Setting standards for simulation in anesthesia: the role of safety criteria in accreditation standards

Safety in medical simulation–overlooked or underappreciated?

“…6 It seems that an unregulated flow of carbon dioxide, which was ''exhaled'' from a Laerdal SimManÒ 3G (Laerdal, Stavanger, Norway) patient simulator, caused a precipitous increase in the temperature of soda lime being used during a simulated case. The authors raise the possibility that simulation may become ''too realistic'' and call for greater awareness of the potential risks associated with taking equipment into environments for which it was not intended (many simulations are carried out in modified offices rather than properly constituted operating rooms or ward areas).…”

“…6 Riem, Boet, and Chandra make the point that many centres choose not to use real gases and vapours, but instead simply generate relevant readings on proprietary monitors to provide the required cues to participants. However, this is the catch; if real equipment and drugs are not used, the lessons learned may not always translate accurately into the clinical environment.…”

“…The result was that the primary frame of at least one member of the audience was not aligned with that of the instructors. 6 One could argue that valuable learning was still possible through debriefing and reflection. Alternatively, one could argue that this semantic dissonance was a source of irritation and frustration which impeded learning and discouraged participation in future simulations.…”

“…We make our approach to dealing with this and other less than ideal aspects of the scenarios explicit through a ''fiction contract''. 6 We explain that actors within the simulation (e.g., the nurse or the surgeon) will comment on attributes such as skin colour when appropriate, either to respond to questions or spontaneously to provide guidance to the participant, and these comments can be relied on and taken at face value. In our experience, most participants are able to accommodate this method of managing semantic fidelity in the face of poor physical fidelity.…”

“…6 Il semble qu'un débit non réglé de monoxyde de carbone, « expiré » par un simulateur de patient Laerdal SimManÒ 3G (Laerdal, Stavanger, Norvège), ait provoqué une augmentation subite de la température de la chaux sodée utilisée dans le cas simulé. Selon les auteurs, la simulation peut potentiellement devenir « trop réaliste »; par conséquent, ils appellent à une vigilance accrue face aux risques potentiels associés à l'installation de matériel dans des environnements non conçus à cet effet (de nombreuses simulations sont réalisées dans des bureaux modifiés plutôt que dans des salles d'opération ou salles d'hôpital reconstituées avec fidélité).…”