At the recent Society of Simulation in Healthcare (SSH) annual meeting, over 4,000 healthcare professionals gathered to network, share and learn best practices related to the use of simulation.  The uses of simulation in healthcare include knowledge and skill building in professional education and performance improvement across the healthcare environment.  The ‘simulator’ has become the center of attention in the simulation industry with most of the research and development poured into creating a more high tech or realistic experience.  This level of realism is known in the simulation jargon as fidelity or the ‘suspension of disbelief’.  When you say the word ‘simulation’, most healthcare professionals immediate think of ‘talking’ mannequins that breathe, bleed, react and respond to clinical actions through a set of complex, computer programmed actions during a laboratory or classroom-based session.  The exhibitors at the conference are dominated by manufacturers that create these types of simulators and all the supporting technology to create a ‘lifelike’ experience for maximum learning.  But, is this type of simulation the only way to maximize fidelity or maximize learning?

In fact, simulation fidelity relies on different elements to be mixed to create the ideal experience for learners based on 1) the equipment (the type of simulation device), 2) the environment (the sensory activation like visual and auditory cues), and 3) the psychological fidelity (how closely the training scenario matches reality).  Behavior-based training such as teamwork, communication, professional behavior, patient engagement, conflict management, feedback, decision-making and clinical leadership have all been shown to be effectively simulated using lower fidelity methods such as case studies and role-plays.  Many of the educational sessions at the conference focused on the use of ‘human simulation’ also known as ‘Standardized Patients’ (SP) in medical education for teaching assessment and treatment skills to medical students in a simulated treatment room through a scripted role-play.  The SP is a trained actor who puts on a hospital gown and simulates that they are ill and in need of medical attention based upon a scenario designed to achieve learning outcomes.  Often times, the encounter is videotaped and participants have an opportunity to review their performance in a post-event debrief.  High fidelity mannequins and SP actors are both effective simulation strategies but have limitations due to cost and scalability across an entire health organization and multi-disciplinary continuum (physicians, nurses, administrators, technicians and other staff).

Almost absent from the recent simulation conference was the effective use of case studies that do not rely on equipment; engaging stories that feel real because they are based upon real occurrences (psychological fidelity) and are sound engineered to produce a realistic sensory experience (environment fidelity).  These types of simulation are lower in equipment fidelity; but when coupled with team debrief, can produce team learning outcomes that are scalable and less resource intensive, meaning less costly to train, less time to train, and overall lower training complexity.

So, when thinking of developing an effective simulation training program for improving individual and team skills in healthcare, educators and facilitators should consider other factors instead of just the simulation equipment to create adequate realism to achieve organizational training goals and learning outcomes.