Preface

Article Outline

• Copyright

This issue of Journal of Critical Care includes a series of articles on medical simulation. Not only is this a timely issue but also it is a subject that requires every practitioner's attention as it is likely to become an integral part of certification and recertification examinations and credentialing. Yet, is this a new phenomenon or merely a “high-technology” approach to a well-established and customary technique to assure competence before allowing practice? I am sure all practicing physicians have been involved in “teaching rounds” in which a patient's history was presented and a specific diagnostic point raised, and we were taught how to examine the patient in a manner geared to eliciting the appropriate information. Equally, we were examined on “long” and “short” cases in which our diagnostic abilities and clinical skills were assessed before being licensed. Subsequent basic and specialty training consisted of repetitive history taking from and clinical examinations of multiple patients for several years during each stage of which performance was assessed. What then, is the current state of simulation, and perhaps more important, “whither it goest”?

This issue of Journal of Critical Care asks and answers some of these questions and raises interesting points about the future. Some programs will increasingly avail themselves of simulated patients and others will use scenarios that approximate the reality of clinical situations; this is already in evidence in intensive care unit, emergency department, and operating room full-scale simulations in selected institutions. All will have to work within financial and time constraints; the 80-hour teaching rule is in effect, and any simulated experience must be incorporated into the hour limit. There is little doubt that for some procedural skills the Nintendo generation will be well prepared; individuals used to using handheld controls, whereas coordinating digital input and hand movement to a video image are advantaged. The orientation of a 2-dimensional screen to needle localization of a specific target and subsequent catheter placement in 3 planes using ultrasound is but one example of the skills required. These skills can be acquired through simulation practice, and it is likely that for some procedures, this will become an educational norm and possible requirement. However, there is no substitute for performing live, and it is unlikely that current proctoring requirements will disappear for many specialists.

In addition to the themed articles, the Journal of Critical Care continues to attract and publish international and domestic articles. The journal is interested in promoting research in all areas related to critical care medicine; a primary focus will remain with material discussing system-based, outcome-determined practice, but additional topic areas including educational innovation will be encouraged. Through its connection with the World Federation of Societies of Intensive and Critical Care Medicine (WFSICCM) and the Society for Complexity in Acute Illness (SCAI), selected abstracts from officially sponsored meetings will be published. The abstracts will be peer-selected, and a member of the WFSICCM Council will participate as chair of the judging and selection committee. It is the intent to increase exposure of excellent work to our international readers. Prize-winning material from the International Pan-Arab Critical Medicine Society (IPACCMS) meeting in Dubai, the SCAI meeting in Cologne, and the 13th Congress on Adult-Pediatric-Neonatal Intensive Care Medicine meeting in Bahia will be published in future issues of the Journal of Critical Care.

I look forward to working with you to insure the continued validity of our journal and to increasing its value to you and all our colleagues. I encourage “letters to the editor” and intend to publish selected material in the future.