The phrase "simulation modalities" may conjure up a variety of images. For example, some nursing staff development professionals think of a sophisticated training mannequin that produces computer-generated EKG printouts, responds to intubation efforts, and virtually behaves in ways similar to an actual patient. Others may think of an IV arm used solely for learning how to start IVs.
The point is, there is a wide range of simulation modalities, but many staff development specialists know of only a few, and still more are as of yet unaware of the vast potential for providing education via simulation.
Low-fidelity simulation modalities
Low-fidelity simulations are described as those that feel the least real to the learner (Holtschneider, 2009; Mt. Hood Community College, 2009). These simulations can be paper- or computer-based and are generally static models that allow for very little learner interaction within the simulation. Examples include computer- or paper-based tasks, mannequins that do not have the capability for providing feedback (e.g., a Resusci Anne that only offers computer printouts that evaluate the accuracy of breaths and compressions), or an IV arm that allows students to practice IV insertion techniques without feedback devices (Holtschneider, Mt. Hood Community College).
Low-fidelity simulation modalities are relatively easy to implement and transport and less expensive to implement than more sophisticated modalities. However, they are the least real of the modalities and therefore do not provide learners with the experience or the feeling of actually working in real-life settings.
High-fidelity simulation modalities
Also referred to as a high-fidelity human patient simulators (HPS), these are often the first thing people think about when we say simulation. When using an HPS, educators can implement a variety of scenarios that they can tape and play back for debriefing or guided reflection, as well as create blended simulations, incorporating actors assuming the role of patients with low-fidelity task trainers.
HPS is usually dependent on some type of computerized mannequin that allows the re-creation of the physical patient in a realistic physical clinical environment. Mannequin-based simulators have become increasingly common in areas such as the OR, emergency department, and critical care units, where life-threatening situations that require recognition and treatment often occur. Some simulators can even mimic the effects of various drugs, track the distribution of the drug in the body, and determine the exact effects that a specific amount of the drug will have on the human body.
The costs associated with these types of simulation generally increase with the level of sophistication of the simulator. Complex simulators may also be more of a challenge to set up and transport than more simple simulation techniques. However, the level of realism introduced by high-fidelity simulation modalities truly brings the learner into an interactive, genuine work environment.
Standardized patient educators
A tactic that adds to the high-fidelity simulation modalities is the use of standardized patient educators (SP). SPs are educators who are specially trained to portray patients, family members, and, at times, even members of the hospital staff.
Using SPs lets learners engage in mock conversations with patients, deal with family members who are frightened and questioning, and cope with colleagues who may not be acting professionally.
SPs are used in a variety of academic settings, such as medical and nursing schools. However, their use is now becoming more common in clinical environments because they add another dimension of reality. However, they also add to the cost. Organizations hiring these educators must screen them carefully and hire only those persons qualified to assume such roles.
Serious gaming
The term "serious gaming" involves the use of video game technology to add another dimension to the learning process. Learners function within specific rules and guidelines while playing interactive computer-based games. These games generally present a complex healthcare situation (e.g., multiple casualties from a terrorist attack arriving at an emergency department) that requires the learner to intervene appropriately.
Although the game format is viewed as a fun way to learn, the games offer deadly serious scenarios. Serious gaming is an increasingly popular training mechanism.
Video and computer games can be developed fairly quickly and can simulate functional entities in various clinical settings. However, they can be expensive to develop and learners must have appropriate training in their use. In addition, they require the availability of adequate equipment for learners.
Desktop simulations and virtual worlds
Desktop simulations and virtual worlds can be run on a desktop computer and only need a screen, mouse, and audio inputs and outputs. The learner can view data, see the patient via animation, perform diagnostic or treatment interventions, and interact with the patient by typing or, in some cases, actually speaking with the patient.
An advanced approach to this type of simulation allows several participants to participate in a virtual world simultaneously. Learners can interact with each other, the patient, and others in this world. A distinct advantage of this type of simulation is the ability to interact with various healthcare team members as well as the patient and family.
Virtual reality and visualization
Virtual reality is a computer-generated world that allows the learner or group of learners to experience various stimuli, often in a 3-D presentation. Learners typically wear head-mounted displays to receive visual and auditory cues. They can interact in the computer-generated world from various sites or be in a physical space in which they can interact with others.
Virtual reality is a rapidly developing field and gives a true sense of realism. However, the creation of a complex virtual patient and treatment setting can be time-consuming and expensive. It requires a complete computer model of the patient environment; a way to track visual, audio, and touch fields; adequate hardware for all sensory modalities; and hardware to compute all models, track inputs, and produce outputs in real time.
References
Holtschneider, M.E. (2009). "Simulation learning modalities: Going beyond sim man!" Concurrent session, NNSDO 2009 convention, July 11, 2009, Philadelphia.
Mt. Hood Community College (2009). "Fidelity simulators." Retrieved October 1, 2009, from www.mhcc.edu/pages/493.asp.
National Nursing Staff Development Organization (2008). "Collaborative efforts across organizations: Building a simulation alliance." Journal for Nurses in Staff Development 24(6): 303–304.
This article was adapted from one that originally appeared in the November 2009 issue of The Staff Educator, an HCPro publication.