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High-level simulators in emergency department education: thoughts from the trainers’ perspective
  1. G Lloyd1,
  2. J Kendall2,
  3. S Meek2,
  4. P Younge2,
  5. on behalf of the South West Emergency Medicine Regional Training Committee
  1. 1Emergency Department, Royal Devon & Exeter Hospital, Exeter, UK
  2. 2Emergency Department, Frenchay Hospital, Bristol, UK
  1. Correspondence to:
 G Lloyd
 Emergency Department, Royal Devon & Exeter Hospital, Barrack Road, Exeter, Devon EX2 5DW, UK; gavin.lloyd{at}

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The use of manikins in emergency department medical education is well established. Early models enabled training in hands-on cardiopulmonary resuscitation. Later improvements in manikin technology provided the realistic simulation of intubation and defibrillation.

The educational advantages of realistic low-level simulators in scenario-based teaching have been previously described1 (box 1). Indeed, they have a key role in adult and paediatric life support group courses. However, the realism in each scenario is limited by the technology. The trainee’s need for a progress report (“what’s the patient doing now?”) is familiar to seasoned instructors—skilled facilitation is essential.

Box 1 Advantages in simulated resuscitation

  • There is no patient risk

  • Errors can be allowed to occur

  • The choice of scenario is not limited

  • The patient’s pathology is known to the instructor

  • Identical scenarios can be presented to different candidates or teams

  • Psychomotor skills can be assessed

  • Interpersonal interactions with other professionals can be explored and training on teamwork, leadership and communication provided

  • The simulated session may be recorded; there are no issues of patient confidentiality—the recordings can be used for research performance assessment or accreditation

But what if the technology allowed the manikin to breathe for itself? What if it had palpable pulses (or did not)? What if the instructor could control the respiratory rate, oxygen saturation and blood pressure in addition to heart rate and rhythm? What if the manikin could actually speak? And what if the model could physiologically respond automatically and appropriately to any given intravenous agent? Could you then not remove the facilitator completely from the room, allowing the trainee to totally engage in the scenario?

In this paper, we describe and compare the two types of high-level simulators currently in use in the …

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  • Funding: With thanks from the Medical and Dental Educational Levy via the Southwest Deanery.

  • Competing interests: None.

  • GL secured the funding, coordinated the programme and trainer evaluation, initiated the trainee evaluation and wrote the paper. All authors acted as trainers during the simulation study days. JK and SM edited the paper. GL acts as guarantor.