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Although rarely thought of as simulations by anesthesia educators, the use of standardized patients to simulate clinical encounters spans 4 decades (Mt Sinai J Med. 1996;63:241-249; J Am Med Assoc. 1997;278:790-791; Int J Dermatol. 1999;38:893-894). Although its efficacy for education and evaluation in the medical community has been well established through extensive research, there is a distinct dearth in the literature in its use for anesthesia trainee education and evaluation. In this article, we discuss this simulation modality via a historic review, its current application in competency assessment, and its use in anesthesiology education and evaluation. We conclude with a "how to guide" to facilitate those considering including standardized patient simulations into their anesthesia training or simulation curriculum.

The increasing role of simulation in medical education has paralleled the advancement of this technology. Full environment simulation (FES) can be used to effectively replicate rare medical catastrophes with exacting realism. It has been suggested that emotion can significantly enhance learning by producing memories that are processed and stored via the amygdaloid complex, which are relatively impervious to extinction and thus forgetting. Theoretically, the addition of emotional content to simulated crises during FES can be used to affect emotional changes in the participants and thus facilitate learning. Here, we discuss the theoretical benefit and the use of FES with emotional enhancement as it relates to improved memory and learning.

A simulator-based educational program has been incorporated into many anesthesia residency training programs. The effectiveness of this method of teaching has been validated by several studies and is generally accepted as an effective method of resident education. Evaluation of performance and positive critical feedback through debriefing has been attributed to the effectiveness of simulator-based education. Perhaps, this process can be used to evaluate the competence of practicing physicians. We report our experience using multimodality simulator technology to assess physicians who may have allowed their competence to lapse. We discuss our simulator-based assessment process and the strengths and limitations of our program. We also discuss the legal ramifications of participating in such assessments. Because of confidentiality agreements signed by all parties involved with this process, cases are discussed in general terms to assure anonymity.