Fidelity vs. Realism
Is this the realism life? or is it just fidelity?
Fidelity refers to the accuracy with which the simulation represents reality.
Fidelity often is associated against Low, Mid & High levels, with lower typically argued to facilitate knowledge accumulation, mid for competence and high for performance and action. These beliefs are somewhat archaic now and there is growing evidence that low fidelity simulators can be used to deliver high realism scenarios.
Realism refers to
To enhance the realism of a simulation one has to take a multi-factorial approach to design, choosing only one component will be unlikely to significantly enhance the learner experience than enhancing all.
Reality has been defined as having 3 domains - physical, semantic and phenomenological:
Physical refers to sight, sound and feel - incorporating moulage, manikin fidelity, simulation patients and environmental factors...
Semantic refers to comparisons to 'real-life' as in the similarity to lived experiences such as sequences, timings, roles and availability of help...
Phenomenological refers to the participants feel and experience - that is, does it feel real to them and their 'world-view'.
In terms of how simulations run, the formation of a 'belief contract' in terms of "suspension of disbelief". Anyone who has undertaken a simulation knows it is harder to maintain eye-contact with a manikin than an actor. In order to maintain this 'contract' both designer and learner must know the rules and stick to them. (Albeit if things go amiss, it can be up to the operator to think fast and find a rational explanation to re-frame the event.) Some of the success of disbelief comes from imagination, often facilitators will 'describe' something not visible due to limitations with manikins/patient, this 'as-if' character can offer more freedom, but potentially at the cost of 'realism'.
Why build realism? One argument being that in order to reach high orders performance, building realism helps and can be demonstrated against Miller's Pyramid [Ref 4].
More learning resources are available below:
The landmark papers to read are by Dieckmann 2007 - Deepening the Theoretical Foundations of Patient Simulation as Social Practice & Tun et al 2015 - Redefining Simulation Fidelity for Healthcare Education
Simulation-based learning: Just like the real thing - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2966567/
The impact of contextualization on immersion in healthcare simulation - https://www.diva-portal.org/smash/get/diva2:917100/FULLTEXT01.pdf
Engagement and learning in simulation: recommendations of the Simnovate Engaged Learning Domain Group - https://stel.bmj.com/content/bmjstel/3/Suppl_1/S23.full.pdf
Promoting Caring by Increasing Realism in the Simulated Environment - https://www.graphyonline.com/archives/IJNCP/2017/IJNCP-257/
Realism in Simulation: How Much Is Enough? - https://jamanetwork.com/journals/jamasurgery/article-abstract/2627286
Increasing Fidelity and Realism in Simulation - http://nursingeducation.lww.com/blog.entry.html/2018/09/19/increasing_fidelity-zEj0.html
High-fidelity is not superior to low-fidelity simulation but leads to overconfidence in medical students - https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-019-1464-7
Low- versus high-fidelity simulations in teaching and assessing clinical skills -
From fairies to SimMan: Tolkien and realism in simulation - https://www.journalsurgicalsimulation.com/contents/volume-3/JSS160002/pdf/
Realism, authenticity, and learning in healthcare simulations: rules of relevance and irrelevance as interactive achievements - https://link.springer.com/article/10.1007/s11251-012-9213-x
Redefining Simulation Fidelity for Healthcare Education - https://journals.sagepub.com/doi/10.1177/1046878115576103
The Relationship Of Fidelity On Simulation Performance - https://commons.und.edu/cgi/viewcontent.cgi?article=3244&context=theses
Beyond Technology: A Scoping Review of Features that Promote Fidelity and Authenticity in Simulation-Based Health Professional Education - https://www.nursingsimulation.org/article/S1876-1399(20)30012-8/fulltext
Choosing the Right Level of Fidelity for Your Simulation Training - https://www.laerdal.com/gb/information/recreating-the-reality-of-birth2/
The effect of simulator fidelity on acquiring non-technical skills: a randomized non-inferiority trial - https://link.springer.com/article/10.1007/s12630-017-0973-2
Emotion, cognitive load and learning outcomes during simulation training - https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2923.2012.04355.x