Volume 4, No. 4 • Winter 1989

Simulation Takes Washington By Storm

Ingrid C. Mellone

On the eve of the Anesthesia Simulator Curriculum Conference in Rockville, Maryland, a gray cloud loomed over the best-laid Anesthesia Patient Safety Foundation and Food and Drug Administration (FDA) plans. Hurricane Hugo had ripped through the Caribbean and was bound for the U.S. mainland. The forecast projected its path through the Washington, D.C. area. But D.C. was spared, and the conference began as planned Saturday, September 23.

Ninety-two exhibitors and educators from the U.S. and Europe convened to explore how Anesthesia Simulators and Training Devices (ASTRADS) could enhance a curriculum for anesthesia personnel. For the last ten years, ASTRADs had existed in isolation at their development sites. No one had ever considered their joint strength as teaching tools.

A subject addressed by all ASTRAD developers to date and important to all anesthesia practitioners is the uptake and distribution of inhaled anesthetics. This was selected as the subject for the model ASTRAI) curriculum. Arthur J.L. Schneider, M.D. of Pennsylvania State University (Hershey) and Arnold 1. Berry, M.D. of Emory University developed the curriculum, which utilizes the potential of each ASTRAD to help the trainee understand uptake and distribution.

Basically, the curriculum follows the aviation industry’s use of simulators and training devices. Pilots first acquire skills using training devices that reproduce real phenomena only to the degree needed to teach a specific learning objective. After acquiring many skiffs from various training devices, the student pilot trains on a simulator, which matches the real world in great dew by integrating learned skills and adding the stresses of reality.

Similarly, the uptake and distribution curriculum starts the student with a physical model and, over several steps of increasing complexity, enables him to progress to full anesthesia simulation.

Eight exhibitors described their ASTRADs on Saturday morning. Dwayne R. Westenskow, M.D. from the University of Utah, “An Oil/Water

Model of Uptake and Distribution”; James H. Philip, M.D. of Brigham & Women’s Hospital, “An Electronic Model of Induction of Anesthesia”; Maricopa Medical Center’s Jerry M. Calkins, M.D., “Interactive Teaching of Uptake and Distribution”; N. Ty Smith, M.D. (University of California, San Diego), “Clinical Problems and Uptake and Distribution Models”; Howard A. Schwid, M.D. of the University of Washington, “Models of Pharmacodynamics of Uptake and Distribution”; Reid M. Rubsamen, M.D. (Massachusetts General Hospital), “A Database of Pathophysiologic Events. What to Expect”; Michael L. Good, M.D. of the University of Florida, “A Simulator with Preprogrammed Events and Explanatory Graphics”; and Stanford University’s David M. Gaba, M.D., “A Simulator that Incorporates OR Stress”.

On Saturday afternoon, the attendees were divided into groups that visited four different ASTRADs for an hour each. The attending educators saw how well-designed educational plans could be enhanced by incorporating computerized training devices and simulators into curricula.

Four additional investigators spoke about their ASTRADs on Sunday morning: Dr. P. Tonner of the University of Bonn, West Germany, “The Uptake of Volatile Anesthetics as a Scientific Basis for Computer-Controlled inhalational Anesthesia in the Operating Room”; Mauricio C. Leon, M.D. of the University of South Florida, “Pulmonary and Artificial Ventilation Mechanics Simulation”; Rhoda D. Levine, M.D. of Albert Einstein College of Medicine, “Computer-Assisted Instruction in Anesthesia”; and Colin F. Mackenzie, M.B. of the University of Maryland, “Simulation of Trauma Anesthesia”.

A lively general discussion followed. Participants examined: different learning styles and their roles in anesthesia instruction; how simulators inherently match certain learning styles; how best to coordinate developmental efforts and ‘Set financial support for further research; and how to make ASTRADS, whose designs are unique to each investigator, more universally available and computer compatible.

The curriculum itself and proceedings of the conference are available for $25.00 from Mr. Ken Bower at the APSF office. The FDA’s Division of Training Support took advantage of the gathering by videotaping interviews with the exhibitors and demonstrations of the ASTRADS. The resultant material wig be made available through the APSF next year.

The investigators thank the FDA (grant number FD-R-00049M 1) and APSF for sponsoring this meeting, the second of its kind in two years.

Ms. Mellone, Department of Anesthesia, University of Florida, Gainesville, worked with Dr. I.S. Gravenstein to produce this conference.