Simulation centers: See one. Do one. Teach One.
Is High Fidelity simulation necessary to pick a medical school? 5 questions to ask about a simulation program.
Massoth C, Roder H, Ohlenburg H, et. al. High-fidelity is not superior to low-fidelity simulation but leads to overconfidence in medical students. BMC Medical Education 2019 19;29.
What did they look at?
This study looked at 135 4th year medical students who were randomly assigned to either a high- or a low fidelity simulated Advanced Life Support training session. High fidelity simulators are realistic devices that provide the user with realistic feedback. Low fidelity simulators usually have limited functions. The outcomes they looked at were theoretical knowledge (pre and post test), self assessment (pre- and post test), and performance in video recorded scenarios rated by experts. Both groups had comparable performance on video analysis. However, the participants of the high-fidelity group considered themselves at an advantage when assigned to the high fidelity teaching group. When asked if they considered themselves to be better performers in handling a resuscitation compared to students in the low fidelity group -41% of the students in the high fidelity group considered themselves to be better performers despite not having witnessed the low fidelity group. Limitations of the study are that it was at a University in Germany so there may not be
Why does this matter?
Don’t be distracted by the “bells and whistles” when you evaluate a medical school. Simulation training is an indispensable tool in medical education, allowing students to practice their skills without risks to a patient. There is ample evidence to support the use of simulation for procedural skills where practice makes perfect. Does it need to be “high tech” or “immersive”? This study seems to suggest it doesn’t. The high fidelity training seemed to increase student’s confidence in their skills despite equal performance to the low fidelity group. They were overconfident. As a matter of fact, some might consider this overconfidence dangerous. Confidence is good, overconfidence is dangerous. A misaligned self assessment can lead to taking more risks which can lead to more errors.
It is easy to be drawn into or even expect high tech learning environments given our current high tech world. Keep in mind that similar to most high tech devices the device is only as good as the user. You can fancy yourself a great photographer because you have a great camera, however, the best photographers can still take a good photo even with a pinhole camera. This study seems to support the “KISS” principle. Keep it simple. Good teachers and good learners and practice are what will make for strong clinical skills. Look past the “bells and whistles” and shiny things when you evaluate a medical school and look at who is teaching you to use those high or low fidelity tools and most data supports it is the amount of practice and not the tools that will improve your procedural skills.
These are 5 better questions to ask yourself when evaluating simulation at a medical school:
How do they integrate their simulation into the curriculum?
How much practice do you get? Is it readily available for when you are ready to learn?
Who is doing the teaching?
Is it used in both the preclinical and clinical curriculum?
Is there both high fidelity (full OR/mannequins) and low fidelity simulation? (procedural models)
