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Fidelity for Dummies

Fidelity for Dummies….This is an introduction post for those of you naive to the world of mannequins and fidelity. For those of us absorbed into this alternate universe these phrases and their meaning are part of our local language.

However it has become apparent to me that not everyone is as into mannequins as I am – *shrug* go figure…. and therefore I thought I would go through some definitions of mannequin terms so that you all stop thinking I am talking about world peace negotiations when I write confederates into a scenario.

Before we get too far into this post we need to talk about fidelity.  What is fidelity? Well the oxford dictionary defines it as

  1. Sexual faithfulness to a spouse of partner
  2. The degree of exactness with which something is copied or reproduced.

Now when I am talking about Simulation fidelity I am talking about the second definition (no wonder I get so many funny looks – thus this post).  But in simulation fidelity many people think fidelity relates only to mannequins and how technical they are.  The truth of the matter is, a bit like children being a combination of nature and nurture, simulation fidelity is a combination of the technical fidelity (or likeness to a real functioning body) and the environmental fidelity (how real the environment looks, how convincing the confederates (see later) are in their roles in the scenario, how they are interacting with the mannequin and bringing it and the scenario to life)

Mannequins

Now the first rule about mannequins is that you must never call them Dummies.  The best way to offend your simulation educator is to refer to them as The Dummy (cringe). They are mannequins or mannikins (if you are american) and in scenarios they have names and if you are terrible with names you call them sir or mam or mate or whatever term you use on your patients when you forget their name. NOT DUMMIES

Broad Types of mannequins (look at the websites for the main mannequin manufacturers for a complete list of features. eg Laerdal, METI (CAE healthcare) and Gaumard)

This is an oversimplification but the broad categories and an idea of the type of features are as follows

  • Low fidelity mannequins – You can identify these by the fact that they are not very sophisticated and may be missing body parts (eg arms and legs ….this one appeared in the ACEM OSCE exam recently). They are often called Part Task trainers or simple CPR mannequins.  From the outside they may look like a whole body or a part of a body (with or without skin eg head with just lungs, face and then larynx – thus the name ‘Part task trainer”) They are designed to do a certain task very well – eg CPR or IV insertion therefore they will have good anatomy and functionality for that task.  They may not have many other functions (eg breathe for themselves) but a bit like your older cars – that means there is less to break and go wrong.  They can be used in immersive scenarios where the environmental fidelity makes up for the technical fidelity (see earlier).  They can also be strapped onto simulated patients or other mannequins to allow procedures to be done
  • Mid fidelity mannequins – these guys step up a level.  They usually have all of their limbs, look like a human (though maybe not any human you have yet met or in fact want to meet) and can do some cool stuff.  They have minimal computer components inside but still enough to do things like have breath sounds, heart sounds and sometimes pulses (and enough for their price tag to still be in the many thousands).  When you bag them their lungs inflate (though they may not breathe spontaneously).  They may make noise or talk or can be combined with speaker headset systems by clever people to make them talk .  You can do lots of things to them although they are all a little bit different (that’s marketing for you) and you will need to be “familiarised” to the mannequin prior to starting a scenario so you know it’s function eg can you defibrillate it, can you intubate it etc.  Other information in scenarios using these mannequins can be got from the confederates/santa etc
  • High fidelity mannequins – these big boys have quite complex internal functioning.  Some are wireless although not all and they are relatively heavy and technical to fix….and uber expensive.  They can do a huge number of funky things – blow pneumothoraces that require draining, dilate their pupils, develop laryngeal oedema – the list is endless.  With these mannequins you should default to getting the information from the mannequin rather than asking the confederates as most of the time you will be directed to find it out yourself or told “as you see it” by the voice of santa/big brother

Definitions of words if used in a simulation 

Whilst these terms have other meanings if used in a simulation or a scenario this is what they mean

Confederate: a confederate is someone who is embedded (ie stuck) in the scenario to either help or hinder (or both).  They may also be called a role player/actor.  They are not a participant and they have a role written into the scenario.  This may be the mother of the patient who will become distressed, the relative that has helpful information to provide, the resus nurse who knows where everything is and can act as “medium” between you and the patient or the treating clinician that comes to challenge your management.  All of these roles have a script as to how they should respond and what information they can provide during the scenario. Very much like an actor’s script they will have a back story for themselves and also for the patient.

Santa: Also called Big Brother, Easter Bunny etc this is the ethereal voice from above that (sometimes) provides you with information that you cannot obtain from the mannequin.  This guys only really functions in the sim lab.  In good scenarios the use of santa is kept to a minimum and as much information as possible is gained from within the scenario to ensure the participants stay immersed.  If you can’t obtain information you “ask santa” which involves staring stupidly at the ceiling and asking your question.  (actually the staring at the ceiling bit is unnecessary but we all seem to do it)  If the information is available in front of you you will get a “as you see it” response.  If it is not you will get your answer or will be directed how to get it eg ring sim switch and ask for it etc.  Out of the sim lab this role may be provided by the person running the scenario eg in scenarios in the Alphabet courses where the scenario runs more like a conversation with the facilitator

Sim Switch: Making referrals, ringing for blood test results, contacting family members all happens through sim switch (again predominantly in the sim lab although the recent ACEM OSCE exam simulated this function by having a conversation on two phones back to back in the same room – might be something to practice so it doesn’t feel too weird). Just make sure you don’t ring the real switch and call for help or you may have the cavalry descend on your simulation as happened in our lab….

Familiarisation: This is a fancy name for taking you through the mannequin do’s and dont’s and features prior to you participating in a scenario so that you can really throw yourself into it.

Facilitator: this is the person running the scenario either from the control room behind the double sided glass or from behind the sim pad or scenario run sheet.

Simulated Patient: different to a confederate a simulated patient actually replaces the mannequin in the scenario.  The advantages are you can actually talk to them and examine them and they may have some signs that they can either fake or demonstrate.  The disadvantages is they won’t generally allow you to do invasive procedures on them (in most cases) although a part task trainer may be strapped to them for an IV for example and you can use a simulated monitor to defibrillate without actually discharging etc.

Scenario: This is the case that is being played out in order for participants to test their knowledge and skills and identify areas to improve and stimulate reflective practice.

Immersive: there are other types of scenarios but immersive is the one where you are basically thrown in (after a bit of an intro and familiarisation hopefully) and you do what you do according to the scenario without too much external direction

Debrief: this is where the real learning happens, we all sit in a room and discuss what went well and what we would like to improve.  Again there are many ways that this may be done and all have value but this is the real opportunity for challenging what makes us do things the way we do it and seek areas that need change to improve our future practice.

Ok that about does it for now.  Obviously other people might have other terms but in our courses this is what you may encounter….hopefully I get a few less blank looks.