Fidelity in Medical Simulation Training – What's Really Important and When?

In medical simulation training, fidelity refers to how closely a simulation replicates real-life clinical scenarios. But fidelity is not a one-size-fits-all concept. Decisions about the level and type of fidelity depend heavily on the particular scenario being simulated and the specific learning outcomes intended. 

For instance, there are high-fidelity manikins that can mimic human physiological responses, such as generating a pulse or breathing autonomously. In contrast, less complex manikins without these features still achieve a form of high fidelity through their remarkable visual realism. 

Another important fidelity tool is moulage, which recreates trauma injuries using lifelike textures, colours, and simulated bleeding to immerse trainees in realistic emergency situations. The Starship Moulage Guide provides comprehensive insights on how moulage enhances realism and aids experiential learning. 

On the other end of the spectrum, low-fidelity simulations can be as simple as printed, paper-based case studies that serve specific educational purposes effectively. For example, teaching inguinal hernia anatomy through a paper-based model allows learners to focus on structural relationships without the distractions or complexity of a high-fidelity clinical environment. 

When High Fidelity Makes a Difference 

Research shows that high-fidelity simulations significantly increase enagement for learners, and enables greater retention of skills. For example, visually enhanced mental simulations have been shown to improve the ability of learners to apply knowledge accurately in stressful, real-life scenarios. A study also found that diagnostic errors were reduced by as much as 57% when high-fidelity simulations were used, particularly in relation to complex emergency scenarios requiring attention to fine details. 

Beyond clinical training, high-fidelity simulation has been shown to reduce litigation risks in the USA. Studies indicate that when armed with realistic training environments, medical practitioners become better prepared, and therefore make fewer mistakes. This has been shown to have a direct impact on the volume of malpractice claims. While the ethical considerations of providing the highest level of patient care are at the forefront, it’s also worth considering the potential for financial impact where applicable. 

Striking the Right Balance 

The level of fidelity required depends on the training being provided. For basic procedures such as IV insertions and memorising anatomy, low-fidelity models are generally sufficient, as well as being more cost-effective. However, for critical procedures such as managing a polytrauma patient in an emergency setting, high-fidelity training is much more necessary.  

Cost, time, and available resources are the biggest contributors to making decisions around the level of fidelity required. Evidence suggests that hybrid models, combining low-fidelity elements for foundational knowledge with high-fidelity enhancements for complex scenario practice, are an optimal solution in many cases. 

Practical Examples for Simulation Training 

Open-wound management is a useful example of how different levels of fidelity might be applied to training scenarios. A low-fidelity approach might include worksheets with photos of injuries, and might focus on the theoretical side of identification and planning of treatment options. This gives learners a basic understanding of the injuries themselves and what responses they might consider. However, this approach lacks the realism of facing the stress and complexity of more severe wounds in a real situation. 

Using practical simulation options such as moulage featuring coloured gels, prosthetics, and simulated bleeding, offers learners a realistic and tactile example of what an emergency situation might entail.  

This can also be achieved with serious gaming tools, immersing learners in virtually simulated situations depicting operating room environments and emergency situations. These can be multi-faceted, inforporating auditory distractions and the pressure of time-sensitive decision making.