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Simulation has always had a place in medical education, from its simplest form of using actors as patients, to practising surgical techniques on cadavers. Human manikins can be used to create a physical "patient" on which to learn, demonstrate, and test resuscitation skills. High fidelity simulator manikins can be used for physiological modelling and can recreate breathing patterns, heart sounds, pulse pressures, and airway problems. They can then be placed in an artificial environment replicating the workplace. Using the parallel with professional flight simulators, learners can be completely immersed in a setting that is relevant and practical to them, whether operating theatres, ward cubicles, or resuscitation areas. This can allow repeat exposure to accurate simulation of real situations.1 The reason why any simulated patient encounter can be such a useful educational tool is neatly summarised by Issenberg et al: “Unlike patients, simulators do not become embarrassed or stressed; have predictable behaviour; are available at any time to fit curriculum needs; can be programmed to simulate selected findings, conditions, situations, complications; allow standardised experience for all trainees; can be used repeatedly with fidelity and reproducibility; and can be used to train both for procedures and difficult management situations.”2 The use of simulators in medicine is fast growing. According to a survey by Morgan and Cleave‐Hogg in 2002 the number of worldwide high fidelity simulators rose from 29 in 1997 to 207 in 2001.3 In this survey, albeit with only a 38% response rate, most of these simulators were found to be used for teaching technical skills, airway management, induction of anaesthesia, monitoring of patients, physiology and pharmacology, advanced cardiac life support and also rare event and crisis management. This was taught to a mix of both undergraduate and postgraduate students. The objectives of the manual skills development (M.S.D): To enhance skill developement for health care providers through immersive simulation To employ a range of learning scenarios and opportunities to obtain prespecified performance objectives using adult learning principles To offer structured and focused training as required, regardless of an individual's specific undergraduate educational background To utilise formative assessment tools to gauge knowledge retention in individual doctors To create a database to facilitate performance trending over time for individuals and also for groups To attain predefined skills levels according to doctors' designated job descriptions To instruct doctors such that they develop problem solving skills translatable into clinical crisis resolution To cover the range of clinical scenarios commonly associated with "the deteriorating patient" To develop verbal communication and listening skills in the "one on one" patient interview setting To provide a facility where coordinated emergency team responses can safely and reliably be observed, critiqued and optimized (e.g. emergency multidisciplinary team interactions such as Medical Emergency Teams and Trauma teams) To create an environment where non - emergency team interactions can be reviewed and analyzed : e.g. communication between Operating Room team members, To allow training for larger scale multidisciplinary events - such as bus crash triaging , or Code Yellow's
