Get access

Man versus machine: the preferred modality


  • Funding: None.

  • Conflict of interest: None.

  • Ethical approval: Ethical approval was sought from the University of Miami Institutional Review Board, but the study was deemed exempt.

Corresponding author’s contact details: David Birnbach, Center for Patient Safety, Jackson Memorial Hospital, University of Miami, 1611 NW 12th Avenue, Miami, FL 33136, USA. E-mail:


Background:  When learning objectives do not specifically dictate the use of one simulation modality over another, we sought to answer the question of which modality is preferred. We also assessed the impact of debriefing, and the frequency of participants asserting their leadership, as well as self-reported comfort and competence, and the ability to generate differential diagnoses when either a standardised patient (SP) or high-technology simulator (HTS) was used.

Methods:  One hundred and forty medical students participated in a simulation-based activity focusing on teamwork, task delegation, role clarity and effective communication. Two similar clinical scenarios were presented, and either an HTS or an SP was used. Following each scenario, participants were surveyed on the realism of the simulation and the patient, and also on their self-assessed comfort and competence. They were also asked to indicate which role they played, to list possible differential diagnoses for the case and, following the second scenario, which modality they preferred.

Results:  The surveys indicated that 91 per cent (127) of students preferred the SP. The perceived realism of the simulation was higher for the second scenario than for the first. Scenarios with an SP were found to be significantly more realistic than the scenarios where the HTS was used. Comfort and competence scores were higher following the second scenario. No differences in the ability of participants to generate a list of differentials were found, and nearly twice as many participants reported taking the leadership role during their second simulation.

Discussion:  We have found low and high technology to have similar effectiveness for achieving learning objectives and for the demonstration of skills; however, students clearly preferred the SPs.