Faculty Development

Although simulation is widespread, popular with learners and teachers and technological developments are leading to the availability of more and more complex simulators, much of the published work has been descriptive rather than grounded in evidence based research (Issenberg et al, 2005). Contemporary research is now focussing on a more analytical, evaluative and inter-disciplinary perspective to identify how best (often costly) simulation can be used.

Simulation is not a substitute for health professionals learning with and from real patients in real clinical contexts, but is best used to teach practical or technical skills prior to working with patients and to replicate clinical scenarios in a safe and controlled environment (Pratt and Sachs, 2006). Gaba(2004) notes that ‘simulation is a technique, not a technology’.

Although the technology can become confining for some users (Kneebone and ApSimon, 2001), other writers remind us that we must take care that the seductive powers of the technology do not lead to a use of simulation where it leads to dependency, becomes self-referential and produces a ‘new reality’ (Kneebone et al, 2005: Bligh and Bleakley, 2006). Kneebone et al (2004) note that simulation must not become an end in itself, disconnected from professional practice, which can lead to over-confidence in learners.  Simulation must be valid. Poor validity is associated with a lack of realism. In some simulators novices can out-perform an expert, which questions the validity of that simulation. Typically this would also lead to a lack of correlation with other outcome measures.

When considering simulation activities, teachers need to think how well they can be controlled (tractability), how well they match the real world (correspondence) and how well they involve learners meaningfully (engagement).   A common misconception is that high fidelity simulation is better than low fidelity. High-fidelity simulation is useful for skills involving complex interactions requiring integration of cognitive and psychomotor skills coupled with interaction with others in the healthcare setting (Gaba, 2006). Maran and Glavin (2003) consider the progression from low to high fidelity simulation compared to the progression through medical education and conclude that the range of fidelity available is almost all potentially useful, but that many simulators are underused due simply to a lack of clear educational goals. Teachers therefore need to learn how to use simulation activities through faculty development and experience so as to make the most of resources and learning opportunities for their students or trainees and to integrate such activities within educational programmes, not as a bolt-on. Many simulation centres now offer training for teachers in the educational use of simulation.