Training Simulators. More Than Just Expensive Toys

Simulation is probably the most powerful of all known training environments. Its diversity of scope, its easy accessibility caused by the explosion of new technologies and its versatility make it a powerful tool for knowledge creation and profit optimization. However, are we using it properly? Are these tools supported by a proper framework and purpose analysis?

At the end of November 2021, the IX SESSEP 2021 Congress (Spanish Society of Clinical Simulation and Patient Safety) was celebrated in Spain. The Congress Organization was kind enough to invite me, along with other colleagues from non-clinical sectors, to take part in a roundtable aimed at sharing experiences in the simulation field across different industries. This event gave me the opportunity to share an enriching space with professionals who also work with simulation environments. It also made me think again about a reality: The simulation associated with training processes to which I was not dedicating the analysis time it deserves.

The ability to recreate physical and chemical phenomena and industrial processes through a computer, no matter how simple or complex the process is, forms the basis of simulation (although we can also think of field simulators, but they are closer to recreation than simulation from a conceptual point of view). To this capability, which has been applied and developed since the middle of the last century, can be added the technological viability of creating a virtual environment, enriching its former value by giving it the physical appearance where these phenomena and processes take place. This brings to the simulation based on mathematical models a dimension of sensory experience with implications that are still unknown, but already perceived (metaverse).

Full-scope simulators, 3D simulators combined with virtual reality, interactive graphic simulators and glass-top simulators refer to the different scopes and different levels of associated investment that this tool potentially possesses. However, in any of these versions, all simulation solutions have a common characteristic: if they lack outline elements, they become, at best, an expensive toy. At worst, a useless and shortly obsolete device unable to keep pace with reality.

Let's review some of those elements, in my opinion essential, whose omission has caused so many simulation initiatives to fail.

The first, especially when talking about process simulation, is to deal with both functional and physical fidelity. Recreating as closely as possible the physical environment in which the processes take place as well as combining this proximity with an accurate response reproduction of the simulated parameters to human input is key for a fluent transfer of the behaviors learned in the simulation environment to the real working environment.

Another significant element is that the training developed using simulation should be strongly oriented to performance improvement. This approach is the reason why investments in simulation have the return, in economic and learning terms, that justifies and makes them possible. To achieve this orientation, there is no other way than to connect in a clear and traceable way those actions performed in the simulator with those performed in the real context through operational procedures. In parallel, this approach requires measuring both the results in simulation and in the real environment to clearly identify where the simulated training is producing the expected effects and where it is not.

Focusing on performance improvement carries the risk of reducing simulation-based training to a simple execution of operational actions in a controlled environment, on the assumption that this leads directly to the learning process.

However, this is not the reality. Simulation-based training is only a part, albeit a powerful one, of training. Its design must consider providing students with knowledge tools that help them to take full advantage of the simulation time and, more crucially, incorporating mechanisms of reflection for the actions developed in the simulator, which effectively produce reasoned learning and not just the mechanical repetition of a sequence of actions. It is the learning process that enables appropriate responses to unexpected situations, rather than those that have been trained for. Knowledge is not only knowing what to do but identifying which processes are activated as a consequence of our know-how.

The more advanced a simulator is, the greater the need to have developed, verified, and tested operational scenarios aimed at providing the exact learning process we are looking for. The improvised proposal of simulation scenarios that have not been previously tested can lead us to dead-end situations that are not possible in reality and that, far from generating the desired learning, produces in the student the feeling that the training is a chaotic process lacking clear objectives and significance for their work reality. In short, it generates rejection of training, under the format of simulation and, by extension, under any other training methodology.

The instructor is another key element of simulation training. A simulator instructor needs some particular skills to contribute to the effectiveness of this method of training. Each of them could be developed at length (how to acquire them and to maintain them, what they contribute) but for reasons of space, I will limit myself to listing just some of them:

• In-depth knowledge of the simulated process and the simulation level of the process.
• Familiarity with the scenario proposed in each simulation session.
• Ability to observe details of the behavior of the students.
• Empathy to understand why such behaviors take place.
• Ability to stimulate and lead the students' reflection based on the experience in the simulator.
• Ability to learn from both mistakes and successes.

Every simulation environment generates parallel learning, not specifically intended, but extremely useful for the best subsequent performance of professionals. The identification and therefore management of emotions that occur in a specific scenario, the importance of coordinated teamwork and interaction with other team members, the frustration management, the application of tools to prevent human error or awareness in the use of personal protective equipment and occupational risk prevention behaviors are some of these learnings. By themselves, they probably do not justify the investment needed for some types of simulators, but, once they are available, it is even possible to design scenarios specifically aimed at these aspects of professional practice.

I would not wish this brief reflection to cause anyone to not consider the idea of using simulation as a training tool because of its difficulty or complexity. Nothing could be so far from my intention. Considering these framework conditions is not difficult and, if they are taken into consideration, the results obtained from simulation applied to training far exceed those to be expected.