ambulance, and disaster intervention use simula-
tion training to various degrees to recreate situa-
tions they are likely to face during the delivery of
their services. The SWAT team trains week in and
week out but may only rarely be called upon to
deliver “on demand” services in an emergency [2].
However, their ability to respond, to react, and to
defuse a crisis will be dependent, in most cases,
on their prior training. They will respond sponta-
neously in an acute crisis but their reaction will be
based on a foundation of training that is designed
to improve the likelihood of responding correctly,
thus saving innocent lives, as well as, possibly
their own.
Simulation-based training and education is new
only to the medical profession: it has been
employed since ancient times when armies pursued
training and testing during war games so to allow
soldiers and their leaders the ability to gauge
their response to conflict, danger, injury, over-
whelming odds, and the confusion of a battle.
As far back as China in 3000 BC, war games
incorporated simulation in battlefield preparation
of warriors by re-enacting gladiator and jousting
competition incorporated rigorous training rituals,
scenarios and repetitive practice rounds to better
prepare the warrior for the execution of his craft
during the extreme conditions they confronted. The
modern era soldier encounters high-tech simulation
in many aspects of his training. This allows the
soldier to be exposed to common and uncommon or
rare battle situations where a precise and deliberate
response can be practiced, tested, corrected, and
matured under extreme conditions. Likewise, the
race car pit crew is criticized when the pit stop of
18 seconds should have taken only 13 seconds. The
pit crew trains repeatedly to hone in their skills and
roles to maximize efficiency in the least amount of
time. Imagine such training for the cardiac arrest
team or other associated medical crises internal or
external to the hospital locale.
The airline industry has aggressively adapted
flight simulation as a mainstay in individual and
crew flight training for routine flight and crisis
management in its efforts to safeguard the public.
Though both industry and the public applaud the
flight simulation training, the use of simulation has
not been widely challenged as a valid education-
training tool for airline pilots or other industries
that incorporate such training and education tech-
nology (nuclear power, military, utility industry,
and safety aspects of the manufacturing industry).
The proof of success and efficacy of simula-
tion training is considered self-evident in many
arenas. However, medicine is extending consider-
able research efforts to validate simulation-based
training and education in regards to learning,
teaching, retention of skills, validation and certifi-
cation for licensing [3].
A human mannequin simulator is similar in
concept to a flight simulator but often pales
in comparison in sophistication, complexity and
hence, cost. Nonetheless, both offer the ability
to provide a venue for routine training and
re-enactment of acute and rare problems. Techno-
logical advances have brought the previously static
“dummy” to a dynamic, complex mannequin that
can provide physiological changes. Wheezing or a
thready pulse, can be interpreted by the examining
student. Output from monitoring devices reflect
changes in the patient's vital signs in response to
interventions by the student. Audio feedback from
the mannequin replicates cries of anguish or pain,
history taking, complaints, and even accolades to
the student. The power of such a teaching tool
is awesome but it must be applied in a construc-
tive manner by individuals capable of developing
a simulation curriculum that fosters learning and
teaching [2]. The purchase of a high-fidelity human
simulator is only the first step toward offering
this educational adjunct to the curriculum of the
