A typology of educationally focused medical simulation tools

Figures & data

Table

Practice points
•Technology has evolved, so should our teaching approach.
•People have different perceptions about simulation training which can cause ambiguity.
•The proposed typology should be used as a guide to reflect on what we are currently offering to our students.
•What is defined as realistic scenario-based simulation training should be student-led.

Table 1.  Proposed typology of simulation methodologies split in 6 levels and with there respective characteristic. Each can either be student or trainer-led

Technological simulation levels	Level 0	Level 1	Level 2	Level 3	Level 4	Level 5
Simulation technique	Written simulations includes pen and paper simulations or “Patient Management Problems” and latent images	3-D models which can be a basic mannequin, low fidelity simulation models, or part-task simulators	Screen-based simulators Computer simulation, Simulation software, videos, DVDs, or Virtual Reality (VR) and surgical simulators	Standardized patients Real or simulated patients (trained actors), Role play	Intermediate fidelity patient simulators Computer controlled, programmable full body size patient simulators not fully interactive	Interactive patient simulators or Computer controlled model driven patient simulators, also known as high-fidelity simulation platforms
Mode of delivery	Usually student led	Student or trainer led	Student or trainer led	Student or trainer led	Preferably trainer led	Preferably student led
Type	Passive		Interactive		Partly interactive	Interactive
Skills addressed	Cognitive	Psychomotor	Cognitive	Psychomotor, cognitive, and interpersonal	Psychomotor, cognitive, and interpersonal	Psychomotor, cognitive, and interpersonal
Facility required	Classroom	Clinical skills room or classroom	Multimedia/Computer laboratory or classroom	Depends on the scenario requirements	Clinical skills room or simulation centre realistic setting (simulated theatre, ICU, A&E or ward)	Simulation centre with realistic setting (simulated theatre, ICU, A&E or ward) usually set up with audio and video recording equipment
Typical use	Patient management problems Diagnosis Mainly for assessment	Demonstration and practice of skills	Cognitive skills Clinical management Sometimes interpersonal skills (software allowing for a team to interact over networked computers)	Same as Level 2 plus patient physical assessment, diagnostic, or management problems Interpersonal skills	Same as Level 3 plus procedural skills Full-scale simulation training Sometimes used for demonstrations	Same as Level 4
Disadvantages	Unrealistic Feedback cannot be given instantaneously after the exercise	Limited range of training functions No or little interactivity	Unrealistic setting Students and trainers have to be familiar with the software/equipment Software has to be kept up to date with the relevant medical regulations/procedures VR sometimes requires very high computational power	For small groups of students only Patients have to be trained and briefed Inconvenient if the exercise has to be repeated many times Not valid for any invasive practice unless used in conjunction with a part-task trainer	May require programming of scenarios Several trainers required for a relatively small group of students Trainers have to be familiar with the equipment Requires an emulated patient monitor for most parameters	Cost (mannequin and facility) Several trainers required for a relatively small group of students Trainers have to be familiar with the equipment Not very portable
Advantages	Low cost (no special equipment required in most cases) One academic may be sufficient for a large number of students	Equipment relatively mobile and always available One academic may be sufficient for a class of students working on the same skill Spares patient discomfort	Relatively low cost, except for VR One academic may be sufficient for a large number of students Students can use it on their own (self learning) Software often provides feedback on performance	Can be very realistic A must for communication skills and patient history taking Allows for truly multiprofesional training	Provides a fairly realistic experience Can be used to apply a broad range of skills Students’ performance sometimes recorded Allows for truly multiprofesional training Usually portable	Provides a realistic experience Can be used to apply a broad range of skills Students’ performance recorded for debriefing Allows for truly multiprofesional training Can be used with real clinical monitoring equipment

Figure 1. Framework for acquisition of experience and skills through simulation training adapted to the pyramid proposed by Miller (1990) and according to the simulation levels defined in the proposed typology (Table 1). Reproduced with permission from Academic Medicine, Journal of the Association of American Medical Colleges.

Miller GE. The assessment of clinical skills/competence/performance. Acad Med 1990; 65: S63–67

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