COSTS
What are the costs of simulator-based training? These costs depend
on many of the same factors that determine the curriculum:
- Types of training involved, ranging from technology in-service to training
in basic anesthesia skills, critical incident management, or CRM
- Target populations for the training, whether equipment technicians, medical
students, novice residents, experienced residents, nurse anesthetists, teaching faculty,
or private practitioners
- Organizational and financial characteristics of the institution
The hardware and software costs of the screen-only simulator are
quite low (as low as a few hundred dollars), whereas the equivalent cost of a complete
hands-on simulator is relatively high (the prices of commercial simulators range
from around $45,000 for intermediate-fidelity simulators [ECS, SimMan] to more than
$200,000, depending on features; one should contact the manufacturers for detailed
information). This cost does not include the necessary clinical equipment (≅$150,000)
and space.[167]
However, even these large expenditures
do not dominate in the cost equation because the capital equipment can be amortized
over a relatively long useful life, with appropriate provisions for service and upgrades.
The dominant cost is likely to be the salaries of expert instructors. An expert
must oversee the curriculum, but the type of training and the target population will
determine the amount of expert instruction required. For example, a single faculty
member can review the summaries of exercises performed by residents on a screen-based
simulator in a few hours per resident per year. A single instructor can use the
simulator to demonstrate pulmonary or cardiovascular physiology to a whole class
of medical students. When training novice residents in basic anesthesia skills,
it may be possible to have senior residents or fellows conduct the sessions at a
low marginal cost. However, when training experienced residents and practitioners
in complex material, such as the handling of critical events, there is likely to
be no substitute for expert instructors. The cost of expert instruction depends
on the organizational arrangements of the institution.
Another organizational factor that affects the cost has to do
with making trainees available for what can be complex, exhausting, and lengthy training
sessions. Removing residents from revenue-producing work for training purposes is
expensive. On the other hand, if simulator training could allow residents or other
anesthetists to work more safely and efficiently, the benefit would outweigh the
cost. Some residency programs are restructuring to make the residency supernumerary
to the demands of the clinic. In such cases, residents are nearly always available
for educational activities, but faculty time may be even more scarce. Many programs
have used simulation training as a recruiting tool. These factors support the belief
that if simulator-based training is deemed to be desirable, innovative changes in
organization will evolve to allow it to occur.
