Simulators in obstetric anaesthesia are a waste of time

Abstract

At the outset of this debate I accept it is marginally unfair to state that simulators are a waste of time. Essentially any innovation that could be said to improve our skills and improve patient safety should be embraced. However we must realise that the beneficial claims made so convincingly for simulators are purely opinions expressed by pioneers of medical simulation. Therefore in this debate it is important to assess objectively whether they show sufficient benefit to justify the claims made for them when balanced against the enormous financial and manpower input invested in them. Simulation in all its forms has been around since time began. In medicine one of the earliest practical examples I witnessed was the performance of an actress at the OSCE (Objective Structured Clinical Examinations) for the final FRCA. Fortunately for me as an examiner, I had the complete picture, but the candidates who encountered her were told that she was presenting for anaesthesia for tubal ligation, that she was HIV-positive, hepatitis-positive and had a morbid fear of needles and of anaesthesia. So convincingly did she portray her fears that all the candidates were extremely sympathetic to her, but overlooked the importance of her infective status. This is a simple example of a simulated situation giving a totally false picture. The fake patient: the simulator/actress used her freedom of expression and imagination, but it was not a valid situation. Aviation simulation is the model that has been copied by anaesthesia. It is now incredibly sophisticated and pilots now have to have a “Simulation Weekend” every six months. So stressful is it that, over the last few years, three pilots, despite having passed rigorous medicals, have shown evidence of myocardial ischaemia while being assessed. Crisis management in aviation is not similar to the operating theatre. A pilot in a crisis situation has a copilot and a comprehensive manual by his side and in any event is dealing with a machine, not a person. Our medical experts have accepted a blind extrapolation from aviation to a biological situation. David Gaba, Professor of Anesthesia and a human factors expert is a pioneer of medical simulation. 1 In anaesthesia he says the applications of patients simulation are: education, training, research, risk management, public relations and performance assessment. Taking his points, while there is little enough distinction between education and training or knowledge and performance, these were always traditionally part of our evaluation as specialists and have not been discovered by Professor Gaba. Indeed the whole basis of our apprenticeship system was encapsulated years ago by Sir William Osler who stated that “the student begins with the patient, continues with the patient and ends his/her career with the patient using books and