In response to the question “who has the most impressive laboratory?”

Dear Editor:

With reference to the article “simulation of loyalty: who has the most impressive laboratory?” published in the April–June 2017 edition, we would like to contribute by responding to the question put forward by the author through a teaching innovation experience we developed during the 2016/17 academic year within the context of the Universidad Autónoma de Madrid's invitation for teaching innovation: “creative strategies for clinical simulation as part of a nursing degree: simulation with puppets and silicone masks”.

Whilst attending to the educational needs of our fourth year students (specific training in caring for people in emergency situations), with regard to their communication skills and advanced level of performance, we were investigating viable proposals which would also be innovative and attractive at the same time.¹ We were also aware of the limited resources with which the majority of us have to work.

With regard to the above, we decided to try with simulation with silicone masks (High Fidelity Silicone Simulation [HFPSS]) our reference being the proposal of MASK-ED™. This simulation was developed by professor Kerry Reid-Searl of the CQ University in Australia to adapt to our environment. The HFPSS consists of using the silicone prosthesis (masks, torsos and gloves) which the educator (who has been appropriately trained) wears so as to become a character and takes on their personality and their mannerisms.^2,3

The simulation activity was developed in 3 phases. During the first phase they worked with tools to carry out the simulation and offer support to subsequent discussion (clinical case, biography of the character, possible lines of development of the dramatisation, complementary documentation for simulation observation, section to assess the development of the communicative interaction and informative paper and informed consent form for the audio recording of the simulation. Furthermore, the setting for simulation was designed to be similar to an observation unit within the emergency service and the character was dressed in the appropriate clothes and accessories. During the second phase the interaction between the student and the patient was simulated for a duration of 20 min. Lastly, discussion was made regarding the development of the simulation with reflection (students and teacher together) on the performance of the communication skills.

The HFPSS allowed us to reproduce quasi genuine settings which foster the safe practice of communication skills. The students who directly participated in simulation acknowledged that they had felt integrated into the atmosphere they interpreted as real and had completely forgotten that the scene had been recreated.

“That room, the attitude of the teacher dressed up and the silicon mask really helped to calm my initial nerves, to isolate me and allow me to act normally, focusing just on what I was doing” (student)

For their part, the teachers regarded the experience as particularly motivating, leaving to one side the initial fears about their drama skills. In this sense, the barrier of the mask allowed them to feel secure about expressing the character and thus achieving great creditability and embodiment.

“The mask isolates you from the environment and this means you can really get inside the character, giving it life with great emotional intensity. The idea of the “teaching inside the patient” is transmitted metaphorically under their skin in a very interesting empathy-embracing working exercise”. (teacher)

To conclude, and returning to the question raised by Raurell-Torredá y Gómez-Ibáñez, we could say that they do not have the most impressive laboratory but that they design it. All those teachers offer an education of excellence, with great creativity and motivation, and generate and develop innovative teaching methods which are economically viable. The most impressive laboratory is therefore the one that appeals to the student's senses, stimulates critical analysis, is emotionally provoking and drives attitudes!!