High-Fidelity Simulation in Nursing Education – A Q&A with a Tech-Savvy Nursing Professor

Published September 1, 2018

3 nursing students with simulation manikin.

1. How long has simulation been used in nursing education? When were computerized patient simulators first used?

Simulation has been used in nursing education for over a hundred years. Nursing faculty have historically used manikins, task trainers and role playing as part of the curriculum. These things in combination with advancing technology have transitioned into the simulation we see today.

The first computerized patient simulator was created in the 1960s. Early computerized patient simulators were very expensive and not widely used. In the early 2000s, fewer than 100 U.S. nursing schools were using computerized patient simulators – today nearly every nursing school uses them.

2. How has the use of computerized patient simulators changed the way nursing instructors approach nursing education?

About Kelly Foltz-Ramos

portrait of Kelly Foltz-Ramos.

Kelly Foltz-Ramos is a nurse practitioner and research assistant professor in the UB School of Nursing. She earned her PhD in curriculum, instruction and the science of learning from the UB Graduate School of Education and is a Certified Simulation Health Educator.


There is a critical need to change the delivery of nursing education because of a shortage of nursing faculty and clinical sites. Simulation, including high fidelity and virtual reality, offers an innovative solution to these problems. High fidelity simulation gives students guaranteed experiences of high-risk, low-occurrence events in a controlled, supportive setting. This is now being used as a portion of clinical hours in many schools to combat the shortage of clinical sites. Virtual reality simulation immerses the student in a realistic situation where they can participate in a scenario with other health care professionals in other locations.

With the cost of virtual reality implementation decreasing, this offers a solution to lack of resources, including both faculty and clinical sites. A 2014 multi-site study by the National Council of State Boards of Nursing showed that nursing schools can replace up to 50 percent of clinical hours with simulation without negatively impacting student outcomes. These results are causing many nursing schools to look closer at how they can better use simulation in the curriculum.

3. How does simulation in nursing education impact the student learning experience and their careers?

Simulation is active, experiential learning, which allows for deeper understanding of the subject matter. In addition, it teaches students how to problem solve. When students encounter a patient situation in clinical, they usually rely on their clinical instructor to help critically think and manage the patient. In simulation, the student is in the driver’s seat making the decisions and learning to manage and prioritize. Simulation has been shown to increase self-confidence in students.

4. How can students effectively translate simulation education to real-life scenarios?

Students and faculty in simulation lab.

An integral aspect of high fidelity simulation is debriefing. Debriefing is the discussion that occurs after a simulation scenario and gives students time to reflect on their own performance. They are facilitated through the process of reviewing the scenario, including what could have been done differently and why. This is where connections are made to what has been learned in the classroom. Students are asked if they have ever encountered a similar patient in the clinical setting. If they have, they share the experience and how it was similar or different. At the end, each student is asked to state a lesson they have learned in the simulation that they will bring with them to the clinical setting. Both of these questions help the students to think about how they will use these lessons in real-life scenarios. Students frequently tell me that they encountered a situation in the hospital and knew what to do because of what they learned in simulation.

5. Tell us about the SON’s new patient simulator, Willy Makit. What features does he have that set him apart from our other manikins?

The biggest difference in the newest simulator is that he is tetherless, so he is not confined to the simulation lab. We can put Willy Makit in a wheelchair or on a stretcher and bring him anywhere on campus. Another new feature is the ability to evaluate the effectiveness of CPR and to provide coaching. Our students are now encountering defibrillators in the hospital setting that have sensors to coach through CPR if the compressions need to be faster or the respirations slower, etc. Our new simulator can do the same thing.