Reconsidering Fidelity in Simulation-Based Training

Academic medicine: journal of the Association of American Medical Colleges (Impact Factor: 2.93). 01/2014; 89(3). DOI: 10.1097/ACM.0000000000000130
Source: PubMed


In simulation-based health professions education, the concept of simulator fidelity is usually understood as the degree to which a simulator looks, feels, and acts like a human patient. Although this can be a useful guide in designing simulators, this definition emphasizes technological advances and physical resemblance over principles of educational effectiveness. In fact, several empirical studies have shown that the degree of fidelity appears to be independent of educational effectiveness. The authors confronted these issues while conducting a recent systematic review of simulation-based health professions education, and in this Perspective they use their experience in conducting that review to examine key concepts and assumptions surrounding the topic of fidelity in simulation.Several concepts typically associated with fidelity are more useful in explaining educational effectiveness, such as transfer of learning, learner engagement, and suspension of disbelief. Given that these concepts more directly influence properties of the learning experience, the authors make the following recommendations: (1) abandon the term fidelity in simulation-based health professions education and replace it with terms reflecting the underlying primary concepts of physical resemblance and functional task alignment; (2) make a shift away from the current emphasis on physical resemblance to a focus on functional correspondence between the simulator and the applied context; and (3) focus on methods to enhance educational effectiveness using principles of transfer of learning, learner engagement, and suspension of disbelief. These recommendations clarify underlying concepts for researchers in simulation-based health professions education and will help advance this burgeoning field.

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Available from: Stanley J. Hamstra, Jan 13, 2015
    • "" These questions may have a number of implications, particularly when considering that any training device—be it a virtual or physical simulator—will likely never be able to faithfully completely replicate the real-world with all its sensory stimuli; in other words, complete (perfect) realism appears to be impossible to achieve, at least with our current technology[10]. In addition, striving to reach full realism can also lead to increased development costs, may lead to lag and motion sickness, and it remains unclear if such high levels of realism are needed for either enjoyment or knowledge transfer (recent work suggests it may not be necessary[5,7]). To date, we have conducted a series of experiments that examined the direct effect of sound on engagement, and on the perception of visual realism (the degree to which visual features within a virtual environment conform to visual features in the real environment[11]), and task performance (the time required to complete a task within a virtual environment), of both static and dynamic 3D rendered (virtual) scenes in both stereoscopic 978-1-4799-8958-4/15/$31.00 ©2015 IEEE QoMEX 2015 3D (S3D) and non-S3D viewing were conducted. "
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    • "It seems that in most cases practitioners refer to the physical resemblance of the training setting as being resembling reality or not. Yet, from a learning perspective, the " functional alignment with the learning task, the instructional design, and the instructor likely have far greater impact on immediate learning, retention and transfer to new settings " (Hamstra et al., 2014, p. 389). "
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