Accreditation standards continue to push EMS programs to document increasing numbers of skills and patient encounters of certain age demographics and complaints.  With this direction, programs have two options to choose from:

Obtain valuable and diverse sites (Hospital, Fire Service, Ambulance Service) with excellent clinical preceptors that can provide students with the opportunity to achieve their requirements with direct, real-world, hands on patient care.

OR

Supplement the program with simulated patient encounters, high-fidelity manikins, and feedback-providing simulators.

Clinical rotations in hospital and in the field are competitive and there’s no guarantee of what patients will be present during shift.  Certainly, technology is improving and providing greater training equipment options that mimic actual patients.  All of this begs certain questions:

Can a student be adequately trained to perform invasive skills in a simulated environment, to the extent that the first time they perform the skill on an actual patient occurs when they are a certified provider?

And, if they CAN…SHOULD they?

Can a manikin that delivers a baby replace the experience of being present for, and assisting with, the delivery of a newborn?  Should a Paramedic’s first intubation be AS A PARAMEDIC, or as a student?

Research continues that is looking into all of this.  Overall, a healthy balance of simulated experiences in the classroom and lab combined with a broad real-world experience requirement is likely best and most practical.  For the high-stress, low-frequency procedures and patients, continued practice in a simulated environment may be the only option and can sharpen skills to be as ready as possible when the actual patient is in need.