A brief history of the development of mannequin simulators for clinical education and training

While still in a relatively nascent stage of development, simulation for healthcare applications has already evolved through its initial historical phases. * Recounting stories of some key simulation technologies could be useful for informing future simulation advocates. In this brief history of medical simulation we focus primarily on the origin of mannequin simulators, especially those employing computer control, and we examine some of the pedagogy and evaluations of effectiveness that aided dissemination. A listing of part-task trainers for surgical and medical procedures (which we refer to as "procedural" simulators) and more limited discussion of their origins are also given to indicate the extent of activity in that area.

* Good and Gravenstein refer to the very early roots of simulation, for instance to the medieval quintain, a mounted figure used for lance practice by horse mounted knights. ¹ There is a successful history of simulation in non-medical domains, with aviation most often cited as the example to emulate. That experience has influenced the development of medical simulators, but is described elsewhere. ^{2, 3}

DEFINITIONS

Some definitions are needed for this discussion. As there is no accepted convention, those used here are arbitrary, although drawn from suggestions by others. "Simulator" refers to a physical object or representation of the full or part task to be replicated. "Simulation" refers to applications of simulators for education or training. The term simulator is used by some specifically to refer to technologies that recreate the full environment in which one or more targeted tasks are carried out. This can also be called fully immersive simulation. The term "part-task trainer" should be applied to technologies that replicate only a portion of a complete process or system. However, simulator is commonly used in a generic sense to apply to all technologies that are used to imitate tasks. Gaba defines 11 spectra of simulation characteristics. ⁴ One spectrum uses the following terms:

verbal (role playing)

standardised patients (actors)

part-task trainers (physical; virtual reality)

computer patient (computer screen; screen based "virtual world")

electronic patient (replica of clinical site; mannequin based; full virtual reality)

While most of these types of simulations and simulators are not examined in this history, all will probably be integrated into the restructuring of the education and training processes for...