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In Reply to Rubio et al

Hamstra, Stanley J. PhD; Brydges, Ryan PhD; Hatala, Rose MD; Cook, David A. MD

doi: 10.1097/ACM.0000000000000461
Letters to the Editor
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Professor of medicine and director, Academy for Innovation in Medical Education, Faculty of Medicine, University of Ottawa, and research director, University of Ottawa Skills and Simulation Centre, Ottawa, Ontario, Canada; shamstra@uottawa.ca.

Assistant professor of medicine, University of Toronto, Toronto, Ontario, Canada.

Associate professor of medicine, University of British Columbia, Vancouver, British Columbia, Canada.

Professor of medicine and medical education, Mayo Clinic College of Medicine, and director, Office of Education Research, Mayo Medical School, Rochester, Minnesota.

Disclosures: None reported.

We thank Dr. Rubio and colleagues for their interest in our work.1 We agree that effective education involves alignment between the clinical task and the simulation task (i.e., “functional task alignment”). We introduced this term to get around the problems associated with the term “fidelity” that we found in the literature, and to highlight the level of analysis necessary for designing effective simulation training. Briefly, functional task alignment involves identifying the essential constructs of the target task and aligning them with the elements of the simulator to be used for training. We feel this is a critical part of the process for designing effective simulation training sessions.

We appreciate Dr. Rubio and colleagues’ illustration about how humans think about reality, but adoption of this particular theoretical viewpoint is not necessary for explaining the factors in volved in effective transfer of learning. To paraphrase, the authors state that simulation should capture the imagination, trigger physiological res ponses, and tap into participants’ history. In short, educational effectiveness depends critically on the way in which learners engage with the educational material, based on their prior experience. This is a fundamental tenet of constructivism, which emphasizes the motivational power that can be drawn from the learner’s appreciation of the relevance of the current lesson to the learner’s unique prior history. Thus, in principle, learner orientation can be managed to emphasize particular expectations about how the simulator aligns with future performance in the applied setting. In this way, effective orientation of the learner to the simulator can create a relevant “prior history.” In short, the learner can “project” fidelity onto the simulator depending on their unique learning objectives.

In our experience in this field, we have seen highly effective educational impact using simple physical design elements. Technological advances are obviously needed in education, but we need to understand why and when to use technology to enhance learning. Key questions for future research include (1) Under what conditions do low-tech simulators confer benefit? (2) What role does learner engagement and sus pension of disbelief play in effective simulation-based training? (3) How do learner preferences regarding technology affect engagement and effectiveness of learning? (4) How can task analysis help in determining simulator technology requirements? and (5) How can we help resource-poor facilities take advantage of research showing the benefit of low-tech simulators?

Stanley J. Hamstra, PhD

Professor of medicine and director, Academy for Innovation in Medical Education, Faculty of Medicine, University of Ottawa, and research director, University of Ottawa Skills and Simulation Centre, Ottawa, Ontario, Canada; shamstra@uottawa.ca.

Ryan Brydges, PhD

Assistant professor of medicine, University of Toronto, Toronto, Ontario, Canada.

Rose Hatala, MD

Associate professor of medicine, University of British Columbia, Vancouver, British Columbia, Canada.

David A. Cook, MD

Professor of medicine and medical education, Mayo Clinic College of Medicine, and director, Office of Education Research, Mayo Medical School, Rochester, Minnesota.

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Reference

1. Hamstra SJ, Brydges R, Hatala R, Zendejas B, Cook DA. Reconsidering Fidelity in Simulation-Based Training. Acad Med. 2014;89:387–392
© 2014 by the Association of American Medical Colleges