Background and Goal of Study:

Simulation has become integral to the training of both undergraduate medical students and professionals. Due to the increasing degree of realism and range of features, the latest mannequins are referred to as high-fidelity simulators. We assessed whether increased realism leads to a likewise improvement in trainees’ outcome, and the influence on individual confidence and self-assessment.

Materials and Methods:

After institutional ethics board approval, 135 fourth-year medical students were randomly allocated to participate in either a high- or a low-fidelity simulated Advanced Life Support training session. Theoretical knowledge and self-assessment pre- and post-tests were completed. Students’ performance in simulated scenarios was recorded and rated by experts. Test results were analyzed using ANOVA, Chi-Squared test and McNemar’s test, data from video analysis were analyzed with Chi-Squared and t-test.

Results and Discussion:

Participants in both groups showed a significant improvement in theoretical knowledge in the post-test as compared to the pre-test, without significant intergroup differences. Performance, as assessed by video analysis, was overall comparable between groups, but, unexpectedly, the low-fidelity group had significantly better results in several sub-items. Participants of the high-fidelity group considered themselves to be advantaged, solely based on their group allocation, compared with those in the low-fidelity group, at both pre- and post-self-assessments. Self-rated assessment of their individual performance was also significantly overrated. Although current literature is controversial, several studies indicate high-fidelity simulation may favor emotional bias and positive expectations regarding the simulation tool.

Conclusion(s):

The use of high-fidelity simulation led to equal or even worse performance and growth in knowledge as compared to low-fidelity simulation, while also inducing undesirable effects such as overrating of the individual performance that happened significantly more often in the high-fidelity group. Hence, in this study, high-fidelity was not beneficial compared to low-fidelity, but rather proved to be an adverse learning tool in this scenario.

04 / High-fidelity is not superior to low-fidelity medical simulation and leads to overconfidence in medical students