As healthcare simulation evolves, so do the ways simulation is used to improve healthcare. Clinical Simulation has evolved from the traditional use in an academic setting to a more non-pedagogical practice focus setting. This growth has created confusion about what to call these healthcare simulation experiences, such as Translational Simulation or Transformational Simulation, or even Mastery-Based Learning. This HealthySimulation.com article written by HealthySimulation.com Content Manager Teresa Gore, PhD, DNP, APRN, FNP-BC, CHSE-A, FSSH, FAAN, will summarize some of the published practice-based clinical simulation terminology in the literature that is not present in the Healthcare Simulation Dictionary.
Some Terms Not Present in the Healthcare Simulation Dictionary
After attending several healthcare simulation conferences and webinars in 2024, the theme of using simulations outside of patient educational purposes to improve healthcare outcomes arose. Two of the terms are transformative simulation and translational simulation. These two terms are not in the Healthcare Simulation Dictionary.
When healthcare simulation professionals are inconsistent with terminology, the issue is that they continue to recreate the wheel rather than further previous research. In a recent taxonomy review article by Weldon et al. (2024), the authors discovered 68 terms related to transformative simulation. Simulationists need to speak the same language to continue to grow the impact of past patient simulations, including systems, process and quality improvement, human factors, workflow process, and safety threats.
Transformative Simulation
Transformative Simulation definition based on a concept taxonomy review by Weldon et al. (2023) is a tool to transform health and care through collective understanding, insight, and learning. Transformative Simulation concept taxonomy alongside the seven simulation-based I’s are based on the medical simulation literature includes:
- Innovation
- Improvement
- Intervention
- Involvement
- Identification
- Inclusion
- Influence
View the LEARN CE/CME Platform Webinar Transformative Healthcare Simulation:
to learn more!
During their work on the “Seven Simulation-Based I’s”, one of the biggest obstacles was the appropriate terminology describing their work. There were 68 different terminologies used for transformative simulation. Simulation can be used outside of a patient scenario. Based on this review and taxonomy, simulation practitioners should aim to consider their primary and secondary (where applicable) when conducting transformative types of simulation—for design, outcome, and reporting clarity. Researchers should consider the different objectives, use the taxonomy to describe and pose the questions that need to be answered, and develop studies that can answer them.
Translational Simulation
The term ‘translational simulation’ was proposed in 2017 as a “functional term for how simulation may be connected directly with health service priorities and patient outcomes, through interventional and diagnostic functions” by Dr. Victoria Brazil. Seven years later, translational simulation is an iterative process and should be based on quality improvement science. This process is accepted as the reason we do this. However, work is required on how to do translational simulation. An example was given for an algorithm with multiple decision points that was not user-friendly. The same example was given with a design thinking approach that improved the ease of use for clinical practitioners and learners (Nickson et al., 2021).
Dr. Victoria Brazil suggests that translational simulation can be used to link educational activities to patient-level outcomes even though measurement outcomes may be harder to measure. Brazil suggests that medical simulation should focus on “not where but why”. Brazil states translational simulation is a conceptual framing of how we think about simulation. This should focus directly on systems and processes in healthcare. Translational Simulation builds upon the simulation education of healthcare providers into complex systems thinking to improve all of healthcare.
View the LEARN CE/CME Platform Webinar Improving Clinical Care Outcomes with Translational Simulation to learn more!
Three core concepts are identifiable in recently published translational simulation studies: a clear identification of simulation purpose, an articulation of the simulation process, and an engagement with the conceptual foundations of translational simulation practice. Simulationists can and should use translational simulation as a conceptual framing. One example is simulating prone positioning with a ventilator patient with COVID. At SESAM 2024, Dr. V. Brazil stated simulation was used to assist in the development of the protocol. Simulation can also be used to determine or improve workflows.
As a part of translational research, Dr. Kim Bailey (2020) defined diagnostic simulation as a system probing to identify latent threats. This includes the recreation of adverse events, trial new equipment or a process, identify culture and professionalism issues, explore patient experiences, assessment the provider’s competence, and to test clinical trial enrollment processes. Examples of diagnostic simulation are provided in the following webinar:
View the LEARN CE/CME Platform Webinar Utilizing Clinical Simulation to Identify and Implement CLABSI Educational Needs to learn more!
Mastery-Based Learning in Medical Simulation
In his recent CE/CME webinar Simulation-based Mastery Learning: Efficacy, Clinical Outcomes, and Documenting Proficiency, Jeffrey H Barsuk, MD, MS Professor of Medicine and Executive Medical Director Northwestern Simulation at Northwestern University Feinberg School of Medicine shared how simulation-based mastery learning (SBML) can be used to improve clinical skills and improve patient outcomes. The individual components of SBML include the need for pretests and posttests, deliberate practice, and the minimum passing standard. Dr. Barsuk described how SBML can be used to document that students (medical and nursing) and residents/fellows have reached a high level of proficiency as required by Entrustable Professional Activities (EPA) or Milestones. He also discusses how SBML also can be used to provide practicing clinicians’ credentials, hospital privileges, and continuing education. Examples of the use of SBML will be given for EPAs, Milestones, credentialing, hospital privileges, and continuing education. At the end of the webinar Dr. Barsuk also shared an immersive/hands-on course held at Northwestern Simulation that teaches attendees how to design and evaluate SBML curricula.
Call to Action: Words Matter!
The call to action is to standardize the terminology used for transformative and translational simulation research and understand the concepts before immediately engaging in change. Simulation professionals should be curious about what is current and then what needs to change to improve the process or outcomes.
- Simulation professionals need to submit new terms and definitions to the Healthcare Simulation Dictionary.
- Simulation professionals need to use the terms within the Healthcare Simulation Dictionary to continue to grow the simulation community.
- Simulation professionals should participate in debates about the taxonomy for the potential impact health care and simulation globally.
Learn More About and Use the Healthcare Simulation Dictionary!
Reference Citations:
- Abrandt Dahlgren, M., & Hopwood, N. (2023). Simulation as a Transformative Pedagogy: Challenging Normativity and Embracing Emergence. In Third International Handbook of Lifelong Learning (pp. 1071-1089). Cham: Springer International Publishing.
- Bailey, K. (2020). Using Translational Simulation in Healthcare to Improve Patient Outcomes. Retrieved at https://www.healthysimulation.com/22544/translational-simulation-in-healthcare/
- Brazil, V. (2017). Translational simulation: not ‘where?’but ‘why?’A functional view of in situ simulation. Advances in Simulation, 2(1), 20.
- Brazil, V., & Reedy, G. (2024). Translational simulation revisited: an evolving conceptual model for the contribution of simulation to healthcare quality and safety. Advances in Simulation, 9(1), 16.
- Nickson, C. P., Petrosoniak, A., Barwick, S., & Brazil, V. (2021). Translational simulation: from description to action. Advances in Simulation, 6, 1-11.
- Weldon, S. M., Buttery, A. G., Spearpoint, K., & Kneebone, R. (2023). Transformative forms of simulation in health care-the seven simulation-based’I’s: a concept taxonomy review of the literature. International Journal of Healthcare Simulation, 1-13.
