Realism in paediatric emergency simulations: A prospective comparison of in situ, low fidelity and centre-based, high fidelity scenarios

Objective
To measure scenario participant and faculty self‐reported realism, engagement and learning for the low fidelity, in situ simulations and compare this to high fidelity, centre‐based simulations.

Methods
A prospective survey of scenario participants and faculty completing in situ and centre‐based paediatric simulations.

Results
There were 382 responses, 276 from scenario participants and 106 from faculty with 241 responses from in situ and 141 from centre‐based simulations. Scenario participant responses showed significantly higher ratings for the centre‐based simulations for respiratory rate (P = 0.007), pulse (P = 0.036), breath sounds (P = 0.002), heart sounds (P < 0.001) and patient noises (P < 0.001). There was a significant difference in overall rating of the scenario reality by scenario participants in favour of the centre‐based simulations (P = 0.005); however, there was no significant difference when rating participant engagement (P = 0.11) and participant learning (P = 0.77). With the centre‐based scenarios, nurses rated the reality of the respiratory rate (P < 0.001), blood pressure (P = 0.016) and abdominal signs (P = 0.003) significantly higher than doctors. Nurses rated the overall reality higher than doctors for the centre simulations (96.8% vs 84.2% rated as realistic, P = 0.041), which was not demonstrated in the in situ scenarios (76.2% vs 73.5%, P = 0.65).

Conclusion
Some aspects of in situ simulations may be less ‘real’ than centre‐based simulations, but there was no significant difference in self‐reported engagement or learning by scenario participants. Low fidelity, in situ simulation provides adequate realism for engagement and learning.