Watch a group of four-year-olds in a play kitchen. They negotiate, collaborate and test the rules of their small society. To us, it’s just play. But to the developmental psychologist Jean Piaget, this was the most serious work a child could do – how we first learn to make sense of the world.
What if clinical simulation taps into this very same human instinct?
Step out of the play kitchen and into a clinical simulation centre. The technology can be dazzling, but look closer at what’s really happening. A team navigates a complex scenario, playing roles, communicating and making decisions. This centre is, in essence, a sophisticated playroom for professionals. Both environments share one foundational principle: they are safe spaces to fail.
Building Mental Models Through Experience
Piaget argued that children build mental models, or ‘schemas’, to make sense of things. A child drops a spoon, learns about gravity and builds a schema. In a simulation, a junior doctor treats a deteriorating patient, applies the sepsis protocol and builds a powerful clinical schema. It’s not always about memorising a flowchart from a protocol – it’s about actively constructing knowledge through doing. This is Piaget’s constructivism in action.
When children play, they constantly learn social rules: how to share, how to take turns, what behaviour is acceptable to their peers. Clinical simulation does precisely this, but for the healthcare team. When we examine human factors, we explore the team’s social rules. Communication frameworks like SBAR are not just acronyms and tools, they are the agreed-upon rules of the game that ensure everyone plays their part effectively and safely.
Questioning the Fidelity Obsession
My millennial generation was raised on the idea that higher fidelity always meant better. But looking at the blocky, low-fidelity worlds of Minecraft and Roblox that captivate today’s youth, we must ask: did we confuse realism with value?
Does that simulation scenario require a hyper-realistic manikin with a lifelike bleeding wound? Or, like in Minecraft, is the learning found in the cognitive act of problem-solving and world-building, regardless of visual fidelity? The goal should be to build the clinician’s internal model, not create a perfect external one.
Where Real Learning Happens
The most profound learning happens when things go wrong. When a child’s tower of blocks collapses, they learn about balance and adapt their understanding. In simulation, the debrief after a scenario is where this occurs, where learning from ‘safe failure’ is processed and cemented.
The debrief is the lowest-fidelity part of the entire process. It’s just people in a room, talking. Yet here, not in the scenario itself, the most valuable learning occurs.
Rethinking What Matters
So, does fidelity really matter? Perhaps our obsession with it is a distraction. The real power of simulation may not lie in its ability to replicate reality perfectly, but in its capacity to harness a timeless human process: learning through doing, failing and, most importantly, reflecting together.
The true measure of a simulation is found not in its realism, but in the quality of thinking it provokes and the learning it leaves behind.