The Society for Simulation in Healthcare is a healthcare simulation organization that was designed to improve performance and reduce errors in patient care through the use of simulation. To help simulationists and learners worldwide become able to better identify clinical simulation terms, the organization created a healthcare simulation dictionary and released updated versions to meet the needs of the medical simulation community. The second edition (2.1) is currently available and helps enhance communication and clarity for healthcare simulationists in teaching, education, assessment, research, and systems integration activities.
The definitions featured within the Healthcare Simulation Dictionary are part of a collection that shows how various terms -and their meanings are being used in the profession today. Ultimately, this second edition expands on the 127 words of the first edition and includes a section on common abbreviations where 27 abbreviations were included. The simulation dictionary also features 40 new terms that have been added that were not in the first edition, and 12 terms that were expanded upon with additional definitions as reflected in the literature.
Further, the terminology defined within this literature is meant to help support the correct choice of language when a healthcare simulation educator is conducting distance, remote, and telesimulations. The dictionary has also been translated into several other languages including German, Turkish, Hebrew, Brazilian Portuguese, and more. Below are some of the Healthcare Simulation Dictionary definitions that are extremely relevant to the clinical simulation community.
Artificial Intelligence (AI): A system of computerized data-gathering and prediction that models human behavior and decision-making with minimal human intervention. In healthcare simulation, AI often refers to underlying programming that provides physiological or system-based algorithm changes based on inputs from users and learners. Often paired with machine learning, in which the software is programmed to alter algorithms and predictions based on observed data and results without human intervention. Virtual patients use artificial intelligence to react appropriately to the user or learner. (Bennett and Hauser, 2013)
Augmented Reality: 1) A type of virtual reality in which synthetic stimuli are superimposed on real-world objects, usually to make information that is otherwise imperceptible to human senses perceptible (M&S Glossary). 2) A technology that overlays digital computer-generated information on objects or places in the real world for the purpose of enhancing the user experience. 3) The combination of reality and overlay of digital information is designed to enhance the learning process. 4) A spectrum of mixed-reality simulation that is partway between the real world and the virtual world. 5) A form of virtual reality that includes head-mounted displays, overlays of computer screens, wearable computers, or displays projected onto humans and manikins (D.R. Berryman et al; M. Bajura et al; H. Fuchs et al).
Debriefer: 1) The individual who facilitates a debriefing session and is knowledgeable and skilled in performing appropriate, structured, and psychologically safe debriefing sessions (Fanning & Gaba, 2007). 2) The person who leads participants through the debriefing. Debriefing by competent instructors and subject matter experts is considered important to maximize the opportunities arising from simulation. (Raemer et al, 2011)
Manikin: 1) A life-sized human-like simulator representing a patient for health care simulation and education (Palaganas, Maxworthy, Epps, & Mancini, 2015). 2) Full or partial body representation of a patient for practice. 3) Full or partial body simulators that can have varying levels of physiologic function and fidelity.
Mixed Reality: 1) A category that encompasses the hybrid combination of virtual reality environments and reality (e.g., real environment, standardized patient, normal manikin simulator). Often encompasses the definition of Augmented Reality (AR), but has more virtual features than typical AR. The blend of what is physically present to what is 100% computer-generated is expressed in this continuum: Reality——— Augmented Reality——— Mixed Reality——— Virtual Reality (Hsieh and Lee, 2017). 2) A simulator that combines virtual and physical components (Robinson et al, 2014).
Patient Simulator: 1) Life-like, anatomically correct, computer-driven manikin with physiologic responses that mimic real patients (Ober, 2009). 2) High- or low-fidelity full-body manikins controlled by instructors to create a structured learning environment in a clinically realistic setting where learning can take precedence over patient care (Good, 2003). Ed note: while these definitions are manikin-oriented, the reader should consider other simulators as meeting the concepts of these definitions.
Prebrief: 1) An information or orientation session held prior to the start of a simulation activity in which instructions or preparatory information is given to the participants. The purpose of the prebriefing is to set the stage for a scenario and assist participants in achieving scenario objectives. 2) The time used by educators, researchers, facilitators, or staff to plan their roles prior to the simulation. Suggested activities in prebriefing include an orientation to the equipment, environment, manikin, roles, time allotment, objectives, and patient situation. For example: Before starting the simulation session, there is a prebriefing where the equipment and its capabilities are reviewed and they are reminded of the equipment available to them in the room (INACSL, 2013). 3) The collaboration and planning of co-facilitators/co-debriefers prior to the simulation activity.
Remote Simulation: Simulation performed with either the facilitator, learners, or both in an offsite location separate from other members to complete educational or assessment activities (Laurent et al., 2014; Shao et al., 2018). Facilitation and assessment can be performed either synchronously or asynchronously using video or web conferencing tools.
Serious Games:
Simulator: 1) A setting, device, computer program, or system that performs simulation (Hancock et al, 2008). 2) Any object or representation used during training or assessment that behaves or operates like a given system and responds to the user’s actions (SSH). 3) A device that duplicates the essential features of a task situation. A simulator generally has three elements – a modeled process that represents, emulates, or otherwise simulates a real-world system; a control system; and a human-machine interface that is representative of the inputs found in the real-world system (Australian Department of Defense). Examples include manikins and part-task trainers.
Standardized Patient: A person who has been carefully coached to simulate an actual patient so accurately that the simulation cannot be detected by a skilled clinician. In performing the simulation, the SP presents the gestalt of the patient being simulated; not just the history, but the body language, the physical findings, and the emotional and personality characteristics as well (Barrows, 1993). 1) An individual trained to portray a patient with a specific condition in a realistic, standardized, and repeatable way and where portrayal/presentation varies based only on learner performance; this strict standardization of performance in a simulated session is what can distinguish standardized patients from simulated patients. 2) SPs can be used for teaching and assessment of learners, including but not limited to history/consultation, physical examination, and other clinical skills in simulated clinical environments Association of Standardized Patient Educators (ASPE). SPs can also be used to give feedback and evaluate learner performance (ASPE). 3) An individual who is trained to portray a real patient in order to simulate a set of symptoms or problems used for healthcare education, evaluation, and research (SSH). 4) More commonly used in the USA and Canada in large part because SPs participate in high-stakes assessments in which SP responses to the learner were standardized. In recent years as SPs have been included in more formative teaching scenarios, their meaning has become interchangeable with the term simulated patient.
Telesimulation: 1) “A telesimulation platform utilizes communications technology to provide mannequin-based simulation education between learners and instructors located remotely from one another. Specifically, the instructor controls the mannequin and moderates the debriefing remotely. During these sessions, the instructor observes the learners in real-time and provides immediate feedback during the debriefing. This platform obviates the need to have instructors, learners, and mannequins in the same place at the same time, potentially allowing simulationbased educational sessions to occur with greater frequency for institutions not located proximate to formal simulation centers. Additionally, the telesimulation platform enables an experienced simulation instructor to observe and directly help new simulation instructors at remote simulation locations. Readily available Webconferencing, screen-sharing software, microphones, and webcams make telesimulation possible. Mannequin-based telesimulation is relatively new and not well represented in the literature, but could facilitate systems changes, providing educational experiences to healthcare professionals in locations not currently benefiting from mannequin-based simulation opportunities. Several research questions need to be addressed in future studies to better develop this educational approach, including technical feasibility, logistic issues, a comparison of telesimulation to other simulation approaches, and assessing limitations of the telesimulation platform” (Hayden et al., 2018, p. 144). 2) “Telesimulation (TS) is a novel concept that uses the internet to link simulators between an instructor and a trainee in different locations” (Okrainec et al., 2010, p. 417). “Telesimulation uses the Internet to link simulators between an instructor and trainee in different locations” (Okrainec et al., 2010, p. 417). “Using two simulators, multiple computers, a series of webcams, and basic video conferencing software, the instructor and trainee can see within each other’s simulators as well as see and speak to each other” (Okrainec et al., 2010, p. 418). Telesimulation differs from “telementoring or teleconferencing because it actually connects two simulators in different physical locations,” allowing teacher and student to see, but not control, what the other is doing in real-time (Okrainec et al., 2010, p. 418). “Telesimulation is a novel, practical, inexpensive, effective, and well-received method for teaching appropriate procedural skills” (Mikrogianakis et al., 2011, p. 427).
Virtual Patient: 1) A representation of an actual patient. Virtual patients can take many forms such as software-based physiological simulators, simulated patients, physical manikins, and simulators, (Ellaway, Poulton, Fors et al., 2008). 2) A computer program that simulates real-life clinical scenarios in which the learner acts as a health care provider obtaining a history and physical exam, and making diagnostic and therapeutic decisions (ASSH).
If you know of healthcare simulation terms that you believe should be added to the Healthcare Simulation Dictionary or a term that you believe should be reviewed, submit your feedback here. View the full Society for Simulation in Healthcare Dictionary on the organization’s website.
Disclaimers: The content included in the Dictionary may contain inaccuracies or typographical errors. SSH makes no warranties about the accuracy, reliability, completeness, or timeliness of the content of the Dictionary, and disclaims all warranties to the fullest extent permitted by law. In no event shall SSH, any organization who provided input to the Dictionary, or any individual in the working group be liable for any damages resulting from the use or inability to use the Dictionary.
Translations of the Dictionary are prepared by volunteer translators. While any reasonable efforts are made to provide accurate translations, portions may be incorrect. No liability is assumed by SSH for any errors, omissions, or ambiguities in the translations provided. Any person or entity that relies on translated content does so at their own risk. SSH shall not be liable for any losses caused by reliance on the accuracy, reliability, or timeliness of translated information.
