It is important to understand that the simulator's response to therapeutic manipulations derives from the constant updating of the mathematical models. The responses of these models such as changes in blood pressure or respiratory rate control a variety of actuator-produced responses, which are, in turn, sensed by real operating room monitors applied to the mannequin. Realism is enhanced with all the props necessary to replicate the patient care environment. Full physiologically responsive patient simulators, suitable for anesthesia training, are marketed by two commercial firms. Part-task trainers such as intubation models and computerized case simulations are also widely used but are not discussed here.
Simulators are expensive to purchase and to maintain.
Simulators must be used effectively and efficiently to produce acceptable return on investment. All levels of cognitive learning are not equally appropriate for full environment simulation. Clinical training involves higher level application of the facts and principles learned primarily in libraries and lecture halls. Higher levels of cognition, including synthesis and analysis, are even more appropriately taught and tested in a simulated environment. Simulators become most effective when training involving motor skills such as endotracheal intubation, airway maintenance and twitch height palpation is mixed with cognitive analysis and synthesis in a realistic distracting environment of alarms, monitors, chart keeping and drape arrangement.