When reality is difficult to simulate

Introduction The number of simulator centres in anaesthesia and intensive care has increased rapidly and the ‘hands-on’ simulators include progressively better functions and features. Nevertheless it is not possible to simulate a patient with all possible functions and systems. You have to choose the most important ones in order to maximize the outcome of the simulation scenarios you wish to use. Methods The use of medical technology is increasing, and so is our attention to the different kinds of monitoring equipment. Every parameter you can look upon by means of a monitor, you can simulate – at least to a certain extent. What about the clinical signs impossible (for the time being) to pick up by a transducer and display on a screen? Anaesthetic and intensive care nurses are asking for the ‘impossible’: lip colour, rash, perspiration, tears, movements, sounds, pupils reflexes, etc. PatSim 1 is a simulator that has these types of clinical signs included. Lip colour and rash are given by light emitting diodes under the skin of the manikin. Perspiration, tears, secretion in the airways, gastric regurgitation, diuresis, bleeding are made by pumps or by pressurised reservoirs and controlled by valves. Movements are pneumatic. Results Although these signs are not exactly ‘true to nature’, they give requisite inputs to the resident in order to give a more complete review of the ‘patient’. They also play important roles in making the simulation scenarios more realistic ( Fig. 1). Figure 1. Keeping the overall ‘Illusion of Realism’ up. Download figure to PowerPoint Even more trivial details such as proper clothing, correct surroundings, etc. influence the success of the scenario. To make an illusion successful, it is important to make the details – even the trivial ones – as realistic as possible. This has a ‘forgiving’ effect for the ‘impossible’ features, e.g. ‘it is only plastic’. In slow-going scenarios typical in intensive care, increased workload of the resident together with manipulated time-scale, may raise the chance that the imperfections of the simulator escape notice.