A DESIGN BASED APPROACH TO SIMULATION FOR TRAINING, ASSESSMENT & RESEARCH

The goal of the research is to determine what constitutes effective simulation design and how this influences training, assessment and research at the individual, team and organisational level in order to address core challenges in acute healthcare. Effective design of simulated learning environments, and simulations, is essential if simulation is to be valuable as a tool for research and safety improvement in the clinical environment. The research comprises a narrative review of the literature on the ‘discourse of fidelity’ including types, limitations, benefits, and current controversies, a set of qualitative studies exploring 1) how individuals construct meaning from simulation, 2) how the perception of realism varies by participant (observer vs. participant, role, experience), and 3) the relative importance of different aspects of fidelity (task, environment, equipment, psychological) to learners, and then 4) a design methodology for simulation including a tool to assess fitness for purpose, and a worked example to demonstrate how well designed simulations can be used to interrogate a clinical environment, and 5) a fourth study in which simulation is used for the iterative test and re-design of a clinical artefact. Understanding gained from the thesis as a whole will help guide more informed allocation of resources in simulation