Barry M. Robinson Medical Simulation


This is my personal website for simulation in healthcare. It is slightly different from other simulation sites since it highlights my own particular interests in this subject. I now have a free guide for simulation operations specialists; the Handbook for Healthcare Simulation Operations Specialists. You can download the latest edition (updated August 2016) of my Casualty Simulation Techniques Guide, free-of-charge. Here is the link to Innovate! Materials and Methods for Healthcare Simulation, a presentation I gave at the Northern Simulation Symposium held at Georgian College, Barrie, Ontario on 27 April 2017.

Over the past year I've been working on a palpation trainer which I built from epoxy/fiberglass and silicone. Students from the George Brown College School of Mechanical Engineering Technologies installed pressure sensors and a microcontroller in the trainer. The trainer has been used in research and I am currently working on the second prototype. You can read about the research in this article Head to Neck Task Trainer to Teach Palpation Skills: Back to Basic published in the "International Journal of Clinical Skills".

I am always interested in hearing from others in the simulation community: let me know what you think.


Simulation, in general, involves running a model which replicates specific characteristics or behaviours of a real-world process. The model captures key features of the real-world process which are relevant to the intended use (e.g. research, education). When a simulation is run, the state of the model changes over time. In the case of healthcare simulation, the model is usually based on human anatomy, physiology, and pathology.

WW2 Simulated Casualty

Photo: Canada. Dept. of National Defence, Library and Archives Canada, PA-151138

During the past decade the use of healthcare simulation has increased dramatically. This has been the result of the acceptance of simulation as a valuable adjunct in the teaching and certification of medical personnel, advances in computer technology including wireless networking and increases in simulation centre funding.

A Short History of Simulation in Healthcare

The history of a technology is important; it gives us perspective and inspires humility. History is a rich source of ideas which can be resurrected, reused, or repurposed.

In 18th century France, Angélique Marguerite Le Boursier du Coudray (1712-1794) used a cloth birthing simulator to teach her techniques to midwives and surgeons. About the same time, Dr. Giovanni Antonio Galli (1708-1782) developed a birthing simulator for training his students and midwives in Bologna, Italy. Obstetric simulators, called obstetrical phantoms, were available in the early part of the 20th century. The one pictured to the below left is from the collection of the Museum of Health Care at Kingston, Ontario, Canada. In the United States, the Chase Hospital Doll was introduced in 1911 as a training aid for nurses. By the early 1940s the Chase Doll had been outfitted with an injection pad on the arm and other improvements. A modified Chase Doll was used by the U.S. Army to train medical corpsmen in the 1940s. The image above right shows the Royal Canadian Army Medical Corps working on a simulated casualty during the Second World War.

Obstetric Phantom

Photo: Obstetric Phantom, from the Museum of Health Care
at Kingston, Accession Number 001033001

If you would like to know more about the history of simulation in healthcare I recommend the following articles. I have included links to the original articles when possible.

Terminology, Spelling and Hypertext

The field of healthcare simulation, as a formal discipline, is relatively new and the terminology remains in flux. The phrase "simulation in healthcare" refers to either medical or casualty simulation. Casualty simulation is a type of healthcare simulation using trauma-based scenarios in the prehospital environment.

Moulage is associated with simulation and usually refers to either casualty simulation as a whole or as makeup used in a medical simulation setting, medical moulage. The word itself comes from the French, see moulage. In the past, moulage referred to sculptures illustrating medical conditions, usually sculpted from wax. You can see an example of a wax moulage here from the Museum of Healthcare in Kingston, Ontario. I prefer the term makeup or special makeup effects, to distinguish it from other types of makeup. Three-dimensional makeup can be referred to by technique; prosthetics (also prosthetic appliances or just appliances), which are effects pre-made from a variety of materials or out-of-kit, sculpted directly on the patient/casualty as needed, using skin-safe materials from the makeup artist's kit.

Manikin/Mannequin: According to Wikipedia, "manikin" is specific to human models used in medical education. Other reliable sources treat "manikin" as a synonym of "mannequin." Both words are used interchangeably in simulation literature. "Patient simulator" is often used in place of term "mannequin" for high-fidelity simulators. You can find a detailed discussion of "mannequin" versus "manikin" in What's In a Name? A Mannequin by Any Other Name Would Work As Well by David M. Gaba, MD. The term "phantom" was once used for partial-task trainers; examples are the obstetric phantom and the ophthalmophantom. Phantom now refers to medical imaging simulators for ultrasound, MRI, radiology and other types of medical imaging.

Healthcare Simulation Operations Specialist (see The Society for Simulation in Healthcare definition), simulation specialist, simulation technician or technologist, and simulation operator are terms which refer to the same general job description. A simulation specialist is someone who manages the technical aspects of the simulation. According to online job descriptions this job requires not only a background in healthcare but expertise with computer networks, video recording, and an ability to create promotional materials for simulation centre activities. A discussion of the role of the simulation specialist/technician/technologist/operator can be found in "Who's Driving? The Role and Training of the Human Patient Simulation Operator" by Laura Gantt, CIN: Computers, Informatics, Nursing Vol. 30, No. 11, 579-586 DOI: 10.1097/NXN.0b013e318266ca52. A similar job, based on an online health care recruiting description, is a Patient Care Simulation Facilitator. Those working as simulation specialists are sometimes referred to as simulation ghosts; a reference to the behind-the-scenes work that is done to make the simulation happen.

Simulationist is a term used in modeling and simulation which is now gaining traction in healthcare simulation. For a detailed definition of the term "simulationist" in modeling and simulation see "Educating the Simulationists" by Tuncer Ören in Conceptions of curriculum for simulation education (panel), Proceedings of the 2000 Winter Simulation Conference: 1635-1644. In healthcare simulation, the simulationist is usually an educator rather than a person involved with the technical aspects of the simulation. Simulationists are defined as "Practitioners of simulation" in "Simulation and Adult Learning", Ernest E. Wang, Simulation in Healthcare, Part I: The Future of Medical Education and Training, Disease-a-Month, Volume 57 Number 11 November 2011. As defined in a job description, "The Simulationist acts as a collaborator in the design, development, management and measurement of outcomes based experiential learning initiatives . . . " from Simulationist (job description), Staff Professional Jobs, Riverside Methodist Hospital, Columbus, Ohio, dated 04/17/2014, accessed May 4, 2014. You can see a similar definition of simulationist at SIM-one FAQs. There are other job titles, such as the Practicum Skills Coordinator and the Academic Program Technologist, which combine the roles of simulationist and simulation specialist.

Pre-briefing/Briefing/Debriefing: The term "pre-briefing" when used in healthcare simulation is poorly defined but seems to refer to the same thing as "briefing", for example, "Pre-briefing includes information on what to expect during the simulation, a review of the medical diagnosis, and a definition of the simulation objectives." from Simulation Helps Prepare Nurses for Reality at the Galen College of Nursing website, accessed on September 5, 2015. A better word to use to describe this introduction to the simulation environment and the scenario is "briefing." During a briefing, information is passed along to a specific group of people, as in press briefing. The word "briefing" comes from legal brief (from the Latin "brevis" (short) by way of Old French and Middle English ), a summary of important facts in a case. In the military, a briefing is a short intoduction to the exercise or operation taking place. Ususally this includes an orientation to the ground, the type of exercise, safety instructions, introduction of staff, a timetable of when events will happen and any other information the participants need to know.

Part of the problem may be a misunderstanding of the terms "debriefing" and "briefing". A debriefing is used to recover information from participants after an exercise or mission. Use of the word "debrief" most likely dates from World War II; the Merriam-Webster online dictionary places the first use in 1945. The prefix "de" indicates "negation", "removal", "reversal" or "separation". A debrief can occur independently of a briefing. A pre-briefing, the prefix "pre" meaning "before", can only occur when an associated briefing will be given (i.e. "before the briefing"). The White House uses the term "pre-briefing" to refer to a staff meeting before a press briefing. See the archived articles from the Clinton White House and other examples at Wordnik. It may also mean the release of key points of a speech prior to the speech being given. See "Political trick or good PR? A short guide to the art of pre-briefing" from The Guardian.

Orders Group and the After Action Report: Both of these terms originated in the military. I haven't yet heard of these being used in healthcare simulation but it wouldn't be a bad idea. An Orders Group, usually refered to as the "O Group", is a meeting of the organizers and staff prior to the beginning of the exercise. The purpose is to introduce staff, state expectations and goals, assign roles and responsibilities, and to iron out any problems before the exercise begins. An After Action Report takes place after the exercise. Organizers and staff either meet or submit a written report outlining what went right, what went wrong, and whether the goals and expecations were met.

Shrapnel: I began my work in simulation in the military and I've found that one commonly misused word, in the military, the medical, and the civilian world, is "shrapnel." This term has been used to describe fragments from industrial accidents, domestic terrorism, and military munitions. Shrapnel is a specific type of artillery shell which was last used early in the First World War. At best, the use of the term "shrapnel" does not provide any additional information regarding the weapon or injury; in many cases it simply causes confusion. A more descriptive term for pieces of a munition is "fragment." You can learn more about shrapnel at "Shrapnel and Shell Fragments" an edited version of a 1952 article by Major General H. W. Blakely, U.S. Army Center of Military History website, 6 October 2011, accessed May 10, 2014. For another article see "Shrapnel: The Man, The Missile, And The Myth" by DG Burris and NM Rich, J R Army Med Corps 2003; 149: 337-339. (PDF file)

Spelling and Grammar: Several terms used frequently in medical writing do not have one standard spelling. Health care can be spelled either as two words "health care" or one word "healthcare." There does not seem to be a preference; both are used frequently in North America and Britain. Another term, "prehospital", can be written either with or without the hyphen. "Prehospital" seems to be the preferred spelling but the hyphenated "pre-hospital" is used on occasion.

As a Canadian, some of the words I use are spelled differently from American English. One example is "colour" and "color". Another example which involves both spelling and usage is the word "practice", a noun in Canadian English where the verb is "practise". This differs from American English use in which "practice" is both the noun and verb. I have noticed several Canadian articles which use the American spelling; this may be a result of spell-checkers or exposure to the American usage.

If you want to find out more about proper grammar and word usage, see "Ask the Editor" at Mirriam-Webster. I've tried to use proper grammar and spelling on this website but I may have the occasional lapse.

Hyperlinks: You'll notice that I make liberal use of hyperlinks in my writing. I try to follow the original intent of the World Wide Web which is to allow users to easily share information. Tim Berners-Lee wrote in The World Wide Web: A very short personal history that "The dream behind the Web is of a common information space in which we communicate by sharing information. Its universality is essential: the fact that a hypertext link can point to anything, be it personal, local or global, be it draft or highly polished." Hyperlinking is a powerful tool which enriches content and encourages exploration.

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