PROLIFERATION OF SIMULATION CENTERS
At this time, despite the lack of definitive cost-effectiveness
data, training with realistic simulators is under way in more than 150 sites around
the world,[168]
with many of them
Figure 84-15
Simulator control room. On the left
side is the simulator workstation for control of the simulator system itself. In
the middle is the audio control desk with integrated
control of several wireless headset channels and the remote mixer. On the right
are flat screens for selection and control of the multiple views of the video cameras.
For anesthesia crisis resource management courses, a multiquad-split view, including
the vital sign monitor, is digitally recorded on a hard disk and used for playback.
Marks allow jumping to interesting scenes without fast forward or rewind delay.
(Taken at the control room of the Center for Patient Safety and Simulation,
Tübingen, Germany.)
choosing to conduct fairly "high-end" crisis management and critical incident training
sessions ( Table 84-12
).
These programs have already "voted with their feet" on the issue of cost versus benefit.
With so many centers exploring the realities of simulation training, we can expect
to see additional data on efficacy and cost within the next
TABLE 84-12 -- Websites of simulation centers and other useful resources about simulation
|
http://www.hmc.psu.edu/simulation/ |
|
Penn State Medical Center, lists of available simulator
systems (and links to manufacturers!) |
|
http://www.uni-mainz.de/FB/Medizin/Anaesthesie/SESAM/welcome.html |
|
Homepage of SESAM (Society in Europe for Simulation
Applied to Medicine) |
|
http://www.simulation-users.fsnet.co.uk/ |
|
Patient Simulation User's Group, website run by Barts
and the London Medical Simulation Centre |
|
http://web.anes.rochester.edu/simulate/simusers.htm |
|
http://web.anes.rochester.edu/simulate/webpages.htm |
|
University of Rochester Medical Center providing
lists of and updated links to many simulation centers around the world |
|
http://www.bristol.ac.uk/Depts/BMSC/europe.htm |
|
Bristol Simulation Center, map-based list of simulator
sites in Europe and worldwide |
|
http://anesthesia.stanford.edu/VASimulator/simulator.htm |
|
VA-Palo Alto HCS/Stanford University (David Gaba) |
|
http://www.medizin.uni-tuebingen.de/psz/english/ |
|
Center for Patient Safety and Simulation, University
of Tübingen (Marcus Rall) |
few years. A definitive study is in principle possible, but it would require a very
large number of subjects evaluated by multiple raters and would thus be complex and
costly. Still other factors complicate assessment of the effectiveness of simulator-based
training. Studying the impact of a single session of a course that uses a new technology
and a new approach to training may underestimate the course's impact when it is used
on a regular and repetitive basis. For example, it is widely believed in commercial
aviation that CRM training must begin with the initial training of pilots and must
be continued throughout their career. The social psychologists Robert Helmreich
and H. Clayton Foushee, two of the main architects of CRM training, have written
[169]
: "Data indicate that even intensive initial
CRM training constitutes only an awareness phase and introduction to the concepts,
and that continuing reinforcement is essential to produce long-term changes in human
factors practice." Similarly, United Airlines states in its CRM manual[170]
:
"Command/Leadership/Resource management [United's terminology for CRM] cannot be
a one-shot approach. It has to be a coordinated long range program. It must therefore
be an integral part of the entire training effort: new hire training, transition
and upgrade programs, and recurrent training." Finally, the principles and procedures
taught in training must be reinforced within the operational environment. Simulator-based
safety training can be totally negated if production pressures or latent failures
in the workplace make it impossible to implement its teachings effectively.
It is still too early to make definitive statements about either
the benefits or the costs of simulator-based training in anesthesia. To some extent,
a catch-22 is involved. One cannot attempt to determine the true cost-effectiveness
until simulation is widespread enough for complex and expensive studies to be undertaken
and until there is more experience on the different organizational aspects of providing
the training. On the other hand, many institutions will shy away from taking the
risk until the cost-effectiveness is proven.
