The purpose of clinical simulation healthcare is not to mirror reality. The primary objective of the most commonly used simulation is to improve the performance of humans as it relates to caring for patients within the context of healthcare. Too many times we get lost in toiling over the details of trying to re-create a scenario as realistic as possible. This often leads to what I describe as invisible barriers to simulation insofar as design, perceived resource limitations, or operational realities limit the bandwidth that the simulation program is able to accomplish. It’s important to remember that the primary objective is not to simulate, but to educate. (Certain exceptions may apply to research projects, and human factors design elements, or other factors studying mimicking existing process flow etc.)
When we run a simulation we are not trying to convince the participant that it is real (because if they did think it was real they would likely be a little crazy J). What we need to do is create an environment that helps the participant feel as if there is some realistic comparison to the simulation to what they do when they are actually caring for patients. We need to enter into what is frequently referred to as a fictional contract or psychological contract that allows the participants to drop into their role as a normal care provider knowing that the simulation is artificial, but has value to their learning and their future practice.
Many, many decisions go into the design of simulation. Often times the specifics of the learning objectives and outcomes do not receive as much attention in the design phase as some of the other elements to try to create “perfect fidelity”. In doing so we often unnecessarily add to the complexity of the scenario that may increase the setup time, the cleanup time, expose the scenario to the potential of technical failure. Further, we can actually confuse the participant as during the scenario they are constantly trying to assess what they are supposed to be interpreting as “real” versus that which is simulated.
So the next time you’re designing a scenario start with learning objectives, outcome objectives, and then answer the question, “what do I really need to provide to allow the potential participant, or participants” a general feeling of realistic sensation that will allow them to participate in a meaningful way.