Planning and Designing Scenario-based Simulations UCSF Center for Faculty Educators & Kanbar Center for Simulation disclosures Sandrijn van Schaik, MD Pam Bellefeuille, RN A step-wise approach 2015

Workshop Objectives Plan a scenario-based simulation session Create objectives for simulation scenarios Design a simulation scenario appropriate for your learners

Workshop Overview Six steps to curriculum development applied to simulation Creating educational objectives for simulation Planning a simulation session Scenario design: use of a template

Simulation Simulation session: a curricular activity in which simulation is the educational strategy Simulation: a broad term to describe education utilizing mannequins, partial task trainers, standardized patients and/or virtual reality This workshop focuses on scenario-based simulation using mannequins

Curricular design Six step approach (David Kern) Problem identification Needs assessment of learners Goals and objectives Educational strategies (Simulation) Implementation Evaluation and feedback

Example Master’s Entry Program in Nursing at UCSF (MEPN)

Step 1. Problem identification What problem does the curriculum address: Students in the MEPN program have no clinical experience and a very short training period during which they need to acquire clinical skills Stakeholders Students School of nursing Future employers Patients!

Step 2. Assess needs of targeted learners What do the learners need to know? Technical skills (taking a blood pressure, placing a bladder catheter, applying oxygen devices etc) Teamwork and communication skills Critical thinking (apply knowledge) How do they learn this best? Practice!

Step 3. Define goals and objectives What is the overall purpose of your simulation curricular activity? Objectives What specific and measurable outcomes should a learner expect to achieve by participating in your simulation exercise?

Learning objectives for simulation Specific Define exactly what needs to be learned Measurable Can you assess that the objectives were met? Acceptable Appropriate complexity for learners, relevant to their learning needs Realistic Achievable considering limitations of fidelity, time etc. Time bound At the end of one session, multiple sessions?

Examples Goal: treat a patient with urinary retention Objectives: Recognize symptoms of urinary retention Select appropriate equipment for bladder catheterization Insert catheter with proper technique Goal: manage a patient in respiratory distress Recognize hypoxia Select the appropriate oxygen delivery device Assess effectiveness of the intervention

Exercise 1: Small groups: think of a simulation scenario that can be used to reach an educational goal and create up to 3 learning objectives for that scenario (10 minutes)

Exercise 1 Discussion: Critique goals & objectives Questions to consider: Are objectives measurable? Reasonable number of objectives? Is simulation the best strategy? What other strategies should be considered to reach the objectives?

Step 4. Educational Strategies Which simulation method is the right teaching modality for all or part of your needs? Scenario-based using mannequin Partial task trainer Standardized patient Combination?

Step 4. Educational Strategies Integration in the Curriculum Simulation is most successful if related to other educational content and/or clinical experiences Deliberate Practice Practice followed by feedback and reflection, followed by focused repeated practice Mastery Learning Learner progresses through educational units of increasing level of difficulty

Exercise 2: Describe how you will address the following aspects in planning your simulation Integration in the curriculum Deliberate Practice Mastery Learning

Step 5. Implementation Planning the simulation session Preparing the learning content (scenario) Scheduling the session Preparing the instructors Preparing the learners Preparing the environment Preparing the technical staff

Scenario Design Use a template Helps establish common understanding with other faculty instructors about goals and objectives Helps identify what is needed to reach the objectives Helps with implementation phase Identify necessary resources Ensures staff understands & prepares what you need

Scenario Design Template: standard form for creating scenarios for mannequin-based simulation Goals and objectives Initial state of patient Equipment and props needed What are the possible/desired developments? What are the endpoints? Several templates exist: Kanbar has a word-based template

Trigger End Scenario design Scenario development states Scenario goes from one state to the next when a certain trigger is achieved (or not achieved) Example: Patient has an unstable arrhythmia. Shock is delivered, patient goes to sinus tachycardia. Baseline state Trigger Intermediate state Resolution state End

Exercise 3: Use the Kanbar template to create a simulation scenario building on goals and objectives from exercise 1

Exercise 3 Discussion: critique scenario design Questions to consider: Appropriate complexity? Feasibility with available resources and in allotted time? Will this scenario allow the learners to reach the learning objectives?

Step 5. Implementation Planning the simulation session Preparing the learning content (scenario) Scheduling the session Preparing the instructors Preparing the learners Preparing the environment Preparing the technical staff

Planning the simulation session Scheduling the session When, how long, how often? Preparing the learning content Design the scenario(s) Discussion/learning points for debriefing Debriefing is where most of the learning takes place! Preparing the instructors How are instructors trained? Where will they be, what will they do? Need for confederates?

Planning the simulation session Preparing the learners How are learners oriented to the simulator? What will learners do, how many in each group and how will roles be divided? Preparing the environment What equipment do you need? What props? AV-needs? Where will you pre- and debrief? Preparing the technical staff At Kanbar, staff will help you with much of the planning and preparation

6. Evaluation and feedback Did your simulation exercise allow the participants to achieve the learning objectives? How do you measure this? How do you use this evaluation to improve your simulation exercise/program?

Other things to consider… Make sure you have realistic expectations about what mannequins and other equipment can and cannot do Always schedule a dry-run (with simulation staff) ahead of time Who is operating the mannequins? Will they need to be trained?

Other things to consider…. Effectively conducting a simulation scenario requires preparation, flexibility, skill, practice Debriefing is often thought to be the most important part of a simulation Various approaches described Good debriefing is not easy and requires practice Video recording/play back can augment debriefing Simulation allows for assessment of learners Literature has many tools Consider using video recording, AV capture system with integrated assessment features