One very disturbing trend in the country in the past few years has been the idea that unless you perform simulation in a $8million center on a Medisim HPS, you are not really doing anything. This is crazy.

The literature shows that high tech simulation is more effective for technical tasks (laparoscopy), but low tech simulation is still useful. Many of the studies focus on student attitudes toward the simulation. If you asked someone what was more enjoyable and useful to you – an afternoon off service at the sim center, or a vigorous verbal war game in the ICU or at the bedside, what would you choose?

When you try to think of how to simulate the tragedy in Aurora, are we going to wait until we can set up a multi-agency disaster drill (which you might do twice a year at most), or is it better to get 10 players around a table and say “OK we just got word from the ECC there is an active shooter at the theater, you are the administrator on call and you are the ED attending, tell me what you are going to do first, second and third?” Then you add variants as the scenario plays out (“your OR calls down and tells you no more patients can come up for at least 60 minutes, you just got word there are two patients coming in a medic unit hypotensive with GSWs to the abdomen and the only other hospital said they are not taking any more patients,  what are you going to do?)

We need to do both and stop this idea that only high cost, high tech simulation is useful, it is not supported by evidence, and even if low tech was not as useful, it is a lot easier to do and schedule, and is a lot cheaper. What we need is structure to the low tech simulation and a way to evaluate performance. I have tried to provide some information on how to do that in the war games manual. Please take a look at it. Here is the link:

If you really dont have $1 let me know and I’ll send you a free copy.