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.
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.