Health Practitioners and Simulation Training

By Bonnie Hutchinson

Let’s assume that you aspire to be, not merely a competent health practitioner, but an expert health practitioner. You came into the field with high ideals. You intend to achieve mastery in your chosen profession. You want to be of optimum benefit to those who need your skills.

To be an expert practitioner requires numerous types of training. You’ve been in classrooms and practicum placements. You’ve had coaching and feedback from trainers, supervisors and peers. Whether you’re a student or an experienced health practitioner, you’ve probably also had some form of simulation training.

Why simulation training is especially useful for health practitioners

The nature of health practice has some built-in qualities that make simulation training especially useful.

  • You can’t “practice” performing medical procedures on real patients, because you could do harm.
    Simulation training allows you to practice procedures in ways that can do no harm.
  • Certain situations – like life-and-death medical emergencies – don’t occur often enough to give you opportunities to learn and excel. (Of course, you don’t want life-threatening incidents to occur more often!). But when a medical emergency does happen, you cannot be “still learning.” You need to be expert.
    Simulation training can give you the opportunity to practice responding to life-or-death situations – or any rarely-occurring situation – until you achieve mastery.
  • You may not be able to receive immediate feedback on what you’re doing well and what could be improved, in classrooms or real-world practice. Sometimes you could accidentally be “practicing” something incorrectly.
    Virtual simulation training can give you immediate feedback and identify exactly what you need to correct and practice next.
  • You may sometimes feel nervous in front of your peers, supervisors or patients, and that interferes with your ability to learn.
    Virtual simulation training allows you to practice privately until you become proficient and confident.

Simulation training is not the be-all and end-all of practitioner training. For example, simulation training is not the best method to acquire cognitive knowledge.  It does not increase a practitioner’s capacity for empathy.

Simulation training is especially valuable when…

  • There is a well-defined learning objective or task,
  • Skill can be developed and improved through repeated practice, and
  • There is an agreed standard within the profession, that is, there’s a way to measure when you’ve acquired an acceptable skill level (though of course there’s always opportunity to improve).

There is now substantial proof of the benefits of virtual and augmented reality simulation training. Prakesh et al (2017) mentions, “…significant advances [are] being made in the development and availability of virtual and augmented reality simulations… That can offer us many different options for learning about clinical conditions, procedural skills, and systems of care.”[1]

Different types of simulation training are appropriate for different types of learning. For example, simulations with live models acting as patients are especially useful in practicing patient interaction skills. Simulations with mannequins are useful for practicing some protocols and medical procedures.

A limitation of both those types of simulation is that it is impossible for a live model or a mannequin – however skillfully made up or costumed – to replicate the characteristics of a genuinely sick person. For example, neither a live model nor mannequin can replicate the breathing rate and especially breathing effort of a sick person. For that, a virtual simulation avatar is the option with the best visual fidelity.

A crucial skill area that benefits from virtual simulation training

That brings us to cue recognition. “Cues” are features of the patient or the environment to which you can attach meaning. These could include, for example, any of the Airway, Breathing, Circulation, Disability or Environment features that  practitioners must assess during the first few minutes of patient contact. Accurately recognizing patient cues leads directly to being able to identify and diagnose the patient’s problem. That in turn leads to the correct treatment of the problem.[2]

A Johns Hopkins study[3] makes obvious how crucial cue recognition is. The study reports that medical errors are the third leading cause of death in the US (after heart disease and cancer).

The most common type of medical error is error of diagnosis. In about 75% of diagnostic errors, human cognitive error was at least partly to blame.

Unfortunately, errors in diagnosis are “highly prevalent, often preventable, and generally lead to greater morbidity and mortality than other types of error.”[4]

This combination of danger and preventability has led to a recent push within the medical world to recognize the importance of “non-technical skills” such as cue recognition.[5]

Anything that helps health practitioners become more and more skilled at recognizing diagnostic cues is going to enhance patient safety, patient care and patient outcomes. Virtual simulation training can do that.

Imagine personal access to simulation training

Some forms of simulation training are available only in highly expensive facilities or only a few times a year. Wouldn’t it be great to have simulation training accessible to you at any time?

Hone Virtual Education is developing virtual simulation training modules you can download to your augmented reality smartphone or tablet. You can use the training modules whenever and wherever you choose. You can use them again and again until you reach your desired level of mastery.

The first Hone simulation training modules are focussed on diagnostic cue recognition in the first few minutes of patient contact, when you’re initially assessing Airway, Breathing, Circulation, Disability and Environment.

Each module allows you to practice specific observation skills again and again. Once your accuracy is assured, the modules increase the speed with which cues are presented. You learn to make assessments and decisions more quickly. That’s especially valuable in the high pressure environments in which most health practitioners work.

Training outcomes

Pressure, time constraints, high mental workload, fear, embarrassment, feelings of being judged on performance, distraction, and information chaos are all known to increase the pressure on health practitioners. All of these factors are common within acute care practice environments.

Hone’s virtual simulation training is intended to help you handle those pressures. The modules help you to…

  • Build a mental diagnostic cue “pattern recognition database” more quickly than is possible otherwise;
  • Assess and keep improving your own performance – privately;
  • Reduce your “mental workload” during the initial stages of patient contact, because you’ve honed your skills until they’re almost automatic;
  • Lower any performance anxiety and workplace stress by improving your confidence…

all of which leads to the ultimate goal…

  • Improved patient safety, patient care and patient outcomes.

Virtual simulation training that meets external standards

The Royal Canadian College of Physicians and Surgeons has recognized that simulation training can play a valuable role in developing “non-technical skills,” and has set standards for simulation training. The Hone augmented reality virtual simulation technique conforms to the Royal College of Physicians and Surgeons of Canada Accreditation Standards for Simulation Programs 3.1, 3.1.1, 3.1.2, and 3.1.3.

Hone virtual simulation training also conforms to the standards set by the Paramedic Association of Canada for physical, physiological, procedural and cognitive simulation fidelity well enough to supplement the evaluation of certain C and P requirements, such as 4.3.e (Conduct Respiratory System Assessment and Interpret Findings).[6]

As well, Hone virtual simulation training modules have most of the characteristics identified as ideal by a consensus group of the 2017 Academic Emergency Medicine Consensus Conference “Catalyzing System Change Through Health Care Simulation: Systems, Competency, and Outcomes.”[7]

Find out more

The first Hone Cue Recognition modules will soon be released. In the meantime, check out

  • Learn more about Hone Cue Recognition simulation training;
  • Be notified of updates and launch dates;
  • Apply to be a beta tester as new modules are developed for health practitioners in high-stress environments.



Bonnie Hutchinson is a writer and lifelong learner with degrees in Education and Whole Systems Design as well as extensive training and experience in adult learning and teaching. She’s author of bestselling Transitions: Pathways to the Life and World Your Soul Desires.

[1] S. Prakash, S. Bihari, P. Need, C. Sprick and L.  Schuwirth (2017). Immersive high fidelity simulation of critically ill patients to study cognitive errors: a pilot study. BMC Medical Education, 17, 36.

[2] J. W. Beasley, T. B. Wetterneck, J. Temte, J. A. Lapim., P. Smith, A. J. Rivera-Rodriguez and B. Karsh, (2011). Information Chaos in Primary Care: Implications for Physician Performance and Patient Safety. The Journal of the American Board of Family Medicine, 24(6), 745-751, doi:10.3122/jabfm.2011.06.100255

[3] The Johns Hopkins study, led by Dr. Martin Makary of the Johns Hopkins School of Medicine, was released in 2016. A follow-up about whether anything had changed was reported by Ray Sipherd, special to  Published 9:31 AM ET Thu, 22 Feb 2018 and updated 9:39 AM ET Wed, 28 Feb 2018.

[4] A. S. Saber Tehrani, H. Lee, S. C. Mathews, A. Shore, M. A. Makary, P. J. Pronovost, d. E. Newman-Toker (2015), 25-Year summary of US malpractice claims for diagnostic errors 1986–2010: an analysis from the National Practitioner Data Bank. BMJ Qual Saf. 2013;22:672–80. View Article Google Scholar

[5] Prakash et al (2017), op. cit.

[6] Paramedic Association of Canada. (n.d.). National Occupational Competency Profile. Retrieved from

[7] J. L. McGrath, J. M. Taekman, P. Dev, D. R. Danforth, D. Mohan, N. Kman, A. Chrichlow, W. F. Bond (2017), Using Virtual Reality Simulation Environments to Assess Competence for Emergency Medicine Learners, Academic Emergency Medicine 2018 Feb;25(2):186-195. doi: 10.1111/acem.13308. Epub 2017 Oct 11.

Hone CUE Recognition on the App Store

The Hone CUE Recognition App will soon be available on the App Store for early adopters. When it is available - you will be able to download it via the link below.