Healthcare simulation is a dynamic and effective method of experiential learning that can be incorporated into any clinical education program. There is no better teacher than experience and no safer way to gain healthcare experience than through the use of clinical simulation. However, there is a learning curve involved for the clinical educator who is new to or unfamiliar with healthcare simulation and the experience can be intimidating. This HealthySimulation.com article will break down the process and walk the novice educator through the basic design and development of an effective clinical simulation experience.
Who, What, When, Where?
When initiating a healthcare simulation, the first decision to be made should be whom the clinical simulation is intended to teach. Are the target learners nurses? Physicians? Ancillary personnel? A mixed group of these? If the target learners are pre-hospital emergency care providers, the healthcare simulation will be very different from that designed for nurses at the bedside on an obstetric unit, for example. If the clinical simulation includes different levels of experience or licensure, such as nurses and physicians, one will need to include elements of varying complexity to meet learning goals for both.
“What” refers to the topic being covered in the clinical simulation experience as well as the equipment needed. What is the subject on which education will be focused? Is the subject the correct execution of a skill or treatment? Is the subject using therapeutic communication? Once the topic is clarified, the clinical simulationist can begin to flesh out the elements needed to design the proper learning experience.
What type of fidelity is desired? If a high-fidelity manikin is needed, will the manikin be available on the requested dates? How will the manikin be transported to the desired location? A standardized patient actor (SP) or simple task trainer may be more suitable. Consider the feasibility of all types of fidelity and decide which is available and most effective.
Next, identify when will the clinical simulation take place. The proposed timeline must allow adequate time for the clinical simulation educator to prepare, research, and review the proposed scenario. A reasonable expectation would be to allow at least two to four weeks for adequate preparation. Expecting a compelling and engaging experiential learning event to be created without adequate preparation is unrealistic.
Finally, one must decide where the clinical simulation will take place. Is there a healthcare simulation center with advanced technology accessible? Is the area available for use on the requested dates? If the desire is to supply the clinical simulation event in situ (on the unit), what equipment will need to be transported to the unit? Will there be dedicated space for the event or is space dependent on patient load? Having this information will give the clinical simulation educator a better idea of location needs.
Developing the Clinical Simulation Scenario
Once the who, what, when, and where decisions have been made, the development process can begin. The clinical simulation educator can find templates for healthcare simulation writing by doing a quick Google search online. (The Society for Simulation in Healthcare (SSH) has a great one that can be downloaded.)
The development process is then guided by the predetermined topic, learner audience, and desired outcomes. The learning goals should be created based on these determinations and will be the ‘north star’ which guides the rest of the development process. Learning objectives should be clearly defined and limited to five or fewer to keep the clinical simulation scenario from becoming too broad in scope. The clinical simulation educator can refer to Bloom’s Taxonomy for developing learning goals. Most common in a clinical simulation are those related to remembering, understanding, and application of knowledge.
Learning objectives will be different for each medical simulation and target audience. For example, if the healthcare simulation educator’s goal is to have the learners practice a skill, the objectives should not focus on communication as a primary goal. On the other hand, if the objective is to improve professional communication, the focus should not be on the completion of a correct IV insertion.
Ultimately, the written scenario should include all elements needed to carry out the learning event and be clear to anyone who is involved in preparing for the experience. All equipment needed, including manikins, desired fidelity, and other items such as IV pumps, moulage, and monitoring should be clearly defined. Including these details in the first planning stage will allow for fewer surprises down the line when preparing for the event.
Non-technical equipment must be prepared as well. For example, the patient should have an identifying armband and any allergy bands and ask, will the clinical simulation require lab results to be presented? Radiology reports? EKG results? Any supporting documents should be prepared and included in the written scenario as attachments or appendixes. If medications are to be included, these must also be prepared and included in the equipment section of the template.
Medications (demos) used for healthcare simulation can be bought from clinical simulation supply companies if the budget allows. Alternatively, labels can be downloaded online or handwritten and placed on IV bags or empty vials. Candy or mints can be used as pills or tablets. These items can be simple or elaborate, depending on the stated learning goals and budget or time constraints.
If moulage is needed, the healthcare simulation educator will need to include a description of this in the written scenario for reference. This should be specific, describing exactly what should be included, such as bruising, bleeding, bandages, catheter, urine, etc. By having as much detail as possible, the healthcare simulation can be re-created by others who may not have had any part in the original development. The written scenario should be expected to be re-used many times and should be easy to follow – even if the initial team is no longer involved.
If using an SP, the written scenario must include a section for the SP to prepare. This will include a specific script as well as background information about the patient’s history, chief complaint, symptomatology, and even social history. Having the proper patient background allows the SP to fully understand the patient and provide a more realistic experience for the learner.
One common mistake is not allowing the SP time to become comfortable with the role and any unfamiliar medical terminology. Another possible consideration prior to using SPs is to have a backup person assigned to the role in the event one is unavailable on the date of the event.
Finally, one should have the completed scenario reviewed by a subject matter expert for accuracy. Clinical simulation should follow best clinical practices and should meet stated learning goals. One should expect some edits or rewrites to be needed, which is why adequate time for scenario development is so important.
Practice, Practice, Practice
After the clinical scenario has been written, edited, and reviewed, the clinical simulation educator should schedule a dry run with the same staff and equipment to be used for the final learning experience. Having this dry run is invaluable for making sure the scenario flows as expected and that the timing is correct. If the clinical simulation educator has allowed five to 10 minutes for the scenario to take place and the scenario takes twice as long as expected, there will need to be modifications made.
Further, if technology is included, the dry run gives the simulationist a chance to work out any technical issues that may arise. There is never a guarantee that technology will not malfunction, but practice can help reduce the odds. Once the dry run is completed and issues addressed, the medical simulation scenario is ready to move forward.
In conclusion, healthcare simulation is a proven method for clinical staff to learn, practice, and perfect skills in a way that is tangible and free from patient harm. A well-developed medical simulation scenario can be changed as needed and used multiple times, in different settings, and for different learners. The time put in up front will more than pay for itself with a successful learning event that will affect clinical staff like no other. By using this process, the novice clinical simulationist can develop scenarios that are engaging, clinically valid, and streamlined for ongoing use.
