The matter of 'fidelity': Keep it simple or complex?

Simulation often relies on a case-based learning approach and is used as a teaching tool for a variety of audiences. The knowledge transmission goes beyond the mere exchange of soft skills and practical abilities, including practical knowledge and decision-making behaviour as well. As it seems, simulation requirements largely depend on the skills, abilities or competences to be conveyed. Unfortunately, we lack any scientific evidence as to how much learners should be stressed to achieve a positive learning outcome. As regards learning and practising purely technical skills, however, it can be generally assumed that simulations should be as anatomically/physiologically close to reality as possible. On the other hand, teaching soft or decision-making skills and sharing practical knowledge poses less stringent requirements on simulation realism. For simulation-based learning, learning outcomes depend not only on knowledge, practical skills and motivational variables, but also on the onset of negative emotions, perception of own ability and personality profile. 'Simulation' training alone does not appear to guarantee learning success. Rather, it seems necessary to establish a simulation setting suitable for the education level, needs and personality characteristics of the students. Thus, it is fair to conclude that there is no evidence correlating the realism of a simulation scenario with the learning success of students.