Situating Simulators : The integration of simulations in medical practice

Abstract: This study examined the practices of integrating simulators into medical education. Simulators have been observed in use to discern how medical practices are created out of the simulations. Video recordings of the simulations have been analysed, complemented by interviews with instructors and students. To contextualise the simulations, the author also shadowed students on an anaesthesiology course, of which simulator training was an introductory element.Analysing this material in the theoretical framework of situated learning and communities in practice showed how medical practices and medical participants are reconstituted in simulations. Reconstitution occurs as the instructors speak about the simulations in medical terms and as they use their own bodies and voices to reconstitute the patient body. It repeatedly defmes the simulation as medical practice and relies on the student's previous knowledge and the instructor's presence and intervention. Reconstitution describes what occurs in the simulator centre, but it also contributes to the theoretical discussion oflearning in practice as it further develops Wenger's understanding of participation.The simulations are not isolated events separate from the medical apprenticeship. They are embedded in the hospital's work, connected to the rest of the training the students take part in, and an opportunity for students to interact with others in their role as doctors-in-training. This indicates that in the simulations the students are involved in learning to be doctors rather than just learning medical skills, which emphasises the importance of the instructing doctor's role in a simulation.The study also considers the simulators as artefacts in practice. Rather than seeing simulators as predefined representations of medical understandings with distinct boundaries between the artefact and the user, the simulators are considered to be part of a relational practice, intra-action. Considering the relationship between the simulator and the user allows for ambivalent definitions of machine, user, and even agency.