ABSTRACT
In his contribution to a handbook on surgical education Gunther Kress asks, “What actually is simulation?” In the chapter he provides the beginning of an answer, proposing that simulation
can become the tool which, on the one hand provides the fullest possible environment for learning, providing careful, precise design to guide engagement by the learner, while on the other offering entire [patient] safety. It allows simultaneously embodied and explicit conditions for learning in an environment which is shaped by the teacher as designer and is reshaped by the learner as interpreter.
(Kress, 2011b, p. 225) The question Gunther asks is a timely one. Simulation is now a key area in surgical and medical educational research, and professional medical organizations and medical engineering companies invest more than ever in the development of simulation. Their investment is driven not only by technological innovation, but also by profound social-political changes of the last decades, most notably the emergence of neo-liberal notions of efficiency and public accountability, evidenced in “metrics” and rankings of all sorts; an emerging discourse of “patient safety,” fuelled by statistics of adverse events in hospitals; and regulatory caps on the maximum number of working hours (currently standing at 48 per week) that reduce opportunities for clinical exposure and reshape the “apprenticeship” through which trainees learn to become specialist doctors.