Summary

Fidelity is a multi-dimensional concept in healthcare simulation that goes beyond just the physical resemblance of equipment to the real counterpart. The various facets of fidelity include the fidelity of the equipment itself, the simulated environment, the conceptual clarity in representing the underlying clinical condition, and ultimately, the psychological or emotional fidelity in replicating the real-life experience for the learners.

A useful framework proposed by Dieckmann separates the “sim center level” which is the literal representation of the simulation tools (e.g. this is a clicker) from the desired “scenario level” where learners treat these as the intended objects/procedures (e.g. an ultrasound probe). Effective facilitation involves setting an immersive scene that allows learners to transition and remain engaged at the scenario level, suspending disbelief about the literal nature of the simulation tools.

Achieving an appropriate level of fidelity is a nuanced process that requires an adaptive approach mapped to the specific learners and learning objectives, rather than defaulting to maximum fidelity. For novice learners, low fidelity setups like static models or part-task trainers may be more suitable to avoid cognitive overload. As learners gain experience, the level of fidelity can be gradually increased in complexity and realism.

The degree of fidelity should also align with the learning objectives. High equipment fidelity may be unnecessary for certain procedural skills. Instead, the focus should be on providing realistic perceptual cues most relevant for the skills being taught, even if through low-cost solutions. Subject matter experts can provide valuable inputs on the essential details that help reinforce immersion and fidelity for learners.

In many cases, combining different modalities like manikin-based simulations augmented with simulated patient actors, part-task trainers, artificial fluids etc. can help achieve the desired realism within technological limitations. For certain scenarios, taking the simulation outside of the center into real-world settings like outdoor environments or confined spaces can incorporate realistic environmental constraints.

Ultimately, the goal is to strike a balance in fidelity – achieving sufficient psychological realism and immersion to effectively meet the learning objectives without being overwhelmed by unnecessary complexity. Considerations of cost-effectiveness in achieving sustainable and reproducible solutions are also important.

References

Rudolph JW, Simon R, Raemer DB. Which reality matters? Questions on the path to high engagement in healthcare simulation. Simul Healthc. 2007 Fall;2(3):161-3. doi: 10.1097/SIH.0b013e31813d1035. PMID: 19088618.

Dieckmann, P. (2005). “Ein bisschen wirkliche Echtheit simulieren” Über Simulatorsettings in der Anästhesiologie. [Online: http://docserver.bis.uni-oldenburg.de/publikationen/dissertation /2005/diebis05/diebis05.html] Oldenburg: Universität, Dissertation.