FUTURE OF PATIENT SIMULATION IN ANESTHESIA
Though past its first decade of consistent development, the field
of anesthesia simulation is still new. Simulators have become more sophisticated,
and users can now choose from different models offered by multiple manufacturers.
Improvements in simulators will depend on the demand for the devices and on the
trade-off between fidelity and cost. Many otherwise desirable improvements may be
too costly for the impact that they can be expected to produce.
The physiologic and pharmacologic models used in the simulators
have become more sophisticated and are supported by ever-improving computer hardware.
However, medical simulators will remain far behind those used in aviation. Unlike
aeronautical engineers, physicians do not design and build the system that they wish
to model. The fundamental differential equations of fluid mechanics and aerodynamics
are firmly established,
thereby allowing supercomputers to provide technically meaningful simulations as
replacements for many wind tunnel tests. Furthermore, there are still wind tunnel
tests, as well as test flights of actual prototype aircraft. Sophisticated instrumentation
can be built into test structures to define their behavior accurately. Physicians
will never have this type of knowledge about the human body.
A profound milestone will be the development of virtual reality
simulators that will eventually allow the subject to be completely immersed in a
simulated situation without physically replicating the OR environment. The development
of virtual reality hardware and software for entertainment is proceeding, but not
as explosively as some had predicted. As the field expands and matures, the tools
will become available to convert screen-only simulators or mannequin-based simulators
to virtual reality. For some time, however, mannequin-based simulators will offer
some advantages over virtual reality. A virtual reality system would have to contain
computer models of all available monitoring equipment. The mannequin-based simulator
deals with this issue by simulating actual clinical equipment. Realistic simulators
will have an advantage in simulation scenarios involving multiple personnel such
as ACRM and other combined team training until the technology is available for complex
linking of multiple individual virtual reality simulators. Perhaps in another 20
years we will see virtual reality simulations take over from computer screen- and
mannequin-based simulations. Virtual reality will become the norm for training in
many complex work fields, and virtual reality technology is likely to change the
nature of work itself.
Patient simulators have emerged from their purely experimental
phase to become an accepted, though still new component of research and training
in health care. It is highly likely that simulators will become a regular part of
the initial and recurrent training of most anesthetists and many other clinicians.
The anesthesia community can be proud of its pioneering role in developing patient
simulation technology and simulation-based training curricula. As this process continues,
it is also likely that anesthetists will continue to lead the rest of health care
in the evolution of this technology and its educational, research, and evaluation
applications.[171]
