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Simulation and learning

The development and adoption of simulation training reflects development in theories of learning from more individually oriented activities to those that view learning from a socio-cultural perspective. Simulations that focus on improving team performance are therefore becoming increasingly commonplace in high risk environments such as wards, anaesthesia, complex deliveries, trauma, surgery and emergency situations.

As simulation becomes an accepted part of everyday education and training for health professionals, attention is being paid to how simulation can best be used to develop technical and non-technical skills. Simulation appears to work most effectively when it is designed to meet curricular outcomes, includes realistic and relevant content, interesting and engaging learning methods and prepares learners for working in the clinical context in terms of activities, skills and competencies (Issenberg et al., 2005). Table 2 lists the best practice features of simulation as identified in two systematic literature reviews.

Simulation helps skills acquisition, maintenance and assessment in the move from ‘novice to expert’ (Dreyfus and Dreyfus, 1985). The key element here is building simulation activities into learners’ progression (Figure 1). For example, students must practise and master female catheterisation skills and pass an assessment before going on clinical rotations or doctors in training might have to provide evidence of competence in resuscitation using a simulator before interacting with patients. Learners can therefore have their first encounter with patients at a higher level of technical and clinical proficiency, which protects patients.


Table 2 - Best practice features of simulation

  • Formative feedback (feedback for learning) during simulation
  • An opportunity for deliberate (purposeful) and repetitive practice
  • Curriculum integration
  • Outcome measurement
  • Simulation fidelity (i.e. it must be as lifelike as possible)
  • Skills acquisition and maintenance
  • Mastery learning
  • Transfer to practice
  • Team training
  • High stakes testing
  • Instructor training
  • Educational and professional context
  • A variety of conditions and range of difficulties

McGaghie et al., 2010; Issenberg et al., 2005

Figure 1 Simulation Activities integrated into the learning programme
WPBAs = workplace-based assessments

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