Past Present and Future of Simulation in Pediatrics

The development of simulation has been evolving in technology and utilization over the last several centuries, with the increased application over the past 2 to 3 decades in the field of pediatrics. Today, simulation-based medical education (SBME) is widely used by a majority of pediatric training programs and is marked by a large variety of technologies and continued interest and availability of research in the field.  The history of simulation in medicine has its origins in fields such as the military, commercial aviation, and NASA. Disciplines, like medicine, where the importance of safe knowledge acquisition and practice is of utmost importance, quickly followed suit. The application of medical simulation to pediatrics had its infancy as an adjunct to obstetrics and surgical training. One of the earliest examples of simulation for the express purpose of medical education is from the late 1700s, where pelvic part-task trainers were developed with a pelvis, glass uterus filled with fluid, and a flexible fetus used to teach midwives delivery skills. Over the next two hundred years, there were continued improvements in the “realism” of part-task trainers and even some full-body mannequins, but the modern era of mannequin trainers had their roots in the field of anesthesia. In the mid-1900s, more sophisticated mannequins were developed. Unfortunately, while these proved to be effective training tools but were far too expensive for mass production. The anesthesia community then led a medical education reform over the coming decades to incorporate simulation-based medical education into the mainstream.   Today, there are numerous simulation centers and hospitals that utilize a variety of human patient simulators that range from low to high fidelity mannequins, the most sophisticated of which are capable of responding to learner stimuli such as drug administration, compressions, voice, physical exam, and even procedural interventions. The simulation armamentarium also includes task trainers, standardized patients, desktop/screen-based, and virtual and augmented reality (VR and AR). Each technology has its utility both alone and in combination, depending on the educational objective hoping to be met.