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We could go to the extreme of a high-fidelity injection pad that would ooze fake blood when the needle is withdrawn and has the exact feel of penetrating skin and tissue, but is it really going to make you better at giving an injection than a medium-fidelity injection pad?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