High Fidelity Simulation

High Fidelity Simulation is a healthcare education methodology that involves the use of sophisticated life-like manikins (sometimes called mannequins) in realistic patient environments. Simulation scenarios can take place anywhere, from austere environments for EMS or Military Simulations, to clinical environments like surgical simulation inside a simulation centers. These complex manikins, which are also known as human patient simulators or high-fidelity simulators mimic human anatomy and physiology.

In Healthcare Simulation, the degree to which a particular manikin can reproduce or mimic human physiology is known as fidelity. The manikins that most closely resemble human anatomy are designated as high-fidelity manikins. A static manikin with very limited functionality is designated as low-fidelity. Low fidelity manikins also known as task trainers may be used for repeated practice of clinical skills such catheter placement or wound care.

Most high-fidelity manikins have expanding chests that breathe, have variable heart rates and tones, measurable blood pressure, and palpable pulses. They vary in their particular components but may include EKG displays, pulse oximeter, arterial waveforms, pulmonary artery waveforms and anesthetic gases. Various procedures can be performed on the manikins such as bag-mask ventilation, intubation, defibrillation, chest tube placement, cricothyrotomy and others.


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Usually high-fidelity patient simulators are computerized, contain hydraulics and compressors and have external monitors which display various physiological functions. Many manikins are articulated, change color, exhibit seizures, speak and cry. Some high-fidelity simulators are very specialized such as trauma manikins with severely damaged or missing limbs, birthing manikins that mimic a woman during labor and delivery, newborn or premature babies and smaller pediatric manikins.

Most high-fidelity manikins are operated by specially trained simulation technologists in a separate control room. The operator can view the progress of the scenario and make changes to the simulator as the session progresses. Typically, an educator or content expert will also be present in the control room directing the educational component of the scenario. Learners must respond to changes in the manikin and not from instructor cues. High-fidelity manikins create more realistic clinical scenarios and thus aid the learner. Several companies manufacture high-fidelity manikins. For example, Laerdal produces the SimMan series, CAE Healthcare the LucinaAR birthing simulator with hologram capabilities and Gaumard sells Victoria a high-fidelity birthing manikin.

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In order to address healthcare performance gaps or learning needs, educators create simulated scenarios based on the identified needs. For example, emergency room responses to newly admitted chest pain patients were not found to meet nationally accepted standards. By participating in simulation, emergency room staff are provided an opportunity to practice and improve their knowledge and clinical skills related to care of chest pain patients. High-fidelity manikins can be used to mimic this clinical situation. Every detail of a scenario is carefully planned and tested.


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Typically, simulators are either set up in a simulation lab or a human patient simulator is brought to the ER (in situ simulation). Healthcare professionals or students assume various roles and respond to the patient situation which are assigned during the prebriefing. Following the scenario, a debriefing session is held where participants reflect and identify practice/knowledge gaps and propose changes to their future responses in a similar situation. Scenarios have been created for a wide variety of clinical situations including rare clinical events, ongoing residency training and undergraduate education in medicine, nursing and other allied health professions. In addition, high-fidelity simulation provides an opportunity for healthcare teams to improve team communication, team dynamics and other soft skills.

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The key advantage of high-fidelity simulation is that it allows learners of all levels an opportunity to immerse themselves in a simulated clinical scenario that looks and feels real. The higher the fidelity, the more likely the learner will to suspend disbelief and engage in the learning activity. Ultimately, the more knowledgeable the healthcare practitioner is, the safer the patient will be.

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