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Micro vs. Macro Realism in Simulation

A medical simulation can have a thousand different objectives and it must be determined beforehand what level of realism is important to the learning objective. When thinking up a scenario one must decide where to focus limited resources. For example, if I am recreating a very general “Code Blue” emergency response used to train personnel from many different departments then it is a waste of time to insure that every drawer and cabinet is stocked perfectly with every possible piece of equipment. Obviously, each department will stock its rooms their own way and it does not distract from my learning objective if equipment is not in the exact location that each student is accustomed to. However, if my goal is to teach the students the location of equipment on the code cart for use during a Code Blue then the cart should be stocked exactly how it is in real-life.
Micro realism or Micro Stocking is a term that I use to define those scenarios that are usually unit or equipment specific and must be exactly the same as the environment or equipment used in real life.
Macro simulation refers to creating a generalized “feel”, environment, or conditions that closely resemble the area or feeling the student will encounter.
Quite often scenario preparation will encompass both macro and micro simulation techniques. Let’s look at a very common use of simulation, teaching insertion of central lines, to more clearly define macro vs. micro realism. For this scenario I would setup the learning environment in a simulated ICU or patient care room. The room would have the general feel of a patient’s room, cabinets, lights, monitors, oxygen hookups, etc… but each detail of the room would not match exactly the layout of a patient’s room. This is macro realism. The student feels like this is a patient care environment. Quite often a student will immediately change their behavior immediately upon entering the scenario if the macro elements of the scenario are “real” enough. Micro realism must also be included in this scenario. Central Line kits are generally uniform throughout an organization. This means that every time a central line is started in the hospital the exact same equipment is used. If this is the case then when preparing a central line scenario the exact central line kit the student will be using for patient care must be included in the scenario. There is no point in teaching the very specific steps and sterile procedures necessary for inserting a central line if the student is confused by equipment they have never used before the first time they are asked to perform the real thing. The next time you are preparing a scenario or training your staff consider Micro vs. Macro realism and it will help you save time, resources, and increase the realism and impact of your training.

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