Past Present and Future of Simulation in Internal Medicine

Simulation training has its roots in the aviation industry, with the first flight simulators built in the 1930s. The military, NASA, and commercial airlines further pioneered simulation techniques to improve pilot training and safety. The field of medicine implemented forms of simulation for training as early as the 1950s, but it wasn’t until the turn of the century that medical simulation took off. Anesthesia was an early adopter of simulation; a first simulator appeared in the 1960s, which could reproduce some physiology, respond to drugs, and teach basic airway management. Since then, medical simulation has expanded across all disciplines of medicine. In particular, internal medicine residencies are increasingly making use of simulation to teach their house-staff, mediate deficiencies, and maintain proficiency in key areas of practice. The medical simulation utilizes multiple diverse modalities to teach learners in internal medicine. For example, scenarios with standardized patients are often used to assess interpersonal skills and communication; while task trainers, cadavers and animal models are employed to replicate procedures without putting patients at risk; and medical emergencies are simulated with interactive software, virtual reality, and high fidelity mannequins which have led to improved patient survival in some cases. Debriefing, which occurs at the end of the simulation, is a key aspect of learning, soliciting learner self-reflection, and uncovering the ways they think about and approach medical problems. Simulation is poised to expand in the future. Much like aircraft pilots are routinely tested for proficiency and ability to handle emergency situations during their careers, medical boards are starting to use simulation to assess clinical competency. For instance, the American Board of Internal Medicine (ABIM) offers the option of a simulated cardiac catheterization skills assessment to interventional cardiologists to maintain their certification in this procedure. Similarly, the American Board of Anesthesiology board exam incorporates an Objective Structured Clinical Examination (OSCE) to assess communication, professionalism, and technical skills. These offerings will likely expand to internal medicine and other specialties. Another growing and evolving area of simulation is virtual reality, which will have an increasing application to all fields of medicine; sight, sound, and new functions such as haptics provide an immersive world for learners to develop clinical skills. Interprofessional simulation is useful to understand and improve team dynamics and communication and is particularly important to the role of the internal medicine physician who is tasked with coordinating patient care. And beyond training and education, simulation has real-world implications, including improved patient safety and healthcare quality.