Simulations provide many advantages over traditional clinical training.1 They carefully plan and gradually increase the difficulty of the situations created. Here, learners ease into new tasks rather than perform them as the need arises in a clinical setting. This aspect also allows learners to gather experience in simulations of life-threatening clinical situations. Such situations are often too uncommon for thorough training and their severity can preclude trainee participation even when they do arise. Simulations also afford learners unlimited repetition and “permission to fail,” both of which are impractical and unethical in a clinical setting. Learners also receive immediate feedback and objective performance reviews from simulation technology.
In addition, simulations let learners proceed at their own pace, which means the learner sets their own agenda. These technologies also present opportunities for collaborative and interdisciplinary learning opportunities that incorporate the teamwork required in clinical care. Further, simulations can reduce the use of cadavers and live animal teaching laboratories in clinical training. They also minimize ethical concerns that arise when trainees learn on patients, particularly when safety depends on the clinician’s knowledge.1
Simulations, however, also have significant limitations that educators and trainees must contend with in clinical training.2,3 First, they cannot replicate a clinical situation perfectly. Inadequate technological design, for example, may communicate unrealistic messages that omit important physical or emotional cues. If a simulation’s commitment to realism slips, shortcuts, such as the omission of safety procedures and patient consent, also may teach problematic habits. Similarly, it is difficult to replicate genuine communication in such a setting.
Moreover, simulations face possible hesitance to participate from healthcare professionals, especially those unfamiliar with the method.3 So far, however, healthcare professionals appear to participate readily and accept simulations as a viable and beneficial educational tool.4 Finally, educators – no matter how enthusiastic about simulations – need to consider their own development as they introduce simulations into their curriculum.3 Traditional teaching methods require different preparations than simulation facilitations do.
To date, research suggests that simulations improve learning outcomes in comparison to no intervention or traditional practice.4,5 Improved skills, however, do not equate directly with improved clinical performance or patient outcomes.2 Further, many simulation-based studies only focus on the initial effects of simulation training.5 Future study, therefore, needs to focus on simulations’ ability to help learners transfer skills and improve their performance on real patients in order to improve patients outcomes. This focus includes attention to when and how to use simulations most effectively and cost-efficiently.4
Discrepancy between the learning (simulation) and performance (clinical) environments poses the biggest barrier to skill transfer. Four factors influence how well skills can be transferred: the amount of initial learning, the extent of the similarity between learning and performance environments, the perceived similarity between the two environments, and the motivation of the learner.6 Educators initially may strive to create the greatest possible similarity between the two environments to increase memory recall. This approach, however, increases cognitive load on the learner because they may not yet have the skill set and knowledge to navigate such a realistic simulation. This greater cognitive load actually reduces initial learning and, subsequently, knowledge and skill transfer.6 Instead, a scaffolding framework – in which simulations sequentially increase in similarity to performance environments – at first reduces cognitive load on the learners and eventually ensures greater similarity between the learning and performance environments.7
References
1. Kneebone, R. Simulation in surgical training: educational issues and practical implications. Med. Educ. 37, 267–277 (2003). https://doi.org/10.1046/j.1365-2923.2003.01440.x.
2. Weller, J. M., Nestel, D., Marshall, S. D., Brooks, P. M. & Conn, J. J. Simulation in clinical teaching and learning. Med. J. Aust. 196, 594–594 (2012). https://doi.org/10.5694/mja10.11474.
3. Good, M. L. Patient simulation for training basic and advanced clinical skills. Med. Educ. 37, 14–21 (2003). https://doi.org/10.1046/j.1365-2923.37.s1.6.x.
4. Cook, D. A. et al. Technology-Enhanced Simulation for Health Professions Education: A Systematic Review and Meta-analysis. JAMA 306, 978–988 (2011). https://doi.org/10.1001/jama.2011.1234.
5. Teteris, E., Fraser, K., Wright, B. & McLaughlin, K. Does training learners on simulators benefit real patients? Adv. Health Sci. Educ. 17, 137–144 (2012). https://doi.org/10.1007/s10459-011-9304-5.
6. Alessi, S. M. Fidelity in the design of instructional simulations. J. Comput.-Based Instr. 15, 40–47 (1988). https://doi.org/10.1177/104687810003100205.
7. Vygotsky, L. S. Mind in Society: The Development of Higher Psychological Processes. (Harvard Univ Pr, 1978).
