Testing Interventions in a Medical Simulator: Challenges and Solutions

When testing medical interventions in a simulator, establishing an environment that allows findings to generalize to clinical settings; designing scenarios that are representative of clinical situations and that can be delivered consistently; and ensuring correct operation of simulator systems to ensure efficient data collection, can be challenging. We address these factors using the example of a study that tested auditory displays for the pulse oximeter conducted in a medical simulator with anesthesiologist participants. To establish fidelity of the clinical setting, the simulator was arranged as an operating room (OR) and actors trained to conduct surgery based on real cases. To ensure that scenarios were presented uniformly to each participant, we devised a novel approach: visual displays of vital signs were video-recorded and auditory displays then dubbed into the recordings that were displayed to participants via a monitor. Timing of actors’ actions was controlled by the simulator coordinator via verbal cues through earpieces according to a script that corresponded to the recorded displays. To allow for any technical malfunctions and to ensure effective data collection, we established redundant systems for recording scenarios and carried out piloting and training prior to conducting experimental sessions. Taking into account these factors, we were able to show that a novel auditory display was more effective for identifying oxygen saturation values than a standard display. Participants appeared to accept the simulator setting as natural and reacted in ways similar to behavior displayed in the OR. We conducted 20 sessions without any loss of data.