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IN BRIEF
* Simulation allows students to work through complex clinical problems without jeopardizing patients.
* Hands-on learning enables participants to gain knowledge and skill and to make good decisions.
* This author reviews the use of simulation as a teaching tool in health care education.
Simulation is an approach to experiential learning that allows students to work through complex clinical problems without jeopardizing patients. High-fidelity human patient simulators, which use complex computer-driven models of physiology, have made this type of learning even more realistic. Simulation enables multiple students to experience the same complex case, balancing the education of the group.
The major impediment to widespread acceptance of simulation as an effective teaching tool is the lack of a reliable and valid method of evaluation. In light of this, two possible courses exist-one is to adopt a change in the current methods of evaluation; the second is to adopt simulation without concrete proof of its effectiveness.
THE ORIGINS OF SIMULATION
Simulation derives its foundation as an educational method from as far back as the "writings of Aristotle and the practices of Socrates."1 (p500) These predate the evolution of learning theories traced back to John Dewey's work on experiential learning. Dewey's original concept of reflective thought as "active, persistent, and careful consideration of any belief or supposed form of knowledge in the light of the grounds that support it and the further conclusions to which it tends"2 (p6) can be considered a basic tenant of any simulation. Others describe simulation as "models or representations of some facet of the human experience."3 (p178) In practical application, simulation requires participants to be active in the review and evaluation of the information available in a given scenario. This active review leads to the synthesis of a plan of action to deal with the information. Simulation in health care, therefore, can be defined as the use of scenarios to expose providers to a variety of simulated conditions or patients to enable participants to broaden their skills and knowledge base.
Dewey further contends that thinking begins with a "forked road" when a situation presents various alternatives.2 (p11) If one goes from situation to situation without difficulty or the need for decision, no reflection occurs; however, when a difficulty or...