| Advantages |
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| Safety and error management |
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Provision of a safe environment for training that does not expose patients or trainees to risk3,5,17,18,19
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| Planning training |
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Simulator based clinical training can be planned and designated with predesigned clinical encounters within a systematic curriculum rather than relying on random case availability3,5,19
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| Teamwork and behavioural skills |
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Multidisciplinary team training and specific behavioural skills can be taught using simulated environments5,19,20
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| Analysis of training |
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The component parts of learning a skill can be analysed by trainees and trainers. A simulation can be frozen to allow discussion, and then repeated or alternative techniques demonstrated17,18,21
|
| Rare event training |
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Unlimited exposure to uncommon but critical or fatal events that require a rapid clinical response. Crisis intervention skills can also be taught9,11,17,18,19,22,23,24
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| Technology |
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New technology can be tested and learnt how to be used without affecting patient safety. Over‐reliance on technology as a substitute for clinical examination can be taught17,21
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| Educational theory |
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Simulation training is compatible with Kolb's theory of experiential learning and allows the opportunity for reflection in a structured environment. It also focuses on learner centred training11,17,25,26
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| Disadvantages |
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| Cost |
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High capital costs. Cost benefits are indirect, intangible, and long term5
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| Infrastructure |
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Lack of trainers and curricula5
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| Technical difficulties |
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Difficulty in evaluating some findings in physical examination, for example, patient skin colour17,21
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Computer anomalies affecting scenario programming27
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| Attitude of learners |
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Participants will always approach a simulator differently to real life. Two common changes in attitude can occur: (a) hypervigilance, which causes excessive concern because one knows an event is about to occur; and (b) cavalier behaviour, which occurs because it is clear no human life is at stake. These effects may co exist and counterbalance17,28
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| Evidence |
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There is a limited amount of good quality evidence on the effect of simulation based training18
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