第７回 Simulation and training in anaesthesia　(麻酔科におけるシミュレーションとトレーニング) 平成27年12月26日　午前７時〜8時半 要旨 麻酔科や救急救命ではシミュレーションによる訓練が効果的だが、その他の精神科医、病理学者、皮膚科医などでは条件や環境がまったくことなるので事情は異なってくる 下の抜粋部で、マネキンを使ってのシミュレーション訓練と飛行機のパイロットのそれと比較検証している。医療現場ではシミュレーションと実際の現場とのギャップが大きすぎて、効果的な訓練法とはならないとしている。 シミュレーション訓練の有効性を、パイロットの訓練と比較しているのは分かりやすくて、論文の書き方で参考となる。英語に関しては、consider +Vingやallow 人 to Vという表現が良く使われている。 　 　We agree in principle with their comments, particularly in relation to a need for standards in simulation. 　We too would like to see the progressive adoption of summative assessment in simulation. However, we would advocate preceeding with caustion. The evidence that hig-fidelity simulation is an effective educational and training tool is indeed growing, but we do not believe that it is yet sufficient to justify its uncritical adoption for the selection, assessment, and revaidation of doctors. 　In aviation, qualified airline pilots undertake simulated critical incidents every 6 months and must manage them safely to maintain their flying privileges. About 5% are found to require further training to meet the required standard. As a result, travelling on a scheduled flight is the safest way to travel. This rigorous quality assurance system has been established without deference to detailed economic modelling or a study showing that it improves passenger outcome. So why not introduce something similar for doctors? 　 　First, the fidelity of patient simulation is not yet as close to reality as that of flight simulation; although they are becoming increasingly advanced, manikins cannot move nor can their skin change colour. In our experience, some doctors find it very difficult to engage in a scenario with manikins and their performance does not necessarily reflect true life. We agree with Dr Guha and colleagues that if career-changing (or ending) decisions are to be made on the basis of performance in a simulated scenario, then the assessment criteria must be robust, reproducible, and not open to interoperator variability or bias. 　 　Pilots must be able to take off, navigate, and land safely, with iterations within that general schema based upon variations in conditions and equipment. This is not the case in medicine. The skills required to practice as a paediatrician are very different from those needed to be a psychiatrist, pathologist, or dermatologist, for example. Although perhaps anaesthesia and emergency medicine are most suited to simulation, many specialities are not. Anaesthetists are at the forefront of developing best practice in simulation, but the views and opinions of doctors from other specialities should also be sought.