There is a bit more to simulation than what was suggested. My only experience was a month elective solely focused on simulation but I was able to observe the inner workings of the simulator group. First, there is a lot of coding and writing up scenarios. If you've never done it before, you'd be surprised at how difficult it can be create a scenario that works in the simulator. I was able to draw from my experiences with real cases but I had to consider all the factors that went into the scenario in order the guide the participants in the correct pathway. Then there is the actual running of the scenario. The behind the scenes can be quite chaotic in a busy scenario that involves multiple people. You have the manage the technicians (or if you are the simulator technician, you have to control the dummy), play out the scenario, cue the actors etc etc. And all of this has to go smoothly! Why? Have you ever SEEN medical professionals during a simulation? Putting aside all the eye rolls and outright defiance of the situation clearly being simulated you have to learn to deal with people who are so afraid of being judged that they argue over every little incident. If things aren't perfect, they toss out any learning opportunities as the simulator "not being real life."
That is probably the simplest part of the simulator; the easiest part to grasp because it is the most obvious. However, how does one keep people coming back to utilize the simulator? Lets face it, if only a few people use the simulator then it is all money down the drain because it is very expensive to upkeep that dummy and to buy all the medical equipment needed for the scenarios. There is a whole business behind the scenes that one is not taught in clinical practice (fund raising, budgeting, advertising etc).
Then there is the whole practice of creating a sustainable learning environment. Have you ever went to a simulator center and they have lots of machines and arcades to help you learn echos and laparoscopic surgeries etc. Surprisingly, those arcades are very much used in the months of July and with outside visitors and rarely touched at other times. Clinicians need scenarios to keep their interests up. This is done by building curriculums. One of my projects during that month was to select a topic and create plan if teaching that topic while keeping in mind my resources and timing I would realistically be able to obtain. I had to make it in such a way that I could target a large scale audience (i.e. 20+ residents) and keep them occupied for the duration that I stated. Not as easy as it looks since you can't really put more than 4-5 people in a simulator room and get them all involved. These large scale sessions take a LOT of time to plan and to execute.
Ok, then there is the whole TEACHING aspect. I may not be the best teacher in the medical world but I am confident I am nowhere near the other end of the spectrum. I have seen and experienced some terrible teachers out there. Some people were just not meant to teach. Also contrary to what another person has thought, a clinician is quite possibly one of the best jobs where one can be both great at the job AND be a great teacher. Having the time to create and run scenarios under the tutelage of good teachers will (hopefully) teach you to become a better one too. One of the biggest concerns voiced by my mentor during that month was that they would never allow anyone (especially new people) to run scenarios without reviewing the plan first. It was absolutely crucial that the creator and executor of scenarios weren't teaching the wrong things and were teaching the wrong way.
Then, moving beyond teaching, there is the debrief. This was one of the hardest parts of simulation for me. How do you sit down a group of medical professionals who just went through an artificial scenario and get them on board with you to get them to learn? How many complaints have I heard in the hospital that everyone was required to go to the simulator for JCAHO mandated simulator training? How often have I heard about how useless simulation was in those conversations? And with all due respect, the ones MOST resistant are the 40+ year olds. So knowing that people come in with those prejudices, how does one give them constructive criticism that they can take away with them and hopefully put into their practice? There are a number of articles out there about debriefing and getting "smart" people to learn. And with debriefings, there truly is a WRONG way to do it. If your participants do not get anything out of their time there, then you have wasted everyone's efforts.
Finally, the last time I will touch on is the amount of research that one can get into with simulation. There are the obvious ones about quality improvement but also ones about the psychology of simulation. One can also utilize their creative side in creating props or simulated disease states (e.x. a pus filled pocket for practicing I&Ds using cardboard, styrofoam, gel, latex gloves and ioban). I was never really into this aspect but I was aware of how much potential there is in this field.
I am only able to touch on a few things but my point is that there is so much more than just "making scenarios." If a center is small and that is mainly how it is used, then fine, one probably doesn't need to do a whole fellowship. But there are large simulator centers out there, actively participating in research, gathering support from the all the hospital departments that require specifically trained people to help further their endeavors. Simulators cost a LOT of money to maintain and they will not be sustainable if there isn't a financial/educational benefit. That is what fellowship can teach you. A year to focus on the lesser known but equally as important aspects of simulation.
