The Use of Simulation for Training Teamwork Skills in Health Care
How Low Can You Go?
In recent years, high fidelity simulation has become an increasingly popular tool for training teamwork skills in high risk industries. Although we do not doubt its usefulness as a training tool, we are disturbed by the tendency to equate the term simulation with high fidelity simulators. We believe that this is unfortunate, because other types of simulation, such as case studies, role plays, and part task trainers, have an established base of research to support their effectiveness for training teamwork related attitudes, knowledge, and skills. Although there is a tendency to believe that more fidelity is always better, the published research does not support this conclusion. Specifically, we were unable to identify any studies that found a direct correlation between the level of simulation fidelity and training related outcomes, such as learning, transfer, and safety. Like any other tool, the effectiveness of simulation technology depends on how it is used.
In the final analysis, the choice of simulation depends on a number of factors, such as the training needs, the available resources, and the number of people to be trained. In a perfect world you would provide as much training as necessary to maintain the margin of safety. For example, if trainees required 50 hours of teamwork skills training per year—10 hours of lecture and case studies, 30 hours of part task trainers, and 10 hours of full motion simulation—that is what you would provide. More often than not, the training budget is under- funded, the training staff are overworked, and the time frame is unrealistically short. Therefore, we recommend that trainers maximize their training resources by leveraging low fidelity simulations to the greatest extent possible. When properly designed, these alternatives to full mission simulation can be a cost effective means for training teamwork related knowledge, skills, and attitudes.
In the title of this paper, we asked ‘‘How low can you go?’’ when it comes to simulation fidelity in teamwork skills training. As we have shown, low cost technologies, such as case studies, role plays, and part task trainers, have been effectively used to train teamwork related knowledge, skills, and attitudes in several high risk industries. Although trainees and instructional developers may prefer the ‘‘bells and whistles’’ of full mission simulators, we implore them to at least explore the use of lower fidelity alternatives, especially during the earliest phases of teamwork skill acquisition. After all, effective training is clearly not synonymous with full mission simulation.