Alinier Guillaume, Oriot Denis
Hamad Medical Corporation Ambulance Service, Medical City, Doha, Qatar.
School of Allied Health Professions, Midwifery and Social Work, University of Hertfordshire, College Lane, Hatfield, AL10 9AB, UK.
Adv Simul (Lond). 2022 Mar 18;7(1):8. doi: 10.1186/s41077-022-00206-3.
The level of performance of every clinician and of the overall multiprofessional team relies on the skills and expertise they have individually and collectively acquired through education, training, self-directed learning, and reflection. Simulation-based education (SBE) is playing an increasingly important role in that respect, and it is sometimes said that it is an art to facilitate. Many explanations can justify this assertion. Although there is generally an emphasis on making everything as realistic or "high-fidelity" as possible, it is often futile and this is where the art of simulation comes into play with an element of modulation of realism linked to the intended learning objectives. The atmosphere created by the educators; how the learners are made to engage and interact; how physical, technical, and contextual elements are simulated or represented; and what type of technology is used need to be appropriately adapted to contribute to the immersiveness of any SBE activity. Although it inevitably carries a negative connotation, some form of "deception" is more commonly used than one may think for the benefit of learners during SBE. High levels of realism are sometimes achieved by making learners believe something works or reacts as would be expected in real life, whereas it is achieved in a totally different manner. Learners do not need to know, see, or understand these "tricks of the trade", shortcuts, or artistic or technological aspects, and this can be considered a form of benevolent deception. Similarly, information may be withheld to recreate a realistic situation and push learners to demonstrate specific learning outcomes, but it needs to be practised with caution and be justifiable. These forms of "positive" deception are part of most SBE activities and are used to help learners bridge the reality gap so they can suspend disbelief more easily, exercise critical thinking, and treat the simulation more realistically without damaging the trust they place in their educators. This article will discuss how aspects of SBE activities are often manipulated, modified, or hidden from learners to facilitate the learning experience and present a simulation fidelity model encompassing the environmental, patient, semantical, and phenomenal dimensions.
每位临床医生以及整个多专业团队的表现水平，取决于他们通过教育、培训、自主学习和反思而单独或共同获得的技能与专业知识。基于模拟的教育（SBE）在这方面正发挥着越来越重要的作用，有时人们说这是一门促进学习的艺术。对此有许多解释可以说得通。虽然通常强调要使一切尽可能逼真或“高保真”，但这往往是徒劳的，而这正是模拟艺术发挥作用之处，即要根据预期的学习目标对逼真度进行一定程度的调整。教育者营造的氛围；如何促使学习者参与并互动；如何模拟或呈现物理、技术和情境要素；以及使用何种技术，都需要进行适当调整，以增强任何SBE活动的沉浸感。尽管它不可避免地带有负面含义，但在SBE中，为了学习者的利益，某种形式的“欺骗”比人们想象的更为常用。有时通过让学习者相信某事物的运行方式或反应与现实生活中预期的一样来实现高度逼真，而实际上却是以完全不同的方式达成的。学习者无需知道、看到或理解这些“业内诀窍 ”、捷径、艺术或技术方面的内容，这可被视为一种善意的欺骗形式。同样，可能会隐瞒信息以重现真实情境，并促使学习者展示特定的学习成果，但需要谨慎行事且要有正当理由。这些“积极”欺骗形式是大多数SBE活动的一部分，用于帮助学习者弥合现实差距，以便他们能更轻松地暂时放下怀疑，进行批判性思考，并更现实地对待模拟情境，同时又不会损害他们对教育者的信任。本文将讨论SBE活动的各个方面如何经常对学习者进行操控、修改或隐瞒，以促进学习体验，并提出一个涵盖环境、患者、语义和现象维度的模拟逼真度模型。
