Simulation-based education in Canada: will anesthesia lead in the future?

Abstract

It is remarkable that 40 years have elapsed since Denson and Abrahamson first introduced high fidelity simulation (Sim One) to facilitate the teaching of endotracheal intubation and the induction of anesthesia. The concept of utilizing a simulator for clinical training was far ahead of its time and not immediately embraced by anesthesiologists or other educators. Simulation technology for medical education underwent a revival in the mid-1980s when computer-generated screen based simulation programs made their appearance, focusing primarily on pharmacology and physiology applications relevant to anesthesia. The anesthesiologist could choose one of many scenarios that might be encountered by a clinical anesthesiologist. These programs allowed the learner to interpret information and make pharmacological and therapeutic decisions. Such simulators were novel and afforded a meaningful learning experience, especially for novice learners; however, they did not duplicate the application of practical skills and knowledge in a clinical environment in real time. In 1986, Gaba et al. at Stanford University developed a full-scale, high fidelity simulator (‘‘The Comprehensive Anesthesia Simulation Environment [CASE]’’) which allowed the anesthesiologist to manage critical situations. With Jeff Cooper in Boston, they developed an organized program called ‘‘Anesthesia Crisis Resource Management’’ (ACRM), applying principles from the airline industry where pilots and airline crew use ‘‘Crew Resource Management’’ programs to elicit human responses in a realistic environment. The objective of ACRM is to teach participants the importance of non-technical skills such as team working, task management, decision-making and situation awareness, focusing on communication and leadership skills. In the late 90s, several simulation centres appeared in Canada, led by anesthesiologists, to allow learners to practice difficult and rare scenarios without placing patients at risk. Today, simulation centres have been developed in over 50 centres across Canada, including many community colleges, in addition to hospitals and universities. In spite of the exponential growth of simulation, many professions and disciplines have been slow to recognize that simulationbased education is more than a teaching tool—it is a novel form of ‘‘experiential education’’, with which non-technical skills required in professional practice can be learned. Educators know that these are difficult (if not impossible) to teach in the clinical environment. Most Canadian academic departments of anesthesia have been progressive in integrating simulation into the undergraduate and/or postgraduate curricula. Undergraduate medical students who are given time in an anesthesia simulator, enthusiastically compete with each other to manage the airway, and pharmacologically treat simple hemodynamic problems. It is often their first opportunity to independently treat a ‘‘patient problem’’ and the majority find it very enjoyable and a great learning experience. At the postgraduate level, simulators are used to teach firstyear residents how to ‘‘troubleshoot’’ the anesthesia gas machine through clinically relevant scenarios, and manage common intraoperative anesthetic problems. Postgraduate years 2–5 often spend at least two, three-hour sessions each year in the simulation center. They usually share this experience in a small group and are usually not in the same R. J. Byrick, MD (&) V. N. Naik, MD Department of Anesthesia, St. Michael’s Hospital, 30 Bond Street, Toronto, ON M5B 1W8, Canada e-mail: robert.byrick@utoronto.ca