The future vision of simulation in health care
- Correspondence to: Professor David M Gaba Patient Simulation Center of Innovation at VA Palo Alto Health Care System, Center for Immersive and Simulation-based Learning, Stanford University, Anesthesia Service, 112A, VA Palo Alto HCS, 3801 Miranda Avenue, Palo Alto, CA 94304, USA;
Simulation is a technique—not a technology—to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner. The diverse applications of simulation in health care can be categorised by 11 dimensions: aims and purposes of the simulation activity; unit of participation; experience level of participants; health care domain; professional discipline of participants; type of knowledge, skill, attitudes, or behaviours addressed; the simulated patient’s age; technology applicable or required; site of simulation; extent of direct participation; and method of feedback used. Using simulation to improve safety will require full integration of its applications into the routine structures and practices of health care. The costs and benefits of simulation are difficult to determine, especially for the most challenging applications, where long term use may be required. Various driving forces and implementation mechanisms can be expected to propel simulation forward, including professional societies, liability insurers, health care payers, and ultimately the public. The future of simulation in health care depends on the commitment and ingenuity of the health care simulation community to see that improved patient safety using this tool becomes a reality.
↵* See the web sites of SMS at www.socmedsim.org and SESAM at www.uni-mainz.de/FB/Medizin/Anaesthesie/SESAM/welcome
↵* In November, 1942, speaking after the second battle of El Alamein, Churchill said: “Now this is not the end. It is not even the beginning of the end. But it is, perhaps, the end of the beginning.”