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State of the science: the doll is dead: simulation in palliative care education
  1. Lowri Evans1 and
  2. Mark Taubert2
  1. 1 Speciality Registrar in Palliative Medicine, Wales Deanery, Cardiff University School of Medicine, Cardiff, UK
  2. 2 Palliative Medicine, Velindre University NHS Trust, Cardiff, UK
  1. Correspondence to Mark Taubert, Honorary Senior Lecturer and Consultant in Palliative Medicine, Velindre University NHS Trust and Cardiff University School of Medicine, Cardiff, Caerdydd CF14 2TL, UK; mtaubert{at}


Objectives Both simulation and high-fidelity simulation involving manikins, clinical training suites, wards, computer programs and theatres have established themselves in medical undergraduate and postgraduate education. Popular among students, they have been shown to be effective learning tools. Contrasted with this is the potential risk to patients and their proxy associated with learning ‘at the bedside’, which can pose a real challenge in medical and palliative settings. The need for education and training methods that do not expose the patient to preventable communication blunders from less experienced practitioners is a priority.

Methods Here, we provide a summary review on the current literature and evidence for simulation and high-fidelity simulation in palliative and end-of-life care settings, and discuss potential uses of technologies including virtual and augmented reality in future training.

Results The most common form of simulation in palliative medicine is often an actor-based role-play scenario with particular emphasis on communication skills. This is expensive and time-consuming to set up. Less evidence was found on the use of high-fidelity simulation in end-of-life care teaching.

Conclusion Palliative medicine has been slow to adapt to an educational method and environment that now is widely used across other areas of healthcare. There has been less emphasis on training with manikins and even less on using computer simulation and virtual reality environments to recreate challenging end-of-life care scenarios. We provide some examples of where this could benefit the curriculum.

  • simulation
  • high fidelity
  • education
  • virtual reality
  • augmented reality
  • mannequins
  • ethics
  • end of life care
  • palliative

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  • Contributors LE wrote the initial draft, and MT wrote and edited the document.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.