Previous Abstract | Next Abstract
Printable Version
October 16, 2006
9:00 AM - 11:00 AM
Room Hall E, Area F
Preliminary Evaluation of a Transparent Reality Simulation of the Anesthesia Machine Pre-Use Check
Samsun Lampotang, Ph.D., David E. Lizdas, B.S.M.E., Robert M. Carr, M.B.A., Michael E. Mahla, M.D., Jeffrey M. Feldman, M.D.
Anesthesiology, University of Florida, Gainesville, Florida
Introduction. The anesthesia machine pre-use check has been statistically associated with a decreased risk of 24-h postoperative severe morbidity and mortality [1]. Yet in a recent web survey only 20% of anesthesia providers performed a pre-use check before every case and instruction was lacking during formal training [2]. With an APSF grant and an IBM award, we developed a simulation of the 1993 FDA checkout available free of charge to anyone at

Methods. Development. We authored a transparent reality simulation [3] in Director MX (Macromedia, San Francisco, CA), consisting of 3 sets of simulation learning objects, for the content ("see one"), practice ("do one") and assessment ("test oneself") components of self-instruction. We designed and implemented a companion e-learning system where individual performance of any on-line user worldwide can be monitored and logged to a database. The content module emphasizes the rationale behind each step and orients users to the simulation and how to use it. An intelligent tutor monitors practice performance and provides tiered and context-sensitive guidance if the learner struggles. In the assessment module, the integrity of the anesthesia machine is randomized to an intact or defective state and users have to perform and interpret the checkout steps correctly. Evaluation. (a) In a US anesthesia residency program with 75 residents, completing the simulation was made a graduation requirement; a 30-minute orientation lecture was also provided. (b) Users worldwide were required to complete surveys on the simulation.

Results. After 24/7 access to the online simulation for 7 weeks, 21 residents had started using the simulation and 8 had completed the entire simulation. Highest score was 40 (average 36, maximum 46). Survey results. For questions with answers on a scale of 1-10 (10 = strongly agree), results were: ability to view the rationale for each step was useful (50% of users chose 10), simulation was intuitive to use (54% chose ≥ 8) and increased my understanding and confidence (68% chose ≥7) and the assessment was useful (64% chose ≥ 7). For multiple choice questions, the percentage of responders picking a given answer is reported: I was exposed to rationale previously never explained (32%), simulation was realistic (93%), intelligent tutor was helpful (79%), learned something new from practice module (96%), prefer learning from simulations rather than written materials (97%), simulation is time consuming but better than alternatives (53%), failures were realistic and accurately modeled (88%), learned from experiencing simulated failures never encountered with a real machine (91%), this simulation will help me detect and identify failures in actual machines (91%), simulation will cause me to check more regularly (77%) and quicker (64%), and similar transparent reality simulations for other medical equipment are needed (95%).

Discussion. Transparent reality simulation is designed to facilitate mental model acquisition via exploration and visualization. Users of the APSF simulation surmised that it may change their behavior and performance. Further study is required to verify if it will truly alter clinical practice.


1. Anesthesiology 102:257-268, 2005

2. Anesthesiology 103: A1195, 2005

3. Educational Technology 46:55:59, 2006.

Anesthesiology 2006; 105: A934