The term “simulation” is a generic term for any technique that allows duplication or imitation of a portion of a clinical encounter. You likely have already learned with simulation during your medical training. You have used simulation if you have participated in any form of problem-based learning using paper cases, have practiced suturing on a pig’s foot, or have been assessed using standardized patient encounters.

In order to understand simulation better, it is helpful to categorize the types of simulation. One set of classifications focuses on the objective of the simulation, such as cognitive, procedural, or teamwork practice. Another category focuses on the fidelity, or level of realism, of each simulation. Table 33.1 is a matrix with examples of different types of simulation.

All forms of simulation are used for either instruction (teaching) or assessment (testing). Many medical educators are excited about the possibilities of testing using higher-fidelity simulations. In addition, recent pressure from both the public and various accrediting bodies has led to a search for examination methods that reliably test skills such as communication and teamwork. It is important to note that some forms of simulation lend themselves to assessment better than others.

The first medical simulator mannequin was created in the 1960s for anesthesiologists. It was not until the 1980s with the advent of smaller and more affordable personal computers that mannequins were developed for mainstream medical training. Around this time, simulation was being used in other sectors, such as aviation, nuclear power, and the military. Until the start of the twenty-first century, medical simulation was being used mainly in anesthesia and some surgical fields. Since the early 2000s, medical simulation has spread to all levels of medical training (undergraduate medical school to continuing medical education) and into many different specialties.

There are several studies showing improved outcomes after the use of simulation (Cook et al). Some of the studies have examined the effect of medical simulation training on patient safety and clinical outcomes (Wayne et al.), whereas other studies have demonstrated that simulation is an effective training tool for both procedural and cognitive skills (Hall et al.).

High-fidelity simulation is used for several purposes in medical training. One of the common uses is for “code” practice training emphasizing Advanced Cardiac Life Support (ACLS) and Advanced Trauma Life Support (ATLS) skills. Many hospitals use the full-body mannequins as a platform for teaching, practicing, and assessing these specific skills.

High-fidelity simulation also is used frequently for team training, or crisis resource management . These scenarios bring people together in a simulation to practice management of a crisis or a chaotic situation. This is similar to the crew resource management from military aviation and nuclear power plants. In the 1970s, studies by the aviation industry determined the causes of several airline accidents. From these findings, a program of “crew resource management” was developed. The same ideas from crew resource management were translated into the operating room environment and dubbed “crisis resource management.” As a student, you may participate in some crisis resource management scenarios in the simulation laboratory.

Medical training institutions are using high-fidelity simulation in remediation or in root-cause analysis of medical mistakes. Some institutions are bringing actual cases from morbidity and mortality reports to the simulation laboratory for analysis and reflection.

The specialty of anesthesia was the first to embrace simulation as a part of the training process. Simulation has been used in anesthesia to teach cognitive aspects of the field, including knowledge content and clinical decision making, as well as crisis resource management.

Crisis resource management training is intended to improve patient safety by emphasizing team work and communication. The specific areas within crisis resource management focus on addressing communication, resource management, situational awareness, and role clarity. Key behaviors in crisis resource management include:

Each simulation laboratory is unique. Some have only full-body mannequins, while others have only task trainers for endoscopies or laparoscopies. Some have very realistic features with newly-built or renovated centers, while others may be a mannequin set up in a classroom or closet. Either way, the simulation team works to make the simulation feel realistic to the participants.

Most of the simulation centers you will encounter during your anesthesia rotations will involve full-body mannequin simulation. Typically, the physical layout of one of these simulation centers will include several rooms, one with the mannequin, a control room, and a debriefing room. The room with the mannequin usually looks similar to a clinical room, such as an operating room, an ICU room, or a floor room in the hospital. Sometimes the room is not “decorated” as a clinical room, but is just an available space with the mannequin and monitor. In this case, one room may hold all three sections: the mannequin, the control area, and the debriefing area. Before the simulation encounter, you should receive enough information from the simulation staff to understand the clinical environment in which you are practicing, and thus what resources are available to you (Fig. 33.2).

The simulation room with the mannequin may have other equipment available. Some of this equipment may be for intubation, defibrillation (mannequins are able to receive real electric shocks), and medication administration. If a piece of equipment is not available in the room, you should be able to ask for it. Sometimes it will be given to you, and other times it will be “simulated”.