Monthly Archives: October 2014

Ebola and Fidelity

hazmat_shutterstock_135522821_aThose of you who are used to my normal musings and rants against perfecting the “fidelity” and realism used in simulations might be surprised to hear me speak of examples of simulations where perfect/near perfect fidelity does matter.

Various association social forums are abuzz with people talking about simulations involving personal protective equipment in the light of the current unfolding of the Ebola crisis. It is important to differentiate this type of simulation and recognize the importance of re-creating the aspects of the care environment that is the subject of the education in the most highly realistic way available. In this case we are probably talking about using the actual Personal Protective Equipment (PPE) equipment that will be used in the care of the patient suspected of Ebola at any given facility.

This is a high-stakes simulation where the interaction with the actual equipment that one will be using in the care environment is germane to a successful outcome of such interaction. In this case the successful outcome is keeping the healthcare worker safe when caring for a patient with a communicable disease.  More broadly this falls under the umbrella of simulation for human factors.

Human factors in this context being defined as “In industry, human factors (also known as ergonomics) is the study of how humans behave physically and psychologically in relation to particular environments, products, or services.” (source: searchsoa.techtarget.com/definition/human-factors)

Other examples of when human factors types of simulation are employed are in areas such as product testing, equipment familiarization objectives, environmental design testing. So for instance if we are evaluating the number of errors that occurs in the programming of a specific IV pump in stressful situations, it would be important to have the actual IV pump or a highly realistic operational replica of the same. This is in contrast to having the actual IV pump used in a hospital for scenario focused on an acute resuscitation of the sepsis patient, but not specifically around the programming of the IV pump. The latter example represents more of when the IV pump is included more as a prop in the scenario versus that of the subject of the learning objectives and inquiry on the safety surrounding its programming.

So yes world, even I fully believe that there are some examples of simulations where a re-creation of highly realistic items or elements is part and parcel to successful simulations. The important thing is that we continuously match the learning objectives and educational outcomes to those elements included are simulations so that we continue to be most efficient and efficacious in our designs of simulation-based education encounters. What I continue to discourage is a simple habit of spending intense time and money in highly realistic re-creations of the care environment when they are not germane to the learning objectives and educational outcomes.

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Beware of Some of the Costs of Fidelity and Simulation

Fidelity is a concept that is often not thought about in detail and can contribute to being a barrier in the adoption simulation. It is also one of the most misused words in simulation, and can unnecessarily contribute to raising the costs and complexities of simulations. It can results in a significant desire to make every attempt to re-create the reality of the patient care environment without consideration of the necessity related to accomplishing the learning objectives. This has tremendous implications. Trying to overdo fidelity can cause unnecessary set up time, cleanup time, and therefore add significant costs and inefficiencies to accomplishing a simulation-based encounter. This is not to suggest tat we shouldn’t consider planning for elements that help create a more realistic presentation f what we are trying to simulate, it is just suggesting caution that each element be carefully considered for necessity and overall impact to the entire scenario including costs.BloodyMess

This set of costs is very concerning because they are in a category of what I consider add to the hidden barriers of simulation. This arises from imbedding elements of simulations in to the design that contribute to the complexity, overall costs and don’t add to the educational outcomes.

Furthermore, attempts at trying to re-create fidelity can often add confusion for the simulation participants in trying to interpret what it is that is being simulated. As I have discussed previously, there is no such thing as suspension of disbelief. Participants of simulations are constantly having to interpret their environment. Since they are engaged in a simulation they are always hyperaware of the fact that some things are simulated and some things are attempts at creating normalcy. The take-home message is that the learning objective should be carefully considered to determine what aspects of a corresponding actual situation needs to be simulated in the laboratory environment.

A careful orientation of the learner along with describing the capabilities and limitations of the simulation will engage the participant in a way that you could accomplish the learning objectives with a minimal amount of work placed into recreating the fidelity of the situation. This is particularly true of trying to re-create the environment, physical exam findings or situation that a patient is likely to be found in when compared to an actual clinical encounter.

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