Practical Updates in Anesthesiology
Dr. Mark Wigginton MB,BS FRCA
The Fall & Rise of Simulation
Anatomical models
• Anatomical stone sculpture from 24,000
years BC
• Egyptian
• Mayan
• 18th & 19th century memento mori
• Song dynasty – Wang Wei-Ye (987-1067)
De Humani Corporis Fabrica Libri Septum
by Andrea Vesalio 1543
Interactive models
• 1739 British maternity hospital opens with a promise,
– “all the inconveniences which might otherwise happen to women
from pupils practising too early on real objects will be entirely
prevented: for by this method and contrivance each pupil will
become in a great measure proficient in his business before he
attempts a real delivery.”
• Giovanni Antonio Galli
• Dr. Ozenne
• Marguerite Le Boursier du Coudray
Angélique Margeurite Le Boursier du Coudray
1714 -1789
‘The Machine’ – Musée Flaubert et
d'Histoire de la Médecine, Rouen
The Flexner Report
Facilities for teaching Obstetrics in
US Hospitals - 1909
• Southwestern University Medical College,
Texas
– “in the corner of one [lecture room] is an
abused manikin.”
• Georgia College of Eclectic Medicine &
Surgery, Georgia
– “limited to a tattered manikin.”
Commenting on medical training institutions
• Of the four institutions in the state of Texas only one was felt,
“capable of maintaining a medical school whose graduates deserve
the right to practice among its inhabitants.”
• “Those who deal with medical education in Tennessee are therefore
making the worst, not the best, of their limited possibilities.”
• Portland and Salem, Oregon, “Neither of these schools has either
resources or ideals; there is no justification for their existence.”
• University of Michigan Department of Medicine & Surgery, “There is
no question that if the entire state university were at Detroit, the
medical department would be better off.”
– “A faculty of distinction, with a hospital well equipped for the care
of the sick, and for teaching and research, can successfully
overcome the most serious difficulties of the situation.”
Sim One
Laerdal
Simulation manufacturers
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Laerdal
CAE Healthcare (formerly METI)
Gaumard
Simulab
• Improvised & local adaptations
Current Simulation Technology for
Anesthesia
• Task trainers
• Low fidelity mannequins
• High fidelity mannequins
Blue Phantom
Pediatric HAL
Sim Man 3G
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Quality CPR feedback
Convulsions
Bleeding wounds
Wireless monitor
Secretions
Drug and event recognition
Eye signs
Vascular access
Chest decompression and chest drain
Airway complications
Human Patient Simulator
Train the trainers
• Being an expert in a field of medicine does not
qualify to teach simulation in that field
• Ensure consistency of teaching standards
• Ensure maximum use from simulators
• Ensure educational value of course/scenario
design
• Not all train the trainers are equal
• Insufficient trained trainers to support the amount
of simulation based medical education
International Societies
The Australian Model
• November 2010 – MONASH University report,
“Faculty development is a critical issue in
effective simulation based education.”
• Health Workforce Australia (SLE Program)
– Phase 1: Australian Simulation Education & Technical
training (AusSETT)
– Phase 2: National Health Education & Training in
Simulation (NHET-Sim)
Public interest
Proof of benefit
The Future
Standardise train the trainers
National strategy
Share ideas (for free) Standardise courses
References
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Owen H. Early Use of Simulation in Medical Education. Simulation in Healthcare 2012;
7(2): 102-116
Cooper J., Taqueti V. A brief history of the development of mannequin simulators for
clinical education and training. Qual Saf Health Care 2004; 13(Suppl 1): i11-i18
Daniels K., Parness A. Development and Use of Mechanical Devices for Simulation of
Seizure and Hemorrhage in Obstetrical Team Training Simulation in Healthcare 2008; 3:
42-46
McGaghie W., Draycott T., Dunn W., Lopez C. Evaluating the Impact of Simulation on
Translational Patient Outcomes Simulation in Healthcare Vol. 6, No. 7, August 2011
Supplement S42-47
McGaghie W., Issenberg S., Cohen E., Barsuk J., Wayne D. Does simulation-based
medical education with deliberate practice yield better results than traditional clinical
education? A meta-analytic comparative review of the evidence. Acad Med 2011;86:706
–711.
Issenberg S., McGaghie W., Hart I., et al. Simulation technology for health care
professional skills training and assessment. JAMA 1999; 282:861– 866
Draycott TJ, Sibanda T, Owen L, et al. Does training in obstetric emergencies improve
neonatal outcome? BJOG 2006;113:177–182.
Draycott TJ, Crofts JF, Ash JP, et al. Improving neonatal outcome through practical
shoulder dystocia training. Obstet Gynecol 2008;112:14–20.
Howard S, Gaba D, Fish K, Yang G, Sarnquist F. Anesthesia crisis resource
management training: teaching anesthesiologists to handle critical incidents. Aviat
Space Environ Med 1992; 63:763–70
Denson J., Abrahamson S. A Computer-controlled Patient Simulator. JAMA
1969;208:504-8
Flexner A. Medical Education in the United States and Canada: A report to the Carnegie
Foundation for the Advancement of Teaching. New York,NY;1910 Available at
http://www.carnegiefoundation.org/sites/default/files/elibrary/Carnegie_Flexner_Report.
pdf (last accessed 01/01/2014)
Gelbert NR. The King’s Midwife: A History and Mystery of Madame du Coudray. Berkley,
CA: University California Press; 1998
Porter R. Blood and Guts: A Short History of Medicine. London: The Penguin Press;
2002
Russell KF. Ivory Anatomical Manikins. Med Hist 1972;16:131-142
https://www.hwa.gov.au/sites/uploads/simulated-learning-environments-medical-