SIMULATION BASED

LEARNING
Introduction
Simulation is as old as human beings on earth. Not only human
beings but even animals use the technique of simulation to train
their young ones to teach them to adjust in their physical
environment. The use of simulation in teaching is comparatively
very recent.
◦Simulation has been in use since the man on earth but its
systematic use stated after the First World War in the training of
pilots in air force. The pilots were given all types of experiences
of actual flying in office room, on maps or on models prepared
to acquiring the trainees with the strategy of war fair.
Definition
◦Simulation is a method whereby an artificial or hypothetical
experience that engages the learner in an activity that reflects
real-life conditions but without the risk-taking consequences of
an actual situation is created (Rystedt & Lindstrom, 2001).

◦ Simulation allows participants to make decisions in a safe

environment, witness the consequences, and evaluate the
effectiveness of their actions (DeYoung, 2003; Lyons & Milton,
1999).
Origin
◦Historically, chess is believed to be the original war game. In India
Rajas and Nawabas used to play war games in their palaces and
decided the fate of the battles. By 18th century military games
were in use for the analysis of possible real world battle situations.
Purpose
◦To help students practice decision-making and problem-solving
skills and to develop human interaction abilities in a controlled
and safe-setting.
◦By means of active involvement in a simulation exercise, a
game, or a role-playing situation, the student achieves
cognitive, affective and psychomotor outcomes.
◦Students have a chance to apply principles and theories they
have learned and to see how and when these principles work.
Uses
Simulation technique can be used to achieve many learning
objectives.
Simulations can help nursing student gain skill in applying the
nursing process. Eg: They can practice gathering and analyzing
data, setting priorities, sending and evaluating outcomes.
Learn to solve problems efficiently with minimal wasting of time
and resources.
◦In the acquisition of communication skills. Eg: Students can
put themselves in the shoes of others (patients, families, co-
workers, supervisors, physicians) and learn something.
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About these people’s feelings and how to interact effectively

with them. They get immediate feedback about how they affect
other people learning communication.
Simulation is also an avenue for attitude change. Eg: Discover
of factors about certain people and situations that they never
realized before and that will change their attitudes in the future,
and this can lead to more productive and acceptable behavior.
◦ Decision-making skills can be fostered via simulation. Eg: The
results are undesirable; they can backtrack and look at the
factors that led them to a poor decision. The instructor and
classmates (if a group is involved) can help the student gain
insight in to why a decision was effective.
.
Simulation technique can be applied to the learning of
psychomotor skills. Eg: When students practice skills in a
college laboratory using mannequins and hospital-type
equipment, they are involved in a patient care simulation.
◦ Used to evaluate the student learning and competence. Eg:
Written exams have been developed in a simulation format to
test the application of knowledge.
Principles
1. Players take on roles, which are representatives or the real
world and then make decisions in response to their assessment
of the setting in which they find themselves.

2. The experiences simulated are consequences, which

simulated their decisions and their general performance.

3. The ‘monitor’ the results of their action are brought to reflect

upon the relationship between their own decisions and the
resultant consequences.
Steps in simulation
There is no hierarchy of following rigid steps in simulated
techniques in classroom learning. Ned Flanders has recommended
the following procedural steps in simulated teaching.
Step 1: First of all the teacher must assign letter (A,B,C)
designation to all the members of the group and develop a system
of rotating the role assignment by letters so that each individual
has the opportunity to participate and as a chance to be actor, foil
and observer.
◦Step-2: It includes planning, preparation and deciding the topic
of the skill to be practiced through simulated technique. The
teacher should carefully and intelligently select and appropriate
topic for each actor according to his knowledge and interest in
the subject.
.

Step 3: The teacher should decide in advance as regards the

name of the member of the group Who will start conversation. A
detailed schedule for actor interaction should be drawn.
◦Step 4: The teacher should decide the procedure of evaluation
and decide on what kind of data the observers are record and
who their data and opinions can best be presented to the actor
when the interactions stops.
◦Step 5: Conduct the first practice session on a topic or skill you
decide. Provide the actor with feedback on his performance
and be prepared, if necessary, to alter the procedure for the
second in order to improve the training procedure. AS soon as
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the practice sessions are working smoothly and each person
has opportunity to be actor, increase the difficulty of the task by
privately instructing the foils or restricting the instructor’s role.
Step 6: This is the last step in simulation. Now the teacher
should be prepared to alert the procedure, change topic and
move on the next skill so as to prevent a significant challenge
to each actor and to keep interest as high as possible. The task
should be neither high nor too easy for the participants.
Role of the teacher
It includes
1. Planning
2. Facilitating
3. Debriefing

1. Planning
Planning begins with choosing or developing and appropriate
simulation that will meet course objectives. Assign some
reading for the student to do before class. Textbooks or library
resources should be pointed out to students so that they can
prepare for the simulation.
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Teacher is responsible for preparing environment, it includes

arrangements of chairs and tables, ventilations, lighting.

2. Facilitating
Teacher should function as a facilitator during the actual
process of the simulation. After introducing the activity
you may take a backseat and talk relatively little.
You must coach students who are trying to find their
way through a sticky problem and encourage creative
thinking and act as an information resource.
Take notes during the class so that in later discussion
you can refer back to specific strengths and weaknesses
of the process.
 .Debriefing
3.

Your role is the final discussion or debriefing session.

Immediately following the simulation when the
information is fresh in everyone’s mind. You should
briefly summarize what has taken place. Self-analysis
can help students gain insight into why they made
certain decisions or took a specific course of action. In
simulations where emotions have run high, ventilation
of feelings should be part of the debriefing.
At the end of the discussion period you should point out
how principles and concepts have been applied and how
the experience ties in to the learning objectives.
Types
Written simulation
2. Audiovisual simulation
1. 3. Live stimulated simulations

1. Written simulation
Individual uses either paper and pencil latent image
format.
Purposes:
• Problem solving
• Decision making.
• To evaluate student’s ability to apply the
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2. Audiovisual simulations

An entire simulation can be placed on videotape.

Management vignettes can be dramatized and filmed.
Questions can be posed for the viewers right on the screen,
and the alternative outcomes, dependent on which
approaches to a solution are chosen, can be all taped.
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3. Live stimulated simulations

Lincoln, Layton and Holdmen (1978) described their

experiences with simulated patients. The patients were
healthy people, usually students, who were trained in the
role they were to play. Simulated patient used their own
history as much as possible but memorized and added the
elements of the history that had been created for the
simulation. Nursing students found the experience to be
beneficial. They would be much more relax and confident
when meeting their first real patient.
Types of simulation
equipment
Many types of simulation equipment are available to nurse
educators. Models range from equipment that teaches a simple,
single skill (e.g. Inserting an intravenous access into an arm
assessing vital signs, such as heart, lung, and bowel sounds) to
very advanced, realistic equipment that can simulate reality-
based scenarios in a clinical setting, such as an intensive care
unit. Fletcher (1995) described the term “fidelity” as the degree
of accuracy depicted by the simulation, compared to the real
experience. Whereas static or low fidelity models are useful for
practice and testing of specific skills, high-fidelity models
challenge students to make clinical decisions based on data
obtained from assessments and interventions.
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The word fidelity is often used in the simulation domain to describe the
accuracy of the system being used. Fidelity is defined as “precision of
reproduction” the extent to which an electronic device, for example, a
stereo system or television, accurately reproduces sound or images.

1.Low-Fidelity Simulators

Low-fidelity simulators are often less in detail and vitality of a

living situation. In introducing and practicing psycho-motor
skill, they generally lack the realism. A good example of a low
simulator would be a foam intramuscular injection lator.
Administering injections not only requires technology skill but
also relies heavily on interpersonal skills, which are difficult to
demonstrate with a foam model.
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2. Moderate-Fidelity Simulators
A moderate-fidelity simulator offers more realism than a
static, low-fidelity model. They offer breath sounds, heart
sounds, and pulse but may lack corresponding chest
movement or functional eyes, which one would expect in a
high-fidelity simulator.

3. High-Fidelity Simulators
High-fidelity simulators produce the most realistic simulated patient
experiences.High-fidelity models are often life-size mannequins
with features such as palpable pulses, visible respirations,
measurable blood pressure and pulse oximetry, vocal sounds, open
orifices, and minimal movement, all programmed by computer.
Conclusion

Simulator based learning moves the risk and negates the

effect of adverse outcomes. In the area of medicine,
procedures that results in undesirable consequences are
damaging, not only to the patient, but also to the practitioner
in the forms of a damaged reputation and litigation and to the
hospital on terms of the costs of extended patient stays and
treatment. Hence simulation plays a vital role in achieving
desired skills.
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Thank you