Anaesthesiology

The virtual anaesthesiologist: computer- and web-based training in anaesthesiology

From stunningly realistic 3-D video games to online virtual worlds, computers offer humans an expanding choice of virtual realities not just for recreation and entertainment, but increasingly also for educational purposes.  Flight and combat simulation programs offer valuable training for both civilian and military applications, and a growing number of medical procedures can now be taught and practiced via computer- and web-based simulations.  Recent progress in the development of novel web-enabled applications for anaesthesiology is expanding the possibilities both for training and credentialing.

In the field of anaesthesiology, the financial and logistical challenges posed by the adoption of mannequin patient simulators have caused some critics to question whether this approach should be used systematically for training and credentialing.  An attractive alternative is the use of computer- and web-based technologies that offer increasingly sophisticated simulations of anaesthesiology procedures.

In the June issue of the Journal of Critical Care, Samsun Lampotang of the University of Florida outlines the development and use of computer- and web-based methods for anaesthesiology training, and discusses the future application of these simulation platforms - particularly with respect to their increasing popularity for credentialing.  Associated with both the Department of Anaesthesiology and the Center for Simulation, Advanced Learning and Technology, both in Gainesville, Lampotang is well-positioned to also explore the technological basis and practical application of these simulation programs.

As an example, Lampotang describes the development and application of the VAM (Virtual Anesthesia Machine) simulation, an interactive, web-based educational simulation of an anaesthesia machine.  Originally developed for internal use at the University of Florida for the training of anaesthesia residents, VAM uses Director (Macromedia, now Adobe) as an authoring platform.  One of the reasons for the choice of this software was its lack of a royalty requirement for materials created by it - an important consideration given the intention of VAM's creators to make this simulation package freely available worldwide via the web.  Now widely considered to be one of the pioneering web-based anaesthesia simulations, VAM is currently available in multiple languages (23 for software localization, and 11 for the accompanying workbook provided via funding from the Anesthesia Patient Safety Foundation).

One major question that arises with regard to simulation software is whether or not it is actually effective in training physicians and nurses in anaesthesiology procedures.  The answer is, quite simply, yes.  Numerous studies have shown computer simulations to be effective tools, and several web-based applications have been validated in the context of their adoption for anaesthesia machine training by various anaesthesia programs in the United States, Europe, and other areas.

A recent evaluation of VAM - carried out to determine how effective this platform is as a learning tool - examined the transparent reality simulation format used by VAM.  By directly comparing two simulations, each used by a similar group of study participants, it was found that the VAM simulation using transparent reality (depicting color-coded gas molecules moving through simplified tubing, as opposed the use of an opaque, photorealistic simulation) was more effective in enabling in teaching component functions of the machine and cause-effect dynamics and relations among components.

With the adoption in 2008 of computer-based written examinations by the American Board of Anesthesiology, it is clear that computer- and web-based simulations will continue to expand their impact on the training and certification process of anaesthesiologists.  Continual improvements in these programs, such as through the more creative use of graphics, video, and user interactivity, will only accelerate this development.

Review by Samsun Lampotang on computer-based anaesthesiology training, Journal of Critical Care, June 2008

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