As simulation becomes an accepted part of everyday education and training for health professionals, attention is being paid to how simulation can best be used to develop technical and non-technical skills. Simulation appears to work most effectively when it is designed to meet curricular outcomes, includes realistic and relevant content, interesting and engaging learning methods and prepares learners for working in the clinical context in terms of activities, skills and competencies (Issenberg et al, 2005). Table 2 lists the best practice features of simulation as identified in two systematic literature reviews.
Simulation helps skills acquisition, maintenance and assessment in the move from ‘novice to expert’ (Dreyfus and Dreyfus, 1985). The key element here is building simulation activities into learners’ progression (Figures 1 and 2). For example medical students must practice and master the skills and pass an assessment before embarking on clinical rotations or trainees might have to provide evidence of competence in a simulator before interacting with patients. Learners can therefore have their first encounter with patients at a higher level of technical and clinical proficiency, which protects patients (Ziv et al, 2003).