Fidelity vs Technology and Why We Are Doing Simulations In Healthcare

Fidelity Defined by Merriam-Webste a : the quality or state of being faithful  b : accuracy in details : exactness

The concept and definition of fidelity versus technology is one of the most confusing in all of simulation. However the terminology is so commonly used that it seems almost intuitive or easily understood.  The fact of the matter is it’s very complicated by the fact that a given piece of equipment, environment or situation may have aspects of a hint of realism, but we try to use the term fidelity as an umbrella to the entire situation. Often times the word fidelity is misused or improperly substituted for the word technology. I.e. high technology versus high fidelity.  The term technology refers to the level of sophistication that a device contains or utilizes that can be often described in terms of the quantity of electronics, sensing pneumatics, state change capabilities etc.

Remember fidelity is a comparison of exactness, or easier thought of as a comparison to something in the real world of healthcare. There can be many types of fidelity. For example, environmental fidelity, may refer to whether a physical space or situation in a simulation laboratory seems similar to where equivalent patient care may actually take place. Psychological fidelity may refer to whether a given simulation scenario created the same sense in the learner that they may experience when caring for a patient in the real-life. However, it is very common to use the word fidelity to refer to a computerized simulator and therein lies part of the confusion.

Most commonly available high technology, computerized simulators have aspects of fidelity that are realistically comparable to that of caring for real patient, as well as some aspects that are nothing like caring for a real patient. Let’s take a hypothetical example of a simulator called “TeachingMan XL”. When palpating the carotid or radial pulse of TeachingMan XL you believe it is quite realistic when compared to that of a real patient. So the term high fidelity may be applied in the context of palpating the pulse. The same simulator however might have vocal cord anatomy that appears to be somewhat similar, but not very realistic when compared to that of real patient. Particularly if you factor in the assessments of soft tissue pliability compared to that of her real person, moisture, dynamic color changes etc. so in our simulator TeachingMan XL we might say the vocal cord anatomy exhibits medium fidelity.

Now stand back and engage in a conversation with your average computerized simulator. Usually the simulator can respond to you by a series of pre-recorded audio responses, or perhaps someone speaking through a microphone associated with the control panel which is being piped through a speaker in the mannequins head. There is no facial expression or mouth movement when the simulator “converses” with you. This is nothing at all like having a conversation with a real patient therefore we would relate the capability of the simulator to have a conversation as low fidelity. I would worry if we had participants that felt a sense of high fidelity when talking to the plastic man!!!!

 The confusion comes in when people mistakenly use the term fidelity as an umbrella term to describe the simulator. While the simulator described in this essay is clearly high technology, it has aspects of high fidelity (i.e. the pulse palpation) as well as very low fidelity (the ability to carry on conversation). Many people mistaken refer to the simulator as high fidelity, when they really mean high technology.

When trying to adjust for the fidelity of the simulation, it is important to first consider the learning objectives. It is critically important to remember that we are NOT trying to simulate reality. The encounter with any patient, or group of patients is so complex it is virtually impossible to reproduce in its entirety. Nor would we want to. We are conducting simulation scenarios to create an environment that allows people to suspend their disbelief and engage in the care as if they were functioning in the real clinical practice environment. We want this to occur so that we can form an opinion, deliver feedback, and lead the participant(s) to engage in active reflection via a debriefing encounter to allow them to improve as healthcare providers. Thus the purpose of the simulation is to accomplish the learning and assessment objectives, not to simulate reality.

There are varying degrees of things that we can adjust to change the fidelity. Many of the decisions in simulation scenario design are often predicated upon equipment availability, the complexity of the setup, the complexity of the cleanup, as well as the overall time investment made by the participants as well as the facilitators. The key to designing a successful simulation scenario is to make sure there is a continued focus on the educational outcome of the scenario and not to become enamored by the technological capabilities, possibilities of the simulation equipment, environment or environmental manipulators such as complicated moulage or other theatrical engagement.   Provide just enough fidelity, but don’t overdo it!

So in closing, I would encourage you to stop and think the next time you use the phrase High Fidelity, to consider if that is what you really meant!

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