A Novel Multidimensional Fidelity Framework for Cardiac Surgery Simulation: A Thematic Literature Review.

Introduction: Simulation-based training is increasingly being adopted in cardiac surgery to train future surgeons. Although low- and high-fidelity cardiac surgical simulations have been described previously, simulation fidelity or the degree to which a simulation replicates reality is poorly defined and not well established. This study examines the literature on the themes of fidelity using a novel multidimensional surgical framework. Methods: A keyword-based literature review was conducted to retrieve published cardiac surgical simulation studies using MEDLINE and EMBASE, from January 2000 to February 2020. The search was limited to the date of publication and not by type. Within predefined dimensions, the included articles were thematically analyzed using a hybrid coding approach to identify fidelity themes and subthemes. Results: Twenty-six articles were included in the thematic analysis after duplicate removal, screening, and eligibility assessment based on the inclusion and exclusion criteria. Seven themes were identified within physical, surgical, and interactional dimensions. They were derived from environmental, equipment, anatomical, physiological, procedural, perceptual, and psychological simulation components. Subthemes for three levels of realism were generated for each theme by using an iterative process. Conclusion: This fidelity framework provides educators with actionable guidance for designing cost-effective cardiac surgical simulation for competency-based training by enabling selective fidelity utilization. Educators can apply this framework through aligning learning objectives, fidelity dimensions and levels accordingly. The framework facilitates optimal resource allocation by designing effective and fit for learner simulations.