SIMULATOR CENTERS - RESEARCH REVIEW

Prepared by Sarah Karmin and Hilary Schmidt
(Center for Education Research and Evaluation)

Overview: In support of the Simulation Subcommittee to Education Strategic Planning Phase II, Sarah Karmin (administrative assistant to the task force) has initiated a comprehensive web-based review of medical simulation centers in the United States, in search of missions, scope, types of simulators/simulations in use (and under development), programs supported by simulation, and resources needed to support these centers.

A Google search using Simulation/Simulators/Medical Centers/ Medical Schools as search terms, supplemented by lists found on some of the webpages revealed the following:

• 45 US Medical Schools with mannequin simulators
• 24 US Medical Schools with Simulation Centers with Websites
• 8 International Medical Schools with Simulator Centers with Websites
• 26 International Anesthesia Simulator sites and users
• 1 Government Training Center (Combat Trauma Patient Simulator)
• Several user groups and societies focused on medical simulation

In addition, the search revealed that other types of simulation such as virtual reality and standardized patient facilities are distinct, treated separately from mannequins, but prevalent. The summary that follows focuses primarily on mannequin simulation. Subsequent reports will focus on the other areas of simulation.

The web-pages of 16 of the US simulation centers (next page) have been carefully reviewed and searched to determine missions, popular technologies and programs at Simulation Centers across the country. The Centers are listed on the following page, and one page summaries of the key features of each of these 16 Simulation Centers (as best as could be extracted from the web-pages) is appended.

You will note that of the sixteen simulation centers, all sixteen use mannequins in their simulation centers as a teaching tool. Eight of the Simulation Centers are either housed in the Department of Anesthesiology or focus on Anesthesiology while three Simulation Centers share equally between Anesthesiology and other disciplines. However, each Mannequin is used across departments including areas such as surgery, pharmacology, and nursing, and for training and assessment of undergraduates and graduates.

Six Simulation Centers use simulators from Medical Education Technologies, Inc. (METI), Sarasota Florida. However, half of the remaining ten do not mention the manufacturer of their simulator. According to the press release for the PedaSim arrival at the Borough of Manhattan Community College in 1999, METI sells PediaSim, including mannequin, electronics box and software to medical schools for $175,000. The adult version costs roughly the same amount, although a college that already has an adult version can buy the PediaSim mannequin and software for $35,000 and plug it into its existing equipment. A complete listing of METI installations can be found on their website: http://www.meti.com

Number of Institutions using METI Mannequin Simulators

Aside from mannequins, Simulation Centers take advantage of 3D models, Computer Based Learning, Internet and Video Learning Systems, some of which are described in the pages that follow.

Seven Mission Statements were found on Center websites. All Missions include their desire to improve the quality of health care and half of the mission statements specifically mention the role of the simulator in improving medical education.

In the following pages you will find the name and location of the Simulation Center, the Mission of the Center, Type of Simulator, Programs offered, Website address, Contact Information and Funding Sources for each of the 15 Centers listed below:

• The Center for Medical Simulation (Cambridge, MA)
• USUHS Patient Simulation Laboratory (Bethesda, MD)
• Center for Research in Human Simulation at Virginia Commonwealth University
• Anesthesiology Simulator Lab at University of Southern Florida,
• WISER Institute of Simulation, Education and Research at University of Pittsburgh,
• Department of Anesthesiology Simulator and University of Kansas Medical Center, Simulator at the Department of Anesthesiology at UCLA,
• Department of Anesthesiology UCLA Los Angeles, CA
• Department of Anesthesiology Simulation Laboratory at the University of Arizona Tucson,
• Anesthesia Simulator at the University of Rochester Medical Center,
• The Simulation Development and Cognitive Science Center at Penn State,
• Houston Center for Advanced Patient Simulation at Baylor College of Medicine,
• Patient Simulation Laboratory at Wake Forest University,
• Center for Integration of Medicine and Innovative Technology, Cambridge MA,
• Simulation Center at Stanford University,
• Borough of Manhattan Community College.

The Center for Medical Simulation - Cambridge, Mass

Mission: CMS is an educational organization dedicated to improving the quality of health care through teaching team work and clinical decision-making using simulation. CMS offers programs for physicians, nurses, technicians and industry personnel using its unique clinical environment.

Simulator: Wide variety including mannequins and computers.

Programs: CMS offers educational programs for Anesthesiologists, Emergency Medicine Physicians, Radiologists, Internal Medicine Physicians, Radiologists, Surgeons, and others. Courses for Nurses, Paramedics, Respiratory Therapists, and other clinical personnel are also provided. CMS has special programs for Medical Device and Pharmaceutical Company personnel. All programs make extensive use of full-scale simulation systems, computer simulations, and part-task trainers. The Center charges a fee for participation. Currently, all Anesthesia faculty participate in simulation-based training and receive malpractice insurance discounts. CMS and Harvard's Risk management foundation have also developed a Delivery Crisis Resource Management for Obstetrical Nurse and Physician Staff.

Clinical
Medicine
Radiology
Emergency
Anesthesia and Surgery
Students
Emergency Medical Services
Programs at Harvard Medical School
Patient/Doctor
Clinical Physiology
Pharmacology
Scenario Files
Industry Programs at CMS
Medical Device and Pharmaceutical Laboratory
Anesthesia for Amateurs
Clinical Facility Photographic Setting
Teleconferences
Risk Management Programs at CMS
Incident Reenactment
Teamwork programs
Clinician Retraining
Case teleconferences
Teleconferences
M&M Conferences
National Meetings
Industry Programs

Website: http://www.harvardmedsim.org

Contact Info: jhalasz@harvardmedsim.org
617-768-8907

Funding: Simulator Case Files sponsored by a grant from Josiah Macy Jr. Foundation to the Harvard-MIT Div. of Health Sciences & Tech. and to the Center for Medical Simulation.

USUHS Patient Simulation Laboratory - Bethesda, Maryland

Mission: No information found on Website

Simulator: MANNEQUIN - Collaborative project between the National Naval Medical Center's Department of Anesthesiology Physiology, and Anatomy. Designed with 20+ patient profiles. Each one is defined by 43 specific characteristics including cardiovascular, pulmonary and metabolic attributes. They can be altered to create new patients. Instructors can select type, severity and speed of a case and tailor it to match ability of student, then assess clinical judgment, decision making, and performance of student. Lesson can be paused to provide instructor with opportunity to give student feedback and clinical situations can be repeated until desired level of performance is achieved. Mannequin presents a number of various medical problems and altered physiologic states. Choosing from over 30 problem events, a certain scenario may present any number of characteristics and complications including difficult airway management, cardiovascular conditions, allergic reactions, problems with equipment set-up and equipment failure.

Programs: Scenarios applicable to combat casualty care, anesthesia, critical care, trauma, and emergency medicine. USU's 3rd year anesthesia rotation med students are instructed in the basic fundamentals of anesthesia and the role of the anesthesiologies. They learn to connect a patient to ventilatory support sources, whether it be an oxygen mask, or an endotracheal tube, a powered ventilator or manual ventilation. They combine what they've learned from lectures with clinical experience and perform procedures and administer anesthesia, without putting patient at risk.

Walter Reed Army Medical Center conducts 16 -week Critical Care Nursing Course to prepare military and civilian nurses. Patient Simulation Lab. Augments the simulated battlefield scenarios of their field readiness training. Students rehearse wide variety of patient care emergencies.

Presents advanced case scenarios for USU's Graduate School of Nursing students who already have practical experience in health care and come to learn unique aspects of anesthesia for nurse anesthetist program. Allows individuals to learn advanced skills in prep for increased responsibilities.

Anesthesia Residents
Scenarios are designated with the directors of the anesthesia residency programs from regional military hospitals. Goal is for them to learn how to handle problems which are not only very severe but also very rare.

Website: http://www.usuhs.mil/psl

Contact: rkyle@usuhs.mil

Funding: No information found on Website

Center for Research in Human Simulation - Virginia Commonwealth University Richmond, VA

Mission: No information found on Website

Simulation: MANNEQUIN
The Simulation Laboratory is located within the Education Division and consists of 2 full-body Patient Simulators, MedSim and Laerdal, which can be used in the operating room, critical care or emergency medical settings.
Recent addition of the MPL/Laerdal SimMan Universal Patient Simulator allows for simulation training at remote locations. Offers unique airway anatomy that provides health care providers the opportunity to practice flexible fiberoptic skills.
State of the art audiovisual equipment enables instructors to record training sessions and provide detailed debriefings for simulation participants.
Facility also has an adjoining classroom/conference room with closed circuit tv and projection screen with live viewing from simulation lab. Intercom added to allow classroom participants to communicate directly into simulation center allowing for immediate interaction during live sessions. Study area is located within facility for participants to work on computer-based education programs.
Dept of Nurse Anesthesia has also acquired the Immersion Medical PreOp Endoscopy Simulator that delivers realistic, procedure-based training of fiberoptic skills and bronchoscopy procedural cognitive and motor skills. Simulator hardware interfaces with a PC device that demonstrates 3-D interactive models.

Programs: Department of Anesthesiology
Located in Education Division - has served as a resource in education of resident physicians and faculty development in Anesthesiology Dept. offered simulation to medical students, residents in other specialties, trainees in other disciplines, colleagues and members of the community. Trains and education people in human pharmacologic interventions and physiologic consequences. Attention is focused to actions of the individual learning a variety of technical skills without patient risk as well as being on the cutting edge of technology.

First Year Students
Orientation to the Operating Room Environment
Clinical Enrichment Workshops
Utilization of Anesthesia Equipment
Patient Assessment: Pre-and Post Operative Patient Interviews
Induction Sequence Workshop
Invasive and Non-invasive Monitoring Labs
OR Record Keeping Lab
Alternative Airway Management Course

Third Year Students
Anesthesia Crisis Resource Management Course - NRSA 606 - 15 week semester course that intensely covers the advanced concepts and principles of anesthetic management with an emphasis on crisis management. Provides graduate nurse anesthesia students with hands-on experience in managing crisis situations, which includes overseeing the environment, equipment and operating room team members.

Other: School of Allied Health Professionals & the University Community and VCU Health System
4th year VCU Medical Student Emergency Medicine Elective Rotation
Consulting Partner with Virginia Commonwealth Reanimation Engineering Shock Center
Dept of Radiation Sciences or Training
ACLS mock code practice School of Pharmacy "Critical Care Elective"
Basic Life Support Certification
Office Based Anesthesia Emergencies Workshop for the American Dental Society of Anesthesiologists
Anesthesia Pharmaceutical and Equipment Groups
VCUHS Dept of Education and Professional Devp "Orientation to Acute Care Nursing"
VCUHS Emergency Medicine Resident Training for Airway Management
VCUHS Department of Internal Medicine, Division of Gastroenterology "Conscious Sedation and Patient Simulation" August 2001
Richmond Public Schools - Partnership in Math and Science (PIMS) 2001 for middle school kids

Professional Service
First Annual Crisis Resource Management Workshop for Grad Nurse Anesthesia Students from Northeastern / New England Med Center 2001

Research in Simulation
Simulation research for "Mars Society Second national Mars Symposium" sponsored by NASA, Colorado, 8/99. Demonstration of varied levels of health care providers responding to medical crisis in space

Research Posters
Assessing the authenticity of the human patient simulation experience AANA National Meeting, SF, CA, 2001
Enhancing CRNA clinical instructor teaching effectiveness: The development of high fidelity trigger films
Presented at AANA Assembly of School Faculty, Tampa FLA 2001
"Content Analysis of the Computerized Full-Body Patient Simulation
Experience" Presented at "Society for Technology in Anesthesia" Meeting
Phoenix AZ 2001
"Assessing Graduate Nurse Anesthesia Student Performance: Use of an Experiential Model in Anesthesia Learning and Outcome Measurement" Presented at "Society for Technology in Anesthesia" meeting Phoenix, AZ 2001

Website: http://www.anesthesiology.vcu.edu

Contact: anesed@vcu.edu

Funding: Grants: Agilent Technologies, Continuum of Anesthesia Care Program" An Anesthesia Patient Safety Project AANA
AANA Foundation, "Enhancing CRNA Clinical Instructor Teaching Effectiveness: The development of high fidelity trigger films"

Anesthesiology Simulator Lab - University of Southern Florida Tampa, FL

Mission: Anesthesia Supervision Assessment Center
The Supervision Assessment Center is located in the Dept of Anesthesiology at USF. Center is designed to accomplish 3 goals:

1. To provide physicians with an opportunity to demonstrate their knowledge of science basic to anesthesiology and clinical practice relevant to the medical specialty of anesthesiology.
2. To provide an objective and reproducible context for the physician to demonstrate clinical skills essential for delivery of a safe anesthetic to patients evaluated as ASAI and II in non-hospital settings.
3. To permit the non-anesthesiologist physician to demonstrate satisfactory competence to supervise other healthcare providers, specifically Certified Registered Nurse Anesthetists (CRNA's), during the delivery of anesthesia to patients evaluated as ASA I and II in non-hospital settings.

Simulator: Mannequin
Anesthesiology Simulator Laboratory - METI Human Patient Simulation
(Medical Education Technologies, Inc., Sarasota Florida) - realistic, hands-on simulator in which the clinical environment and the patient are represented as physical objects. Specially instrumented mannequin models the patient, and commercially available clinical equipment is used to make up the work environment. The simulator can model with gender as young, old, healthy or very ill. It can also model some physiological aspects of pregnancy. The model-driven, life sized mannequin, breathes, has pulses, and models of physiology and pharmacology that permit accurate representation of human resources. The simulator reacts to intravenous drugs, CPR, defibrillation, tracheal intubation, ventilation, and a variety of other interventions.

The combination of the METI Human Patient Simulator and the realistic medical scenarios, provide a very plausible clinical training environment. The simulator also supports training in dealing with specific crises or events. A critical event can be set up and the trainee learns to both recognize the event and provide appropriate treatment.

Programs: Trainees can practice assessing patients by:
Observing physical signs such as chest wall motion, pulses, urinary output, and heart and breath sounds or by observing the cardiovascular variables displayed on the physiological monitor. Mannequin supports many clinical activities. Complete airway management can be practiced including mask ventilation, tracheal and bronchial intubation, cricothyrotomy and transtracheal jet ventilation. The airway can be made "difficult" in several ways including changes in the neck/head alignment. The electromechanical computer controlled lungs are embedded in its chest and breathe spontaneously as well as by hand or mechanical ventilation. Lung mechanics can be adjusted. Incoming gases are detected.

Potential utility of the METI Human Patient Simulator
Allow for the simulation of rarely occurring phenomena which the trainee might not otherwise observe in day-to-day experience. Enables repeated training of specific events or scenarios. Enable hands-on refresher training as well as instruction on new and alternative techniques. Enable the reconstruction of critical events so that the observed adverse physical reactions of the patient and the clinician's responses can be analyzed. Augment the present instruction of medical and nursing students and residents. Enable a trainee to practice his or her analysis, response, and technique with no risk of death or injury to a patient.

Website: http://www.med.usf.edu/ANESTHESIOLOGY/simulator_01.html

Contact: No information found on Website

Funding: No information found on Website

Wiser Institute of Simulation, Education and Research - University of Pittsburgh Pittsburgh, PA

Mission: The Peter M. Winter Institute for Simulation Education and Research (WISER), allied with the Safer Center for Resuscitation and Research at the U of Pittsburgh, is dedicated to medical education and educational research. The Institute features advanced instructional technology to develop innovative medical education programs that are ultimately targeted towards improving the public medical welfare and safety. Its educational research missions include the application of university standards of excellence and professionalism to study the efficacy of educational training programs and their impact on learning and on clinical care.

Goal: The Institute facilitates the development of academic educational researchers. The Institute is a forum that facilitates interdisciplinary contacts and relationships throughout the medical center, university, national and international medical education communities. It also provides consultative services to propagate these training methods. Central issue is the development of effective training methods in skill acquisition and retention and engendering the motivation to learn and use these skills by general public and health care professionals.

Simulator: Anesthesiology The Institute employs and develops advanced instructional technology-including interactive human simulation, computer-based simulation technology, Internet, and video learning systems-to enhance medical education.

Programs: Medical Student Courses in critical care and anesthesiology
EMT Courses
Resident/Fellow/Faculty Difficult Airway Management
Medivac
Trauma

Website: http://www.wiser.pitt.edu

Contacts: wiserhelp@upmc.edu

Funding: No information found on Website

Department of Anesthesiology Simulator at University of Kansas Medical Center Kansas City, KS

Mission: No information found on Website

Simulator: Mannequin
CAE-LINK anesthesia simulator to assist in the training of anesthesia personnel and other medical personnel with medical monitors, and a lifelike mannequin that simulates all pertinent body functions including breathing, peripheral pulses and heart tones. The simulator features an automated drug recognition system for more than 70 drugs which are computer modeled with full pharacokinetics and pharmacodynamics. Two dozen redefined patients are provided with the system and up to 32 different critical events may be activated. The critical events may be modified for their severity, duration of onset, absence of strength of event manifestations and patient response to treatment.

Programs: Curriculum: Distinct for CA1-2 and CA3
CA1 - simulator is introduced along with a review of the importance of simulation training. The simulator is used to teach the CA1 residents anesthesia machine setup, monitor operations, and basic patient management techniques. Each resident completes an entire introduction on the anesthesia simulator prior to inducing an actual patient.

CA1-2 residents continue to have regularly scheduled simulator sessions of both known and unknown formats. The complexity of cases presented progresses as required by the resident level of training.

During the CA1 year, screen-based simulators are introduced as a means of practicing the concepts of patient management. A distinct set of cases is required to be completed on the screen-based simulator during the course of the CA1 year.

CA3 year residents will be required to design a simulator session, with staff assistance, for presentation to CA2 residents.

Website: http://www.kumc.edu/anes/simulator/html

Contact: Stephen Tarver Director of Simulation Education
913-588-6670

Funding: No information found on Website

Department of Anesthesiology UCLA Los Angeles, CA

Mission: No information found on Website

Simulator: Mannequin
Anesthesia simulation is the use of a computerized, life-like mannequin to recreate a patient in a clinical environment. The Human Patient Simulator, representing the patient, has palpable pulses, audible heart tones, breathes, and can even talk. The "patient" can be intubated by direct laryngoscopy, or difficult airway scenarios can be recreated and the appropriate procedures performed. Physiologic responses to these procedures are monitored on actual patient care monitors; the response to events may be varied to represent normal or pathologic responses. Neuromuscualar blocking agents can be monitored by ulnar nerve stimulation.
Over 40 medications' pharmacological responses are modeled. The simulated drugs are administered in standard fashion via IV tubing after identifying them to the simulator by scanning their label. Ventilation is performed with either an anesthesia machine or a standard ventilator while pulmonary gas exchange and mechanics are monitored in standard fashion.

Simulator - on site since July 1996.
Located in the Center for the Health Sciences.

Programs: Procedures and circumstances can be reproduced for routine events as well as critical incidences. Not only intraoperative care but also trauma care and cardiac life support can be reproduced in the simulator setting. This allows other departments within the medical center to receive training from experts within the Dept of Anesthesiology or their respective depts.

Used every month for critical incidences sessions for the senior residents. During these sessions senior residents get hands-on experience with the complex, infrequently occurring scenarios. Workshops are limited to 3 residents per session and are followed by debriefing, consisting of a review and critique of the videotaped session.

New residents in the UCLA Dept. of Anesthesiology receive training on the simulator before entering the actual OR. During their starting month, new residents participate in four simulator sessions, one each week. The sessions emphasize the technique of induction, emergence issues, management of hypoxemia and management of intraoperative hemodynamic changes.

Medical student sessions are held every 2 weeks for the students on the anesthesiology service, to acquaint them with airway management and assessment of critically ill patients. Oliveview Medical Center, King/Drew Medical Center and the West LA VA Hospital, all UCLA affiliated programs, participate on an ongoing basis in these simulation sessions.

Website: http://www.anes.ucla.edu/dept/simulator.html

Contact: No information found on Website

Funding: No information found on Website

Department of Anesthesiology Simulation Laboratory - University of Arizona Tucson, AZ

Mission: No information found on Website

Simulator: Mannequin Mock operating room contains a state-of-the-art, full scale interactive human patient simulator designed by Medical Education Technologies, Inc. Computer-controlled, model driven mannequin is connected to conventional OR equipment, such as a Narkomed anesthesia machine and a Datex physiologic monitoring system. Actors play the roles of surgeons, nurses, technicians or other personnel. Training sessions are recorded by multiple built-in video cameras for subsequent debriefing sessions.

Programs: Simulator laboratory is used for all levels of anesthesia training, from an introduction to basic anesthesia concepts and skills to advanced crisis management. It is used to teach paramedics, medical students, anesthesia residents, and experienced anesthesiologists. Sim training sessions can include:

Pharmacology - The simulator recognizes injected drugs and inhaled anesthetics, responding with appropriate cardiovascular, respiratory and nervous system changes. This enables realistic demonstrations of specific drug effects, drug interactions, and the effects of varying pharmacokinetics.

Physiology - The patient simulator incorporates respiratory and cardiovascular physiologic models. Internal factors, such as pulmonary compliance, cardiac contractility and systemic vascular resistance, can be varied to dynamically demonstrate respiratory and cardiovascular physiologic principles.

Airway Management - The realistic and dynamic airway is used to teach routine intubation as well as difficult airway management. The simulator can be programmed for a variety of different patient profiles with underlying pathologies or conditions. Students may or may not be apprised of all such conditions as they create and implement an anesthetic plan for a given surgery.

Monitoring - The patient simulator generates signals for a wide variety of invasive and noninvasive respiratory and cardiovascular monitors. Students are taught tot interpret EKG waveforms, arterial pressure waveforms, capnometry, oximetry, and central venous waveforms.

Anesthetic Planning - The simulator can be programmed for a variety of different patient profiles with underlying pathologies or conditions. Students may or may not be apprised of all such conditions as they create and implement an anesthetic plan for a given surgery.

Crisis Management - Critical events can be triggered during a training session. The student can practice managing common critical events, such as respiratory arrest, and rare events, such as malignant hyperthermia. Subsequent debriefing sessions are used to review the subject's performance and suggest areas for improvement.

Website: http://www.ahsc.arizona.edu/anesth/sim.shtml

Contacts:

Scott Morgan smorgan@u.arizona.edu
520-626-5604
Robert Loeb rloeb@u.arizona.edu
520-626-9106

Funding: No information found on Website

Anesthesia Simulator - University of Rochester Medical Center Rochester, NY

Mission: No information found on Website

Simulator: Mannequin
METI Human Patient Simulator

Programs: No information found on Website

Website: http://web.anes.rochester.edu/simulate/simusers.htm

Contact: barry_zimmerman@urmc.rochester.edu

Funding: No information found on Website

The Simulation Development and Cognitive Science Center - Penn State

Mission: Use state of the art teaching tools and methodologies to further medical education at all levels of training. Advance educational technology by improving on existing tools and applications and developing novel approaches to medical education.
Goals: Increase the safety, efficacy, and effectiveness of patient care through innovative, interdisciplinary training. Promote learning in a safe, controlled environment away from the clinical setting development of curriculum for training in medical specialties. Develop surgical skills training outside the operating room
Approach: Address educational needs for computer simulation through: concept, development, validation, distribution. Integrate cognitive and technical skills. Develop industrial collaborations.

Simulators: Including mannequin and computer program simulations.
Lab is a multidisciplinary collaboration between the Anesthesia, Surgery and Nursing Depts at the Penn State University College of Medicine at the Hershey Medical Center

Human Patient Simulator (HPS) - Can be used by trainees at any educational level by programming appropriately complex scenarios for that level.

AccuTouch Endoscopy Simulator - Interactive system that permits learning and practice in anatomy, equipment handling, diagnostic procedures, and treatment options. There is visual realism (the tissue looks real), physical realism ( the tissue 'moves' when it is touched), physiological realism (the patient exhibits bleeding, vital sign changes, coughing, etc.) and tactile realism (users feel resistance to their movements). There are bronchoscopy, sigmoidoscopy, and colonoscopy modules. All provide educational content before and during the procedure, real time feedback during the procedure, and a performance report after the procedure.

CathSim Intravenous Simulator - uses virtual reality-based patients to teach peripheral intravenous catheterization. There is a haptic element to the simulation, to give the trainees the "pop" as the catheter enters the vein. The simulator has adult, geriatric, and pediatric patients. First, the trainee views a preprocedure video. During the simulation the trainee gets real time feedback from the program and the patient. After the module, post-procedure information is presented. Then the trainee receives performance feedback. As in the other virtual reality trainers, this feedback is stored for the trainee so that trends in performance can be observed.

Minimally Invasive Surgical Training system (MIST system) - trains surgical residents to perform a series of tasks which are directly drawn from a common minimally invasive procedure, a cholecystectomy (removal of the gal bladder). The procedure was differentiated into six tasks, including grasping objects, passing them from one hand to another, manipulating objects in space, switching tools, and diathermy. Trainees do not experience through the tools the subtle feedback that tissue would provide, but the tools themselves are based on real clinical equipment and allow the trainee to adjust to the feel of the equipment.

Dexter - a fiberoptic training system that uses a nonanatomic model and a real flexible bronchoscope to help trainees understand how to maneuver the scope through difficult areas and how to keep oriented to the patient while getting the scope to a particular location. It also teaches how to judge distance from one point to another, which would be useful when documenting an abnormality in a patient.

The eXpert Training System - teaches equipment and techniques as well as allowing trainees to adapt to the unique environment of minimally invasive surgery. The trainer consists of a box through which trocars and instruments are placed. It can be used with either a stationary camera (both hands can manipulate tools) or a real laparoscopic camera. Trainees begin on an introductory board which allows them to become familiar with the tools and the environment. They can also use anatomic models in the box, which allow practice of real techniques.

Part task trainers - used to teach anatomic and or psychomotor aspects of a technique.

Anatomic models are available for catheterization, invasive monitor placement, chest needle decompression and airway management. There is also a full body manikin to practice CPR. Several models teach spinal and epidural procedures. Non-anatomic models include trainers for bronchoscopy and respiratory physiology.

There are several computer program simulations available. These include an ACLS program, a bronchoscopy tutorial, EKG tutorials, a program on anesthetic administration and an ICU program. These stations can be incorporated into the curriculum as practice stations or can be used during free time to brush up on topics.

Programs:
HPS Programs/Methodologies - patient condition known or unkown to trainee diagnosis only, diagnosis and treatment with pauses for discussion or run in real time teamwork skills (medical content is irrelevant), evaluation / testing (use try until you pass, not one chance with a grade)

Website: http://www.hmc.psu.edu/simulation/

Contact: jhenry@psu.edu

Funding: Eberly Family Foundation
American Sterilizer Company (AMSCO)
Arrow International
Hewlett Packard
Draeger Medical, Inc

Houston Center for Advanced Patient Simulation, Baylor College of Medicine Department of Anesthesiology, Texas

Mission:
Goals:
Build confidence and increase performance
Maintain and enhance skill and mental sharpness
Provide the most powerful educational tool available
Advanced crisis resource management training
Develop individualized programs
Present the most believable education tool for allied health, physicians, industry representatives and attorneys

By combining an extensive series of lectures and clinical simulation we hope to build the residents knowledge, clinical skills and confidence, as well as provide hands-on experiences in anesthetic induction, emergence, extubation, the pharmacokinetics of commonly used medications, and the management of life threatening emergencies uncommonly encountered.

Simulator: Mannequin
HCAPS combines high fidelity human patient simulation, life-like adult and pediatric mannequins with extensive computer hardware and software to allow realistic interactions and interventions to occur in programmed scenarios. This offers the residents a unique opportunity to develop their clinical skills through participation in a wide range of controlled scenarios.
The human patient simulator teaching tool is based on flight simulator technology, capable of replicating pulmonary, cardiac, and renal physiology as well as pharmacology interactions.

Programs:
The Department of Anesthesiology at Baylor College of Medicine incorporates the Houston Center for Advanced Patient Simulation into its training program.

History:
NPDC began in 1999 with the goal of investigating human performance issues as they relate to clinical training and simulation. HCAPS joined with the Department of Psychology at Rice University to provide participants with custom study designs and curricula to explore components of performance issues in patient simulation.

Website: http://anesnet.anes.bcm.tmc.edu/script/simulator.asp

Contact: Phone: 713-798-7356

Funding: No information found on Website

Patient Simulation Laboratory - Wake Forest University Winston Salem, NC

Mission: No information found on Website

Simulator: Mannequin Department of Anesthesiology
The PSL is a multidisciplinary and institutional teaching center that opened in May 1999. Developed as a joint project between the Hospital, Medical School and Department of Anesthesiology, it features a highly technical mannequin with realistic pulmonary, cardiovascular, and pharmacological models. The mannequin can simulate a variety of traumatic, cardio, and airway emergencies and will respond to a number of invasive procedures, and over 70 different medications.

Although directed by the Department of Anesthesiology, the PSL is open to many different nursing, medical and public groups both within and outside the Medical Center. The Laboratory has a number of Simulation Specialists capable of training in these many disciplines. For example, within the Department of Anesthesiology, the PSL is used to train medical students, student nurse anesthetists, CRNAs, and residents.
The laboratory is outfitted with the latest in cardiovascular monitoring, an anesthesia machine, defibrillator, and airway equipment. A comprehensive multimedia system is used to capture human performance on videotape or to provide live, interactive feeds to specific audiences. All presentations are given in electronic format.
The lab is open five days/week.

Programs: No information found on Website

Website:

Contact: Ian Saunders - Lab Coordinator

Funding: No information found on Website

Center for Integration of Medicine and Innovative Technology - CIMIT Cambridge, MA

Mission: CIMIT's mission is to improve patient care by bringing together scientists, engineers, and clinicians to catalyze development of innovative technology, emphasizing minimally invasive diagnosis and therapy.
The overall goal is to achieve a realistic, accurate, real-time medical simulation. The team's specific aims are to:
The use of technology has revolutionized health care to date; and the explosion of technologies now being developed has the potential to change the face of health care even more dramatically in the near future. While the explosive growth in areas such as imaging, robotics, fiberoptics, high-speed computing and biomedical engineering have demonstrated vast potential for medical use, the challenge of successfully taking these technologies from bench to bedside remains.
Team's specific aims are to:
Develop tissue modeling, which is the most complex problem in surgical simulation, and which involves both biomechanical testing of living tissues and real-time deformation of an organ.
Develop haptic renderings as a way to provide, through a mechanical interface, the sensation of touching a virtual object.
Develop geometric modeling and visual feedback, the process that allows recreating, on a computer monitor, the typical visual display associated with a specific category of procedures.
Describe the functional interactions between different organs as well as internal functionality of blood vessels.
Develop a learning system in order to turn the simulator into a teaching instrument. This aim is relatively dependent on targeted application and therefore requires understanding the user domain.

Simulators: Mannequin and web based simulations / education
SIMIT is a non-profit consortium of world-leading academic and research institutions founded by Partners HealthCare System, Massachusetts General Hospital, Brigham and Women's Hospital, Massachusetts Institute of Technology, and Draper Laboratory. The newest affiliate to join is Beth Israel Deaconess Medical Center.

VIRGIL - Chest Trauma Training Simulator
VIRGIL was developed to train Army medics in how to alleviate three conditions commonly caused by chest trauma, namely tension pneumothorax (collapsing lung with trapped air under pressure), hemothorax (collapsed lung with blood in the chest cavity), and hemopneumothorax (blood and air in the chest cavity). The system concept encompasses a CD-based, stand-alone training tutorial which instructs the medic in basic diagnosis, triage, and step-wise care of the chest trauma patient, from the ABC's through evacuation and transport of the patient with a chest tube.

As part of the learning system, medic recruits first interact with a web-based tutorial that provides information on basic first aid, detailed descriptions of these three conditions, protocols and video demonstrations of the procedures required to alleviate these conditions, and detailed descriptions of common complications and appropriate counter-actions. Upon demonstrating mastery of the content knowledge, recruits are then introduced to the simulator.

After this educational session, the medic moves to the mannequin simulation, which incorporates a flesh-like tissue, bone-like ribs and pockets of blood-like liquid with a computer that contains an exact model of the mannequin with the addition of internal organs. A touch screen computer interface leads the trainee through a self-directed or instructor-led combat treatment scenario, in which the trainee must recognize and treat tension pneumothorax, hemothorax, or pneumothorax. The movement and placement of chest darts and chest tubes is monitored in real time, and immediate feedback is given to the trainee to show the results of his/her intervention. Correct treatment, minor errors, and fatal errors are all recorded during serial training sessions using unique identifier information, permitting documentation of trainee performance, and assessing competence according to standards established by the supervising authority.

Programs: Under the leadership of John Parrish, MD, Director, CIMIT has assembled a superb team of clinicians, scientists, and researchers to lead its scientific programs and a solid management team with expertise in operations, technology development and program management.

CIMIT is a crucible in which teams of clinicians, scientists, and engineers identify difficult problems, generate new ideas and develop innovative solutions. It also supplies a mechanism to facilitate the transfer and ultimate application to patient care. Programs in technology assessment, technology development, industry liaison, regulatory affairs, international, and education facilitate its work.

Website: http://www.cimit.org/

Contact: No information found on Website

Funding: Started in 1994 with seed funding from philanthropy and Mass General Hospital, CIMIT received major federal funding through the Department of Defense in 1998. CIMIT continues to seek additional support from other sources to accomplish the broad spectrum of technology development and assessment. CIMIT also hopes to derive support from licensed rights to intellectual property and inventions developed through CIMIT.

Simulation Center, Stanford University - Stanford, CA

Mission: The Simulation Center is dedicated to support hands-on and realistic simulation based training as well as inquiry and research on patient safety issues. Having this kind of dedicated Center means that simulation can be conducted at any time during the week or on weekends with no interruptions for use of the "OR" for clinical purposes.

Simulator: Mannequin
The original facility opened in July, 1995 and was located on the campus of the Palo Alto Division of Veterans Affairs Medical Center which had graciously donated the space and had performed the renovation.

The new Simulation Center opened in January of 1998 and is also located on the campus of the VA Palo Alto Health Care System (VAPACHS) Palo Alto Division. The new Simulation Center is a fully dedicated facility for conducting simulation-based training courses and research on patient safety. The new facility includes a 450 square-foot simulation room equipped with gas supplies and a surgical light enabling one to set up a fully functional and realistic operating room. Anesthesia and surgical equipment have been graciously donatec by Datex-Ohmeda (anesthesia machine and monitor), Hewlett Packard (monitor and defibrillator), Seimens (pumps), and the VAPAHCS (OR table and surgical supplies). The patient mannequin lies on an OR table, gurney, or bed. At the other end of the room there are gas supplies to support setting up an ICU bay, a delivery room, or an ER cubicle. There are several microphones and video cameras mounted in the room to capture the activities taking place in the simulation room.

Adjacent to the simulation room is the control groom which comprises the guts of the Patient Simulator and the simulator instructor's control station. The wireless microphone receivers and video recorders (computer controlled) are also in here. From here, the instructor can call up and modify simulation scenarios, watch the performance of the simulation participants, direct the surgeon and nurses (actors), and even provide the patient's "voice" (through a speaker under the mannequin's head).

A critical part of simulator-based training is debriefing using the videotapes of the simulation session. A separate debriefing room exists with several large video monitors on which participants can watch their performance in the simulation session.

Programs: Have developed a simulator-based curriculum on Anesthesia Crisis Resource Management. The syllabus has since been published. The ACRM course includes brief didactic sessions, but it is primarily made up of a set (lasting several hours) of highly realistic simulation scenarios, each followed by a detailed debriefing session which includes reviewing videotapes of the simulation session. The course addresses medical and technical issues relevant to the simulated scenarios, but it concentrates on basic generic principles of anesthesia crisis management.

Patient Safety Center of Inquiry
Fatigue in the Health Care Industry
Safety Culture and Survey Techniques in Patient Safety
Anesthesia Crisis Resource Management (ACRM)
Criteria for ACRM Training
Continuing Medical Education Courses in ACRM (ACRM CME)
Simulated Delivery Room Environment
Crisis Management Training in the Intensive Care Unit
Crisis Management Training in Emergency Medicine

Website: http://anesthesia.stanford.edu/VASimulator/simulator.htm

Contact: David M. Gaba

Funding: No information found on Website

Borough of Manhattan Community College New York, NY

Mission: No information found on Website

Simulator: Mannequin
BMCC introduced METI's first pediatric simulator in New York in 1999. The PediaSim is a "plug and play" lifelike mannequin developed by METI that represents a pediatric patient. It breathes, has a pulse, and its eyes constrict and dilate in response to changing neurologic conditions. The system is driven by complex software based on sophisticated mathematical models of human physiology and pharmacology.

Used in conjunction with a portable remote personal computer, a trained instructor can use the PediaSim as a "practice patient," simulating a range of complex medical conditions from head traumas to head colds. The PediaSim reacts realistically to various treatments allowing the instructor to accurately assess the actions of a student in treating a pediatric patient.
The Simulator will be used in training students enrolled in the Departments of Allied Health Sciences and Nursing.
PediaSim's heart also generates sounds, including a range of pathological ones, and students can measure arterial blood pressure. Drug reactions can be monitored and scenarios such as hypothermia, head trauma, allergic reactions, and cardiac arrest can be generated.

Programs: During training sessions, students can perform a diverse set of actions and interventions For example, the realistic upper airway enables professionals to direct laryngoscopy and tracheal intubation.

Website: http://fox.rollins.edu/~tlairson/ecom/virtualpatient.html

Contact: No information found on Website

Funding: No information found on Website