Healthcare simulation is a technique that imitates real clinical scenarios to train healthcare providers in a risk-free environment. This methodology acts as a critical bridge between classroom knowledge and actual patient care, allowing learners to practice high-stakes procedures and refine decision-making skills without consequences for real patients. Simulation aims to improve both the technical competence of individual practitioners and the non-technical skills, such as teamwork and communication, of multidisciplinary teams. By exposing providers to controlled representations of complex or rare events, the purpose is to enhance healthcare quality and improve patient safety outcomes. This educational method is structured to provide deliberate practice and immediate, objective feedback.
Defining Healthcare Simulation and Fidelity Levels
Healthcare simulation is the imitation of a real-world process or system using a substitute model to achieve specific educational, assessment, or system integration goals. The process is characterized by a controlled environment where activities can be replicated, observed, and measured against predefined learning objectives. It provides a structured setting for learners to make mistakes and experience the consequences of their actions, which yields powerful insights into patient care dynamics.
A core concept in this field is “fidelity,” which describes the degree of realism the simulation possesses compared to the actual clinical experience it represents. Fidelity is a spectrum encompassing physical, conceptual, and psychological elements. Low-fidelity simulation uses less realistic equipment, such as simple static models, often for practicing foundational psychomotor skills in isolation. Mid-fidelity simulation introduces functional realism, such as a manikin displaying basic physiological signs like heart and lung sounds, helping learners build procedural competence. High-fidelity simulation represents the most realistic experience, using complex, computerized manikins that mimic a wide range of human physiological responses, enabling the practice of advanced decision-making and team management in realistic settings.
Key Simulation Modalities and Tools
The level of fidelity a simulation achieves is directly related to the modalities and tools employed to create the experience.
Simulation Tools
- High-tech patient simulators, or manikins, are full-body models capable of replicating physiological responses, including palpable pulses, changing heart rhythms, and vocalizing patient complaints. These sophisticated devices are central to high-fidelity training and allow practitioners to perform invasive maneuvers like defibrillation or airway management.
- Task trainers are focused physical models representing a specific body part, such as an arm for IV insertion or a torso for chest tube placement. These trainers are designed to allow for the repetitive practice of a single skill until competence is achieved.
- Standardized Patients (SPs) are trained actors who portray patients, family members, or other team members. They are invaluable for training communication, empathy, and history-taking skills, often providing the highest level of psychological fidelity.
- Virtual Reality (VR) and Augmented Reality (AR) systems create immersive, computer-generated environments for practicing complex procedures like surgery, offering the benefit of unlimited repeatability and easy parameter changes.
The Essential Phases of a Simulation Session
An effective simulation-based learning experience is a three-part process with mandatory, sequential phases.
Pre-Briefing
The process begins with the pre-briefing, which sets the stage for the learning event and is crucial for establishing a psychologically safe environment. During this phase, the facilitator outlines the learning objectives, defines the roles for participants, and clarifies what equipment within the simulated environment is functional. A fundamental element is the “fiction contract,” where participants agree to treat the simulated scenario as real, while the facilitator reinforces the basic assumption that all participants are capable and want to improve.
Scenario Execution
Following the pre-briefing is the scenario execution, which is the actual clinical role-play or task performance where learners apply their knowledge and skills. This phase is typically recorded using audio-visual systems for later review and analysis during the final phase. The scenario execution can range from an individual practicing a technical skill to a full multidisciplinary team managing a complex trauma.
Debriefing
The final and most significant phase is the debriefing, a structured, guided discussion that occurs immediately after the scenario. Facilitators guide participants to analyze their actions, explore their decision-making processes, and discuss team dynamics and communication effectiveness. This reflection moves beyond simply reviewing technical performance to focus on the underlying cognitive and behavioral factors that influenced the scenario’s outcome. By fostering a collaborative and non-judgmental atmosphere, the debriefing helps learners connect their simulated actions to real-world patient care.