Canadian Journal of Anesthesia

, Volume 51, Issue 5, pp 455–464 | Cite as

Full scale computer simulators in anesthesia training and evaluation

  • Anne K. Wong
General Anesthesia



With the advent of competency-based curriculum, technology such as full scale computer simulators have acquired an increasingly important role in anesthesia both in training and evaluation. This article reviews the current role of full scale computer simulators in teaching and evaluation in anesthesia.


This review draws from existing anesthesia and medical education literature in order to examine and assess the current role of full scale computer simulators in anesthesia education today.

Principal findings

The last decade has witnessed a major increase in the use of full scale computer simulators in anesthesia. Many applications have been found for these simulators including teaching and training, evaluation and research. Despite the increasing use and application of full scale computers in anesthesia in the area of teaching and training, definitive studies evaluating its cost effectiveness, its efficacy compared to traditional training methods or its impact on patient outcome are still pending. Although there is some preliminary evidence of reliability and validity in using the simulator to evaluate clinical competence, development in this area has not progressed enough to justify its use in formal, summative evaluation of competence in anesthesia at this time.


As technology acquires an increasingly important role in medical education, full scale computer simulators represent an exciting potential in anesthesia. However, the full potential and role of simulators in anesthesia is still in development and will require a dovetailing of clinical theory and practice with current research in medical education.


Crisis Management Anesthesia Resident Crew Resource Management Objective Structure Clinical Exam Full Scale Simulator 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Des simulateurs informatisés grandeur nature pour la formation et l’évaluation en anesthésie



Avec l’avènement du programme d’enseignement axé sur les compétences, une technologie comme celle des simulateurs informatisés grandeur nature a acquis un rôle sans cesse plus important pour la formation et l’évaluation en anesthésie. Le présent article passe en revue le rôle actuel de ces simulateurs en anesthésie.


Nous avons extrait des publications existantes sur la formation en anesthésie et en médecine les données qui nous ont permis de vérifier et d’évaluer le rôle actuel des simulateurs.

Constatations principales

Au cours de la dernière décennie, l’usage des simulateurs informatisés grandeur nature s’est grandement développée en anesthésie. Ces simulateurs ont été trouvés utiles dans l’enseignement et la formation, l’évaluation et la recherche. Malgré leur usage croissant et la multiplicité de leurs applications dans l’enseignement et la formation en anesthésie, des études formelles qui évaluent la rentabilité des simulateurs, leur efficacité comparée aux méthodes de formation traditionnelles ou leur impact sur l’évolution des patients n’ont pas encore été réalisées. Une sorte de fiabilité et de validité préalables à leur usage ont été établies pour évaluer la compétence clinique, mais c’est un domaine qui n’a pas suffisamment évolué pour justifier l’usage actuel de cette technologie dans l’examen formel et le bilan de la compétence en anesthésie.


La technologie joue un rôle croissant dans la formation médicale. Les simulateurs informatisés grandeur nature offrent donc de grandes possibilités en anesthésie. Leur développement constant va nécessiter une harmonisation de la théorie et de la pratique cliniques avec la recherche courante en formation médicale.


  1. 1.
    Carraccio C, Wolfsthal SD, Englander R, Ferentz K, Martin C. Shifting paradigms: from Flexner to competencies. Acad Med 2002; 77: 361–7.PubMedCrossRefGoogle Scholar
  2. 2.
    The Royal College of Physicians and Surgeons of Canada’s Canadian Medical Educational Directions for Specialists 2000 project. Skills for the new millennium: report of the societal needs working group. 1996; available from URL: Scholar
  3. 3.
    Issenberg SB, McGaghie WC, Hart IR, et al. Simulation technology for health care professional skills training and assessment. JAMA 1999; 282: 861–6.PubMedCrossRefGoogle Scholar
  4. 4.
    Iserson K. Simulating our future: real changes in medical education. Acad Med 1999; 74: 752–4.PubMedCrossRefGoogle Scholar
  5. 5.
    Chopra V. Anaesthesia simulators. Bailliere’s Clinical Anesthesiology 1996; 10: 297–315.CrossRefGoogle Scholar
  6. 6.
    Kurrek MM, Devitt JH. The cost for construction and operation of a simulation centre. Can J Anaesth 1997; 44: 1191–5.PubMedGoogle Scholar
  7. 7.
    Morgan PJ, Cleave-Hogg D. A worldwide survey of the use of simulation in anesthesia. Can J Anesth 2002; 49: 659–62.PubMedGoogle Scholar
  8. 8.
    Howard SK, Gaba DM, Fish KJ, Yang G, Sarnquist FH. Anesthesia crisis resource management training: teaching anesthesiologists to handle critical incidents. Aviat Space Environ Med 1992; 63: 763–70.PubMedGoogle Scholar
  9. 9.
    Gaba DM. Human work environment and simulators.In: Miller RD (Ed.). Anesthesia, 5th ed. Philadelphia: Churchill Livingstone Inc.; 2000: 2613–68.Google Scholar
  10. 10.
    Chopra V. What can you do with a simulator? Quality assurance.In: Henson LC, Lee AC (Eds). Simulators in Anesthesiology Education. New York: Plenum Press; 1988: 39–48.Google Scholar
  11. 11.
    Gaba DM, Fish KJ, Howard SK. Crisis Management in Anesthesiology. New York: Churchill Livingstone Inc.; 1994.Google Scholar
  12. 12.
    Helmreich RL, Schafer HG. Turning silk purses into sows’ ears: human factors in medicine.In: Henson LC, Lee AC (Eds). Simulators in Anesthesiology Education. New York: Plenum Press; 1998: 1–7.Google Scholar
  13. 13.
    Fletcher GC, McGeorge P, Flin RH, Glavin RJ, Maran NJ. The role of non-technical skills in anaesthesia: a review of current literature. Br J Anaesth 2002; 88: 418–29.PubMedCrossRefGoogle Scholar
  14. 14.
    Cooper JB, Gaba DM. A strategy for preventing anesthesia accidents. Int Anesthesiol Clin 1989; 27: 148–52.PubMedCrossRefGoogle Scholar
  15. 15.
    Ericsson KA, Charness N. Expert performance. Am Psychol 1994; 49: 725–47.CrossRefGoogle Scholar
  16. 16.
    Byrick RJ. Intergrating realistic simulation into educational programs: a Canadian perspective.In: Ikeda K, Doi M, Kazama T (Eds). State-of-the-Art Technology in Anesthesia and Intensive Care. Amsterdam, Netherlands: Elsevier Science BV; 1998: 175–82.Google Scholar
  17. 17.
    Lee AC. Using simulators for medical students and anesthesia resident education.In: Henson LC, Lee AC (Eds). Simulators in Anesthesiology Education. New York: Plenum Press; 1998: 23–8.Google Scholar
  18. 18.
    Cleave-Hogg D, Morgan PJ. Experiential learning in an anaesthesia simulation centre: analysis of students’ comments. Med Teach 2002; 24: 23–6.PubMedCrossRefGoogle Scholar
  19. 19.
    Fish MP, Flanagan B. Incorporation of a realistic anesthesia simulator into an anesthesia clerkship.In: Henson LC, Lee AC (Eds). Simulators in Anesthesiology Education. New York: Plenum Press; 1998: 115–9.Google Scholar
  20. 20.
    Chopra V, Gesink BJ, de Jong J, Bovill JG, Spierdijk J, Brand R. Does training on an anaesthesia simulator lead to improvement in performance? Br J Anaesth 1994; 73: 293–7.PubMedCrossRefGoogle Scholar
  21. 21.
    Morgan PJ, Cleave-Hogg D, McIlroy J, Devitt JH. A comparison of experiential and visual learning for undergraduate medical students. Anesthesiology 2002; 96; 10–6.PubMedCrossRefGoogle Scholar
  22. 22.
    Nyssen AS, Larbuisson R, Janssens M, Pendeville P, Mayne A. A comparison of the training value of two types of anesthesia simulators: computer screen-based and mannequin-based simulators. Anesth Analg 2002; 94: 1560–5.PubMedCrossRefGoogle Scholar
  23. 23.
    Cayne BS. New Webster’s Dictionary and Thesaurus of the English Language. Danbury, CT: Lexicon Publications Inc.; 1992: 200.Google Scholar
  24. 24.
    Norman GR. Defining competence: a methodological review.In: Neufeld VR, Norman GR (Eds). Assessing Clinical Competence. New York: Springer Publishing Company; 1989: 5–35.Google Scholar
  25. 25.
    Miller GE. The assessment of clinical skills/competence/performance. Acad Med 1990; 65: S63–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Wass V, Van der Vleuten C, Shatzer J, Jones R. Assessment of clinical competence. Lancet 2001; 357: 945–9.PubMedCrossRefGoogle Scholar
  27. 27.
    Holmboe ES, Hawkins RE. Methods for evaluating the clinical competence of residents in internal medicine: a review. Ann Intern Med 1998; 129: 42–8.PubMedGoogle Scholar
  28. 28.
    Martin JA, Regehr G, Reznick R, et al. Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg 1997; 84: 273–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Morgan PJ, Cleave-Hogg D. Evaluation of medical students’ performance using the anaesthesia simulator. Med Educ 2000; 34: 42–5.PubMedCrossRefGoogle Scholar
  30. 30.
    Gaba DM, Howard SK, Flanagan B, Smith BE, Fish KJ, Botney R. Assessment of clinical performance during simulated crisis using both technical and behavioral ratings. Anesthesiology 1998; 89: 8–18.PubMedCrossRefGoogle Scholar
  31. 31.
    Forrest FC, Taylor MA, Postlethwaite K, Aspinall R. Use of a high-fidelity simulator to develop testing of the technical performance of novice anaesthetists. Br J Anaesth 2002; 88: 338–44.PubMedCrossRefGoogle Scholar
  32. 32.
    Neufeld VR. An introduction to measurement properties.In: Neufeld VR, Norman GR (Eds). Assisting Clinical Competence. New York: Springer Publishing Company; 1989: 39–50.Google Scholar
  33. 33.
    Byrne AJ, Greaves JD. Assessment instruments used during anaesthetic simulation: review of published studies. Br J Anaesth 2001; 86: 445–50.PubMedCrossRefGoogle Scholar
  34. 34.
    Devitt JH, Kurrek MM, Cohen MM, et al. Testing the raters: inter-rater reliability of standardized anaesthesia simulator performance. Can J Anaesth 1997; 44: 924–8.PubMedGoogle Scholar
  35. 35.
    Devitt JH, Kurrek MM, Cohen MM, et al. Testing internal consistency and construct validity during evaluation of performance in a patient simulator. Anesth Analg 1998; 86: 1160–4.PubMedCrossRefGoogle Scholar
  36. 36.
    Devitt JH, Kurrek MM, Cohen MM, Cleave-Hogg D. The validity of performance assessments using simulation. Anesthesiology 2001; 95: 36–42.PubMedCrossRefGoogle Scholar
  37. 37.
    Morgan PJ, Cleave-Hogg DM, Guest CB, Herold J. Validity and reliability of undergraduate performance assessments in an anesthesia simulator. Can J Anesth 2001; 48: 225–33.PubMedCrossRefGoogle Scholar
  38. 38.
    Schwid HA, Rooke GA, Carline J, et al. Evaluation of anesthesia residents using mannequin-based simulation. A multiinstitutional study. Anesthesiology 2002; 97: 1434–44.PubMedCrossRefGoogle Scholar
  39. 39.
    Weller JM, Bloch M, Young S, et al. Evaluation of high fidelity patient simulator in assessment of performance of anaesthetists. Br J Anaesth 2003; 90: 43–7.PubMedCrossRefGoogle Scholar
  40. 40.
    Eva KW, Neville AJ, Norman GR. Exploring the etiology of content specificity: factors influencing analogic transfer and problem solving. Acad Med 1998; 73: S1–5.PubMedCrossRefGoogle Scholar
  41. 41.
    Norman GR. Evaluation of problem-solving ability.In: Hart I, Harden R, Walton H (Eds). Newer Developments in Assessing Clinical Competency. Montreal: Heal Publishers; 1986: 47–51.Google Scholar
  42. 42.
    Norman GR. Striking the balance. Acad Med 1994; 69: 209–10.PubMedCrossRefGoogle Scholar
  43. 43.
    Swanson DB, Norman GR, Linn RL. Performancebased assessment: lessons from the health professions. Educ Res 1995; 24: 5–11.Google Scholar
  44. 44.
    Girard M, Drolet P. Anesthesiology simulators: networking is the key (Editorial). Can J Anesth 2002; 49: 647–9.PubMedGoogle Scholar
  45. 45.
    Helmreich RL, Davies JM. Anaesthetic simulation and lessons to be learned from aviation. Can J Anaesth 1997; 44: 907–12.PubMedGoogle Scholar
  46. 46.
    Kapur PA, Steadman RH. Patient simulator competency testing: ready for take off? (Editorial). Anesth Analg 1998; 86: 1157–9.PubMedCrossRefGoogle Scholar
  47. 47.
    Whitcomb M. Competency-based graduate medical education? Of course! But how should competency be assessed? Acad Med 2002; 77: 359–60.PubMedCrossRefGoogle Scholar

Copyright information

© Canadian Anesthesiologists 2004

Authors and Affiliations

  1. 1.Department of AnaesthesiaMcMaster University, St. Joseph’s HealthcareHamiltonCanada

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