Nicki Murff

    Simulation “refers to an artificial representation of a real world process to achieve educational goals through experiential learning.”1 Last week’s post, “Simulation in Healthcare Education,” delved into the definition of simulation in a healthcare setting and its four main purposes: education, assessment, research, and system integration.

    Though simulation has been used in different fields, including the medical field, for many years, its use in healthcare education has seen a particular increase in recent years. This leaves educators, healthcare administrators, and program coordinators faced with the choice of whether they too should take steps to integrate simulation into their curriculum. Implementing simulation into a healthcare curriculum can have dramatic impacts in skills training, faculty capacity, and patient safety.

    Simulation’s Impact on Faculty and Students

    A dissertation by Tiffany Zyniewicz, PhDc, MSN, RN at The University of Southern Mississippi College of Nursing compared various studies conducted from 2005 to 2015 that examined the result of implementing simulation in a 1:1 or 1:2 ratio of simulation-to-clinical hours in healthcare. One 2015 study had this key finding when using a 1:2 simulation to clinical replacement ratio: “Students perceived significantly greater opportunities for collaboration with their peers in the simulated clinical setting,” but also: “students reported significantly higher satisfaction in learning in the traditional clinical setting.”2 Since student satisfaction and peer collaboration are both necessary for student success, the goal of simulation should not be to replace clinical training altogether, but to supplement and enhance education in a clinical setting.

    Further, a 2014 study found:

    "The replacement of 50 percent of traditional clinical with simulation at a 1:2 ratio of simulation to clinical hours resulted in a 49 percent increase in faculty capacity without negative effects to work-life quality for faculty or student simulation/clinical experiences."2

    One of the major reasons that simulation entered the medical education field is because of the significant report put out by the Institute of Medicine (IOM) in 1999, To Err Is Human. This report looked at the toll medical errors take on patient safety in U.S. hospitals and recommended simulation as one solution to the problem. The report stated:

    “…health care organizations and teaching institutions should participate in the development and use of simulation for training novice practitioners, problem solving, and crisis management, especially when new and potentially hazardous procedures and equipment are introduced.”3

    Simulation’s Impact on Skills Training and Patient Safety

    Using simulation to educate students on specific and complicated tasks in a risk-free environment may seem intuitive to some, but there are those who are slow to adapt and who question its necessity and impact on real-world patients. While the IOM report encouraged the use of simulation for novice practitioners, simulation programs aimed at experienced practitioners can have surprising results. A 2017 study conducted in the United Kingdom, which implemented weekly in-situ simulation team training for a pediatric Medical Emergency Team, concluded, “sustained improvement in the hospital response to critically deteriorating in-patients, significantly improved patient outcomes and substantial savings.”4

    Simulation can also have positive impacts on a student’s clinical education. A study in 2011 found that, “after four weeks of clinical, students that had experienced simulation scored significantly higher on overall clinical performance than their peers who had not experienced simulation.”2

    Economics of Simulation

    Some may be asking the question, “Why use simulation?” not from a technical standpoint, but rather from a financial one. Creating a simulation program from the ground up can be expensive, and it can be difficult to pinpoint evidence that proves its return on investment (ROI). While educators are often intimately acquainted with the importance of simulation and the specific products and tools – which range from task trainers, manikins, and simulators, to furniture, simulated medication, and medical gloves – that might be required to stage successful scenarios, health care and school administrators may have different priorities. Becoming familiar with the costs – both of using simulation and of not using simulation – can help educators appropriately express the value of simulation.

    A paper released after a breakout session at the 2017 Academic Emergency Medicine Consensus Conference that discussed the cost-benefit and return on investment of simulation could be helpful for educators to use as a tool; it can be viewed here. Additionally, the article, “Issues of cost-benefit and cost-effectiveness for simulation in health professions education,” from Advances in Simulation helpfully breaks down financial questions that surround simulation.5,6

    Simulation is Customizable

    Something that makes simulation so interesting is its wide range of uses and applications. A smaller school or nursing program can customize their simulation curriculum to fit their needs and budget. Typically, as the fidelity (realism) of a manikin or device increases, so does the price. While a realistic, immersive scenario should always be the goal in simulation, there are many ways to creatively stretch a budget while still achieving realism. Additionally, not every task or skill set requires a high-fidelity simulator. Task-trainers and wearable tech are appropriate for teaching the basics of several skills. Adding in simulated participants (SPs) – who can sometimes be volunteers – can add a layer of humanization to a scenario that can make it especially effective.7

    View the 2019 Pocket Nurse Simulation and Healthcare Catalog

    Simulation provides a way for learners to be more engaged, improve their skills in a safe, risk-free setting, and collaborate with their peers. Simulation can also lower the student to teacher ratio and increase faculty capacity.2 While implementing a full-scale simulation program can be daunting, the results justify the journey, and there will always be support at Pocket Nurse for those who choose to join us in advancing healthcare simulation.

    Nicki Murff is Marketing Coordinator for Pocket Nurse. This is the second article in our three-part series, Simulation in Healthcare Education: What, Why, and How. The third article will be published the week of September 23; next week we are celebrating Healthcare Simulation Week. If you are interested in simulation solutions for education, see our online catalog. 


    1. - “Simulation-based medical teaching and learning”

    2. - The university of southern Mississippi college of nursing – “Simulation as Replacement for Clinical in Undergraduate Nursing Education: Ratios of Simulation to Clinical Replacement Time”

    3. Kohn LT, Corrigan JM, Donaldson MS, editors. To err is human: building a safer health system A report of the Committee on Quality of Health Care in America, Institute of Medicine. Washington, DC: National Academy Press; 2000. [Reference list]

    4. – “Regular in-situ simulation training of paediatric Medical Emergency Team leads to sustained improvements in hospital response to deteriorating patients, improved outcomes in intensive care and financial savings.”

    5. - “Communicating Value in Simulation: Cost-Benefit Analysis and Return on Investment”

    6. – “Issues of cost-benefit and cost-effectiveness for simulation in health professions education.”

    7. - “Simulation and its role in medical education.”