However, when it comes to a catalog full of simulation manikins, from a CPR torso that costs a few hundred dollars to a fully responsive, high-fidelity simulator that costs hundreds of thousands, the one question that always comes to mind is:
“Which type should I choose? Is higher fidelity always better?”
The short answer is: not necessarily.
High-fidelity manikins are capable of responding to sophisticated stimuli as well as generating sophisticated clinical scenarios, yet not every learning objective requires that sort of realism. The focus should be on what it is you want to teach, and how various types of manikins fit within your learning outcomes and financial constraints.
This article will enable you to:
- Comprehend tangible, practical distinctions among low-, mid-and high-fidelity manikins.
- Recognize each fidelity level’s alignment with your training objectives.
- Sidestep frivolous “bleeding-edge” technology purchases.
- Support an evidence-driven, sound expenditure in your program.
What is the actual difference between Low-, Mid-, and High-Fidelity Manikins？
What “Fidelity” Really Means
Simulation ‘fidelity’ isn’t just how realistic a manikin appears; it also focuses on how closely a simulation replicates real-time clinical experiences. This is done on three primary dimensions
- Physical fidelity – a simulation’s touch, skin texture, and shape accuracy
- Physiological fidelity – a simulation’s vital signs, breath, and other body responses, accuracy
- Contextual/psychological fidelity – a simulation’s clinical environment, interaction, and emotional response accuracy
Different types of manikins may achieve fidelity on physical, physiological, and contextual/psychological levels. Each of these dimensions is crucial for making an informed decision.
Low vs. Mid vs. High Fidelity Manikins： What’s the Actual Difference?
| Fidelity Level | Core Characteristics | Typical Features | Best Used For | Advantages | Limitations |
| Low-Fidelity | Simple, non-electronic models | Basic task trainers (CPR torso, IV arm, catheterization models) | Repetitive skills practice, procedural learning | Low cost, durable, easy to maintain, scalable for groups | No vital sign feedback, lacks realism and interaction |
| Mid-Fidelity | Some electronic components with limited vital sign feedback | Simulated vital signs (heart rate, BP, respiratory sounds) | Basic assessment and emergency response drills | Balanced cost and functionality, suitable for small-team training | Limited physiological reactions, less emotional engagement |
| High-Fidelity | Complex physiology with programmable responses and voice interaction | Dynamic patient scenarios, speech, blinking, changing heart rhythm, breathing patterns | Advanced clinical decision-making, crisis resource management | Highly realistic, ideal for full scenario-based training | High purchase and maintenance costs require tech support |
- An instructor teaching CPR or giving injections → Low-fidelity is ideal for repetition and confidence-building.
- Training in raw vital sign monitoring or a first look at primary assessment → Mid-fidelity offers critical feedback loops.
- Simulation of team responses to simulated cardiac arrest or anaphylaxis → High-fidelity offers requisite realism and complexity.
Low, Mid, and High Fidelity Manikins： Which is right for my training goal？
The biggest problem educators are likely to bingo into isn’t understanding the technology – it is matching the goal with the correct tool. Here is a working framework to help with that choice.
| Training Goal | Recommended Fidelity | Why It Works |
| Basic procedural skills (CPR, injection, catheterization, dressing changes) | Low-Fidelity | Emphasizes repetition and muscle memory; cost-effective for early learners |
| Vital sign assessment, basic emergency response | Mid-Fidelity | Adds realism with dynamic feedback to develop clinical judgment |
| Advanced resuscitation, crisis management, team communication | High-Fidelity | Enables complex physiological and behavioral interactions |
| OSCE or skills assessment scenarios | Mid–High Fidelity | Balances realism with standardized control for fair evaluation |
Looking Through the ROI Lens
From a return on investment perspective, gain in fidelity doesn’t instantly equate gain in learning outcomes. The association between fidelity, cost, and learning effectiveness looks more like a curve than a straight line.
- Low fidelity with good instructional design yields a greater learning outcome.
- High fidelity with poor instructional design -> costly let down.
A simulator’s worth is derived not from its price tag or technological sophistication, but rather from how well it’s woven into thoughtfully designed comprehensive instructional strategies.
From time to time, a well facilitated low fidelity session can outperform in learning impact from an unstructured high-fidelity simulation.
Breaking the “More Expensive Is Better” Myth
Why is it that some people believe that because a simulator is high-fidelity, it “feels more real,” that it must deliver better training outcomes? Evidence and experience from other healthcare simulation centers tell us otherwise.
- Low-fidelity manikins are more than adequate for teaching foundational psychomotor skills.
- Basic data interpretation is better taught using mid-fidelity simulators.
- High-fidelity systems are superior for teaching high-stakes, team-based, or emotionally charged scenarios in which the realism of the systems drives deep engagement and critical thinking.
No matter how sophisticated a device or how advanced the simulation, the most impactful factor for learning success is the way the material is taught. Ask yourself:
- Are learning outcomes clear and achievable?
- Are outcomes coupled with the correct challenge and adequate feedback?
- Does the debriefing process enhance the ability for reflection so that knowledge can be applied to practice?
If it is before 2:00 a.m. and you are a health care provider working in a busy emergency department, you appreciate a simulator that can go into cardiac arrest. A beginner learning CPR doesn’t, however, need a manikin that can blink and speak.
Summary
Step-by-Step Decision Framework
- Outline outcomes– What do you foresee as the outcome of the learners’ work? Mastery of skills, clinical reasoning, or communications as a team?
- Pinpoint necessary learning components– Are the changes in vital signs, changes in the voice, or simply responding to a question accurately?
- Review your assets as well as your limitations– calculate purchase price, upkeep, faculty instruction, or area.
- Align degree of fidelity to intended function– Use the simplest manikin you can find that will fulfill the learning outcome.
- Refine the instructional strategy– Appropriate allocation of the positive pre-briefing, scenario designing, and the post-briefing will enhance learning outcomes.
Cost–Realism–Learning Outcome Matrix
| Fidelity Level | Relative Cost | Realism | Training Focus | Learning ROI |
| Low-Fidelity | ★ | ★ | Psychomotor skills | ★★★ (excellent value) |
| Mid-Fidelity | ★★ | ★★ | Assessment & judgment | ★★☆ (balanced) |
| High-Fidelity | ★★★ | ★★★ | Teamwork, crisis, decision-making | ★★☆–★★★ (depends on design) |
