Healthcare simulation—Past, Present, and Future

摘要

In acute care settings, quick decision making and rapid execution are critical. Chesley Sullenberger's emergency landing of Flight 1549 in 2009, where he saved 155 lives,1 epitomizes this. Similar scenarios in medicine include the urgent need to choose between open and endovascular repair in an abdominal aortic aneurysm or between cardiopulmonary resuscitation (CPR) and cesarean delivery during obstetric cardiac arrest. Such high-stakes decision making underpins the evolution of health care simulation, transitioning from passive dummies and large mammals to advanced patient simulators and simulated patients (actors). This shift allows for controlled andragogical content delivery and accelerated experiential learning. The concept of fidelity—functional and physical—plays a crucial role in the effectiveness of these simulations. Functional fidelity resembles trainee behavior in simulated and real environments. By contrast, physical fidelity involves the match between the appearance and behavior of the simulated and real patients. Physiological fidelity is essential in acute care simulations requiring real-time, realistic intervention responses. Mathematical human physiology and pharmacology models facilitate these simulations,2 similar to the necessity of flight models in aviation simulators. Innovations in simulation include interactive visualizations and objective performance metrics based on physiological parameters. The transition from a fixed duration/variable performance model to a fixed performance/variable duration paradigm in medical training is underway. With the ability to simulate multiple critical scenarios within a short period, the learning experience has become more efficient and comprehensive. Despite these advancements, challenges remain in ensuring that simulations are as realistic and effective as possible. Continuous improvement in simulation technology and methods is essential for maintaining high health care education and training standards. The teaching of surgery and other skills has historically followed the “see one, do one, teach one” method established by Halsted.3 However, this traditional approach has challenged various factors, including restricted working hours, economic and social contexts, productivity, legal and ethical issues, and time constraints.4 The advent of laparoscopy and the necessity for quick education in minimally invasive techniques brought simulation to the forefront.5 While effective for laparoscopic surgery, simulation's role in open surgery remains underexplored.6 Similarly, the heterogeneity in robotic surgery curricula highlights the need for standardized training methods.7 The COVID-19 pandemic further disrupted traditional surgical training, limiting residents' exposure to operating rooms. This shift necessitated the adoption of e-learning and new technologies such as virtual and augmented reality.8 These tools have potential but require further integration and validation within surgical curricula.9 Our augmented reality projects demonstrate the potential of telementoring in surgical education. This technology facilitates training students and residents through a 3-phase educational model that challenges the traditional mentor–mentee relationship. Initial results indicate effectiveness, suggesting a need for deliberate practice and motivation within surgical training curricula.10 Integrating augmented reality (AR) and virtual reality (VR) into surgical training is a significant step forward. These technologies provide immersive, interactive experiences that enhance learning outcomes. For example, AR can overlay digital information onto real-world environments, aiding in complex surgical procedures by providing real-time data and guidance. Conversely, VR can simulate entire surgical environments, allowing trainees to practice procedures risk-free. Despite their promise, these technologies face several challenges in implementation. High costs, technical complexities, and the