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BMJ Support Palliat Care. 2019 Jun;9(2):117-119. doi: 10.1136/bmjspcare-2018-001595. Epub 2018 Sep 25.

State of the science: the doll is dead: simulation in palliative care education.

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Speciality Registrar in Palliative Medicine, Wales Deanery, Cardiff University School of Medicine, Cardiff, UK.
Palliative Medicine, Velindre University NHS Trust, Cardiff, UK



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.


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.


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.


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.


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

Conflict of interest statement

Competing interests: None declared.

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