Learn more about HCSSC’s approach to Practical Simulation
Benefits of Healthcare Simulation
Why use simulation to educate healthcare students and professionals? What is the overall benefit to the participant and, for that matter, to society as a whole?
Simulation can be used to improve the educational process at both the efficacy (how well) and efficiency (how fast) levels. Healthcare simulation also has the potential to
improve patient outcomes and reduce risk to healthcare institutions and individual practitioners by substituting simulated training exercises for risky patient-based training
exercises and by allowing practice for risky, infrequent patient emergencies.
Barriers to Developing Simulation Modules
With these clear benefits, the question is,
"why don't more organizations and educational programs use simulation?"
The follow list offers some possible answers.
- Faculty may lack knowledge
about the available simulation tools and how to use them.
- Faculty may lack knowledge, skill, and/or formal training in educational processes. Healthcare professionals,
even those who engage in teaching activities on a regular basis, may have had no formal training on educational theories, concepts, or processes related to course design and
implementation. They may not be comfortable with setting clear educational goals and objectives or developing effective curriculum materials.
- Faculty generally has a
limited amount of time to devote to designing simulation activities and learning to operate simulators.
- Healthcare education requires that a relatively large number of participants
be trained, but simulation at its highest power use is best suited for one-on-one or small group educational sessions. Use of simulators, except for demonstration purposes, is typically a
very hands-on activity. Therefore, it is often necessary for multiple instructors to be trained to be able to provide multiple small group simulation encounters.
- The number of
simulators and full time personnel available to support simulation may be limited due to lack of resources.
The philosophy and methods introduced in this manual
are designed to help overcome these barriers to allow simulation faculty and participants to be actively engaged in effective simulation educational activities.
Selected HCSSC Results to Date
- 70+ instructors provided over 9,000 simulation encounters at MUSC during 2008- 2009 with the assistance of two simulation specialists.
- 170 1st year Medical Students learn to
take vital signs during the first week of class, using scenarios designed so the participants could run them independently.
- 500+ ADN student encounters from Jan – Mar using
programmed nursing care scenarios. 20+ clinical faculties were trained to operate the simulators while instructing their groups.
- 200+ BSN students participated in nursing
care scenarios during Fundamentals. One week after opening their newly renovated lab, USC Columbia trained 8 faculty members to run scenarios for all 200+ Fundamentals students.
Achieving Practical Simulation
Practical Simulation Defined: Practical Simulation is a term used by HCSSC to describe a level of simulation with the following characteristics:
- Modules and scenarios are standardized
- Large numbers of participants have access to simulation
- Instructors can rapidly learn to run scenarios, and
- Value is demonstrated through objective outcome measures.
Practical Simulation provides the antidote to the common barriers to simulation. In order to have large numbers of participants experience the same simulation experience, the scenarios and modules
must be standardized and allow multiple instructors to run the scenarios and modules consistently. Although a high level of activity is one measure of achieving Practical Simulation, it is not
the only one. Modules and scenarios are standardized to allow for data collection for demonstrating the value of the simulation activities, both at an individual and an aggregate level.
Decision makers want to see a return on their investment in simulation equipment and personnel.
The Practical Simulation Pyramid of Success illustrates how achieving Practical
Simulation begins with careful planning and requires a functional simulation environment. Once quality, standardized simulation activities are established, value can be demonstrated through
outcome measures and communicated to appropriate stakeholders.
Methods for Achieving Practical Simulation
Expert Instructor, Expert Simulator Operator approach
Currently, across the country, the most commonly used method for providing simulation activities is an Expert Instructor, Expert Simulator Operator approach.
In this approach the instructor is present at the simulation as the content expert and teacher, and a second individual, the expert simulator operator, is also present.
The simulator is generally operated in a manual mode or with a scenario that is modified "on the fly" during
the simulation session. This approach limits objective education outcomes from the session and the number of participants
that can participate is limited by the availability of the instructor and the simulator operator.
Expert Scenario, Competent Facilitator approach
The HCSSC method of providing simulation activities follows the Expert Scenario, Competent Facilitator approach. In this approach,
the simulator runs scenarios that have been programmed with a specific set of objectives, built-in grading, and feedback. The content for
the scenarios is provided by experts in the field. The programming is done by local, trained support personnel or an outside group,
such as HCSSC. This programming not only allows educational outcomes to be measured, but also allows facilitators to be easily trained to
run the scenarios, eliminating the need for an expert operator for every simulator. One simulation support person can assist with multiple simulations simultaneously.
The HCSSC has actually developed scenarios in which the participants run the simulators, allowing several groups to work through simulation scenarios with one instructor in a supervisory role.
Programmed scenarios of this type are designed so participants can learn to run them after a brief orientation.
Utilization of simulation will increase as the complexity of operating and
teaching with the simulation decreases. The current HCSSC methods are designed to increase the use of simulation.
Examples of HCSSC Programmed Scenarios
The HCSSC scenarios are programmed so that facilitators interact with logically organized menus.
With a well programmed scenario, physiology, pathophysiology, pharmacodynamics, seizures, airway obstruction, etc. are pre-programmed. In most cases the programmed scenarios also
result in an "automated" debriefing guide. Facilitators do not need to know much about the simulator user interface; therefore, a limited amount of training is needed.
The following are examples of the menus
that run HCSSC scenarios. Menus are discussed in greater detail in the simulator specific chapters.
Simulation Learning System
The Expert Scenario, Competent Facilitator Model for developing simulation learning activities requires that there be a support structure within which the activities occur.
This structure, the Simulation Learning System, has multiple elements.
- Curriculum---the simulation activity related course materials and the media through which course materials are accessed or utilized. In most nursing programs the curriculum or
didactic portion of the simulation activity takes place in the classroom or online. It is important that participants come prepared to the simulation activity.
- Training Tools---the simulator and scenario are selected
to support the objectives of the simulation activity. Choosing the appropriate simulator(s) for the educational goals and objectives is a key to creating a successful learning activity.
- Performance Evaluation---the measurement
system that assesses whether or not the educational goals and objectives of the simulation have been met. Some simulators have performance evaluation capabilities that can be programmed into the simulation activity. For example, SimMan®
and SimBaby® allow the programmer to include automatic grading points within a debriefing log. Other simulators require that the course developer create a separate performance evaluation tool. This may be an Excel spreadsheet or a
checklist that is completed for each participant.
- Feedback to Participant---the process of providing the results of any given simulation session to the participant. There are two types of feedback for participants that are
associated with any learning activity - Formative and Summative. Formative feedback is designed to provide the learner with feedback to help them improve there performance. Summative feedback provides an overall evaluation of the
participant's performance at the conclusion of the learning activity (e.g. a test or quiz.) Depending on the simulation learning activity, one or both types of feedback may be provided to participants. The Expert Scenario,
Competent Facilitator model includes a specific process for creating standardized feedback to participants.
Data Collection System---the process and method through which outcome data and
information are collected, analyzed and represented. To demonstrate that the simulation learning activity had a positive impact on participant knowledge or skill development and a value-statement can be communicated, it
is important to collect data to be analyzed. The sophistication of the data collection system will depend upon the research and educational objectives of the simulation learning activity. Some simulators, such as SimMan®,
SimBaby® and Noelle® actually collect performance data that can be exported and evaluated. Other simulators require the data collection methods to be developed.
- The simulation learning activity is created to address specific educational goals and objectives
- The performance evaluation tool(s) is created to measure whether or not the specific educational goals and objectives have been met as a result of the learning activity.
- The facilitator uses the evaluation tool(s)
as a basis for the formative or summative feedback to the participant, which is specific to the educational goals and objectives.
Roles in the Simulation
Practical Simulation requires several supporting roles. These roles may be fulfilled by one or more persons in a full or part-time capacity.
- Simulation Specialist- This role is key to
achieving practical simulation. This person works directly with faculty to create or implement existing simulation scenarios. They also plan course logistics and support all classes and sessions. The simulation specialist is
responsible for implementing the quality assurance activities related to setting up and running the simulations and for collecting data during simulations. The Simulation Specialist maintains and troubleshoots the simulators and
- Administrative Coordinator- The person fulfilling this role is generally responsible for scheduling courses, registration and tracking of participants.
- Information Technology Coordinator-
Practical Simulation and its supporting infrastructure involve a lot of computer technology. It is important that each simulation lab have adequate IT support.
Other important roles in offering
simulation educational opportunities include:
- Facilitator- The instructor that runs the simulation activity. Facilitators are assigned to specific simulations and trained to run them. They also manage the
participants in their assigned sessions. The term facilitator is used to reflect the student-centered nature of simulation activities.
- Course Director-The simulation activities themselves are developed or
modified by program faculty. The person responsible for oversight of a particular simulation activity may be a course coordinator or other lead faculty member. This simulation "Course Director" is
responsible for setting educational goals and objectives, developing or identifying corresponding curriculum materials and evaluations, working with the simulation specialists by providing the expertise needed
to write or offer any simulation programs, establishing the number of classes, establishing how often courses will be scheduled and identifying and training facilitators in content areas, as needed.
The participants in the simulation activity.
Barriers to Achieving Practical Simulation
There are three major obstacles that can prevent a nursing program from achieving
- Running the high fidelity simulator by manually adjusting the parameters "on the fly." This requires a highly trained operator for it to be successful and it is impossible
to get reproducible results for measuring outcomes. Manual operation of the simulator requires the instructor to run the simulator GUI, change parameters according to participant actions and appropriate physiology.
- Performance evaluation is not integrated into the scenario. Not only does the instructor have to manually operate the simulator if it is run without programmed scenarios, but a separate checklist of performance
criteria is required.
- Debriefing that is unstructured, loose. Debriefing should be focused and provide the opportunity for the instructor to guide the participant to fill any observed knowledge, skill or judgment gap.
Practical Simulation Key Requirements
Practical Simulation is achieved when the following key elements are present:
- A large number of instructors (facilitators) who operate a range of simulator tools,
including high fidelity simulators
- Methodologies that allow facilitators to run complex human patient simulations with limited technical training
- Simulators flexible enough to be adapted to the wide range of
training objectives to meet the needs of the stakeholders
Standardization across multiple teachers
- Simulation-supported performance evaluation and outcome measures for communicating
value to the stakeholders
- Structured debriefing
- Large numbers of participants participating in a wide-range of simulation activities across the curriculum