title: Resident Perceptions and Cost Analysis of a Virtual Patient Application for Anesthesia-Related Critical Incidents.
abstract: BACKGROUND
  Since there are limitations on the amount of time residents can spend in full-scale simulation sessions, we introduced a virtual patient application into our anesthesiology program to su pplement mannequin-based simulation sessions. Previous investigations have demonstrated a positive educational effect for virtual patients, but suggest that further research is needed to clarify how to effectively implement virtual patients in medical education. We present a description of the implementation of a virtual patient application in our residency training program, the residents' evaluation of their experience with the application, and a cost analysis of incorporation of the application into the residency program, in order to determine the residents' perceptions of the value and estimate the cost of using virtual patients in anesthesia residency training.
  
  
  METHODS
  For 20 years all anesthesia residents in our training program have been required to complete ten simulated cases using a virtual patient application prior to the end of their CA-1 year. Residents are given access to the anesthesia virtual patient application on departmental computers and also on their own personal computers. Residents complete 10 required cases on their own or in pairs and send printed case logs to an anesthesia attending for review and feedback. Participants anonymously completed surveys rating their perceptions of the virtual patient application's effectiveness. Cost to implement this program was estimated retrospectively.
  
  
  RESULTS
  In total, 404 residents completed 3593 virtual patient cases in approximately 2800 hours. RESIDENT PERCEPTIONS: 252 residents completed the anonymous survey (62%). Almost all the respondents (97%) rated the virtual patient curriculum as worthwhile; 88% rated the application to be realistic; 97% felt better prepared to handle anesthesia-related critical incidents; 87% stated they had at least one event in a real operating room similar to an emergency presented in the virtual patient application, and 40% stated they experienced more than one such event. 93% were stimulated to read about management of anesthesia-related critical incidents after using the application. COST-ANALYSIS: The estimated cost to implement the screen-based curriculum for 20 years was $44,000 including the cost of software and faculty time. Therefore the cost for the 2800 hours of virtual patient simulation was about $16 per hour.
  
  
  CONCLUSIONS
  The anesthesia virtual patient application was easily incorporated into our residency training program at the University of Washington. The application was well-received by anesthesia residents, helped them feel more prepared to manage critical incidents, and stimulated them to read more concerning the management of anesthesia-related critical incidents. The virtual patient application is far less expensive than mannequin-based simulation and much more available. Therefore, virtual patients should be considered an easily accessible supplement to mannequin-based simulation training.
authors.affiliation: Professor of Anesthesiology, University of California-Irvine.
authors.forename: Howard A
authors.initials: HA
authors.lastname: Schwid
authors.affiliation: Professor of Anesthesiology, University of Washington.
authors.forename: Karen J
authors.initials: KJ
authors.lastname: Souter