Manikin Money: Our Role in Improving Healthcare Simulation Technology


Blog post by SimGHOSTS president Scott Crawford

Manikin Money: Our Role in Improving Healthcare Simulation Technology

The Simulation Specialist often has the most intimate knowledge of the fundamental operations and usability of simulation equipment. As the cost of healthcare climbs and the need to maximize effectiveness of educational dollars receives even more pressure, the importance of this role becomes even greater. Knowing the needs of the educator, the center and the benefit to the learner is vital to making any purchasing decision.

One area of constant debate is that of realism and fidelity. This debate can be related both to the definition of the terms, often used interchangeably, and the expected need of realism to enhance learning. Realism/Fidelity is defined as “Believability, or the degree to which a simulated experience approaches reality.” By the INACLS Standards of Best Practice 1. While this is certainly important and the degree to which training matches reality has importance, the ability to teach a transferable skill does not always require “high fidelity”. Early investigations into the use of mannequins in training emergency medicine found inconsistencies in the literature. This is mentioned by Frintz 2 and Baeubien 3 and also relates the need for fidelity in simulation training. Fidelity is more complex than the term often implies and encompasses three distinct areas. 1. Equipment: The physical manikin or task trainer and its ability to mimic reality. 2. Environment: The environment (room and surroundings) mimic that of a reality for the scenario. 3. Psychosocial: The trainee believes it represents accurate training.

The important take away from this early description of fidelity is that equipment fidelity does not seem to greatly impact team training effectiveness. Environmental fidelity can enhance well designed cases and curriculum, but a fancy simulator by itself cannot make a poorly designed training program better by itself.

Early learners, particularly medical students, who primarily need to work on integrating cognitive stimuli into, orders and care plans are often best served by high psychological fidelity that may not require high equipment fidelity. As the skill of the learner progresses the level of equipment and environmental fidelity becomes more important to the psychological fidelity as well.

Simulation specialists should seek out the educators of the center and become involved not only with the scenario design to ensure effective use of equipment initially, but also integrate feedback from prior sessions related to the learner’s experience to help guide educators moving forward about how to improve the sessions. This knowledge of equipment, collecting feedback from the sessions and planning of programs can guide effective purchasing decisions.

Vendors although certainly interest in selling a product will be best served in the long run by providing appropriate equipment that is used, loved and will need to be serviced, replaced and expanded into other training areas. This will allow for “Vendor longevity,” important metric evaluating commercial off-the- shelf equipment 4. The price, features, reliability and functionality within your simulation center must all be considered with any purchasing decision.



1. Meakim, C., Boese, T., Decker, S., Franklin, A. E., Gloe, D., Lioce, L., ... & Borum, J. C. (2013). Standards of best practice: Simulation standard I: Terminology. Clinical Simulation in Nursing, 9(6), S3-S11.

2. Fritz, P. Z., Gray, T., & Flanagan, B. (2008). Review of mannequin‐based high‐fidelity simulation in emergency medicine. Emergency Medicine Australasia, 20(1), 1-9.

3. Beaubien, J. M., & Baker, D. P. (2004). The use of simulation for training teamwork skills in health care: how low can you go?. Quality and safety in health care, 13(suppl 1), i51-i56.

4. Sedigh-Ali, S., Ghafoor, A., & Paul, R. A. (2001). Software engineering metrics for COTS-based systems. Computer, 34(5), 44-50.