The Spectrum of Simulation

What is simulation?

This depends on who you ask. Most will reference Gaba's seminal work which stated that:

"Simulation is a technique—not a technology—to replace or amplify real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner" [1]

This work went on to consider 11 dimensions of current and future applications: [1]

  1. The purpose and aims of the simulation activity

  2. The unit of participation in the simulation

  3. The experience level of simulation participants

  4. The health care domain in which the simulation is applied

  5. The health care discipline of personnel participating in the simulation

  6. The type of knowledge, skill, attitudes, or behaviour addressed in simulation

  7. The age of the patient being simulated

  8. The technology applicable or required for simulations

  9. The site of simulation participation

  10. The extent of directed participation in simulation

  11. The feedback method accompanying simulation

In essence, the core elements for consideration of any simulation are therefore the following:

  • Is the activity for teaching or testing

  • For an individual, stable or unstable team

  • Novice or expert simulation volunteers, undergraduate or postgraduate

  • Considering Miller's Pyramid; are learners prepared for your activity?

  • Is the technology appropriate for the level of challenge?

  • High vs. Low Fidelity or Realism, fully immersive environment in situ, replicated in a simulation suite, pen & paper or virtual setting?

  • Hands-on, remote viewing, virtual reality, augmented reality or mixed reality?

  • Debriefing - either "hot" or post-hoc, formal or informal feedback

A core question I would ask anyone embarking on a new simulation intervention would be: "Is simulation the right tool for my project?". Don't let gut feelings get in the way as simulation activities are financially, resource and time intensive and similar benefits can be seen with other interventions and project leads should be prepared beforehand.

Simulation has many uses but it can be considered worthwhile considering it as a tool in the following interventions:

  1. For Education - to teach learners about a given topic, or to test knowledge application and thereby looking to bridge the 'theory to practice' gap. Often referencing education principles of scaffolding, deliberate practice and constructivism .

  2. Skill acquisition and mastery learning; i.e. practice makes perfect

  3. Low Frequency, High Risk Scenario preparation / Major Incident Protocol training

  4. Testing of systems and services from a patient safety perspective

  5. An "aid" to assessment - albeit caution should be used in interpreting performance in these settings, there are many successful models for this, including OSCEs & MOSLERs.

  6. For research - though key challenges include recruiting multiple centres to

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