Reconsidering Fidelity in Simulation-Based Training

Hamstra, Stanley J. PhD; Brydges, Ryan PhD; Hatala, Rose MD, MSc; Zendejas, Benjamin MD, MSc; Cook, David A. MD, MHPE

doi: 10.1097/ACM.0000000000000130
Perspectives

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.

Dr. Hamstra is professor, Departments of Medicine, Anesthesia and Surgery; research director, University of Ottawa Skills and Simulation Centre; and director, Academy for Innovation in Medical Education, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.

Dr. Brydges is assistant professor, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.

Dr. Hatala is associate professor, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

Dr. Zendejas is resident, Department of Surgery, Mayo Clinic College of Medicine, Rochester, Minnesota.

Dr. Cook is professor of medicine and medical education, Department of Medicine, Mayo Clinic College of Medicine, and director, Office of Education Research, Mayo Medical School, Rochester, Minnesota.

Funding/Support: Funding for this work was provided by Mayo Clinic Division of General Internal Medicine and Mayo Medical School.

Other disclosures: None reported.

Ethical approval: Reported as not applicable.

Previous presentations: Portions of this work were previously presented to the Centre for Health Education Scholarship at the University of British Columbia, Vancouver, British Columbia, Canada, June 15, 2011, the International Meeting for Simulation in Healthcare, San Diego, California, January 31, 2012, and the International Conference on Residency Education, Royal College of Physicians and Surgeons of Canada, Ottawa, Ontario, Canada, October 20, 2012.

Correspondence should be sent to Dr. Hamstra, RGN 2034, AIME–Faculty of Medicine, University of Ottawa, Ottawa, Ontario, K1H 8M5, Canada; telephone: (613) 562-5800 ext. 8092; e-mail: shamstra@uottawa.ca.

© 2014 by the Association of American Medical Colleges