Page 139 - Journal of Special Operations Medicine - Winter 2015

from the
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”The Ground Truth”
training (LTT). Each of these has a dif-
I do not have a crystal ball, but I see ferent role in training, and the best use
your future; it involves training and of them is most likely in a blended
testing using medical simulation. This SGM F. Bowling model that plays to the strengths of
has already been going on for several 18D, ATP each one.
decades, but I expect to see some great
advances in the quality of simulation USSOCOM Novice learners should begin with ru-
we use and how we use it. I believe Senior Enlisted Medical Advisor dimentary simulators in a stress-free,
there are some general principles to task-focused environment. We should
follow when it comes to simulations. then gradually introduce the learner to more high-
fidelity simulators in scenario-based training in a gradu-
First, if you are not taking care of a casualty in combat, ally more stressful environment. Careful analysis should
it is simulation. be used to select the right simulator or blend of simula-
tors to use for a given training iteration.
Second, the goal of simulation is to emulate combat ca-
sualty care in realistic environments and tactical situa- When it comes to simulation, the word “fidelity” is of-
tions to evoke an emotive training experience in order ten mentioned. What is fidelity? In the fields of scientific
to refine coping strategies and maintain proficiency be- modeling and simulation:
tween combat engagements.
Fidelity refers to the degree to which a model or simula-
Third, simulation is used for stress inoculation training, tion reproduces the state and behavior of a real world
or training within environments that have high cogni- object, feature or condition. Fidelity is therefore a mea-
tive and stress load. Training should engage the opera- sure of the realism of a model or simulation. 1
tor and allow him/her to develop muscle memory and
engage coping strategies. When under stress, what do The degree of fidelity may not need to be very high in
we fall back to? We execute what is in our “muscle most circumstances. For example, a simple upper torso
memory”—thus, the need for repetition. Unless we are manikin is adequate for teaching CPR. Therefore, for
able to maintain the ability for critical thinking, we are simple tasks and novice individuals, fidelity can be low.
most likely to execute according to muscle memory or However, for more highly trained individuals practic-
training. ing difficult or complicated tasks, the fidelity should
be higher. This is because a more difficult task requires
Practicing coping strategies within an emotively stress- higher fidelity for more realism to add to the stress and
ful environment better allows us to maintain the abil- cognitive load. This is to ensure the simulation matches
ity to reason critically in a stressful environment with a the cognitive load and stress found in the real world and
burdensome, high cognitive load. Examples of coping because a more highly trained individual is expected to
strategies are self-talk checklists, deep breathing, and handle a higher cognitive load and a more stressful en-
following algorithms. vironment. How do we measure fidelity? I believe that
in the realm of medical simulation, fidelity is best mea-
There are several different types of simulators and each sured by end-user feedback.
has pros and cons. Some of the different types of simula-
tion are virtual reality, augmented reality, gaming, task Some qualities of fidelity such as tissue fidelity, hap-
trainers, role players, manikins, cadavers, and live- tissue tic feedback, and physiological engine response are

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