This Article Abstract Résumé de cet Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Morgan, P. J. Articles by Cleave-Hogg, D. Search for Related Content PubMed PubMed Citation Articles by Morgan, P. J. Articles by Cleave-Hogg, D.

A worldwide survey of the use of simulation in anesthesia

[Une enquête mondiale sur l’usage de la simulation en anesthésie]

Pamela J. Morgan, MD CCFP FRCPC^* and Doreen Cleave-Hogg, BA MA PhD

^* From the Department of Anesthesia, Sunnybrook & Women’s College Health Sciences Centre, and
The Centre for Research in Education, University of Toronto, Toronto, Ontario, Canada.

Address correspondence to: Dr. Pamela J. Morgan, Department of Anesthesia, Sunnybrook & Women’s College Health Sciences Centre, Women’s College Campus, 76 Grenville Street, Toronto, Ontario M5S 1B2, Canada. Phone: 416-323-6400, ext. 4349; Fax: 416-323-6307; E-mail: pam.morgan{at}utoronto.ca

	Abstract

TOP Abstract Introduction Methods Results Discussion References

 
Purpose: To gather information regarding the global use of simulation technology in education, evaluation and research in anesthesia.

Methods: The WorldWide Web was searched and located sites with simulation centres (n = 158) were mailed a 67-item questionnaire requesting information regarding demographics, personnel, education use and research involvement. Comments were solicited. Medical school data only are reported in this article.

Results: Two web sites were used to generate the list of simulation centres. Sixty responses were received (38%), with 41 emanating from medical schools. Seventy-seven percent of centres were involved in undergraduate education and 85% in postgraduate education. Few centres were involved in evaluation and/or competency assessments. Sixty-one percent of centres indicated ongoing research with a further 25% interested in international collaboration. University or university departmental-based funding largely supported simulation technology used in medical schools. The lack of financial and human resources was the single most common problem identified by respondents.

Conclusions: From the survey responses received, opportunities for the simulator to be used for the assessment of performance appear to be under-utilized. This may be due to the lack of research in this area, lack of standardized, valid and reliable tests and the fact that most centres have only recently acquired this technology. Further research supporting the use of the simulator in education and evaluation is required.

	Introduction

TOP Abstract Introduction Methods Results Discussion References

 
SIMULATION technology has experienced an exponential growth over the past few years. Its potential for education and evaluation requires exploration and research.¹ The simulator offers opportunities for standardized, reproducible critical events in a realistic and safe environment. Both rare and common scenarios can be developed to accommodate teaching and evaluation at various educational levels such as undergraduate, postgraduate, continuing medical education and practice assessment.² The ability to videotape sessions allowing feedback and reflection on performance has tremendous possibilities as a learning tool. In spite of the inherent advantages of this environment, there are few indicators as to the extent of high-fidelity patient simulation use around the world.

To address these issues, a survey was designed to gather data regarding simulation technology and its application in education, evaluation and research. In addition, information regarding the financial and resource aspects of acquisition and operation was solicited.

	Methods

TOP Abstract Introduction Methods Results Discussion References

 
A 67-question survey was developed to gather information regarding the use of high-fidelity patient simulators in education and research around the world (available at www.cja-jca.org). Categories of questions included: demographics, personnel, funding for acquisition and maintenance and use in undergraduate, postgraduate and continuing education and practice assessment. Also requested was information on interdepartmental collaboration and research applications. Comments were solicited with specific reference to problems experienced and major benefits attained.

The WorldWide Web was searched using key words: "human patient simulator (HPS), simulation, anesthesia and centre or centre". In addition, individual search strategies, which included the name of the country i.e., "Japan and simulator or simulation", were conducted. The search located 158 simulation centres and the survey was mailed to all centres. After a period of two months, non-respondents who had available e-mail addresses were sent reminder notices and surveys. Data were collected and tabulated in an anonymous fashion. For the purposes of this article, data from simulation centres involved with medical students or residents/faculty in anesthesiology are reported. Comments were categorized. Descriptive statistics were performed for each survey category.

	Results

TOP Abstract Introduction Methods Results Discussion References

 
The WorldWide Web search identified two websites listing current simulator sites and programs: www.anes.rochester.edu/simulate/simusers.htm and www.bristol.ac.uk/Depts/BMSC/centres.htm. The Bristol website listed all simulation centres identified by Medical Education Technologies Incorporated (METI, Sarasota, FL, USA) and MedSim Incorporated (International Headquarters, Kfar Sava, Israel, Corporate Headquarters, Fort Lauderdale, FL, USA) as owning a HPS and included simulation centres that did not have websites. This information generated the list of 158 simulation centres to which surveys were sent. No further simulator sites were located using the alternate search strategy using country name. After the second mailing, 60 surveys were returned for a return rate of 38%. Of the 60 surveys, 41 were from simulation centres involved in education of medical students or anesthesiology residents/faculty, 21 from North America and 20 from other parts of the world. The remaining 19 surveys involved simulator use in nursing, paramedic, respiratory therapist or army training. Ninety-five percent of centres had either a METI HPS^TM (Medical Education Technologies Incorporated, Sarasota, FL, USA) or MedSim HPS^TM (MedSim USA Incorporated, Fort Lauderdale, FL, USA) and one centre had a METI simulator as well as a PediaSim HPS^TM (Medical Education Technologies Incorporated, Sarasota, FL, USA) and an anesthetic computer controlled emergency situation simulator, (ACCESS; A.J. Byrne, Swansea, United Kingdom). Thirty of the 41 centres (73%) acquired their simulators within the past five years (1996–2000 inclusive).

The following results report the number of responses to each question; some questions were left unanswered.

Eighty-one percent of centres reported that dedicated personnel were responsible for the operation of the simulator and that the majority of the personnel received funding for this position from either the university or university department. Faculties were involved in all centres with 42% of institutions indicating that the faculties were reimbursed for their time. Seventy-eight percent of respondents indicated that faculty members were relieved of clinical duties to participate in simulator-related activities.

The funding for simulator acquisition came from 1) the university or university department (76%); 2) government (15%); 3) private sector or other (13%); and 4) rented (3%). Six centres indicated multiple funding sources. The operation and maintenance costs were supported by 1) university or university department (83%); 2) government (15%); 3) private sector or other (8%) with 13% of centres reporting multiple sources of support.

Seventy-seven percent of centres used the simulator for undergraduate education and 85% for postgraduate education. Physiology and pharmacology were the most commonly taught topics in the undergraduate program with a wide variety of topics addressed in the postgraduate program (Figure). Few centres reported the use of the simulator for evaluation purposes at any educational level. The majority of continuing medical education events was funded privately or by participants in the 21 centres reporting the use of the simulator for this purpose. Forty-nine percent of respondents indicated that the simulator should be used for maintenance of certification. However, only 15% of centres currently used the simulator for practice assessment.

View larger version (40K): [in this window] [in a new window]   FIGURE Educational uses of the simulator.

The activities related to research and publications are summarized in Table I. Anecdotal comments regarding problems and benefits of simulator education and evaluation were transcribed and categorized using key words (Table II).

	Discussion

TOP Abstract Introduction Methods Results Discussion References

Research into the value of the HPS in education, evaluation and research in anesthesia should be encouraged.

	Footnotes

 
This study was supported by the Department of Anesthesia, Sunnybrook & Women’s College Health Sciences Centre, Toronto, Ontario, Canada.

Revision received February 1, 2002. Accepted for publication December 20, 2001.

	References

TOP Abstract Introduction Methods Results Discussion References

 
1 Gaba DM, DeAnda A. A comprehensive anesthesia simulation environment: re-creating the operating room for research and training. Anesthesiology 1988; 69: 387–94.[Medline]

2 Issenberg SB, McGaghie WC, Hart IR, et al. Simulation technology for health care professional skills training and assessment. JAMA 1999; 282: 861–6.[Abstract/Free Full Text]

3 Morgan PJ, Cleave-Hogg D. Evaluation of medical students’ performance using the anaesthesia simulator. Med Educ 2000; 34: 42–5.[Medline]

4 Morgan PJ, Cleave-Hogg DM, Guest CB, Herold J. Validity and reliability of undergraduate performance assessments in an anesthesia simulator. Can J Anesth 2001; 48: 225–33.[Abstract/Free Full Text]

5 Devitt JH, Kurrek MM, Cohen MM, et al. Testing internal consistency and construct validity during evaluation of performance in a patient simulator. Anesth Analg 1998; 86: 1160–4.[Abstract]

6 Morgan PJ, Cleave-Hogg D, McIlroy J, Devitt JH. A comparison of experiential and visual learning for undergraduate medical students. Anesthesiology 2002; 96: 10–6.[Medline]

7 Shimada Y, Nishiwaki K, Cooper JB. Use of medical simulators subject of international study. J Clin Monit Comput 1998; 14: 499–503.[Medline]

8 Kapur PA, Steadman RH. Patient simulator competency testing: ready for takeoff? Anesth Analg 1998; 86: 1157–9.[Medline]

This article has been cited by other articles:

				M. B. Brett-Fleegler, R. J. Vinci, D. L. Weiner, S. K. Harris, M.-C. Shih, and M. E. Kleinman A Simulator-Based Tool That Assesses Pediatric Resident Resuscitation Competency Pediatrics, March 1, 2008; 121(3): e597 - e603. [Abstract] [Full Text] [PDF]

				M. Srinivasan, J. C. Hwang, D. West, and P. M. Yellowlees Assessment of Clinical Skills Using Simulator Technologies Acad Psychiatry, December 1, 2006; 30(6): 505 - 515. [Abstract] [Full Text] [PDF]

				J McFetrich A structured literature review on the use of high fidelity patient simulators for teaching in emergency medicine. Emerg. Med. J., July 1, 2006; 23(7): 509 - 511. [Abstract] [Full Text] [PDF]

				H. Berkenstadt, A. Ziv, N. Gafni, and A. Sidi Incorporating simulation-based objective structured clinical examination into the israeli national board examination in anesthesiology. Anesth. Analg., March 1, 2006; 102(3): 853 - 858. [Abstract] [Full Text] [PDF]

				M. S. Goodrow, K. R. Rosen, and J. Wood Using Cardiovascular and Pulmonary Simulation to Teach Undergraduate Medical Students: Cases from Two Schools Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2005; 9(4): 275 - 289. [Abstract] [PDF]

				M. P. Eason Simulation Devices in Cardiothoracic and Vascular Anesthesia Seminars in Cardiothoracic and Vascular Anesthesia, December 1, 2005; 9(4): 309 - 323. [Abstract] [PDF]

				G. L. Savoldelli, V. N. Naik, S. J. Hamstra, and P. J. Morgan Barriers to use of simulation-based education: [Les barrieres a l'utilisation de la formation basee sur simulateur] Can J Anesth, November 1, 2005; 52(9): 944 - 950. [Abstract] [Full Text] [PDF]

				H. Berkenstadt, G. S. Kantor, Y. Yusim, N. Gafni, A. Perel, T. Ezri, and A. Ziv The Feasibility of Sharing Simulation-Based Evaluation Scenarios in Anesthesiology Anesth. Analg., October 1, 2005; 101(4): 1068 - 1074. [Abstract] [Full Text] [PDF]

				D. A.E. Shephard The changing pattern of anesthesia, 1954-2004: a review based on the content of the Canadian Journal of Anesthesia in its first half-century: [La transformation du modele de l'anesthesie, 1954-2004 : une revue fondee sur le contenu du premier demi-siecle du Journal canadien d'anesthesie] Can J Anesth, March 1, 2005; 52(3): 238 - 248. [Abstract] [Full Text] [PDF]

				J. M. Taekman, G. Hobbs, L. Barber, B. G. Phillips-Bute, M. C. Wright, M. F. Newman, and M. Stafford-Smith Preliminary Report on the Use of High-Fidelity Simulation in the Training of Study Coordinators Conducting a Clinical Research Protocol Anesth. Analg., August 1, 2004; 99(2): 521 - 527. [Abstract] [Full Text] [PDF]

				A. K. Wong Full scale computer simulators in anesthesia training and evaluation: [Des simulateurs informatises grandeur nature pour la formation et l'evaluation en anesthesie] Can J Anesth, May 1, 2004; 51(5): 455 - 464. [Abstract] [Full Text] [PDF]

				P. J. Morgan, D. Cleave-Hogg, S. DeSousa, and J. Tarshis High-fidelity patient simulation: validation of performance checklists Br. J. Anaesth., March 1, 2004; 92(3): 388 - 392. [Abstract] [Full Text] [PDF]

				M. Girard and P. Drolet Anesthesiology simulators: networking is the key/Les simulateurs d'anesthesiologie : le travail en reseau est la cle Can J Anesth, August 1, 2002; 49(7): 647 - 649. [Full Text] [PDF]

This Article Abstract Résumé de cet Article Full Text (PDF) Submit a scholarly reply Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Morgan, P. J. Articles by Cleave-Hogg, D. Search for Related Content PubMed PubMed Citation Articles by Morgan, P. J. Articles by Cleave-Hogg, D.