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Role of simulation for paediatric proceduralists: Practice makes perfect or trial and error?

Simulation (from the Latin simulates, to copy) denotes the imitation of any real or anticipated activity as part of a training or evaluation process. This entails representing key characteristics of a selected physical or abstract system in order to feign a real event for the purpose of practice, learning, evaluation and testing, or to gain an understanding of systems, human actions and their interactions. Much of the current medical literature has focused on the impact of minimally invasive surgery (MIS) and other technological innovations as the driving force for simulation in health care. While the advent of MIS within both adult general and paediatric surgery unmasked specific training issues, especially those relating to a counter-intuitive visual–spatial interface with greatly reduced proprioceptive feedback, the concept of simulation as a means of improving performance and avoiding unnecessary loss of life and limb remains a very old one. Hundreds of years ago, lance-carrying mediaeval knights increased their chances of achieving longevity in their chosen occupation by practising with a mounted figure called a quintain (Fig. 1). More recently, safety and cost considerations in potentially hazardous industries have led to the incorporation of simulation. In 1931, one of the first flight simulators, The Link Trainer or ‘Blue box’, was patented (Fig. 2), becoming well known during the Second World War with the ensuing need to train a large number of pilots and reduce the risk of carrier landings. In the 1960s, the National Aeronautics and Space Administration extensively used simulation to ensure the success of the Apollo Space Program. The catastrophes at the Three Mile Island in 1979 and, 7 years later, in Chernobyl, highlighted the importance of simulation in the nuclear industry. Despite the success of these programmes, the use of simulation in medicine remains somewhat controversial and certainly inconsistent. As simulation is still not widely accepted, despite the use of increasingly sophisticated simulation technology across a range of specialties, including anaesthesia, surgery, neonatology and obstetrics, paediatric clinicians need to understand the important role this modality may play as an adjunct to training, learning new techniques and maintenance of clinical skills.