Simulation based learning (SBL) is an active learning method that provides learners with exposure to realistic clinical situations using life-like examples in a safe environment.
Active learning strategies offer learners opportunities to develop their critical thinking, problem-solving, and reflection skills. It also promotes learners engagement and transfer of knowledge and skills into practice. (McGaghie et al. 2014, Shin et al. 2015, Reising et al. 2017, Jakobsen et al. 2018.)
Simulations can be carried out using human patient simulators (HPSs) or standardized patients (SPs). High-fidelity, computer-driven HPSs are appropriate in contexts where learners are supposed to practise e.g. assessing patients’ vital signs. The high-fidelity HPSs are human-like and anatomically correct. The computerization enables a variety of physiological responses and actions (e.g., patients’ voices, lung sounds with rising of the chest, heart rates and palpable pulses, cyanoses). Different vital functions can be programmed for HPSs and monitors to simulate different diseases or conditions. By using HPSs, it is possible to practice realistic and concurrent planning of nursing interventions and to have real-time response for further interventions (Arthur et al., 2013, Howard et al., 2010, Smith et al. 2012).
In scenarios that require the patient or client to move, shuffle, or communicate naturally, such as in patient examination or therapeutic communication situations, SPs are more appropriate (Slater et al. 2016, Webster 2014). An SP can be an actor or role-player who is trained to simulate illness or a real patient who has been trained to present his or her illness; in both cases, the presentation of illness is standardised (Barrows 1993, Stayt 2012). In addition, SPs have been demonstrated to enhance the learners’ cultural sensitivity and cultural competence and hence are essential in perspective of confirming culturally diverse simulation learning (Bahreman & Swoboda 2016, Foronda et al. 2018).
Once learners have accepted their roles and agreed to their level of responsibility in the simulation, the instructor executes the simulation that holds a level of realism. Realism is confirmed physically, conceptually, and psychologically. Transferable learning occurs when the learning objectives and learner readiness are compatible with the experience represented in simulation. Physical fidelity will support psychologic fidelity, but poorly designed scenarios cannot achieve realism with high technologic or physical fidelity alone. (Paige et al. 2013, Hamstra 2014.)
Important part of psychological fidelity is also to consider potential opportunities to demonstrate patients´ diversity, including e.g. family, gender, age, ethnic, and psychosocial factors and how equivalent they are to reality. Other health care providers within the simulation could also demonstrate diversity, consisting of variation of sex and background across all provider roles and avoidance of stereotypes of negative characterizations. (Sabus 2016.)