Background: Medical simulation is traditionally performed in a technologically advanced simulation center; however, these centers are expensive to build and maintain and may not provide good functional fidelity. Using wireless mannequins, high-fidelity simulation can be conducted in situ at a fraction of the cost of building a simulation center. Objectives: The primary objective of this study is to compare participant assessment of the effectiveness of simulation in situ versus simulation conducted at a stationary simulation center. A secondary objective is to compare the participant costs of simulation in situ with simulation at a stationary center. Methods: Simulations involved ED physicians, nurses, and health care assistants from three public hospitals within the Region of Tuscany - two community hospitals and one academic university hospital. ED providers were randomized by site to either simulation training in situ at their ED or at a simulation center in Florence. The same scenarios and instructors were used in each environment. After completion of their assigned simulation and debriefing session, participants completed survey questions asked on five-point Likert scales. The proportion of participants in each simulation environment who answered 4 or 5 to each survey question is reported and compared with Fisher's exact test. To calculate participant costs, we surveyed individuals assigned to simulation center training and collected data on costs of transportation, parking, and food, for both the simulation center training and for a standard day at work. Participant costs are reported as means with SD, and compared with a t-test. Results: A total of 47 individuals participated in the simulation sessions; 23 (49%) had previously participated in medical simulation. There was no significant difference in participant responses to questions regarding the effectiveness of simulation in medical training. Participants randomized to simulation in situ were more likely to want to participate in future in situ training (p=0.05). Mean per-participant costs to travel to the simulation center were significantly greater than the costs for training in situ (€ 45.79, SD € 27.24 versus € 4.50, SD € 6.14; p<0.001). Conclusion: Simulation conducted in situ was as effective as simulation conducted in the simulation center, but at significantly less cost to the individual participant. (Table presented).
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