• Rachel H Ellaway, Roger Kneebone, Kevin Lachapelle, and David Topps.
• Northern Ontario School of Medicine, Canada. rachel.ellaway@normed.ca
• Med Teach. 2009 Aug 1; 31 (8): 725-31.

AbstractSimulation modalities are generally used independently of one another, largely due to physical and operational limitations to integration. Recent developments are enabling simulators and simulation environments to progress beyond single intervention models towards integrated continua of simulation. Moving to greater integration can improve contextualisation, better management of the transition from individual simulation to clinical practice, and provide wider opportunities to synthesise skills and approaches to practice. Simulation integration may involve experiential, modelling, technical, narrative, and evaluation dimensions; it includes both direct actions and activities, and technical and systems designs. The work in developing these integration continua is ongoing and takes many forms in many places. The framework of 'practica continua' proposed in this article links theoretical approaches and practical examples of integrated uses of simulation in education.

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