Dawn Mangine

    According to the Society for Simulation in Healthcare (SSIH), simulation education is “the bridge between classroom learning and real-life clinical experience.” (From the SSH About page.) Healthcare simulation, in particular, has four main purposes: Education, assessment, research, and system integration.

    • Simulation education: Simulation in education provides a safe and controlled environment to teach a wide set of skills, both technical (e.g. injections, IV placement) and non-technical (soft skills such as communicating with patients).
    • Simulation-based assessment: Simulation also provides a reliable educational assessment method. Assessing knowledge via exams, whether written or oral, have been a traditional way of testing for competency. However, when real tasks can be accurately simulated, having students demonstrate competency becomes the basis for effective evaluation.
    • Simulated-based research: Testing medical devices or new techniques under a range of simulated conditions before they are used on real patients is one type of simulated-based research. Other types of research in this area include studying new procedures and methods in simulated conditions, and data collection via patterns in computer-based simulations. “The ultimate goal of increasing knowledge and understanding to improve training, evaluation, and design of systems is the same.”
    • Systems integration of simulation: This refers to the integration of simulation-based learning into institutional healthcare training and delivery systems. (SSH About page)

    “We simulate to observe phenomenon and solve problems. We simulate as a way to experiment complex situations while minimizing risk. In health care, we simulate to improve patient safety and practitioner skill sets.” – Clinical Simulation in Nursing, Editorial, 2017

    History of Simulation

    Medical simulation originated thousands of years ago, with models of human patients built in clay or stone to “demonstrate clinical features of diseases.” (Simulation in Medical Education: Brief history and methodology) Animals were also used to educate practitioners in surgical skills. But the true origins of medical simulation come from a different educational source: Aviation.

    Aviation embraced simulation-learning models as far back as 1929, when the first flight simulator, the “Blue Box,” was invented. Flight simulation proved that trainees exposed to high-risk conditions in safe and controlled environments could learn skills and improve on them. In addition, by standardizing the process, reproducing more and more complex simulations can allow pilots with different skill levels to achieve flight expertise.

    Healthcare simulation as we know it got its start in the 1960s with the development of cardiopulmonary resuscitation (CPR) and the creation of the first manikin simulator to teach mouth-to-mouth resuscitation. The Resusci-Anne enabled physicians to practice CPR techniques including chin tilt and neck extension. In 1968, Dr. Michael Gordon introduced Harvey, the Cardiology Patient Simulator. These types of manikins and simulators have improved and advanced as the technology has advanced.

    Standardized patients (SPs), live actors who simulate clinical cases in scenarios, also were introduced into simulation education in the 1960s. Throughout the 1980s and ‘90s, computerized technology improved realism of manikins and led to significant improvements in team-based training. Finally, virtual reality (VR) is creating even more realistic and immersive environments for healthcare simulation education.

    Read more about building a standardized patient program.

    Adult Learning Theory

    Simulation can play a central role in a student-directed learning model. Andragogy, the method and practice of teaching adult learners, encourages the adoption of student-directed learning in order to improve knowledge and increase engagement. The features of simulation that enhance adult learning include realistic scenarios, the opportunity to practice in a safe way, and constant feedback. Simulation itself doesn’t guarantee learning, but deployed properly, it can be the cornerstone of adult education, especially in healthcare education.

    This is the first part in a three-part series, Simulation in Healthcare Education: What, Why, and How. We will be examining the benefits of simulation and how to use simulation effectively in upcoming posts this month, so stay tuned. And if you're not subscribed to SimTalk Blog yet, now is a good time to sign up!


    “About Simulation” from Society for Simulation in Healthcare (SSIH) About page https://www.ssih.org/About-SSH/About-Simulation

    Editorial, “The Value of Simulation in Health Care: The Obvious, the Tangential, and the Obscure,” Clinical Simulation in Nursing, 2017. https://www.nursingsimulation.org/article/S1876-1399(17)30357-2/fulltext

    Jones, F., Passos-Neto, C.E., Braghiroli, O., “Simulation in Medical Education: Brief history and methodology,” Practices and Practice of Clinical Research, Jul-Aug. 2015. https://pdfs.semanticscholar.org/4bb5/413c9ce13c27a1b5cc2e186b9b157997ba28.pdf