Medical simulation in ‘my world’

Abstract

I read with great interest the editorial by Dr Gilpin and colleagues [1], as we have recently changed the manikin in our centre from one that was ‘fixed’ and had ‘deductive modelling’ to one that is now ‘wireless’ and is controlled ‘on the fly’ (where the instructor changes the manikin’s physiology based on the actions of the candidates in the scenario). I recognise the problems involved in programming an overly complicated ‘deductive model’, for example, in having to change the manikin’s venous capacitance to drop its blood pressure, the oxygen consumption to prevent a desaturation or the ‘ischaemic index sensitivity’ to prevent a cardiac arrest, which detracts from faculty’s concentrating on controlling the scenario, and sometimes resulting in manikin ‘death’ despite correct simulated intervention. During a newer, high-fidelity simulation scenario, candidates only see parameters displayed on a monitor, which can be adapted readily by the controller to achieve a realistic physiological change. The internal physiological programming of the manikin plays no actual part in the scenario provided. A well-delivered scenario can be achieved by ensuring an experienced and well-trained faculty. A typical complex trauma scenario at our centre requires at least five members of faculty and although this requires a large investment in time and manpower, we are able to deliver a realistic scenario using a manikin that is a third of the price of a typical ‘deductive model’. Typical faculty roles are as follows: one overall scenario controller (usually the course director); a manikin controller; a manikin voice operator (so as not to distract the controller); a phone operator; and a facilitator who is able to direct the scenario (receiving headset instructions from the scenario controller) and act in a health and safety role. Pre-planned, fixed manikin programs can become unstuck if candidates do something unpredictable, such as giving the wrong drug or drug dose or decompressing a tension pneuomthorax that does not exist. Newer manikins allow the experienced controller to change parameters appropriately, without spoiling the fidelity of a simulation as a result of having to reprogram a deductive model. Advances in technology should be welcomed, particularly new software provided for handheld devices, but the future lies in well-trained controllers and faculty who have the experience to alter the manikin during scenarios and achieve the pre-determined learning objectives.