SIMULATION IN

ANAESTHESIA

Presenter –Maj Prashant Tiwari

Moderator –Lt Col Gunjan Singh
 LEARNING OBJECTIVES…
 Historical aspect of simulation training
 Uses of simulation in anaesthesiology
 To distinguish and classify different types of patient simulator
 Types of simulator based training approaches
 Simulator fidelity
 Application of simulation training
 Benefits of simulation training
 Challenges
 Crisis resource management
 Anatomy of simulation exercise
 Architecture of simulation
 HISTORICAL ASPECT
 “Laerdal’s rescue Anne” – first ever simulation model designed to teach
cardiopulmonary resuscitation.
 1969- first electromechanical mannequin based simulator “Sim One”
 1976 – Harvey cardiology mannequin simulator
 1982 – Philip JH introduced “Gasman” software for teaching pharmacokinetics
 1986- Comprehensive anaesthesia simulation environment(CASE) by Gaba and
DeAnda
 1986- Anaesthesia simulator consultant by Schwid
 CLASSIFICATION
Simulation – artificial replication of sufficient elements of real world domain to achieve a
stated goal.
Classification of simulators – Cumin and Merry
Based on – type of user interaction , physiological response, type of teaching
1. type of user interaction
a. Hardware based – physical interaction, mannequin based simulator
b. Screen based – using mouse and keyboard like gasman
c. Virtual reality based – using headsets or haptic devices
d. Human based – using actors
 CLASSIFICATION
2. Based on response of simulator
a. Physiological
b. Non physiological

3. Based on type of teaching

a. Knowledge
b. Psychomotor skill
c. Drills
d. Performance
IMPRESSIONS OF SIMULATION TRAINING
ARCHITECTURE OF SIMULATION
MILLERS LEARNING PYRAMID
 SIMULATOR FIDELITY
Fidelity – defines the degree of exactness with which something can be replicated
High fidelity – immersive computer controlled manikin based simulation
Low fidelity – rest all excluding computer controlled
Physical fidelity – it looks real
Functional fidelity – it works well
Psychological fidelity – same effect on user as a real thing
To provide effective simulation training not necessary to have high fidelity
simulator
Essential to provide appropriate fidelity appropriate to desired learning objective
 APPLICATION OF SIMULATION IN
ANAESTHESIA

1. For training and education – training emphasizes preparing individual to perform actual task and
education includes conceptual knowledge and basic skills
- used for early level of vocational or professional education
- for apprenticeship training ( intern and resident )
- practicing clinicians
- adjunct to actual clinical practice
- continuing medical education and training
2. For probing and protocol testing
- inset simulation are powerful tool for testing (system probing)
- evaluation of organisational practices (protocol testing)
- simulation for designing new hospitals and departments
 APPLICATION OF SIMULATION IN ANAESTHESIA

 For testing equipment and supplies

- training of executives, sales representatives and bio engineers
- for research on human factors for developing new monitoring system
For performance assessment
 For research – two objectives
- research about simulation, testing and improvement of technique
- human performance and clinical cognition
 Other uses
- to conduct out reach programmes
- to produce educational vedios
 BENEFITS OF SIMULATION TRAINING
• No risk to patient despite “hands-on” training
• Routine clinical situations, emergency situations can be presented at will
• Can learn actual complex devices in the relevant clinical context
• Same situation can be presented to multiple objects for evaluation
• Errors can be easily recognised with likely correction
• To a reasonable degree training can be standardised and reproducible
• Training can be focused and allow for various forms of feedback
• Clinical time can be skipped or spread up during difficult part of training
• Recording and replay and critique of performance facilitated
 SIMULATION IN CRISIS RESOURCE
MANAGEMENT
 V A – Stanford and colleagues – 1989

 Aim- prevent, ameliorate and resolve critical incidents

 Objectives – learn generic principles of complex problem solving, decision making, resource
management and team work behaviour
-Improve participants in medical, technical, cognitive and social skills in recognition and
treatment of complex medical situation
-Enhance capacity for reflection, self discovery, and teamwork and for building a personalised
tool kit of attitude, behaviours and skills
 SIMULATION IN CRISIS RESOURCE
MANAGEMENT
• Course characteristics - realistic simulation environment replicates a relavent work setting
• Personnel will represent those persons found in the typical work environment
• The bulk of training course consist of realistic simulation followed by debriefing
• Participants may rotate among various roles during different senarios
• Participants can request and receive help from other participants
• Simulation may be supplemented by additional activities like group discussion, role playing etc
• Training involve significant time and cundected with a small group of participants
 SIMULATION IN CRISIS RESOURCE
MANAGEMENT
 Content characteristics - the main emphasis of course on crisis management behaviour ( non
technical skill )
• Observation not equivalent to actual participation in one or more scenario
• Scenarios require participation to engage in appropriate professional interaction

 Faculty characteristics – training should be intense with high level of faculty involvement
• faculty members specially those leading debriefing have special training experience
 SIMULATION IN CRISIS RESOURCE
MANAGEMENT
 Debriefing characteristics – debriefing should be performed with whole group of participants
together and should use audio video recording of sessions
• Debriefing emphasize constructive critique and analysis in which the participants are given the
greatest opportunity to speak
CRISIS RESOURCE MANAGEMENT
ANATOMY OF SIMULATION EXERSICE
 CHALLENGES FOR
SIMULATION TRAINING
1. Comparability of simulation research and evaluation of simulation
2. To define cost effectiveness, expenses need to be put in context return on
investment
3. High fidelity simulation can be effective but cost control is an issue
4. Limited research data on simulation effectiveness
5. Difficult to assess impact on health care
Thank you