Editing Simulation (section)

===Type of models===
====Active models====
Active models that attempt to reproduce living anatomy or physiology are recent developments. The famous [["Harvey" mannequin]] was developed at the [[University of Miami]] and is able to recreate many of the physical findings of the [[cardiology]] examination, including [[palpation]], [[auscultation]], and [[electrocardiography]].<ref name=pmid19103813>{{cite journal |vauthors=Cooper Jeffery B, Taqueti VR |date=December 2008 |title=A brief history of the development of mannequin simulators for clinical education and training |journal=Postgrad Med J |volume=84 | issue=997 |pages=563–570 |pmid=19103813 |pmc=1765785 | doi=10.1136/qshc.2004.009886|doi-access=free }}</ref>

====Interactive models====
More recently, interactive models have been developed that respond to actions taken by a student or physician.<ref name=pmid19103813/> Until recently, these simulations were two dimensional computer programs that acted more like a textbook than a patient. Computer simulations have the advantage of allowing a student to make judgments, and also to make errors. The process of iterative learning through assessment, evaluation, decision making, and error correction creates a much stronger learning environment than passive instruction.

====Computer simulators====
[[File:3DiTeams percuss chest.JPG|right|thumb|[[3DiTeams]] learner is [[Percussion (medicine)|percussing]] the patient's chest in virtual [[field hospital]].]]
Simulators have been proposed as an ideal tool for assessment of students for clinical skills.<ref name="pmid17626526">{{cite journal |vauthors=Murphy D, Challacombe B, Nedas T, Elhage O, Althoefer K, Seneviratne L, Dasgupta P |title=[Equipment and technology in robotics] |language=es|journal=Arch. Esp. Urol. |volume=60 |issue=4 |pages=349–55 |date=May 2007 |pmid=17626526 |doi=10.4321/s0004-06142007000400004|doi-access=free }}</ref> For patients, "cybertherapy" can be used for sessions simulating traumatic experiences, from fear of heights to social anxiety.<ref>{{cite news| url=https://www.nytimes.com/2010/11/23/science/23avatar.html?_r=1&ref=science | work=[[The New York Times]] | title=In Cybertherapy, Avatars Assist With Healing | last=Carey | first=Benedict | date=22 November 2010 | access-date=27 February 2020 | archive-url=https://archive.today/20111002063514/http://www.nytimes.com/2010/11/23/science/23avatar.html | archive-date=2 October 2011 | url-status=unfit}}</ref>

Programmed patients and simulated clinical situations, including mock disaster drills, have been used extensively for education and evaluation. These "lifelike" simulations are expensive, and lack reproducibility. A fully functional "3Di" simulator would be the most specific tool available for teaching and measurement of clinical skills. [[Game engine|Gaming platforms]] have been applied to create these virtual medical environments to create an interactive method for learning and application of information in a clinical context.<ref name=DukeMag>{{cite magazine |author=Dagger, Jacob |magazine=[[Duke Magazine]] |title=The New Game Theory: Update |volume=94 |issue=3 |date=May–June 2008 |url=https://alumni.duke.edu/magazine/articles/new-game-theory-update |access-date=27 February 2020 |url-status=live |archive-url=https://web.archive.org/web/20090609042857/http://dukemagazine.duke.edu/dukemag/issues/050608/depupd.html |archive-date=9 June 2009}}</ref><ref name=SteinbergCNN>{{cite journal |author=Steinberg, Scott |title=How video games can make you smarter |journal=Cable News Network (CNN Tech) |date=31 January 2011 |url=http://www.cnn.com/2011/TECH/gaming.gadgets/01/31/video.games.smarter.steinberg/index.html?_s=PM:TECH |access-date=8 February 2011 |archive-url=https://web.archive.org/web/20110207205453/http://articles.cnn.com/2011-01-31/tech/video.games.smarter.steinberg_1_video-games-interactive-simulations-digital-world?_s=PM:TECH |archive-date=7 February 2011 |url-status=live}}</ref>

Immersive disease state simulations allow a doctor or HCP to experience what a disease actually feels like. Using sensors and transducers symptomatic effects can be delivered to a participant allowing them to experience the patients disease state.

Such a simulator meets the goals of an objective and standardized examination for clinical competence.<ref name="pmid18402731">{{cite journal |vauthors=Vlaovic PD, Sargent ER, Boker JR, etal |title=Immediate impact of an intensive one-week laparoscopy training program on laparoscopic skills among postgraduate urologists |journal=JSLS |volume=12 |issue=1 |pages=1–8 |year=2008 |pmid=18402731 |url=http://openurl.ingenta.com/content/nlm?genre=article&issn=1086-8089&volume=12&issue=1&spage=1&aulast=Vlaovic|archive-url=https://archive.today/20130103122531/http://openurl.ingenta.com/content/nlm?genre=article&issn=1086-8089&volume=12&issue=1&spage=1&aulast=Vlaovic |url-status=dead |archive-date=3 January 2013 |pmc=3016039 }}</ref> This system is superior to examinations that use "[[Simulated patient|standard patients]]" because it permits the quantitative measurement of competence, as well as reproducing the same objective findings.<ref name="pmid18462603">{{cite journal |vauthors=Leung J, Foster E |title=How do we ensure that trainees learn to perform biliary sphincterotomy safely, appropriately, and effectively? |journal=Curr Gastroenterol Rep |volume=10 |issue=2 |pages=163–8 |date=April 2008 |pmid=18462603 |doi=10.1007/s11894-008-0038-3 |s2cid=41259893 |url=http://www.current-reports.com/article_frame.cfm?PubID=GR10-2-2-03&Type=Abstract |url-status=dead |archive-url=https://web.archive.org/web/20090122094330/http://www.current-reports.com/article_frame.cfm?PubID=GR10-2-2-03&Type=Abstract |archive-date=22 January 2009}}</ref>