CURRENT OPINION Simulation in cardiology: state of the art

Simulation is the technique of imitating a process or situation for education, training, modelling of an uncommon or risky scenario, or testing systems when new elements are introduced (such as a new protocol). Simulation training is not new to medicine. Anatomical models were created in ancient times, and in the 1960s the Norwegian toy manufacturer Laerdal pioneered simulation to practise cardiopulmonary resuscitation and critical event drills. Early models were crude, but they were widely adopted. The HARVEY cardiovascular simulator was one of the first manikins developed which was computer driven and provided replication of anatomy with palpable pulses and auscultatable areas. This allowed medical students to experience some of the findings from clinical examination for the first time in a standardized setting. More recently, with advances in technology, there has been a rapid expansion in simulating other aspects of healthcare, with increasing sophistication. Modern computing power allows the recreation of complex anatomical and physiological systems programmed to respond to inputs from the user. There have also been advances in manikins and devices to physically replicate the steps of performing complex procedures. Fidelity is the degree of accuracy with which a simulation replicates a clinical scenario. This is defined in terms of the realism of the environment in which the simulation takes place, the equipment used and the psychological engagement of the learner. It is not necessarily synonymous with the technology of the simulator. . Indeed, evidence suggests that the indiscriminate use of high-technology simulators alone is unlikely to be more effective than other methods. The ability to use realistic clinical environments (or practice in situ), using equipment which closely replicates the look, feel and feedback of clinical situations will facilitate the immersion of the learner into the simulation, but it is important to consider their emotional response and behaviour. There is little to be gained if the learner reacts in an artificial manner, or is encouraged to perform risky actions as a result of a lack of engagement. This may result in the learning of poor practice, or a failure to achieve the intended learning. This lack of psychological engagement may be as a result of a scepticism towards the use of simulation or unfamiliarity with the process, including anxiety related to audio–video recordings. Thoroughbriefing prior to simulations, with an introduction to the equipment and environment used, what to expect, and what capabilities the simulators do not have will help to alleviate some of these issues.