Anesthesia Training Simulators Featured at Meeting

J.S. Gravenstein, M.D

With the help of realistic simulators and computer training devices, an anesthesia trainee can practice procedures simultaneously requiring both the quick recognition of concepts and also dexterity.

The Food and Drug Administration (FDA) and the anesthesia Patient Safety Foundation (APSF) have often stressed that safety in anesthesia depends most heavily upon the clinician in the operating room and secondarily on the instruments with which the clinician works. Education of the practitioner, therefore is a major concern for both organizations. Modem instructional techniques ran greatly facilitate learning by enabling the student to visualize complex concepts with the help of sophisticated computer programs and by making simulators available.

Several investigators have developed training devices and simulators offering excellent instruction to students of anesthesiology. However, these training devices and simulators exist almost exclusively at their development sites. A wider recognition of their advantages, the FDA and the APSF argued, can stimulate a wider adoption of these modem instructional devices. Toward this end, the two organizations sponsored a workshop in Chicago on September 9 and 10, 1988 at which eight investigators displayed anesthesia training devices and simulators (supported by FDA Grant #FD-R-000420-01).

Twenty-one anesthesiologist educators from around the U.S. were invited to become acquainted with these modem educational tools.

After the workshop, the educators provided written evaluations of what they had learned. Following are excerpts (in alphabetical order of principal investigator).

Gas Uptake Simulation (G.U.S.) Developed by: Jerry M. Calkins, M.D. and Jeffrey Spain, M.D.; Maricopa Medical Center, Phoenix, AZ: “It’s a computer program teaching and testing one’s understanding of uptake and distribution of volatile agents. The mouse-driven version has good pulldown menus, easy entry and start-up, clear windows, and excellent graphs. G.U.S. is fun to play, interactive enough to hold your attention, and far superior to ‘book learning’ alone I will be getting this program to teach our own resident group.”

Comprehensive Anesthesia Simulator Environment (CASE) Developed by: David M. Gaba, M.D. and Abe DeAnda, B.S.; Anesthesia Service, Palo Alto, CA: “This system recreates a patient-centered, anesthesia machine-driven operating room environment in which a trainee is presented specific clinical episodes that he must manage. The realism of the system is outstanding, and the debriefing greatly enhances CASE’s value.

UF Anesthesia Simulator Developed by: Michael L. Good, M.D., Sem Lampotang, M.E., Gordon L. Gibby, M.D. and J.S. Gravenstein, M.D.; University of Florida, Gainesville, FL. “The UF Anesthesia Simulator is an actual anesthesia machine with real monitors that creates realistic critical incidents demanding real-life responses. Its instructional sequence has an excellent graphic model, a practical test, and immediate feedback. It has obvious applications to a wide audience now.

GAS MAN Developed by: James Philip, M.E. (E), M.D.; Brigham & Women’s Hospital, Boston, MA: “One of the earliest simulations, only GAS MAN clearly teaches inhalation anesthesia induction to the beginner. Trainees learn this difficult concept using a handbook and computer aided instruction.”

Application of the MGH Hemodynamic Waveform Database Developed by: Reid Rubsamen, M.D., James Welch, B.S., Richard Teplick, M.D., Penny Ford, R.N., M.S. and Ronald Newbower, Ph.D.; Massachusetts General Hospital, Boston, MA: “This project provides rapid access to representative samples of hemodynamic traces via an IBM compatible microcomputer. We appreciated the ability to display each set of tracings on a monitor of the dini6an’s choice. It is applicable to training personnel in operating rooms, recovery rooms, critical care units and emergency rooms.”

Anesthesia Simulator/Recorder (ASR) Developed by: Howard A. Schwid, M.D.; Veterans Administration Medical Center, Seattle, WA: “Dr. Schwid has created a very impressive physiologic and pharmacologic patient model simulating the interactions of the administration of 50 cardiovascular and anesthetic drugs. This simulation is an example of the power, value and versatility of computer models (IBM AT) used for anesthesia and critical care education.”

An Anesthesia-Model-Driven Simulator Developed by: N. Ty Smith, M.D.; Veterans Administration Medical Center, San Diego, CA: “Dr. Smith has produced an elegant, highly sophisticated computer simulation of administering a general anesthetic one that allows, even demands, a high level of cognitive activity on the part of the operator. The screen is uncluttered and easy to read, the graphic display is similar to what we see in the OR, and the real-time nature of operator/computer interactions is a definite plus.”

“Dr. Block” Developed by: Dwayne Westenskow, Ph.D., R.R. Jaklitsch, M.S. and A.A. Bruce, B.S.; University of Utah, Salt Lake City, UT: “This computer model simulates monitoring neuromuscular blockade and reversal, enabling the user to practice on a menu driven IBM AT instead of patients. The student determines drug doses, and the option of up to 20 x real time allows events to occur fast enough for the program to remain challenging. I think it would be popular among medical students and anesthesiology residents.”

Anesthesia Work Station . Simulation of Machine Failures Using an Oil/Water Long Model Developed by: Dwayne Westenskow, Ph.D., Robert Loeb, M.D., Josef Brunner, Ph.D., Barry Feldman, M.S. and Nathan Pace, M.D.; University of Utah, Salt Lake City, UT. “The device is an evolving model of pulmonary mechanics, gas exchange, and distribution of inhalational agents to tissues. Its design is simple and elegant, and the experiments may be easily performed without using living models. It has significant educational potential.”

The response to this workshop was so positive that a second one is being planned for September 22-24, 1989 in Rockville, Maryland, close to Washington, D.C. Anyone interested in attending, either as an exhibitor of a training device, as an educator, or as an interested clinician, should write to this author. The number of participants is limited; we will, therefore, reserve space on a first-come, first-serve basis.

J.S. Gravenstein, M.D., Department of Anesthesiology,

University of Florida, Gainesville, FL 32610-0254 is on the APSF Executive Committee and chairs the Education and Training Committee.