Choosing the Right Level of Fidelity for Your Simulation Training

The "see one, do one" approach to learning can be especially challenging for trainees in labor and delivery. Caring for two patients, the mother and the baby, creates double the possibility for complications and requires double the amount of patient monitoring. The learning curve in labor and delivery can be a never-ending one, and simulation is being used to prepare clinicians for low frequency, high risk events.

Simulation practice can help to address risk and other concerns surrounding maternal care. The wide variety of simulation fidelity options (options for approximating reality) gives educators an array of tools to support experiential learning at all levels, from simple task trainers to sophisticated full-body manikins.

In this article, we examine a range of simulation methods. Building on expert observations, we share how each can support the needs of your learners and help reduce risk in maternal and newborn care.

Using a task trainer, students receive hands-on practice performing psychomotor skills independently and at their own pace. Typically, the focus of task trainers will be on one specific task, such as pelvic exams or umbilical catheterization.

John's Hopkins Medicine cites proper patient care as one primary benefit of task trainers.⁴ "It is understood that clinicians-in-training will treat patients; however, from an ethical perspective, harm to patients as a byproduct of training or lack of experience is justified only after maximizing approaches that do not put patients at risk".⁵ Task trainers help by providing you with the ability to confirm that learners have, in fact, mastered a skill before allowing them to perform on real patients.

There was also a trend showing reduction in peak force used and a shorter delivery duration following the training.

At a lower price-point, task trainers in isolation may exponentially increase learner comprehension. If your learners require clinical attention to detail and hands-on, repetitive practice, a task trainer might be your saving grace.

Realistically portraying a scenario, SPs interact with learners to create a low-risk learning experience. SPs can verbalize symptoms, communicate what they are physically experiencing, and even play the part of family members, which can be useful in gathering patient history and diagnosing symptoms.

SPs allow learners to practice communication skills, establishing what questions need to be asked or how to relay bad news. Allowing the opportunity to recall didactic lessons and put acquired knowledge into action may lead to higher levels of engagement and self-awareness for learners. If you are interested in facilitating an engaging learning process, using a standardized patient may be a great place to start.

Hybrid simulation is when two or more simulation modalities are used in the same simulation session. This form of simulation offers a bridge between simulation methods in that learners can work with real patient and perform clinical skills. Typically, a task trainer or partial simulator is realistically affixed to a SP, allowing for teaching and assessment of technical and communication skills in an integrated fashion.⁷

The use of a SP and birthing simulator may be able to effectively teach the complexities associated with birth, while ensuring that learners communicate and monitor the patient as well. The interaction with a "real" patient combined with hands-on clinical practice can reinforce competent decision making and develop critical thinking skills. Learners can then apply these skills to actual patient encounters, confidently ascertaining the best course of treatment.

To help learners develop their decision-making competency, you may want to consider expanding your simulations to incorporate both standardized patients and task trainers.

Simulators are particularly well-suited for simulations involving traumatic or emergency scenarios. Obstetrics is a key area where manikins have been instrumental in simulating emergencies during labor and delivery. Due to the nature of the emergencies and patient age, educators count on manikins to provide a realistic physiology where SPs cannot.⁸

Simulation with a simulator can provide learners with the ability to practice simulation in teams, reacting to physiological changes in real time, and rehearsing real world scenarios.

The capability for weighing and enacting a clinical pathway is one thing that other methods of simulation cannot deliver. Use of a simulator allows for administration of medication and physiological monitoring, so that learners can grasp the reality of their actions. Additionally, scenarios allow for evidence-based decision making, using clinical procedure in tandem with real human factors and behaviors.

With the right technology and environment, learners can work to develop and hone a skill until they’ve mastered it — without concern for real patient harm. If you feel your learners are ready to take part in full-fledged, high-fidelity simulation, your next steps may lead to a simulator.