5 Fallacies of Simulation

1. The type of simulation modality should dictate the educational activity.

It is not uncommon for PA programs new to simulation to buy equipment or hire standardized patients (SP) before planning on how to use them in their curriculum. After all, there will always be scenarios to run or cases to complete.

But simulation is not a technology or a set of technologies — it’s a technique used as an educational tool to enhance or amplify real-life experiences. Therefore, it should be used in the same way as any other curriculum tool.

As with any change in curriculum, a problem should be identified, a needs assessment completed, and goals and objectives stated. Once this is done, then educational strategies should be developed.

These strategies may use simulation, but the type of simulation (e.g., high fidelity manikins, SPs, etc.) should be dictated by the goals and learning objectives, not vice versa.

Implementation of the educational strategy then follows, culminating with evaluating the educational strategy through faculty and student feedback.

2. Simulation-based education needs to be expensive to be effective.

An important first step in developing a simulation curriculum is the creation of specific, measurable, and relevant learning objectives. If simulation-based educational sessions are chosen to meet the learning objectives, there are many options of tools that can be chosen.

Simulation tools range from less expensive options — apps on portable devices and task trainers, for example — to more expensive options such as simulated human manikins. However, the effectiveness and quality of simulation-based education is based on a well-planned curriculum — not on how expensive the tools in the simulation center were.

3. The majority of student learning takes place during the simulation activity.

Debriefing is an important part of the simulation process — it allows students to defuse any intense emotions that may have arisen. “How did this experience make you feel?” “What went well or what would you have done differently?” Without the chance to reflect, true learning does not occur.

4. Simulation-based training has not translated into better medical outcomes.

Practicing in an environment where it is permissible to make mistakes, and being able to do so repetitively and deliberately, can improve training outcomes. Simulation gives students the opportunity to test new clinical procedures and enhance both their individual and team skills.

Simulation-based training can improve clinician attitudes, behaviors, and performance leading to potential increased patient safety and better clinical outcomes.

5. Due to its subjectivity, simulation–based training has not been used as a part of a summative evaluation.

There has been an explosion in simulation as a method to assess learners because it is both reliable and valid as an evaluation method. Simulation-based summative assessments have been used in PA education primarily through OSCEs (Objective Structured Clinical Exams), with the most common type of simulation involving SPs to model the complaints of real patients.

Simulation-based summative assessments — including those targeting specific performance domains — have been used in high stakes testing for many health care professionals. They also have been incorporated into the process used to license and certify physicians.

The use of manikin-based simulation for high-stakes assessments is gaining in popularity, largely because manikins do not experience fatigue like SPs and, therefore, allow for standardized evaluation of examinees.

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Thank you to Donald Coerver, PhD, PA-C, CHSE, and Jami Smith, MPA, MEd, PA-C, CHSE, for lending their expertise and contributions to this article.