Simulators in training

The rapid pace of change in medical technology has put unprecedented pressure on clinicians to learn new procedures and instrumentation and adopt them safely into their practice without compromising patient outcomes. No longer can a surgeon rely on the skills learned in training to carry them through their career. In the last two decades alone, medicine has seen the introduction of video cameras, ultrasound machines, CT scanners, MRI machines, and robots into the operating room in an effort to provide less invasive and more exact surgical care. Learning to use these devices safely and rapidly is a constant challenge. In addition, cost constraints and concerns about patient safety make it no longer acceptable to practice procedural technique in the real clinical environment. Finally, medical procedures have advanced beyond a one man show requiring the careful coordination of multiple team members to be successful. All of these challenges have caused the medical community to turn to the use of simulators to create a noncritical environment in which to rehearse patient care and gain feedback about performance. The types of simulators used vary greatly in sophistication and design, but can be categorized into three groups-inanimate, animate, and cadaver. This chapter will focus on the development and use of inanimate simulators. The different types of inanimate simulators will be described along with their design. The development of metrics of skills acquisition will also be described and a clinical example of designing a surgical simulator, creating metrics of skills acquisition for it, and proving that practice on simulated tasks improves real clinical performance will be given.