Simulation is defined as the representation of the characteristics or behaviors of one type of system (or collection of systems) through the use of another type of system or model. In discussing healthcare simulation, these models may be physical models that can be touched and handled (mannequin), virtual models that are created by software and exist only in the memory of a computer, or hybrid models that require trainees to interface with not only their physical elements but also their virtual elements. The degree of fidelity of the models (the extent to which they approximate actual human beings) often has a direct influence on the extent to which trainees interacting with those models perform as they would in real life. The more the actions of the trainee during simulation mimic real-life performance the more likely the trainee will be able to identify and address any weaknesses that become manifest and improve on performance as a result of the simulated experience.
In this issue of Pediatric Research, Sa Couto et al. (1) describe a mathematical (virtual, not physical) model of the human heart undergoing the normal transition from in utero to ex utero life. The influence of unique anatomic structures such as the ductus arteriosus and foramen ovale, physiologic processes including elevated pulmonary artery pressure, and external factors such as clamping of the umbilical cord on blood flow and pressure at various locations within the cardiovascular system are discussed in detail. Through a careful review of the literature, the authors were able to obtain references for a number of parameters important in modeling the hemodynamic changes occurring in the first minutes and hours after birth; where this was not possible they were able to derive values based on clinical experience. Although the intent of this work is to create a working model of neonatal cardiovascular physiology to serve as the software platform for a human patient simulator to be used for training healthcare professionals, the implications of these efforts go well beyond this goal.
