Top 6 Problems in Medical Simulation Today

Traditional Medical Simulation with Mannikins at College of DuPage

When was the last time that the trainees at your hospital saw a patient with a rare condition? When was the last time they took care of a patient with a critical illness? How would you feel if that patient were you? 


We might assume that medical education provides clinicians with the breadth of experience required to deliver expert patient care in any required situation. However, even with the incorporation of medical simulation in training, it is difficult to learn all you and your team need to know.  


After 20 years of teaching with mannikin-based simulations, I realized that no matter how hard I tried, our residency’s simulation curriculum was limited by outside forces. The number of trainees and clinical team members to teach and assess combined with the breadth of diseases to know required training in groups, which left individual learning issues to fall by the wayside. Scheduling educators and trainees was like lining up holes in slices of Swiss cheese, becoming as much of a task as the teaching session itself. I felt that my trainees still ended up learning on real patients more than mannikins. Whether you are in school, clinical training, or professional practice, practice makes perfect and the current state of medical simulation does not allow enough breadth and accessibility to gain adequate experience.  


The current state of simulation has many bottlenecks and inefficiencies. These barriers limit the frequency and sustainability of medical simulation training, requiring significant compromises to implement simulation. Read on to learn more about the top 6 problems in medical simulation today. 


Top 6 Problems in Medical

Simulation Today


Limited Availability

Brick-and-mortar simulation centers are a learning resource shared across an entire hospital or academic medical center. Space and time with mannikins and classrooms is limited. Like a busy restaurant, if I was too late in making a reservation at our sim center, key simulation sessions would not run.


Scheduling Difficulty

A faculty educator must be physically present for each session. Clinical and research demands on faculty compete with teaching time which, combined with trainees’ busy clinical schedules, limits the ability to organize a session.


Teaching to the Mean, Not the Individual

In my experience with the Harvard Affiliated Emergency Medicine Residency (HAEMR) program, I found that teaching 60 residents in a single simulation afternoon required that sessions occur in groups rather than individually, limiting my ability as an educator to assess individual competence.


High Cost

Simulation training is only accessible to institutions that can afford it, rather than all of the individuals who need it. Sim mannikins alone can cost tens of thousands of dollars and the space itself can take millions to create.


Limited Repetition and Reinforcement

Sessions are often “one-offs” without the opportunity for repetition that is required for deliberate practice. Covering the breadth of emergency medicine, I would have to sacrifice frequency to cover enough content over time. As a result, my residents could repeat a simulation training session every 1-2 years before graduation. I was able to introduce concepts, but could not support spaced repetition for consolidation and reinforcement of new learning.


Learning Limited by Fear

Fear of judgment limits a learner’s willingness to fully engage with in-person simulations, especially if they feel under prepared (which, paradoxically, is the whole reason for doing simulation in the first place). They may take a more passive role in a session, or be too emotionally activated to vocalize uncertainty. This isn’t my assumption it was direct feedback from my residents for more than a decade, concerned that the teaching faculty for the session might be the same faculty who would be writing their recommendations for hiring in the not-too-distant future.



Taken together, these limitations have put a cap on the efficacy, scalability, and sustainability of brick-and-mortar simulation as a means of achieving true deliberate practice in medical education for students, residents, and professionals in practice.  That is why I co-founded Full Code to provide a solution to these problems using virtual simulation.


Virtual simulation can provide unlimited opportunities to learn, practice and refresh on diagnosis and management skills all core features of deliberate practice. Free of the limitations of scheduling and fears of judgment, it can provide access to all of the critical presentations essential to clinical training while also providing learners with granular performance data on the core Entrustable Professional Activities of patient care: history & physical, stabilization, diagnostics, pharmacologic interventions, consultation, and patient disposition. Full Code’s educator dashboard can provide insights into the cognitive performance of learners across 160+ critical diagnoses with the touch of a button. 


I invite you to learn more about all that virtual simulation can do. Contact us to find out more about Full Code and how we can help your learners become the best clinicians they can be.

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