SOCIETY FOR PREHOSPITAL
EDUCATORS IN CANADA

SPEC
Society m. Prehospital
Educators in Canada

High :fidelity simulation in Canadian
paramedic education
Ron Bowles, President
Society for Prehospital Educators in Canada

was developed in cooperation with the Society

In 2011, the Paramedic Association of
Canada (PAC) released the second iteration of the National Occupational Competency Profile for Paramedics (NOCP), which
contained changes to the overall competency
structure (adding a new section) and many of
its competencies. In addition, a new appendix allowed educational programs to use high
fidelity simulation (HFS) to supplement the
assessment of selected competencies in the

for Prehospital Educators in Canada (SPEC).
SPEC is currently consulting with PAC
and CMA to refine the policy and develop
resources for its implementation. Programs
may to use HFS to obtain up to 10 per cent
of clinical and practicum competencies after a
student has completed a full practicum.
The structure of the NOCP assumes that
effective learning involves the progressive
development of skills, knowledge and attitudes
across a series of performance domains:

Paramedic education. programs, like other
high-risk disciplines, make extensive use of
simulation. The NOCP specifies over 150
specific PCP competencies that must be
demonstrated in simulation. Of these, 16
must be. further demonstrated in the clinical and 76 in the practicum setting. Simulation encompasses a wide range of learning
activities, including skill stations {mastering
psychomotor skills such as drug administration), role plays {e.g. pi:acticing communication
skills), drills (for example, primary survey that
integrates assessment with airway procedures},
and full-call scenarios (for example, a cardiac
arrest call). Each type of "simulation" focuses
on a particular type of practice-based. learning
and involves a different blend of"fidelity."
Fidelity (sometimes called •realism;" see,
for example, Rudolph, Simon, & Raemer,
2007) indicates the degree to which a simulation represents or rcacates the "real" environment of field practice (Gaba, 2004; Garrett,
Tench, et al., 2007). A "low fidelity" simulation
might include a classroom drill using students
as mock-patients. An instructor provides
verbal descriptions of the scene and assessment findings. "High fidelity" simulation, in
contrast, has come to indicate scenarios set in
authentic locations (or in labs or rooms· using
props to recreate authentic locations) and
either standardized patients (specially prepared
actors) or computerized mannequins ("human
patient simulators" that provide realistic pulse,
BP, and ECGs, and allowing students to
perform procedures such as IVs, intubation,
etc). The use of HFS in hca1th education has
grown significantly, and many health programs
have simulation laboratories with HF mannequins in mock hospital wards and operating
theatres.
Paramedics, however, practice in a different environment than other health providers,
requiring different blends of fidelity. 'Ihc HFS
environment described in Appendix A of the
NOCP recognizes that, ifHFS is to be used to
replicate the practicum environment, then the
simulation environment must highlight several
types of fidelity:
Physical (or Environmental) Fidelity:
Paramedics function in· a wide variety of
settings. Often, gaining access, functioning in
cramped situations, or dealing with weather
are factors that affect what and how paramedics complete their calls. Thus, a paramedic HFS
must include realistic environments, such as

clinical and practicum domains. 1hc appendix

outdoor settings, home/office locations, or on
roadways (e.g., in a cordoned off parking lot).
Social and Interpersonal Fidelity: A key
element of the practicum is learning how to
interact in a dynamic, social environment that
includes the patient, fiimily, bystanders, other
responders and other health providers. HFS for
paramedics must include more than a patient
and an ambulance crew.
Physiological · and Procedural Fidelity:
These are the fu:ets of fidelity most often
associated with HFS. Standanli7.ed patients
and mannequins allow students to practice
assessment and treatment in a more authentic manner. Note that, for a HFS scenario, it
is important that students encounter patients
who reprcsentthe appropriate gender, apparent
age, and physical presentation of the calls they
are engaged in.
Conceptual {or Cognitive) Fidelity: Effective HFS provides an overall ex:periencc of
sufficient context and realism that creates a
sense of functioning in an actual clinical or
field environment.
While a growing body of literature supports
HFS as an eftCctivc learning environment, HFS
is often seen as a supplement, but not a. replacement, for practicum. experiences. Further
research is required to better understand how
learning emerges in simulation environments
(Q.uayumi et. al., 2012). A key component of
this research will include exploration of what
fidelity means in different disciplines.
Paramedics practice in unique settings.
And so, an effective high fidelity simulation
environment must· be able to represent and
replicate the complexity and dynamic context
of paramedic practice.

REFERENCES
Garratt B., Tenafi. E., _, der ~ R, Frei/er; P. (2007).
tMntayofthe use ofslmtJated cliniosl leemlng
~andEMLetlcn oftheretrscltoJenees. Ol1JMe,
ON: CBnadilrlAssoclatfal ofSchools of~
R:JdotJh, J. W., Stl'Tal, R., & Raemer. D.B. (2007).
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ergagetTl8l7t;, hEIB/thotn si'rlul!itlon. SlrnlJatlon;,
Hesllhcsle. 2(3). 161-163.
ParamsdlcAsooa/atlon of Gansda. (2001). Natlonsl
occupetiansl CCXTJJ8l&f rcyprolf/9 fOrpsramedicS.
~ K, Donn. S,ZhBrVJ,B, ~ L., Dutton, J.,
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SlmtJationfn l-/Balth Care, 7(5), 295-S07.

students establish a theoretical foundation in
the academic setting, then master skills and
procedures in simulation, followed by application in the clinical (hospital) and practicum (field) setting. The practicum is a critical step, linking classroom learning and field
pi:actice. Paramedic programs across Canada
face increasing challenges in finding adequate
practicum placements as both the number of
students and the expectations of the practicum
have grown. HFS holds promise for relieving
some of the pressure on the practicum environment.

Paramedic programs
across Canada face
increasing challenges
in finding adequate
practicum placements
as both the number
of students and the
expectations of the
practicum have grown.