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Looking back: Simulation for Medical Education Grew in the '60s & '70s

Norway, 1960 - Norwegian toy maker Asmund Laerdal debuted cardiopulmonary resuscitation CPR manikin Resusci-Annie at the First International Symposium on Resuscitation in Stavanger, Norway. It enables the practice of essential skills in hyperextension of the neck and chin lift. Later, it also includes an internal spring attached to the mannequin’s chest wall, which permitted the cardiac compression simulation.

California, 1963 - At the University of Southern California (USC) School of Medicine, Neurologist Dr. Howard Barrows, M.D. introduced Patty Duggar at the 3rd year neurology clerkship - to much resistance. Nevertheless, this became a most influential milestone in the history of patient simulation for medical education. 

Michigan, 1966 - Michigan State University (MSU) Psychiatrist Dr. Hilliard Jason M.D., Ed.D. and colleagues at the Office of Medical Education Research and Development (OMERAD) started a teaching program for first-year medical students that uses videotape and simulated patients. In 1971, Psychologist Dr. Jack L. Maatsch, Ph.D. developed the concept of patient games as a more cost-effective method for teaching the fundamentals of diagnosis and patient management in the classroom. There were four "difficult patient" cases for the students to experience: a hostile patient, a seductive patient, a patient from another culture, and a patient who hated physicians. OMERAD goes on to become the longest continuously operating medical education office in the United States.
Reference: Guilbert JJ. Making a Difference: An Interview with Hilliard Jason. Educ Health [serial online] 2007 [cited 2021 May 14];20:110. Available from:

Florida, 1968 - At the University of Miami Medical School, Dr. Michael S. Gordon. M.D., Ph.D. debuted Cardiology Patient Simulator Harvey at the American Heart Association Scientific Session. The mannequin can reproduce almost any cardiac disease by varying blood pressure, heart sounds, heart murmurs, pulses and breathing. 

Iowa, 1968 - At the University of Iowa, Dr. Robert Kretschmar hired an anonymous nurse to serve as a live pelvic model for students - this method of teaching gynecology from the exam table gives a more effective alternative to the pelvic model Gynny. He went on to enhance this learning method by developing the first GTA program, with "professional patients" acting as "both patient and instructor." 

Colorado, 1969 - At University of Colorado Medical School, Pediatrician Dr. Ray E. Helfer, M.D. trained 3 programmed "mother" for a video-taped interview by 14 medical students. 
Reference: An Objective Comparison of the Pediatric Interviewing Skills of Freshman and Senior Medical Students. Ray E. Helfer. Pediatrics Apr 1970, 45 (4) 623-627

Arizona, early 1970s - At the University of Arizona College of Medicine, Pediatrician Dr. Paula L. Stillman, M.D. started patient instructor (Pl) program to objectively evaluate interviewing medical students' skills at the pediatric clerkship. She also created the Arizona Clinical Interview Rating Scale (ACIR), the first behaviorally-anchored Likert scale to assess medical interviewing skills.

Canada, 1971 - At the McMaster University, Dr Howard Barrows starts standardized patient program at the 1st Problem Based Learning (PBL)-based medical school.

New York, 1971 - At the New York Medical College, Dr. Joseph C. Bamford, Jr., M.D. used simulated patients for the Obstetrics and Gynecology course Patient Sexual Problem Solving in Chical Practice with the of drama students from Hunter College.
Reference: Bamford Jr., J.C. The simulated patient in clinical teaching (1971) Journal of Surgical Research, 11 (11), pp. 563-569. doi: 10.1016/0022-4804(71)90099-0

United Kingdom, 1972 - The University of Leeds started teaching communication skills with the help of actresses and video‚Äźtape simulation.

Massachusetts, 1975 - At the Harvard Medical School, the Women's Community Health Center (WCHC) start to run Pelvic Teaching Program at the request of female medical students.

United Kingdom, 1975 - At the University of Dundee, Prof. Ronald M. Harden introduces Objective Structured Clinical Evaluations (OSCE), including the use of simulated patients, in the British Medical Journal. "The simulated patient may be a doctor not known to the students who as well as acting the role of the patient can score the student's history-taking technique."

United States, 1976-1978 - The American College of Surgeons established Advanced Trauma Life Support (ATLS) Course following orthopaedic surgeon James Styner and his family's experience of receiving dissatisfactory treatment at a rural hospital in Nebraska after a tragic plane crash.

Southern Illinois, 1977 - Southern Illinois University (SIU) School of Medicine starts the use of nonphysician practical instructors, or Programmed Patients, to teach first-year medical students basic physical examination techniques.
Reference: Frazer NB, Miller RH. Training practical instructors (programmed patients) to teach basic physical examination. J Med Educ. 1977 Feb;52(2):149-51. doi: 10.1097/00001888-197702000-00012. PMID: 833837.

Wisconsin, 1978 - The University of Wisconsin School of Medicine starts the use of chronically ill patients to teach medical students how to identify positive findings in neurological, respiratory, and musculoskeletal examinations.
Reference: Anderson KK, Meyer TC. Using instructor-patients to teach physical examination skills. Med Teach. 1979;1(5):244-51. doi: 10.3109/01421597909012613. PMID: 24483263.

Texas, 1977 - The University of Texas Medical Branch Family Medicine Residency started using simulated patient in teaching patient education skills to family practice residents.
Reference: Callaway S, Bosshart DA, O'Donell AA. Patient simulators in teaching patient education skills to family practice residents. J Fam Pract. 1977 Apr;4(4):709-12. PMID: 856937.

Netherlands, 1981 - The Maastricht Medical School starts using simulated patient in its teaching and assessing of medical students' communication skills.
Reference: Van Dalen J, Bartholomeus P, Kerkhofs E, Lulofs R,van Thiel J, Rethans J-J, Scherpbier AJJA, Van derVleuten CPM. Teaching and assessing communication skills in Maastricht: the first twenty years. Med Teacher2001;23:245–51

Massachusetts, 1982 - UMass Chan Medical School officially starts the regular use of simulation in its medical education curriculum.

California, 1983 - The University of Southern California (USC) Keck School of Medicine - where it all started - officially adopts the use of standardized patients in its curriculum.


Last updated Jul 31th 2021

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