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Simulation is merely another tool at the disposal of the educator in the healthcare environment. The challenge in education is to successfully transfer skills learned in the classroom to the real life clinical environment where we are exposed to other professions, skill-mixes, and pressures of work. Simulation allows us to create these challenges in an environment where it is safe to make a mistake. We learn from our mistakes.

Jason Crawford
Clinical Skills Educator & Business Development Lead at QE Gateshead (2014-5)

What is Simulation?

Simulation is derived from Latin simulatus/simulare and refers to re-creating a set of conditions or imitating an event. Healthcare Simulation is a technique to replace or amplify real/anticipated clinical experiences in a controlled environment that evoke or replicate substantial aspects of the real world in a fully interactive fashion1.

Simulation allows clinicians and multi-disciplinary teams to practice high risk, low frequency events in a safe and controlled environment. It also allows analysis of interactions and the application of procedures to a real environment thus maximizing benefit and promoting transferability. It can reproduce situations of risk management, crisis, or undesirable events whilst focusing on difficult decision-making in multi-stakeholder and sometimes multidisciplinary situations2.

Immersiveness of a simulation is its ability to produce a state of being deeply engagement, suspension of disbelief and active involvement, while fidelity is a measure of the realism or degree of similarity of a simulation. Haptic technology in simulation refers to the tactile feedback technology that reproduces a sense of touch.

Simulation can be classified on the basis of fidelity as

  • Low-fidelity simulators are focused on single skills for the learner.
  • Medium-fidelity simulators provide a more realistic representation but do not allow full immersion.
  • High-fidelity simulators provide adequate cues to allow for full immersion and respond/give feedback to treatment interventions.

Simulation may also be classified on the mode used as

  • Standardised patients – are actors/individuals trained for clinical interactions. They are extensively used and can provide constructive feedback to from the patient perspective.
  • Part Task Trainer – are models used for repeated practice of the technical components of a clinical task. Eg. Head-Thorax model for practicing airway skills.
  • Screen based simulators are representations of tasks or environments used to facilitate learning.
  • Full body Mannequin/Manikin – are physical representations of patients. Their complexity varies from being just the physical shape of a patient to incorporating complex electronic equipment for generating physiological responses.
  • Hybrid Simulators – are combinations of any of the above.

Simulation can be done in a simulation suite as well as mobile/in-situ/on field.

In-situ simulation training occurs at the point where healthcare is provided, using normal workplace equipment. Participants act in their normal roles, during normal working hours, which is thought to enhance realism and validity, and may decrease the anxiety that some clinicians associate with traditional simulation training.

One of the most valuable components of a simulation exercise is feedback or debrief and it accounts for up to three-quarters of the time spent. Modern simulation, with its ability to provide audio-visual replay of individual and team interactions, is generally acknowledged to uniquely optimize the learning experience and retain acquired skills longer to use them when facing real encounters and achieve better outcomes.

Simulation-based learning (SBL) is an emerging discipline that can provide safe, effective and real life like learning environments for multiple health groups independently and as teams using the above or a combination of simulation methodologies. There are many learning and educational theories that support simulation based learning such as experiential learning, constructivism, and brain based learning pointing at higher skill retention over time.

Also, there have been many key drivers in development of simulation over the years with patient safety being the foremost. The 2008 Annual report of the Chief Medical Officer, Safer Medical Practicespelled out the importance of simulator training to improve patient safety and clinicians’ performance and to enable experience to be gained without practice on patients. Other drivers have been increased public expectation and awareness, changes in working practice/reduced training time, technological developments and opportunities, medical education reforms and understanding of human factors and non-technical skills in error causation.

Dr Rohit Garkoti
Consultant Anaesthetics
Queen Elizabeth Hospital, Gateshead


1. Gaba DM. The future vision of simulation in health care. Qual Saf Health Care. 2004;13(Suppl 1):i2.

2. HSSAIN I, ALINIER G, SOUAIBY N. In-Situ simulation: A different approach to patient safety through immersive training. Med Emergency, MJEM 2013; 15: 17-28

3. Donaldson. Safer Medical Practice, DOH, 2009.