Take in the Sun and Simulation in Miami Beach

Elliot Regenbogen, MD, on behalf of the General Otolaryngology and Sleep Education Committee

Simulation for demonstration and skill acquisition in healthcare has a long history.^1,2 The Venus of Willendorf, a statue estimated to have been made around 24,000-22,000 BC, is one of the first stone carvings of the human form.² The development of such carvings and sculptures were the progenitors of the first simulator models. Life-sized bronze statues were used in China during the Song Dynasty (960 - 1279) to teach surface anatomy and the location of acupuncture points.³

When Andreas Vesalius published the seminal De Humani Corporis Fabrica in 1543, he ushered in a renaissance of anatomical study in Europe along with an interest in three-dimensional models created in wood, ivory, bronze, and wax. Although cadaveric preservation techniques improved toward the end of the 17^th century, the process was time-consuming and required technicians with a less available skill set. Models made of wax flourished up until the 19^th century, along with plaster casts from frozen specimens, which were less expensive.^4,5

The functional complexity of simulation trainers increased during the 18^th to 20^th centuries, initially driven by the adoption of obstetrics training models. The use of simulation for surgical training can be traced to Sushruta who lived in modern-day India between the 4^th and 6^th centuries BC. However, descriptions of the use of surgical simulators did not appear until the 19^th century—initially for hernia repair and ophthalmic surgery.^6,2

One of the earlier applications of simulation education in otolaryngology was at Columbia University’s College of Physicians and Surgeons in the 1890s. Laryngology was taught over 12 lessons in the Vanderbilt Clinic, during which students practiced on a ‘‘laryngoscopic phantom [made] by Bock of Leipzig…preliminary to the examination of the living subject.’’⁷ When German laryngologist Gustav Killian developed the direct bronchoscope for removal of foreign bodies in 1902, he also developed a bronchoscopy simulator for practice.⁸

The creation of the simple mannequin simulator “Resusci-Anne” in the 1960s marks the beginning of modern training simulators. Asmund Laerdal, a successful Norwegian manufacturer of plastic toys, developed the model for training in mouth-to-mouth ventilation.⁹ Sim One, developed in the mid-1960s, was the starting point for computer-controlled mannequin simulators that could simulate the entire patient.¹⁰ As the complexity of simulation models grew, greater importance was placed on technical and nontechnical skills. The concept of crew resource management from the airline industry was integrated in medical workshops and bootcamps as crisis resource management.¹¹

The AAO-HNSF Annual Meeting & OTO EXPO^TM offers fantastic opportunities for you to get hands-on experience with some of the most cutting-edge and sophisticated simulation training tools available in our field. The 2024 Annual Meeting will feature over two dozen new and returning simulation events, including the Simulation Showcase and SIM Tank and a full program of education sessions. The pre-conference workshop, “Worst-Case Scenarios: Managing OTO Emergencies in Practice” is a half-day hands-on simulation experience geared toward preparing practicing otolaryngologists for low-frequency, high stakes emergency situations that may not occur often in their daily routines. The workshop will be held at the University of Miami – Simulation Hospital Advancing Research & Education (S.H.A.R.E) and will include complex scenarios that enhance decision-making skills, effective communication, and team leadership.

Last year’s SIM Tank and the Simulation Showcase attendees had the opportunity to observe, practice, and have discussions with the inventors of novel simulation trainers from around the world. This year’s program will not disappoint—with exciting new offerings and the return of challenging airway bronchoscopies, 3-D maxillary reconstruction, a master class in frontal sinus dissection, and an escape room that brings the concept of gamification for otolaryngology simulation training to a whole new level!

To view session times, speakers, summaries of all the simulation education sessions, visit the full Education Program and select “Simulation Education.”

We look forward to seeing you this September at the AAO-HNSF 2024 Annual Meeting & OTO EXPO in Miami Beach, Florida, for all the learning opportunities, festivities, and a truly “simulating” experience!

References

1. Owen H. Early use of simulation in medical education. Simul Healthc. 2012 Apr;7(2):102-16. doi: 10.1097/SIH.0b013e3182415a91. PMID: 22374231
2. Markovic¸ D, Markovic-Zivkovic¸ B. Development of anatomical models- chronology. Acta Med Median 2010;49:56-62
3. Schnorrenberger CC. Anatomical roots of Chinese medicine and acupuncture. J Chin Med 2008;19:35Y63
4. Russell KF. Ivory anatomical manikins. Med Hist. 1972 Apr;16(2):131-42. doi: 10.1017/s0025727300017518. PMID: 4558180; PMCID: PMC1034956
5. Spencer L. Chance, circumstance and folly: Richard Berry and the plaster anatomical collection of the Harry Brookes Allen Museum of Anatomy and Pathology. In: University of Melbourne Collections, Issue 2. 2008:3-10.
6. Parihar RS, Saraf S. Sushruta: the first plastic surgeon in 600 B.C. Internet J Plast Surg 2007;4(2):111.
7. https://archive.org/details/columbiauniversi1900colu/page/n33/mode/2up
8. Killian G. On direct endoscopy of the upper air passages and oesophagus; its diagnostic and therapeutic value in the search for and removal of foreign bodies. Br Med J 1902;2:560-571.
9. Grenvik A, Schaefer J. From Resusci-Anne to Sim-Man: the evolution of simulators in medicine. Crit Care Med. 2004 Feb;32(2 Suppl):S56-7. doi: 10.1097/00003246-200402001-00010. PMID: 15043230.
10. Denson JS, Abrahamson S. A computer-controlled patient simulator. JAMA. 1969 Apr 21;208(3):504-8. PMID: 5818529.
11. Cooper JB, Taqueti VR. A brief history of the development of mannequin simulators for clinical education and training. Qual Saf Health Care. 2004 Oct;13 Suppl 1(Suppl 1):i11-8. doi: 10.1136/qhc.13.suppl_1.i11. Erratum in: Qual Saf Health Care. 2005 Feb;14(1):72. PMID: 15465949; PMCID: PMC1765785.