A simulation centre is any location where healthcare education involving experiential learning, aka healthcare simulation, is conducted. Typically, larger facilities with multiple simulation labs are designated as simulation centres whereas, smaller spaces with only a single lab may be named as simulation laboratories. The nomenclature is rather arbitrary and depends on the parent organization, and of course in the some parts of the world the term Simulation Center is used.
Experiential learning in one form or another has been around for centuries, however in the last twenty years, the use of medical simulation in all levels of medical education has grown exponentially. Experiential learning and clinical experience are based on the concept that people learn best through hands on experience followed by a period of reflection in which the learner themselves considers their own behaviors and makes decisions about future actions.
Other names for this type of learning include interactive or immersive learning. Research has shown that clinical simulation education increases the confidence of learners, diminishes the time it takes for learners to reach competency, improves clinical judgement and skills and most importantly reduces error and improves patient safety.
Simulation education is varied and includes task trainers, human patient simulators, standardized patients, surgical trainers and virtual reality and other forms of computerized training. A simulation centre may have any or all of the following types of simulation.
- Task Trainers – simple anatomical models that allow for repeated practice e.g. IV insertion or catheter insertion.
- Human Patient Simulators (HPS) – A range of manikins that mimic the human body.
- This type of simulation typically involves a scenario involving a particular medical situation (aka scenario) e.g. cardiac arrest. The scenario is followed by a period of debriefing which is sometimes conducted in the same room as the simulation but is frequently conducted in a separate room (aka debriefing room). Additional learners may watch the scenario live either through a one-way mirror or electronically. The scenario may have been recorded in which case, the scenario can be played back to learners for review, reflection and identification of ways to improve care.
- Low-Fidelity: Basic models with some capacity to mimic human physiology – most often used in Nursing schools or long-term care facilities.
- High-Fidelity Simulation: Highly specialized manikins with multiple moving parts and functions which more closely resemble human physiology e.g. birthing simulators which allow obstetricians, midwives and nurses to practice normal delivery and difficult or life-threatening deliveries such as shoulder dystocia or postpartum hemorrhage.
- Standardized Patients (SP) – Specially trained individuals who mimic various medical conditions. Standardized Patients are often used for medical student examinations.
- Surgical Simulators – highly specialized simulators for surgeons to practice particular skills e.g. laparoscopic and ultrasound trainers.
- Virtual Reality Simulators – life-like computerized simulations where the learner must respond to the given clinical situation.
Custom built spaces are now fairly common in medical schools, nursing schools, medical centres, clinics and hospitals all over the world. The medical simulation industry estimated to be worth over 3.8 billion pounds. The structure and size of the simulation centre will depend on the desired educational goals and budget. Some institutions have whole buildings dedicated to simulation, some have several floors and others may have a single room or two. Some facilities have a variety of simulation labs such as rooms that mimic regular medical surgical rooms, operating theaters, emergency rooms, critical care rooms or delivery rooms. There may be examination rooms for use with standardized patients, computer labs for virtual reality or rooms dedicated for surgery simulators. Most sim labs have control rooms where the simulation technologist and educator (content expert) overseas the simulation. In addition to the spaces dedicated for simulation labs, there may be classrooms, study rooms, rooms for administrative staff, lab preparation rooms and storage rooms. Manikins and other large pieces of patient simulator equipment may be left in place or interchanged depending on the type of scenario.
Smaller institutions can and do building simulation centres but they may consist of one or two labs and debriefing rooms. As the simulation centre becomes more elaborate with high-fidelity manikins, the cost of the building alone may run into millions of pounds. In addition, simulation centres have complex IT and computer components for video recording and data recording and playback. Many expensive manikins are wireless and tetherless, have voice output, monitor displays and operating computers. Add in anesthesia equipment, defibrillators, medication dispensers, patient monitors, headwalls with gases and suction etc. and the cost of building a simulation centre goes up and up.
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Finally, once a simulation centre is built, funding will be needed for educators and for staff to manage, operate and repair equipment. Funds must be built into any budget for supplies, repair of equipment and replacement of manikins and equipment as they become obsolete.
Perhaps the cost of these simulation centres may seem high, but the value of simulation in undergraduate, graduate and ongoing clinical competency is now well documented. Simulation education and thus simulation centres play a key role in preventing patient harm, and at least for the foreseeable future, simulation centres are here to stay.
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