Simulation Training and Skill Assessment in Anesthesiology

The anesthesia patient safety foundation (APSF) was founded in 1985 with the timeless mission to ensure that “no patient shall be harmed by anesthesia.” This mission is still widely pursued, and progress has certainly been made in the last 30 years with simulation curriculum and advancement playing a significant role in the training of anesthesiologists. In its first year of operation, the APSF awarded four grants to patient safety research, to achieve its goal of improvement in patient safety. In the 1999 report by the Institute of Medicine, To Err is Human, the APSF was recognized as an organization that has made demonstratable positive impacts on patient safety. The APSF can be credited with facilitating the growth of anesthesia simulation as a tool for education, training, research, and assessment. In 1988, the APSF took part in organizing a conference on medical simulation followed by an anesthesia simulator curriculum conference a year later in 1989. After that, a national conference on anesthesia simulation and its role in education took place in 1995. Anesthesiology’s stake in simulation dates as far back as the 1950s when anesthesiologist Dr. Peter Safar demonstrated the ability to perform mouth-to-mouth ventilation on a chemically paralyzed human volunteer. Dr. Safar, together with Dr. Bjorn Lind and toy-maker Asmund Laerdal, went on to create the first resuscitation mannequin, Resusci Anne, in the 1960s. Its use today in BLS education is a testament to the importance of the earliest simulation research and development.  Then, in the late 1960s, medical student Stephen Abrahamson and anesthesiologist Dr. J. Samuel Denson, along with engineers from Aerojet-General Corporation, developed the Sim One, a mannequin simulator controlled remotely by a computer, which has been used for educating anesthesiology residents in airway management. Gaba and colleagues developed the virtual anesthesiology training simulation system in 1986, a true high-fidelity simulator. Unlike its predecessors, this model integrated with the actual operating room (OR) monitors, allowing a systems operator working behind the scene to simulate the physiologic response to hands-on input from trainees. This simulator was used for training in intubation and handling endotracheal tube complications as well. A simulation instructor could run through various scripts with trainees. The focus on anesthesia Crisis Resource Management (CRM) began coming into its own in the 1990s, drawing inspiration from other industries such as aviation’s Crew Resource Management. The advent of high-fidelity simulators allowed for further studies evaluating their practicality in supporting the CRM curriculum.