Conducting Scenario-based

Simulations

Sandrijn van Schaik, MD PhDJenna Shaw-Batista, CNM PhDCynthia Belew, CNM MS

UCSF Center for Faculty Educators & Kanbar Center for Simulation

Workshop Objectives

• Explain the concept of fidelity and its different components

• Create an effective learning experience by enhancing fidelity

• Anticipate common pitfalls in conducting simulation sessions

Workshop Outline

• Introduction

• Preparing your learners for simulation

• The concept of fidelity

• Challenges in conducting simulation scenarios

• Wrap-up

• Evaluation

3

Ice Breaker

Pair-share with your neighbor (5 min):• If you have experience with simulation: 3

issues that you have struggled with during simulation sessions in the past

or

• If you’re new to simulation: 3 issues that you are worried about when thinking of conducting a simulation session

4

Preparing learners for simulation

• Exercise 1: In your small group, read the scenario on your handout and answer the following questions:1. Why do you think this happened?

2. What could have been done by the simulation instructors to prevent this?

5

Preparing learners for simulation

Ask for commitment

Clarify goals

Timing – make it explicit

Permission to make mistakes

Clarify roles

Clarify expectations

Normalize any anxiety

Orient to equipment

Set the stage for the scenario

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Creating a safe learning environment

• Explicitly state the purpose of the simulation

• Clear expectations about roles and actions

• Establish respect for the learners and the learning process

• Orient to equipment and environment

• Describe potential challenges and solutions

• Explain debriefing and confidentiality

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Fidelity of Simulation

Dimensions of Fidelity

• Equipment Fidelity– Highest with physiology-based mannequins

• Environmental Fidelity– Highest with in-situ simulation

• Psychological Fidelity– Most important, dependent on instructor, can be very

high with standardized patients

– Physical resemblance

– Functional task alignment

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BeaubienQual Saf Health Care 2004

Fidelity Requirements

Kern’s 6 steps to curriculum development

1. Problem identification

2. Needs Assessment

3. Goals and Objectives

4. Education Strategies

5. Implementation

6. Evaluation and Feedback

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Fidelity and objectives

• Learning principles of physiology/pathology – Examples: Recognize ventricular tachycardia as a

cause of shock; Apply treatment algorithm for status asthmaticus

– Emphasis on equipment fidelity

• Learning to work in a particular setting– Examples: Locate resuscitation materials; Activate

rapid response team

– Emphasis on environmental fidelity

• Team work– Examples: Closed-loop communication; Task sharing

– Emphasis on psychological fidelity

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Educational strategies

• Is simulation the appropriate teaching modality to reach the educational objectives?

• Is scenario-based simulation the appropriate modality?– Not so good for:

• Procedure training (partial task trainers)

• Patient-doctor interactions (standardized patients)

• Physical exam skills

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Instructor and Confederates

• Instructor can be:– Facilitator

– Invisible observer

– Confederate

• Confederate:– Faculty, staff, actor, or learner who plays a role that

helps the scenario develop; for example: a parent, or a physician in a session with RN students, or an EMT is a scenario in which a patient is brought to the ED by an ambulance

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Active Participation

• Large groups:– Rotating leadership

– (Active) observers

– Plus-delta or interim debriefing technique

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Exercise 2: Challenges and Pitfalls

• Think about how you would address unexpected developments that may occur during a simulation scenario

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TIPS: Be Prepared• Identify limited, attainable learning objectives

• Select level of fidelity based on equipment and objectives– Know what the mannequins can and can’t do

• Write out the scenario(s) using a scenario template– Set people up for success, not failure– Stick to learning objectives, don’t make unnecessarily complex – Realistic responses to actions– Realistic roles, use confederates if needed

• Run through the scenario(s) ahead of time with technical staff

• Think about worst-case scenarios– Equipment failure– “Learner” failure– Scenario failure

• Formulate plan for feedback and debrief

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TIPS: conducting the session

• Set the stage: “Brief” or “prebrief” – Ground rules for safe and supportive learning

environment

– Describe expectations and feedback mechanism(s)

• Assign observers among your learners

• PAY ATTENTION and keep track of time

• Consider using video /B-line to augment feedback and debrief

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