Journal of Clinical Monitoring 13: 317^324, 1997. ß 1997 KluwerAcademic Publishers. Printed in the Netherlands. Simulator andTraining Device FUNCTIONAL ANATOMY OF FULL-SCALE PATIENT SIMULATORS Willem L. van Meurs, PhD, 1; 2; 3 Michael L. Good, MD, 1; 3; 4 and Samsun Lampotang, PhD 1; 2; 3; 5 From the 1 Department of Anesthesiology, University of Florida College of Medicine, 2 Department of Electrical and Computer Engineering, University of Florida College of Engineering, 3 University of Florida Brain Institute, 4 Veterans A¡airs Medical Center, Gainesville, Florida, and 5 Department of Mechanical Engi- neering, University of Florida College of Engineering. Received Jun 6, 1997. Accepted for publication Jun 6, 1997. Address correspondence to Willem L. van Meurs, PhD, Department of Anesthesiology, University of Florida College of Medicine, P.O. Box 100254, Gainesville, FL 32610-0254, U.S.A. Van Meurs WL, Good ML, Lampotang S. Functional anatomy of full-scale patient simulators. J Clin Monit 1997; 13: 317^324 KEY WORDS. Educational simulation, medical students, resi- dents; simulator design; model, mathematical, mechanical, interfacing. INTRODUCTION Originally created as full-scale anesthesia simulators [1^ 4], these state-of-the-art learning systems have evolved signi¢cantly over the past decade to become patient simulators. Full-scale patient simulators help not only anesthesiologists, but a wide variety of medical practi- tioners and students learn the diagnosis and manage- ment of clinical problems without risk to real patients [5, 6]. The success of a simulation exercise depends on design decisions at many levels. In a description of computer simulated patient-physician encounters [7], Friedman states, ``Simulator designers must decide which features of the complete patient should be included, which fea- tures should be purposefully excluded, and how those included should be presented to the users.'' In the con- text of full-scale patient simulation, four speci¢c design levels can be identi¢ed. The hardware design includes the patient mannequin, exterior features, clinical signs representation, mechanical models, and computer sys- tems. The software design includes the user interface, mathematical models, model parameters, communica- tion protocol between computers, code structure, and programming language. The curriculum design includes the target learners, educational needs assessment, learn- ing objectives, patient types, clinical scenarios, and for- mal evaluation methodology. The exercise design in- cludes the number of participants, pace, modulation of severity, student-instructor interaction, and perform- ance evaluation. Simulator hardware and software de- sign decisions are usually made by simulator develop- ers, while curriculum and exercise design decisions are made by clinical instructors. In this paper, we describe the major design considerations made by the simulator developer (hardware and software). Others have previ- ously described curriculum and exercise design deci- sions made by clinical instructors [8^10]. We focus on design decisions concerning the full- scale simulator ``engine,'' the component of the simula- tor that generates the physiologic and pharmacologic responses of the simulated patient. In the ¢rst two sec- tions, general design considerations are discussed, such as the use of scripts or models to control the simulator,