Question about simulators
 

I am not a pilot. My question relates to an article I am researching about safety in health care as it compares to aviation. One area I am interested in is simulation. If anyone has time to address any of the following questions about simulation in aviation, I would have a better perspective about how much health care needs to change to approach the safety record in aviation.
1. How much time on average does a commercial pilot spend in simulator training per year?
2. Do you have materials to study, such as a manual, that tells you what specific emergency situations you must know for the simulator?
3. What is the purpose of simulator training? I mean is it to practice emergency situations that cannot be practiced in a real airplane, or is just to improve your communication skills?

The reason why I am asking these questions is that although medicine is trying to incorporate safety ideas from aviation, there seems to be a huge gap between what medicine is actually doing and what pilots are doing. This seems to come from a lack of understanding about why certain safety practices in aviation are used.

For example, in my field of anesthesiology, simulator training is currently required for a very small percentage of practitioners. Those few people who must do simulator training, only need to attend one "workshop" every 10 years. They are given no manual about what scenarios to prepare for so the failure rate is high. However, no grade is given and everyone passes. Apparently, the idea is to learn to "communicate".
Any comments are welcome.

1. How much time on average does a commercial pilot spend in simulator training per year?
Will vary by carrier (and their approved program), operation, and seat. Captains get more than first officers. Initial training you may get upwards of 30-40 hours of simulator training. I've been through three type ratings, one that was 28 hours, one that was 35 hours, and one that was 24 hours. Recurrent training will vary from upwards of 2 hours.


2. Do you have materials to study, such as a manual, that tells you what specific emergency situations you must know for the simulator?
We have memory action items for emergencies such as engine failures, control jams, cabin depressurizations, onboard fires, etc. These are taught during initial training and are done by memory when the particular situation arises. After accomplishing the memory items and stabilizing the aircraft, we refer to a specific checklist to secure/troubleshoot/minimize the problem.


3. What is the purpose of simulator training? I mean is it to practice emergency situations that cannot be practiced in a real airplane, or is just to improve your communication skills?
We can do things we can't do in the simulator. Engine failures immediately after takeoff, onboard fires, control jams, none can be adequately or safely simulated in an actual aircraft. But more than anything from an airline point of view, it comes down to cost. The simulator is expensive (I've heard everything from $500-1500 an hour), but it's still massively cheaper to operate than the aircraft.

Where I worked at, pilots received around 40 hours initial sim time for new hires, training for a different plane, or up grade training. After the check ride, First officers got a 4 hour check every year and Captains got a 4 hour check every 6 months.
There was no training manual for the sim itself. There was a training syllabus of what was to be trained in the sim. Instructors were to brief students at the beginning of their training on simulator safety.
The sims are used for all types of scenarios that could happen in the plane that either are not practical or safe to practice in the real thing. It's a very powerful learning tool because you can practice real emergency procedures, and if you goof it up, reposition and try again.

Qualification on a new aircraft would involve up to 40-50 hours of sim training, which would be split evenly between pilot flying (PF) and pilot monitoring (PM).



Annual recurrent training for someone who is current on an airplane can vary...

Old School: Emphasis on checking, not training
- First Officer (FO): 4 hours annually, split between PF/PM
- Captain (CA): 4 hours ever six months, split between PF/PM

New Program (FOQA): Emphasis on training/practice
- FO: Two days of ground and sim, about 8 hours sim (some non-motion) split between PF/PM annual
- CA: Same but every six months
- Some companies do both CA and FO every nine months...works out to the same amount of training for the entire pilot group.

You also get classroom training: 16 hours each year (may be 8 hours CBT/ 8 hours classroom)

Pilots have a company Flight Ops Manual with generic company procedures, and an aircraft specific SOP. The SOP will have all normal and emergency procedures, as well procedures performed only for training purposes such as steep turns and intentional stalls. You are on your own recognizance to study as much or as little as you need to. Ideally you would study continuously as opposed to cramming for sim sessions. Some procedures you only look at right before sim since you only do them for training (steep turns, intentional stall entry)

1. Practice emergencies which are dangerous to practice in a real airplane.
2. Save money...airliners cost thousands (or tens of thousands of dollars) per hour to operate.


Communication and teamwork are fundamental to operations in a multi-crew cockpit and are always evaluated...you can fail on that alone. We call it CRM: Crew Resource Management

The manuals we use are not just for sim training....we carry them and use them as references in daily operations and for ongoing study, as well as prep for sim.

Maybe you guys need SOPs which are used for daily ops and training. You might have a disconnect between the hospital procedures and what a state board might want for training/certification. The airlines get around this issue by having the FAA (normally responsible for certification) delegate procedures, training, and certification to the individual airlines....the airlines have their own procedures which they train and certify to (with FAA oversight).

Thanks guys for the thoughtful responses. So in commercial aviation, you have extensive simulator training initially, and then there is recurrent training at least once a year.

One thing medicine is missing is the equivalent of the "SOP manual". If people are coming to these sessions without a review of correct responses to time critical situations, then the chance of success on the simulator is much less than if procedures were regularly reviewed.

Another thing we are missing is the FAA. There is a myriad of people writing regulations for healthcare including medical boards, specialty societies, and patient safety organizations. Regulations are often written by nonphysicians, and some entities have been found to be riddled with conflicts of interest to the point where even a state medical board was stripped of much of its authority.

To give you an idea of the scope of the safety issue in medicine, the estimate of yearly U.S. mortality from medical errors is from 44k to 98K deaths per year and if hospital aquired infections are included, the number approaches 200k. Regretably, after ~12 years of a national mobilization to attack this problem, we cannot show significant overall improvement in the last 12 years. However, we have found isolated areas where rapid improvement has occurred. In each case, some evidence based practice, or a "bundle" of practices was fully adopted by a health care entity.

Thus, if simulation has value, (and I believe it does) then it should produce a measurable effect if it is correctly implemented, and it is fully adopted. So it seems we have two problems in this area:
1. Poor implementation. No SOP manual and infrequent use. I would expect the benefit would fade over time. One session every 10 years seems far too little.
2. Incomplete implementation. Current requirements effect only a small percentage of practitioners (guessing at 10% or less).

I hope this doesn't sound like a rant. I am hoping to explain why there has been little measurable improvement in medical safety, and give some specific ideas about what we must do differently.

Methinks there may be similarities in the aviation world. Congressional knee jerk reactions, etc. But I could be wrong.

Hi N9373M:

Here is the link that describes successful actions by an organization that represents private practice physicians to limit the power of medical boards in two states: http://www.jpands.org/vol16no3/schlafly.pdf

Do state legislatures or the Congress meddle in aviation? I would think that interference would be much less than in medicine for the simple reason that aviation works. When you set the standard for everyone else to meet, then the temptation for outsiders to meddle is less. We have not figured out "the answer" yet in medicine, so there are a myriad of people with ideas. Some ideas are well meaning and evidenced based, others not so much.