To the editor:

I enjoyed the CJEM June 2015 article about the International Federation of Emergency Medicine (IFEM) and continuing professional development.Reference Hobgood, Mulligan and Bodiwala ¹ Hobgood et al. note that there is “at least modest evidence for the use of high-fidelity medical simulation, particularly for use in teamwork training and critical incident communication, two essential EM competencies.”Reference Hobgood, Mulligan and Bodiwala ¹ They also note that “there are core principles that IFEM endorses: every EP should evolve in the multiple domains that are required for practice advancement; patient care should evolve according to the best available evidence; and there is a set of basic core EM knowledge, skills, and attitudes that define the discipline regardless of the location of practice.”Reference Hobgood, Mulligan and Bodiwala ¹

Low-fidelity simulation, used with sound pedagogy, also has a positive effect on learningReference Maran and Glavin ^{2 -} Reference Norman, Muzzin and Williams ⁶ and may be a more effective tool than high-fidelity simulation in global low-resource settings. Simulation feasibility, or required cost and value attained, relates to affordability and logistic implementation.Reference Munshi, Lababidi and Alyousef ⁵ High-fidelity simulation is expensive, challenging to maintain and operate, and may lack contextual validity in low-resource or distributed settings. High-fidelity simulation is not always superior to lower-fidelity; it depends on the type of task involved and the learner’s level.

IFEM represents emergency medicine (EM) learning in global contexts. These contexts exist on a spectrum with rural and remote EM in distributed settings closer to home, where low-fidelity simulation is sustainable and contextually relevant. Moreover, the use of local materials to make low-fidelity trainers can provide insight for learners into the social determinants of health when, for example, local and visiting learners attend village markets together to buy simulation materials. Low-fidelity simulation should be included as a learning tool for core EM knowledge, skills, and attitudes.