he field of health care simulation, created by anesthesiologists almost four decades ago, has shown unprecedented growth in the last five years.¹ The reason for this expanding interest is multifactorial. Many simulation professionals would cite the Institute of Medicine publications To Err Is Human² and Crossing the Quality Chasm³ as the primary catalyst of this change. Others might say the power of experiential learning better fits the needs of a 21st century health care learner.⁴ Regardless of what you believe, simulation training has arrived in health care education. The Society for Simulation in Healthcare <ssih.org> was formed in January 2004. The first issue of Simulation in Healthcare (a peer-reviewed, multidisciplinary journal) was published in January 2006 <www.simulationinhealthcare.com>.

The accrediting bodies of undergraduate and graduate medical education are embracing simulation education <www.acgme.org/acWebsite/bulletin/bulletin12_05.pdf>. The National Board of Medical Examiners and the American Board of Medical Specialties consider simulation an important tool for achieving and assessing clinical competency. Health care specialty societies, such as the American College of Surgeons, have already developed “Education Institute” accreditation methods, which include simulation programs.

Workgroup on Simulation Education
The ASA leadership, in response to this burgeoning interest in simulation (initially through the Continuing Medical Education [CME] Strategy Committee and then the Section on Education and Research) sought to create a process for ASA members to identify and attend high-quality, standardized, simulation-based continuing education courses while affirming a leadership role in this important education and patient safety technique.

The Committee on Outreach Education formed the Workgroup on Simulation Education in December 2004 to bring this vision to fruition. The 21-person workgroup, under the leadership of Michael A. Olympio, M.D., consists of education and simulation experts from ASA and many major U.S. simulation centers. Members of the workgroup include ASA Web Administrator Anita Abbatacola, Paul R. Barach, M.D., ASA Education Specialist Ellen Bateman, Ed.D., Daniel J. Cole, M.D., Jeffrey B. Cooper, Ph.D., David M. Gaba, M.D., Glenn P. Gravlee, M.D., Adam I. Levine, M.D., Gary E. Loyd, M.D., ASA Director of Information Technology Janice L. Plack, Joseph J. Quinlan, M.D., Keith J. Ruskin, M.D., John J. Schaefer III, M.D., Michael A. Seropian, M.D., Elizabeth H. Sinz, M.D., Randolph H. Steadman, M.D., Jeffrey M. Taekman, M.D., Laurence C. Torsher, M.D., Matthew B. Weinger, M.D., and David H. Wilks, M.D. The workgroup was further divided into three- and four-person subgroups charged with the creation and development of key components of the new initiative.

The group accomplished much during the past 18 months, including 1) the creation and administration of a national simulation survey, 2) composition of a white paper on approval of simulation programs, 3) publication of a Web-based national simulation registry, 4) conduct of a “Simulation Saturday” (a nationwide promotional simulation experience for ASA members) and 5) planning for a Simulation Expo in conjunction with the ASA 2006 Annual Meeting in Chicago.

Simulation Survey
An “ASA Member Poll on Simulation Education” was administered electronically to the ASA membership in the fourth quarter of 2005. Of the 1,350 respondents, 77 percent felt that simulation offered benefits over lecture-based CME <www.ASAhq.org/news/MemberPollSimulationStats 111605.pdf>. The majority of respondents felt simulation CME would enhance their skills in the management of common events, the management of infrequent or difficult events and their management of teams during crisis events. Eighty-nine percent stated that they would attend a simulation-based CME course if it was held in a convenient location. Only 9 percent of the respondents were not interested in simulation-based education. The results of the survey were integrated into the white paper proposal for approving simulation programs.

White Paper on Approval of Anesthesiology Simulation Programs
The most significant achievement of the workgroup’s activities is the proposal described in the white paper, which recommends methods to identify, evaluate and approve simulation-based CME and lifelong learning opportunities for ASA members. The white paper will be recommended to the Board of Directors in August 2006. If the white paper is endorsed, it will be sent to the House of Delegates for approval in October 2006. The document is available for review on the Web at <www.ASAhq.org/ASASimWhitePaper031506.pdf>. Nearly 200 constructive and invaluable comments have already been reviewed through the ASA polling Web site <www.surveyconsole.com/console/TakeSurvey?id=189751>, and many more are eagerly anticipated. Such comments will form the basis for revision of the white paper recommendations to the Board of Directors in August.

ASA Simulation Registry
The ASA Simulation Registry <simulation.ASAhq.org/search> is a new Web-based resource developed by the workgroup to help the ASA membership to locate quality simulation-based educational activities and resources. The registry enables an end-user to search for different types of accredited and nonaccredited educational activities, gives background information on each course and provides links to the simulation centers of interest. One intended purpose of the registry is to identify future “applicants” to the approval process and reward those distinguished “ASA-Approved” programs that have met the high standards set forth in the white paper.

Simulation Saturday
The workgroup conducted “Simulation Saturday,” a nationwide simulation event held on March 11, 2006. Simulation centers across the country opened their doors for this activity, which was free to ASA members. Each center developed unique course material, and although most had limited enrollment, the feedback from this activity was overwhelmingly positive. Some centers even awarded free CME credit for participation. The feedback already has been useful in plotting the immediate needs of this initiative and future directions of the workgroup.

Simulation Expo
The workgroup continues to plan for the Simulation Expo to be held from noon to 1:30 p.m. on Saturday, October 14, during the 2006 Annual Meeting in Chicago. The Expo will feature a televised live simulation demonstration with an interactive videoconference link to the Center for Medical Simulation in Boston. The audience will be limited to 1,000 ASA members. Further information and the Expo’s registration process are actively under development.

Final Thoughts
Health care is one of the last high-risk professions to embrace the use of simulation in training (and retraining) its workforce. With the momentum and success that your Workgroup on Simulation Education has already enjoyed, we hope that the ASA membership will support those efforts and become a team player in this exciting initiative.

References:
1. Gaba DM. The future vision of simulation in health care. Qual Saf Health Care 2004; 13(suppl 1):i2-10.
2. Kohn LT, Corrigan JM, Donaldson MS, eds. To Err Is Human: Building a Safer Health System. Washington, DC: National Academies Press; 2000.
3. Institute of Medicine. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: National Academies Press; 2001.
4. Friedman CP. The marvelous medical education machine or how medical education can be unstuck in time. Acad Med. 2000; 75(10):137S-142S.

Jeffrey M. Taekman, M.D., is Assistant Professor of Anesthesiology, Assistant Dean for Educational Technology and Director, Human Simulation and Patient Safety Center, Duke University Medical Center, Durham, North Carolina.