Models simulating the brain, heart, airway, and other body organs have been used to teach human anatomy for many years. Medical science has come a long way from using those models to using today’s high-fidelity simulation models that can talk, breathe, and have palpable pulses. Simulation-based training has been used in other high-hazard professions, such as aviation, the nuclear industry, and the military, to maximize training safety and minimize risk. Health care has lagged behind in simulation applications for a number of reasons, including cost and resistance to change.2
Review of literature shows that flight simulators have been utilized in training since the 1920s. Around the 1960s, the practice of using standardized patients for the training of medical students was started. ResusciAnnie and Harvey for cardiology examinations were developed at the same time that cardiopulmonary resuscitation (CPR) was introduced. The concept of virtual reality was introduced by the entertainment industry in the 1960s via Morton Heilig’s Sensorama. Virtual reality entered the medical field through simulated endoscopies in the 1990s. With advancement in computer technology in the 1990s, software-based simulators were developed, leading to the extensive use of simulators in anesthesia.3
Before 1990, anesthesiologists were not provided formal training in crisis management, although they were suddenly called upon to manage life-threatening crises. Due to this gap in training, Dr. Howard and Dr. Gaba in the 1990s developed a course in anesthesia crisis resource management (ACRM) analogous to courses in crew (cockpit) resource management (CRM) conducted in commercial and military aviation. Two model demonstration courses in ACRM were conducted using realistic anesthesia simulation systems to test the feasibility and acceptance of this kind of training.4 Subsequently, simulation was started to be used by many different subspecialties, including critical care, pediatrics, emergency medicine, and obstetrics/gynecology.5 Around the year 2000, Laerdal introduced a computer-controlled patient simulator mannequin–SimMan, with very realistic features and feedback responses, and subsequently developed more advanced high-quality human simulators. Haptic devices were also used to simulate laparoscopic procedures.