February 3, 2022
When people think of clinical simulation, the first image that comes to mind for many is that of a mannequin like the one in the picture. Since mannequins are an important part of simulation, it is important to understand their contributions to simulation-based educational experiences.
Simulation mannequins range from static human shapes for practicing chest compressions to sophisticated computer-driven systems capable of generating waveforms and numbers on a patient monitor, pupils that respond to light, heart and lung sounds, peripheral pulses and more. Such computer-driven systems are called high-fidelity mannequins, and they add a lot to the realism of simulations.
Jump has a full family of mannequins to support our learners. These include ethnically diverse male and female adult mannequins, including a birthing mannequin, child mannequins and infant and neonate mannequins. They add three types of realism to our simulation events.
There are a variety of actions that can be taken with mannequins to help make simulation scenarios more realistic. This includes displaying vital signs that change in response to learners’ actions or inactions; altering aspects of a mannequin’s physical presentation; and offering opportunities for learners to practice select clinical skills.
This is particularly important for novice learners who do not yet have the experience to draw on to develop a mental picture of specific illnesses. In fact, the physical reality presented through the simulation setting that looks like a real clinical environment, coupled with the clinical responses of the mannequin to learners actions or inactions, may form the first experience a novice learner has with a specific disease process.
While physical reality is helpful for all learners, it is particularly important for novices as they begin to translate what they learned in the classroom into clinical skills, the ability to form diagnoses and implement plans of care. Mannequins also help provide other kinds of reality in simulation scenarios.
A second type of reality can be thought of as situational reality; that is, does the way the scenario unfolds make sense from a clinical perspective? While much of a scenario’s situational reality is the result of the knowledge and skill of the scenario developer, mannequins help make the scenario come to life.
For instance, if learners give the appropriate medication to a mannequin presenting with an asthma attack and the lung constriction improves, the scenario has unfolded in an expected manner. This provides learners with the experience of giving the patient the right medication that results in clinical improvement. This simple but powerful example illustrates the way in which a mannequin can support situational reality.
A third type of reality is emotional reality. That is, do learners feel as if they have really treated an asthma attack? Are novice learners a little stressed? Do more experienced learners feel as if they managed the situation without clinical uncertainty or psychological pressure?
What if more experienced learners faced a scenario where they had to administer both a first and second line medication for an asthma attack before the mannequin patient improved? Or what if the asthma attack was so severe, the patient needed to be intubated and placed on a ventilator? They, too, might begin to feel uncertain. Once again, the mannequin will support reality as learners feel progressive amounts of uncertainty due to the complicated nature of the scenario unfolding before them.
The importance of the three types of realism is about more than accurately replicating the clinical environment or the feelings a learner might experience in a real clinical situation. It’s also about helping create a sense that a scenario is real, which is most closely related to achieving educational goals.
For each educational goal in a simulation-based learning event, facilitators must identify the important characteristics of each expected learner task. It is then their responsibility to replicate those tasks with enough realism to accomplish learning goals set for the simulation.
For example, a facilitator might wish to help cement the concept for novice learners that when a patient’s blood pressure goes down, the heart rate will increase. That means the facilitator must focus on situational reality where the vital signs on the mannequin’s monitor reflect a drop in blood pressure and an increase in heart rate.
If the goal of the simulation is to improve psychomotor skills, then the facilitator must focus on ensuring the learner has all of the equipment necessary to carry out a task. They must also ensure the learner experiences the physical feedback of pressure and force they would encounter in the live clinical setting.
Similarly, simulation scenarios should be constructed in a manner that allows for necessary interpersonal interactions or moments of clinical uncertainty when attempting to recreate emotional reality.
The responses of a mannequin can contribute powerfully to acting and feeling as if the situation is real, regardless of which types of realism the facilitator is focused on. Jump Simulation is proud of our mannequin family and the ways in which we use them to provide world-class learning experiences for those we serve.
This piece is adapted from Dieckmann, Gaba and Rall, 2007.
Dieckmann, P., Gaba, D., & Rall, M. (2007). Deepening the theoretical foundations of patient simulation as social practice. Simulation in Healthcare, 2(3), 183-193.