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(Simulation in Healthcare, 2007, 2, p. 274)

Simulator Fidelity is not a Predictor of

Effective Resuscitation Teamwork


David L Rodgers1; Rudy D Pauley1; Barbara R McKee2; David J Matics2; Louis. E Robinson2

1 Marshall University Graduate School of Education and Professional Development, South Charleston, WV
2 CAMC Health Education and Research Institute, Charleston, WV

Introduction – Within simulation there are many forms of fidelity. Equipment fidelity pertains to the realism of the manikin being used. Psychological fidelity refers to the degree the participant feels the situation is real. Environmental fidelity concerns the realism of the teaching space. Task fidelity refers to realism of the task being performed in the simulation. This study examined the impact of equipment or manikin fidelity as a predictor for improved resuscitation team performance.


Methods 34 senior nursing students from four different nursing programs participated in Advanced Cardiovascular Life Support (ACLS) courses. Two ACLS classes were conducted with 16 participants taking ACLS using a high-fidelity patient simulator and 18 participants taking ACLS with the all elements of the course being the same except the simulator was turned off and operated in a low-fidelity mode. Immediately after completing the course, each participant served as team leader for a simulated cardiac arrest event that was video recorded. Each team leader was supported by other participants (6-7 members per team) from the same cohort group. A panel of expert ACLS instructors who did not participate as instructors in the ACLS course reviewed each video and independently scored team and team leader performance in 14 areas related to resuscitation skills including one item that focused on the teams’ teamwork skills and actions using the ACLS course teamwork criteria as a guide to rate team performance. 

Results – Scores on the Likert-like scale of 1 to 7 with 1 being the lowest level of teamwork performance and 7 being the highest level of teamwork performance showed the low-fidelity group had a teamwork score of 4.54 (SD 1.54) and the high-fidelity group had a teamwork score of 5.06 (SD 1.68). Although higher, the high-fidelity score did not reach a level of significance (t = -1.65, p = .102). 

Discussion/conclusions – The fidelity of the manikin being used in this course was not a predictor for significantly improved teamwork performance. This finding reinforces concepts presented in the simulation literature that a successful simulation involves more than just a simulator. Other forms of simulation fidelity in these classes were very high as each class used a realistic looking manikin, a complete array of working medical equipment, team members had specific roles that required interaction with other team members, and each class was conducted in a realistic clinical environment. These findings indicate that manikin fidelity may not be as important in team training as other forms of fidelity.