Deception and Death in Medical Simulation

From the Institute for Professionalism and Ethical Practice (R.D.T., E.C.M.), Department of Anesthesiology, Perioperative and Pain Medicine (R.D.T.) and Department of Psychiatry (E.C.M), Boston Children's Hospital
Simulation in healthcare: journal of the Society for Simulation in Healthcare (Impact Factor: 1.48). 02/2013; 8(1):1-3. DOI: 10.1097/SIH.0b013e3182869fc2
Source: PubMed
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Available from: Elaine Meyer
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    • "This approach to simulation can be considered a form of deception, a concept which was introduced by Dieckmann et al. (2007b). Deception, which inherently carries some negative connotation, can be very controversial (Truog & Meyer, 2013) in that it requires hiding some element of truth. In the example above, the clinician was deliberately not informed that it is a simulated case and it is through some mechanism made to believe that the patient had the actual pathology to allow simulation training of near absolute fidelity. "
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    ABSTRACT: Background. Fidelity - an intrinsic property of simulation is crucial to simulation design and to educational effectiveness. Yet the term fidelity is inconsistently used, which makes it difficult to draw inferences from current literature and translate research into practice. Aim. In this article, we attempt to bring some clarity to the term simulation fidelity in healthcare education. Method. We are opposed to the notion that high-fidelity simulation requires complete and faithful replication of reality, and instead argue for an accurate representation of real-world cues and stimuli. We address a number of issues surrounding the term fidelity and how it is currently used in the literature. Result. In recognising the limitations of current methods of describing fidelity in the literature, we propose an alternative 3-dimensional framework for fidelity along the axes of the patient, clinical scenario, and healthcare facilities as a means for more precise and practical positioning of current healthcare simulation activities. Conclusion. All aspects of fidelity significantly hinge on the learners’ perceived realism of the context of the learning episode as opposed to any one particular element such as the technology used.
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    ABSTRACT: Psychology is relevant for improving the use of simulation in anesthesiology, as it allows us to describe, explain and optimize the interactions of learners and instructors as well as the design of simulation scenarios and debriefings. Much psychological expertise is not used for simulation in healthcare. This article aims to help bridging the gap between professions. The evidence is building that simulation is effective for learning. Recent psychological work improves the understanding of why this is the case - or why not. Publications range from the elements to be simulated, to optimizing the presentation of scenarios and debriefings to an organizational overview of how simulation can contribute to patient safety, healthcare worker well-beings and quality of care. The psychological analysis helps in capturing the salient characteristics of the tasks to be simulated and in implementing them in a relevant learning setting. Using psychology in simulation allows us to create, recognize and use learning opportunities. The motivations of those involved can be taken into account and the simulation activity can be channeled into a goal-oriented direction. See the Video Supplementary Digital Content 1 (
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