The Healthcare Simulation Dictionary has now been available for almost a decade; the first edition was made available in 2016 through a partnership with the Agency for Healthcare Research and Quality (AHRQ). A second edition expanded on the 127 defined terms and added an additional 40. This publication has been translated into 10 different languages (Version Two, five languages; Version One, five languages), which speaks to the global effort for nomenclature unambiguity in healthcare simulation. To the IMSH 2025 attendees’ delight, a printed copy of the Healthcare Simulation Dictionary Version 3 was in their IMSH 2025 bag. With any luck, this inclusion will improve the awareness of the existence of a reference and drive increased use of the Healthcare Simulation Dictionary. This HealthySimulation.com article by Jill Sanko, PhD, MS, APRN, CHSE-A, FSSH, will review the Healthcare Simulation Dictionary and the importance of simulation professionals to utilize this valuable tool.
History of the Healthcare Simulation Dictionary
According to the dictionary’s website, the Healthcare Simulation Dictionary was designed “to enhance communication and clarity for healthcare simulationists in teaching, education, assessment, research, and systems integration activities.” To some degree, the goal of having definitional term clarity was aided by the publication of the dictionary, yet there is still far too much variability of terms being used when the body of literature is viewed, and collaboration is attempted.
Manikin Versus Mannequin: Or Is There A Better Term?
Over the years there have been many debates and discussions (some contentious) around which term to use for what. Back in 2006, around the time when the Society for Medical Simulation decided to become the Society for Simulation in Healthcare – (to match their journal) an article by Dr. David Gaba titled What’s in a name? A mannequin by any other name would work as well This commentary article aimed to address “what to call the device used to replicate the patient’s body.” The media referred to it as a ‘dummy’, this was not working for the community – for obvious reasons. Thus the French-originating term mannequin was discussed with some historic contextual uses provided, as was the Dutch term mannkin. The article goes on to describe debates among the editorial board around this issue.
Today, the Journal for Simulation in Healthcare notes that the term manikin is to be used when for articles in this publication after a debate about manikin versus mannequin occurred. These dialogues have resulted in consensus in theory, but not practice. A ChatGPT-assisted search noted that more contemporary terms to describe “manikin” include:
- Human Patient Simulators (HPS) – This term is more precise and indicates a greater focus on human-like features and simulation fidelity.
- Medical Simulation Models – This broad term covers a variety of simulation tools, from mannequins to virtual reality environments and standardized patients.
- Patient Simulation Technology – This term emphasizes the technological aspect of the simulators, which are increasingly becoming sophisticated and connected to digital systems.
- High-Fidelity Simulators – This term is used when emphasizing the realism and interactive qualities of modern simulators.
While there are more ‘contemporary terms’ the term mannequin continues to be used, even in the Journal of Simulation in Healthcare. A quick search of just two databases (PubMed and Google Scholar) demonstrates this.
Here are a few examples; a 2018 article titled “Mannequin-Based Telesimulation: Increasing Access to Simulation-Based” is one of the first articles listed via the PubMed database search with a 10-year date constraint. Many other articles are readily found that use the term mannequin in the title or the body of the article. In more than a handful of articles published in the last five years found in a search on PubMed, two new variations of the term terms are noted: high-fidelity mannequin simulation and mannequin-based simulation.
A Google Scholar search of the last five years yielded over 10 pages of articles that used the term mannequin either in the title or article. Moreover, David Gaba’s 2006 argument for the use of the term spelling to be manikin has largely been ignored, There are more recent instances – in the Journal for Simulation in Healthcare where the term is spelled mannequin (shh – don’t tell David Gaba); Here are an additional three referenced articles: (Foronda et al. 2024); (Hayden et al., 2022); (Vida et al., 2021). The fact that even in a journal where a standard has been set, and terminology is still varied portents of a future where we continue to use and produce new terms and never enter into a true consensus among terms used in the field. This has and will continue to impact our field in significant ways.
Distance Simulation and Virtual Simulation
Some recent examples of terminology confusion which subsequently created useful dialogue between two Society for Simulation in Healthcare interest groups, happened in discussions within and among the two groups during their respective meetings at IMSH 2024 and again during planning for a joint webinar to provide concrete examples of how lack of clarity can cause perturbation and slow down work. During a spring call between the leaders of these two groups, a discussion ensued about the similarities and differences between distance-simulation and virtual-simulation.
The idea that these two terms were interchangeable caused confusion regarding the ‘domain’ and purpose of each group. During the spring call (which was to plan for a joint webinar – not to discuss terminology) each group (unbeknownst to the other) made an attempt to understand the use of the terms virtual and distance as related to the work of the respective groups took up a significant portion of time at their face-to-face meetings at the 2024 IMSH. Certainly, this realization prompted some ideas about future joint ventures to address this confusion, but also highlighted the impacts of term-confusion.
The Virtual Simulation Section has the stated mission to “promote the use of serious games and virtual environments in healthcare education.” The Distance Simulation Affinity Group has the aim “to provide a forum for educators to discuss distance simulation education and research.” This provides a context from which to examine the zeitgeist that occurs in the field. The stated missions of these two groups attempt to explain the reason for their existence. For some individuals, the wording makes clear the distinct goals of each entity. However, for many others, confusion around the distinctions abounds and stems from misunderstandings in terminology.
For some the consideration is simple; virtual simulation can be carried out at a distance or in-person whereas distance simulation takes place when the learners are geographically physically spread out. Both can utilize many forms of simulation, which include VR, manikin, tabletop, etc., none of which define the modality. Instead, the focal point that determines the difference is the geographic distance or proximity of the learners and educators. If they are not in the same place, regardless of the modality selected, mannikin, SP, VR, MR, task-trainer, etc, then the term is distance simulation. The Healthcare Simulation Dictionary recently added an addendum that included distance simulation; this may assist the simulation community to understand. Related terms found in the dictionary include remote and telesimulation.
A second noteworthy example comes from the author’s recent work on an umbrella review on in-person simulation outcomes. As part of this work, the authors analyzed over 130 systematic reviews and over 3000 of the source articles for these. This work centered around the impacts of in-person simulation on learning outcomes, but in doing the analysis, the team also paid attention to terminology. A review article has the ability to capture all the terms germane to the topic being studied, which is vital. This can make or break the ability to have a valid and reliable review study. There were many conversations around terms and a copious list of terms searched to ensure we captured all the existing literature on outcomes of in-person simulation.
This work highlighted how much terminology is impacting our field and the ability for us to really understand the body of knowledge that exists. A poignant statement from our results demonstrates this: “Analyses highlighted the need to improve overall research approaches and reduce redundancy, as well as the need to standardize terminology, broaden global diversity, and push for further research funding opportunities to support these efforts.”
The fact that the dictionary exists, terms are defined, and there is still confusion speaks volumes about the issues that permeate our discipline. The examples discussed above highlight just a few terms and the deep confusion/ variability. This confusion exists due to the pervasive incorrect interchangeability of terms found in the literature. As a discipline, healthcare simulation professionals need to decide to pivot and standardize, otherwise we will never reach our collective potential.
Translational Versus Transformational
In a recent HealthySimulation.com article Does Terminology Matter in Healthcare Simulation: Transformational and Translational Simulation?, the clarity needed for terminology was highlighted. In a recent taxonomy review article by Weldon et al. (2024), the authors discovered 68 terms related to transformative simulation. Simulationists need to speak the same language to continue to grow the impact of past patient simulations, including systems, process and quality improvement, human factors, workflow process, and safety threats.
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Healthcare Simulation Dictionary Version 3
The Healthcare Simulation Dictionary Version Three introduced 170 new or revised definitions and over 44 additional simulation-specific terms. The acronym list was expanded.
