The How When Why of High Fidelity Simulation

Abstract

High-Fidelity Simulation (HFS) is a misunderstood term. Too often, HFS is mistakenly used to refer to a particular simulation modality, namely, the full-body, high-complexity patient simulator. However, modality and fidelity are two distinct components of simulation design, and both impact the overall effectiveness of the activity. [1] Simulation educators must understand these elements and the separate, yet complementary roles they play in designing a simulation-based learning experience (SBLE). The term high-fidelity simulation is not used consistently throughout simulation literature. Yet, numerous published studies are attempting to measure its influence. [1] Researchers have studied the effect of HFS on student confidence, and anxiety levels, [2] [3] compared it to SBLE using lower levels of fidelity, [4] and measured its impact on knowledge and skill acquisition in nearly every healthcare discipline and level of the learner. [5] [2] [6] The accuracy of any research is dependent upon clear articulation of the study concepts; modality and fidelity are two critical components of SBLE. However, both lack clear and consistent definitions. [1] [7] [8] The Healthcare Simulation Dictionary recognizes both fidelity and modality as “potentially controversial” terms; acknowledgment on the part of simulation experts that there is a disparity in the usage of these terms in the literature (Joseph Lopreiato, MD personal communication, May 2020). Modality is the term used to refer to the type(s) of simulation equipment or methodology used in an SBLE, such as a task trainer, standardized or simulated patient (SP), full-body manikin, or screen-based simulation. Continuous advancements in technology explain some of the difficulty in clearly defining this term and the categories found within it. [7] The selection of an appropriate modality when planning a simulation activity depends on several factors, including the availability of equipment, stated objectives and desired learning outcomes. [8] It is important to note that within each modality category, there exists an array of products representing a range of fidelity or realism.Fidelity in simulation is a multi-dimensional concept corresponding to the degree of realism created through the selection of simulation equipment, setting, and scenario. [5] Fidelity also refers to the degree of exactness achieved; [9] [1] and corresponds to the believability of the experience and relates to several components of simulation activity. [7] It is important to note the INACSL Standards of Best Practice: Simulation: Simulation Design does not dictate a level of fidelity; rather, the level of realism should be that which promotes the achievement of the expected learning outcomes. [1] Levels (low-, mid-, and high-fidelity) and types (physical, psychological, and conceptual) are associated with fidelity. [10] Participants and educators state a preference for higher levels of fidelity, judging it as superior to lower levels; the evidence does not support this global contention, finding all levels of fidelity beneficial when used appropriately. [11] [10] [12]

Topics & Concepts