Integrating realistic simulation into educational programs: a Canadian perspective

At the University of Toronto we have integrated simulation-based education into all aspects of our academic program: undergraduate teaching of medical students, postgraduate residency training in anaesthesia, continuing profe ssional education and research. We stress the simulator is an educational t ool that provides a realistic environment for teaching clinical skills. It allows the repeated management of rare clinical scenarios, and clinical man agement can be practiced without patient risk. However, simulation is not a replacement for clinical experience. The major limitation to simulation-based education is expense and a major t ime commitment on the part of the instructors. However, we found that parti cipants rated this program highly as a learning experience and as a valuabl e adjunct to clinical experience. The key to this success is using scenario s of graded complexity depending on the level of the trainee and immediate feedback, usually using video-taping as a basis for discussion. Because of the cost newer simulation centres under development in Canada ar e supported by the entire Faculty of Medicine allowing a multidisciplinary approach and a broader source of funding and staffing. This may encourage t he participation of other specialties that deal with the "crisis-prone envi ronment".