Human factors and the cardiac surgical team: a role for simulation.

Human factors play an important role in determining the outcome of cardiac surgery. The interaction of humans with their equipment, and with each other in teams, is critical to success. Simulation provides a means of teaching and assessing the technical and non-technical skills of clinicians and can facilitate research into interventions to improve safety. Simulation in anesthesia has taken much from aviation and provides a model that could be extended to perfusion. The cost of setting up a simulation center (or even of adding a perfusion simulator to an existing center) is relatively high, but the potential return on this investment is also substantial, particularly at a time when access to patients for teaching and research is becoming harder. Different degrees of complexity and fidelity in simulation lend themselves to different objectives, whether in teaching, assessment, or research. In the longer-term, comprehensive simulations of cardiac surgical procedures involving all participants in meaningful simulated roles may be possible.