What equipment might I use in simulation?

Most of the simulation equipment that you will use can be categorised into high fidelity manikins, low-medium fidelity manikins, and task trainers. You will use these in combination with real medical equipment such as electrocardiogram (ECG) machines, intravenous (IV) pumps and defibrillators.

High Fidelity

High fidelity manikins are very lifelike manikins that are interactive and are capable of reproducing a lot of physiological functions such as pulse, blood pressure, bleeding, and breathing. Advanced manikins might have features such as tears, sweat, and tongue oedema.

Examples of high fidelity manikins are: Laerdal SimMan3G or Gaumard Hal.

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SimMan® 3G

SimMan3G is used for military medic, paramedic and clinical simulations, especially involving trauma, advanced and difficult airway scenarios and other emergency scenarios.

Low-medium Fidelity

Low-medium fidelity manikins have fewer features than high fidelity manikins but will usually still have features such as pulse, blood pressure, and veins. Examples of low-medium fidelity manikins are: Laerdal Nursing Anne and Laerdal MegaCode Kelly.

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MegaCode Kelly
Image via Laerdal

Megacode Kelly is a full-body manikin designed for the practice of advanced, difficult, and obstructed airway scenarios and IV therapy.

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Image via Laerdal

Nursing Anne is a manikin designed for scenario-based training for the care and management of a wide variety of in-hospital patients.

Task Trainers

Task Trainers are simulated body parts that are designed for students to learn a specific skill, such as venepuncture, catheterisation, orcardiopulmonary resuscitation (CPR).

Examples of part task trainers are: Limbs & Things Venepuncture Arm

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Image via Limbs & Things

The venepuncture arm can be used for learning venepuncture, IV cannulation, and IV fluids infusion.

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What happens in a debrief?

Every simulation scenario is followed by a debrief. This is when we discuss what happened in the simulation and work through the events to learn from them.

A debrief is not somebody pointing a finger at you and listing all the things you did wrong; it is a facilitator-lead discussion that helps you to identify your strengths and weaknesses, and helps you to plan ways of improving in the future. We also use the debrief to help you recognise professional behaviours that you perform well or to recognise progress in your skill development.

You will be asked about what you were feeling and thinking during the scenario to gain a better understanding of your performance.

You might also be asked about what you would do the same or differently next time, or what steps you need to take to improve your performance. 

As an example, you might discover that you are more likely to make mistakes when it is noisy, or when you are tired. Now that you know this, you can take extra care when you are in these situations so that you are less likely to make a mistake in the real world.

If you were not happy with your performance you might feel uncomfortable in the debrief. This is a normal reaction and it gets better as you have more experience with simulation. Rather than focusing on the negatives you should think about how you can learn from the experience.

If you still feel uncomfortable with your performance after the debrief, ask to speak to the facilitator privately. The last thing we want is for learners to feel embarrassed or to have a negative simulation experience.

Simulations are designed to be a safe learning environment so we like to make sure that you are not left feeling overwhelmed by the experience.

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How to get the most out of simulation

The thought of participating in a simulation scenario makes everyone nervous. The biggest fear is saying or doing something wrong and embarrassing yourself in front of your peers.

Those of us who work in simulation have usually been a participant so understand your concerns. I can tell you not to worry, but it won’t make much of a difference.

I can tell you more about how simulation works though, and it might make you a bit more comfortable with the idea.

Simulation is the re-creation of a healthcare encounter that gives learners an opportunity to apply their skills and knowledge in a professional context. A lot of work goes in to planning a simulation so that the learners will get the most out of the experience.

Simulations are designed to nudge learners along the path to professional competence and expertise. Some learners take little steps on their path to expertise, some take larger steps.

The key is that you need to challenge yourself to be able to move further along the path. Challenging yourself can be uncomfortable but it is much better to make the most of the opportunity to learn using simulation, than having to do the task for real without mastering each step along the way.  

Fidelity AKA faking it

Fidelity is how real or authentic the simulation is. Using an orange to practise injections is low-fidelity. An orange looks nothing like a person. Piercing an orange with a needle does feel similar to piercing skin though, which is why oranges were commonly used to simulate injections.

Now we have injection pads, which are skin coloured and are placed on manikins or real people (simulated patients or SPs). This would be considered medium fidelity.

We could go to the extreme of a high-fidelity injection pad that would ooze fake blood when the needle is withdrawn and has the exact feel of penetrating skin and tissue, but is it really going to make you better at giving an injection than a medium-fidelity injection pad?

Sometimes low or medium fidelity is enough for you to learn the skill, we just need you to play along and pretend it is the real thing.

It feels strange to talk to a plastic manikin. It is even stranger when it answers you! We know that some of the features of the simulation aren’t always accurately reproduced, but we do go to a lot of effort to make it as realistic as it needs to be for the situation.

If you spend your time in the scenario critiquing fidelity you are missing out on learning opportunities. Sometimes after a scenario a participant will say “Oh but I would do it properly if it were a real person”.

We need you to pretend it is a real person, in a real situation, for you to get the most benefit. Likewise, I have also heard participants say “Wow, that felt so real!” after a scenario. Needless to say, those participants have had a great learning experience and recognise the value of the simulation. 

What happens if I mess up?

Hopefully, you learn from the mistake and recognise why it happened so that you can avoid it happening again. The benefit of plastic patients is that you can’t harm them. Simulation is about learning how, when and why we make mistakes so that we can try to prevent them from happening in the future.

When we are designing simulations we are not trying to trap you, or to set you up to fail. We make sure that it is a situation you are capable of managing. We are actually trying to set you up to succeed. We want to build your confidence and help you to recognise that you can cope with new situations or challenges.

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Student testimonials

We asked some students what they thought about participating in simulation as an alternative to traditional teaching methods.  

Watch their video's below.

What were you thinking when going into your first simulation?

What did you think after your first simulation?

What do you get out of a debrief?

What advise would you give someone who was new to simulation?

What are your biggest fears going into a simulation? 

How have you overcome nerves when going into a simulation?

 Your most memorable simulation experience and what you got out of it?

How does the level of realism effect your performance in a simulation?

What have your learnt from simulation?

What do you like most about simulation?

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Benefits of feedback

Feedback is a sensitive issue. It is important for skill development and is something that you will encounter throughout your studies and career. For a lot of people, the thought of giving or receiving feedback creates a lot of anxiety.

After participating in a simulation you might receive feedback from the educator, the patient (simulated patient or voice of manikin), or from your peers. This helps to increase your awareness of how you are perceived by others, and for you to understand how your skills are developing.

Being able to correct and refine your skill development as you progress through your studies helps you to eliminate poor technique or bad habits, and promotes positive behaviours and masterful technique.

The opportunity to receive feedback from the perspective of the patient is not one that you will have when working, so it is great to make the most of this opportunity while you are learning and improve your professional behaviours and communication skills.

Here are some tips on receiving feedback in simulations

When receiving feedback:

  • Manage your initial emotional response – it is natural to feel defensive, try to stay calm and neutral.
  • Concentrate on listening to what is being said and clarify any points to make sure you fully understand the feedback
  • Stop and think! – Use this time to stay calm, be honest with yourself and think about the feedback you have received, and then formulate your response

In responding to feedback:

  • Thank the person who provided the feedback
  • If you have an alternative opinion, you may respectfully say so but make sure you use supporting facts to back up your opinion
  • Try to reach agreement about the future course of action – ask for suggestions if required, and commit to following through.

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