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“The function of education is to teach one to think intensively and to think critically. Intelligence plus character—that is the goal of true education.”

-Martin Luther King, Jr.


  • Describe the levels and types of fidelity for an effective simulation environment.

  • Identify key elements required for an effective simulation environment.

  • Articulate how to identify what type and level of fidelity is required based on the objectives of the simulation.

  • Synthesize at least two strategies that can be incorporated into a simulation practice.

Simulation can be used in all areas in which patient care is performed or in which educating healthcare providers occurs. In clinical practice environments, simulation can be used in the hiring and onboarding process to evaluate critical thinking and practice, for competency evaluations of experienced healthcare providers, and for testing new procedures and practice sites. In academia, simulation can be used to educate students and clinical faculty or to develop faculty expertise in teaching techniques and strategies.

Simulation is a teaching strategy, not just a technology. The National Council of State Boards of Nursing (NCSBN) conducted a national, longitudinal, randomized controlled study replacing clinical hours with simulation in pre-licensure nursing education at 10 schools of nursing (Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, 2014). The study compared a control group in which 10% of clinical time was replaced with simulation with two groups in which 25% and 50% of clinical time was replaced with simulation. Results revealed no statistical differences in the Assessment Technologies Institute Comprehensive Predictor scores, the New Graduate Nurse Performance Survey, the Critical Thinking Diagnostic Scale, or the Global Assessment of Clinical Competency and Readiness for Practice. Therefore, it was determined that simulation can be a substitute for clinical time—if it incorporates International Nursing Association for Clinical Simulation and Learning (INACSL) standards (Hayden et al., 2014).

After the publication of this survey, a group of experts developed NCSBN simulation guidelines (Alexander et al., 2015). These guidelines include a commitment from nursing schools to support the program, have appropriate facilities to conduct simulation, have educational and technical resources and equipment to meet the objectives, have personnel who are qualified and educated to conduct simulation, and have policies and procedures as part of the simulation program. Before conducting simulations, faculty members should be educated on the INACSL standards, simulations based on educational theory (to facilitate the development of clear objectives to be achieved in the simulation), creating a learning environment, facilitation and debriefing methods, evaluating all aspects of the simulation, and providing professional development in using effective simulation.

The environment in which the simulation occurs is critical to the success of the simulation experience. Effective simulation environments require several key elements:

  • Planning that includes clear objectives, evidence-based scenarios, and an evaluation plan

  • Educators who are experienced in simulation and grounded in the INACSL standards

  • Debriefers who ...

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