Journal of Surgical Simulation 2016; 3: A: 7 - 7

Published: 25 February 2016


Oral presentation

Special Issue: From Fairies to SimMan: Tolkein and realism in simulation

Lysa E. Owen
Corresponding author: Lysa E. Owen, University of Dundee, Dundee, UK . Email:


Background/Context:  The body of literature in simulation has been criticized as being too descriptive, lacking in methodologically robust and theoretically underpinned research (1, 2). There is a paucity of empirical and theoretical literature on reality and realism in simulation based learning (3) (4).  This presentation makes an original contribution to the body of literature by using the theoretical conceptualisations of reality described by Dieckmann in simulation and by Tolkien (5) in fantasy writing to challenge and develop our understanding of reality in simulation.  This article reports a qualitative research study which reveals the perceptions of realism in simulation based medical education. 

Methodology:  The research used a qualitative and bi-directional approach (6).  Group interviews were carried out with doctors from a range of medical speciality and career stages. Participants included medical students, foundation doctors, anaesthetists and general practitioners. Interviews were recorded, transcribed and analysed using framework analysis (7). 

Results:  A significant finding was the importance participants placed on realism in their motivation to participate in simulation.  Participants’ descriptions of realism were consistent with the domains of physical, semantical and phenomenological realism and played an important role in their intention to participate in simulation based learning.  The data also revealed that whilst lapses in physical realism were tolerated, lapses in semantic realism were very poorly tolerated.  In addition when there was inconsistency within the secondary reality as described by Tolkien, this resulted in a breakdown of suspension of disbelief.  

Conclusion:   A deeper understanding of these factors will inform course designers as they consider both the processes of simulation based learning as well as seeking robust evidence for its effectiveness (8).  Developing understanding of realism for medical simulation can help course designers and teachers make best use of resources by focusing on the domains of realism which have most impact on learners. 


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3. Dieckmann P, Gaba D, Rall M. Deepening the theoretical foundations of patient simulation as social practice. Simul Healthc 2007; 2: 183-93. doi 10.1097/SIH.0b013e3180f637f5.

4. Zigmont JJ, Kappus LJ, Sudikoff SN. Theoretical foundations of learning through simulation. Semin Perinatol 2011; 35: 47-51. doi: 10.1053/j.semperi.2011.01.002

5. Tolkien JRR. Tree and Leaf. New York: Harper Collins; 1964.

6. Buniss S, Kellly DR. Research paradigms in medical education research. Med Educ 2010; 44: 358-66. doi: 10.1111/j.365-2923.009.03611.x.

7. Ritchie J, Spencer L. Qualitative data anlysis for applied policy research. In: Bryman A, Burgess B, editors. Analyzing qualitative data. London: Routledge; 2002.

8. Issenberg SB, Ringsted C, Ostergaard D, Dieckmann P. Setting a research agenda for simulation-based healthcare education: a synthesis of the outcome from an utstein style meeting. Simul Healthc 2011; 6: 155-67. doi: 10.1097/SIH.0b013e3182207c24


simulation; realism; Tollkein; theory; healthcare simulation; medical education

Additional Information

This presentation was given at the Fifth Annual Homerton Simulation Conference: Innovations in Healthcare, Patient Safety and Simulation, Homerton University Hospital, London, UK, on 10 December 2015. This work has been accepted for publication as a full length article: Owen LE. From Fairies to SimMan: Tolkein and realism in simulation. Journal of Surgical Simulation 2016; 3 (in press).

Conflicts of interest: none declared.