Embodied and Embedded Intelligence: Actor Agents on Virtual Stages

Introduction

Simulations, as defined by Sauve, Renaud, Kaufman, and Marquis (2007) may be argued as the quintessential adaptive learning system. According to Sauve et al. (2007) and Swanson and Ornelas (2001), a key feature of a true simulation is that it behave as a dynamic model of reality which responds to user initiated actions and perceptions. Users can control the reality of the simulation in ways that reflect their learning preferences and existing knowledge. Ideally, simulations are a perfect reflection of individual learning trajectories. Simulations are used in many disciplines but the present focus is on simulations in health care and in particular, the simulation of patients for training health care practitioners. This area was chosen because of the long standing tradition in medical training regarding the use of Standardized Patients, actors paid to act as a patient with a standardized problem (see Barrows, 1993; Brender, 2005 for overviews of Standardized Patients, including their numerous benefits). Moreover, applications in this area could be extended to other service and social professions that work directly with people or clients. The key benefit in all domains is that a simulated client would allow students in any profession to practice high risk skills in a risk free environment.

In a 2009 review article, Nehring and Lashley describe 40 years of simulation practice in the nursing field and not surprisingly, patient simulations play a significant role. Even further back, Lees (1874) describes the use of a task trainer, or a type of mechanical dummy that students could use to practice their bandaging skills. Nehring and Lashley (2009) describe one notable dummy introduced in 1910 as Mrs Chase, who interestingly for the purposes of this article, was actually modeled after a real Mrs. Chase. Mrs. Chase was modified over the years to accommodate different patient procedures and included a major modernization in 1939. According to Nehring and Lashley (2009), the production of Mr. Chase occurred in the 1940s and the Chase couple continued to be produced for the next 30 years eventually to be replaced by mechanized and computerized mannequins. Nehring and Lashley (2009) reviewed 26 studies involving high fidelity computerized mannequins, where fidelity refers to the degree of reality replication, and found that most if not all studies report some positive benefit associated with high fidelity mannequins. However, they caution that the sample sizes are generally small and quite heterogeneous combined with measurement instruments of unknown construct validity. It is important to note that physical mannequins enable the physical manipulations required for procedural skills learning. In order to develop critical communication, interviewing, and assessment skills, Standardized Patients are required.