Healthcare simulation programs continue to become more complex with often ever increasing workloads and volumes of requests to train healthcare professionals of all clinical backgrounds.
This presents a number of challenges for those who are at the forefront of clinical simulation programs at every level. This article by Erin Carn-Bennett, RN, MSN will discuss the application and utilization of The SimZones by Roussin and Weinstock (2017), to any healthcare simulation program curriculum, no matter the location.
The SimZones, is a healthcare simulation organizational innovation that is both systematic and methodological in the approach. In order to apply the most applicable clinical simulation based education modality and methods to an appropriate debrief methodology is the essence of the SimZones method. The SimZones approach for clinical simulation programs was initially created in the Boston Children’s Hospital Simulator Program (2015) and has continued to be used successfully across the globe in a number of healthcare simulation programs.
Roussin and Weinstock (2017) discuss five major challenges to the organization of healthcare simulation programs in their seminal 2017 article and how The SimZones are able to alleviate these challenges.Despite eight years since publication, this healthcare simulation organizational structure and method shows no sign of movement from being a highly useful and cornerstone element to any healthcare simulation program across the globe.
Five major challenges SimZones can support include (but are not limited to):
- Support of both single and double loop educational experiences
- Management of education for clinical simulation educational faculty
- Optimization to clinical simulation participant groups such as: individuals, groups, teams, and others
- Solutions to balance clinical simulation delivery no matter the physical location
- Organization of clinical simulation research and the measurement of value
View the HealthySimulation.com Webinar The Surprising Truth About Emotional Intelligence in Clinical Simulation Debriefing to learn more!
SimZones is an innovative and systematic method of organization for clinical simulation-based education. The SimZones divide clinical simulation experiences into four different “zones.” Each zone from 0 until 4 has different language and application applied to the zone depending on learning outcomes. A different debrief style and also clinical simulation fidelity is applied to each zone’s clinical simulation experience.
There is a different level of signal and noise applied to each SimZone. Signal and noise relates to involvement and proximity of instructor/facilitators and the level of expertise of the clinical simulation participants. All of this also dove tails into the educators intended learning objectives and structure for how the clinical simulation will be run. The SimNurseNZ podcast interviewed Dr Peter Weinstock in 2023 and asked if The SimZones was still here to stay, and the answer was a firm yes. Zone 0: Zone 0 is described as a clinical simulation that includes an element of automated feedback. A zone 0 clinical simulation usually involves either virtual reality, a form of technology with feedback features or a facilitator who is in close proximity and gives directive feedback. For example: A task trainer to perform IV cannulation where nuanced and corrective detailed feedback is given to the novice learner to correct techniques in the moment.
Zone 1: As progression occurs through the SimZones the facilitator becomes less directive yet still remains present. A zone 1 clinical simulation utilizes the “pause and discuss” debrief methodology. With this style of scenario, the facilitator remains present, yet the signal and noise has increased. Foundational skills from zone 0 are translated to a scenario to apply these skills, but facilitators remain nearby to pause and discuss at different learning points.Zone 2: In a zone 2 clinical simulation, the facilitator allows a scenario to run in real time, with no interruption. Signal and noise increase as realism increases and teams or groups are enabled to care for their clinical simulation patient in real time. Zone 2 scenarios utilize a plus delta style of debrief methodology. Zone 0-2 clinical simulation experiences are categorized as a single loop learning experience. This means that healthcare simulation participants are able to reflect on their actions and results within the scenario and consider how to alter their clinical practice for next time.Zone 3: For a zone 3 healthcare simulation scenario, facilitators of the scenario are as invisible as possible within the clinical simulation experience unless required for key information or guidance. The signal and noise level is maximised in order to enhance realism and fidelity of the clinical simulation. A zone 3 scenario involves complete native teams and represents a full team for a critical event. Zone 3 clinical simulation experiences use an advocacy inquiry methodology of debrief. This method of debrief relates to double loop learning and challenges assumptions and values behind individual and collective behaviors that impact on patient outcomes.
Zone 4: Zone 4 relates to after real life events or critical events. The ability to be able to reflect on real life events and to consider actions, results and outcomes can be useful for teams. The zone 3 debrief methodology as well as other debrief methods can be useful within zone 4 or the after critical event debrief. Zone 4 continues to be an evolving landscape in terms of care for teams after real life critical events. A number of after critical event debrief tools have been developed to assist with this process. Healthcare simulation educators are highly skilled as debriefers and are positioned well to be able to run a psychologically safe after critical event review.
The Zones Offer a Unique Opportunity to Develop Successful Medical Simulations
The SimZones is an incredibly powerful, adaptable and useful tool for all healthcare simulation programs. A common language, foundation and system of a clinical simulation program sets everyone up for success from the beginner participants through to expert facilitator. The SimZones seminal article remains a cornerstone organizational innovation for many successful clinical simulation programs across the globe and does not appear to be going anywhere anytime soon.
Learn How to Start a Healthcare Simulation Program From Scratch
Reference:
- Roussin CJ, Weinstock P. SimZones: An Organizational Innovation for Simulation Programs and Centers. Acad Med. 2017 Aug;92(8):1114-1120. doi: 10.1097/ACM.0000000000001746. PMID: 28562455.
