Anesth Analg 2008; 106:354-
© 2008 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000299046.22629.5D
BOOK AND MULTIMEDIA REVIEWS
New Vistas in Patient Safety and Simulation. In Anesthesia Clinics, Vol. 25, No. 2
T. Kyle Harrison, MD, and
David M. Gaba, MD
Clinical Assistant Professor of Anesthesia (Harrison)
Professor of Anesthesia and Associate Dean, VA Palo Alto Health Care System, Stanford University School of Medicine, gaba{at}stanford.edu (Gaba)
New Vistas in Patient Safety and Simulation. In Anesthesia Clinics, Vol. 25, No. 2
Kofke WA, Nadkarni VM, eds. Philadelphia: Lippincott Williams & Wilkins, 2007. ISBN 1-4160-4279-2. 180 pages; $180.00 annual subscription for four issues or $84.00 for a single issue.
It has been nearly 40 years since the first report of medical simulation in health care education1 and almost 20 years since the first report of simulation to teach crisis management skills.2 Since that time, the field has expanded from a handful of interested individuals and institutions to a global enterprise. The field of medical simulation has expanded from anesthesiology to internal medicine, emergency medicine, pediatrics, surgery, radiology, nursing, and allied health. The Society for Simulation in Healthcare has expanded exponentially with over 1300 participants attending the annual meeting in 2007 and over 2000 expected in 2008. As we are likely at the tipping point for the industry-wide and even mandatory adoption of simulation in health care, the monograph appearing in the 2007 Anesthesiology Clinics devoted to medical simulation and patient safety is very timely.
New Vistas in Patient Safety and Simulation is a 12-chapter monograph on medical simulation and how it has been incorporated into medical training and also discusses the possible directions that simulation will likely take in the future. The text is well written and manages to cover the broad spectrum of medical simulation from mannequin-based patient simulation to standardized patient actors to virtual reality. Each chapter covers a different aspect of simulation and patient safety. On the whole, the field is well covered in this text without much redundancy between chapters.
The text begins with a concise overview of the history of medical simulation and discusses how the American Society of Anesthesiologist (ASA) through its committee on simulation education has been working to advance simulation and provide for consistent and high-quality simulation experiences for its members. The monograph then goes on to explore many different aspects of medical simulation and attempts to answer the question "Does simulation improve patient safety?" This topic is explored with a nice review of the scholarly studies to date concerning simulation’s effects on self-efficacy, competence, and operational performance. The provocative idea of using simulation to credential and certify health care providers is discussed in the chapter on credentialing and certifying. The authors discuss how at a national level—albeit in the very small country of Israel—they have been able to use simulation to conduct high-stakes evaluations both in medical school applicants and in anesthesiology board examinations. However, the chapter failed to fully explore the potential problems associated with using simulation in this fashion, for example how adequately to standardize the simulation experience and how best to grade the examination consistently and fairly. These and other issues can be glossed over in teaching applications of simulation, but they need to be resolved before widespread use of simulation for high-stakes testing can be deployed.
There are several chapters on how simulation can be used to improve team performance and how it can be used for team training, including an excellent review of crew (crisis) resource management principles. The idea of a statewide integrated system of simulation centers is also explored, thus allowing for the coordination of multiple disparate simulation centers in one state (Oregon) to address statewide clinical workforce and patient safety issues.
Although on the whole the text is well written, not all chapters hit their mark. The chapter on virtual reality (VR) simulation fails to address the topic of VR simulation in a broad sense and becomes bogged down in computer science information that is not that useful to anyone but hardcore VR enthusiasts (who are not targets of this volume). In addition, the chapter on integrating standardized patients into simulation fails to explore the field completely, in particular failing to discuss the important work of Roger Kneebone’s group at Imperial College (and analogous efforts by other groups) on hybrid simulation, in which task trainers and standardized patients are used together to provide a high-fidelity simulation environment.3
Several issues of interest to those just entering the field are not discussed in any of the chapters. One is the basic techniques of postsimulation debriefing. A nice chapter is provided on the debriefing technique, "debriefing with good judgment," but it would have been useful to include a more basic review of debriefing theory. Also a chapter on scenario design would be useful to those trying to create their own curricula and materials. Finally, a chapter on the audiovisual technologies associated with simulation would have been helpful to those challenged with setting up a robust simulation program.
All and all New Vistas in Patient Safety and Simulation is a useful text discussing the state of the art of medical simulation in 2007. The field is changing rapidly, thus an update to this volume will be needed in a few years. But for now, it provides a nice overview of the current state of the field of medical simulation and a preview where it is headed both for the casual reader interested in medical simulation and for the old hand in the simulation business.
References
- Abrahamson S, Denson JS, Wolf RM. Effectiveness of a simulator in training anesthesiology residents. J Med Educ 1969;44:515–9 [Reprinted in Qual Saf Health Care 2004;13: 395–9]
- Gaba DM, DeAnda A. A comprehensive anesthesia simulation environment: re-creating the operating room for research and teaching. Anesthesiology 1988;69: 387–94[Web of Science][Medline]
- Kneebone R, Kidd J, Nestel D, Asvall S, Paraskeva P, Darzi A. An innovative model for teaching and learning clinical procedures. Med Educ 2002;36:628–34[Web of Science][Medline]
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