Simulation for Team Training and Assessment: Case Studies of Online Training with Virtual Worlds William LeRoy Heinrichs Æ Patricia Youngblood Æ Phillip M. Harter Æ Parvati Dev Published online: 11 January 2008 Ó Socie ´te ´ Internationale de Chirurgie 2008 Abstract Individuals in clinical training programs con- cerned with critical medical care must learn to manage clinical cases effectively as a member of a team. However, practice on live patients is often unpredictable and fre- quently repetitive. The widely substituted alternative for real patients—high-fidelity, manikin-based simulators (human patient simulator)—are expensive and require trainees to be in the same place at the same time, whereas online computer-based simulations, or virtual worlds, allow simultaneous participation from different locations. Here we present three virtual world studies for team training and assessment in acute-care medicine: (1) training emergency department (ED) teams to manage individual trauma cases; (2) prehospital and in-hospital disaster preparedness train- ing; (3) training ED and hospital staff to manage mass casualties after chemical, biological, radiological, nuclear, or explosive incidents. The research team created realistic virtual victims of trauma (6 cases), nerve toxin exposure (10 cases), and blast trauma (10 cases); the latter two groups were supported by rules-based, pathophysiologic models of asphyxia and hypovolemia. Evaluation of these virtual world simulation exercises shows that trainees find them to be adequately realistic to ‘‘suspend disbelief,’’ and they quickly learn to use Internet voice communication and user interface to navigate their online character/avatar to work effectively in a critical care team. Our findings demonstrate that these virtual ED environments fulfill their promise of providing repeated practice opportunities in dispersed locations with uncommon, life-threatening trauma cases in a safe, reproducible, flexible setting. Clinical medical education over the past century has been based on the apprentice system characterized by student– patient encounters in which trainees observe, or sometimes participate in, the care of ‘‘private’’ patients in the practices of clinical instructors or learn by examining and treating ‘‘public’’ patients assigned to them for care under the supervision of clinical instructors. With the development of simulation concepts and technologies, situated or experi- ential learning in simulation environments is becoming an important component of medical training. This type of training takes the form of learning in a variety of simulated environments ranging from encounters with simulated patients to participation in real or virtual team-based sim- ulated medical activities [1]. Anesthesia crisis resource management The widely adopted, simulation-based learning environ- ment for anesthesia training is a high-fidelity human simulator, an instrumented manikin running a computa- tional model of physiology and pharmacology representing the patient, and a team of health care personnel managing the simulated medical case—all in a physical space rep- resenting an operating room or other dynamic critical care environment. Initial reports of full-size manikins designed W. L. Heinrichs (&) Á P. Youngblood Á P. Dev SUMMIT (Stanford University Medical Media and Information Technologies), Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA e-mail: LeRoy.Heinrichs@stanford.edu P. M. Harter Department of Surgery, Division of Emergency Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA 123 World J Surg (2008) 32:161–170 DOI 10.1007/s00268-007-9354-2