JMIR Publications

ABSTRACT

Simulation is a cornerstone of health professions education, yet the assumption that greater fidelity automatically enhances learner engagement is overly simplistic. Fidelity is multidimensional—spanning physical, emotional, contextual, qualitative, and quantitative aspects—and interacts with both intrinsic learner factors (motivation, stress, prior experience) and extrinsic factors (facilitation, debriefing, psychological safety). The fiction contract plays a pivotal role, enabling learners to engage authentically regardless of the simulation’s technical realism. Importantly, high technological complexity does not necessarily equal high fidelity or greater educational value. Instead, fidelity should be tailored to the learning objective: mannequins for procedural practice, actors for communication or emotional scenarios, and task trainers for targeted skills. This viewpoint advocates for a goal-oriented, multimodal approach in which high-fidelity simulation is redefined not as the pursuit of realism, but as the alignment of fidelity with pedagogy to foster learner engagement and optimize outcomes.