Designing Effective Simulation Experiences: A Proposed Template

Mohammad M. Mousavian, DMD, ML^{1, 2}, Adam S. Hockman, MA^{1, 3}

¹MGH Institute of Health Professions, Boston, MA
²Harvard Medical School, Boston, MA
³ABA Technologies, Inc., Melbourne, FL

The authors declare no conflict of interest.

Corresponding Author:  Adam Hockman, MA, MGH Institute of Health Professions, Boston, Massachusetts (Email: ahockman@mghihp.edu)

Brief Description

Simulation educators and operation specialists use planning templates and worksheets to guide the design, development, and delivery of high-quality simulation (sim) experiences. These can vary in small and big ways between and within institutions. In this paper, we introduce a template that tries to consolidate and streamline the information needed to create meaningful learning experiences.

Introduction

Institutions that build out their simulation capabilities and adopt debriefing practices often create internal templates to help operation staff and educators design effective simulation activities. As with anything, not all templates are created equal, and they can quickly become hindrance to securing funding or lab time. A good template earns its worth when designers consistently rely upon it to build learning activities. The proposed template was created after reviewing dozens of others and considering these core ideas:

Templates should:

1. Prompt the use of best practice in simulation design and delivery
2. Act as a project charter to get everyone on the same page and specify what’s to be designed and how
3. Link activities to learning objectives, standards, and desired outcomes
4. Be flexible enough to meet the needs of different specialties and support innovation
5. Be functional and easy to use, improve the quality of the simulation activities, and positively impact learner outcomes
6. Be iterative. Teams should regularly meet to discuss components of the template and design process and determine if they warrant changes

Whether you adopt this template or not, we hope you will consider and evaluate your own templates using the guidance provided above.

You can find the full template in the appendix. In the remaining sections of this article, we break down each part of the template and provide our rationale for including it.

Rationale: This section collects background information and details about the simulation. It is meant to be an efficient snapshot of the involved stakeholders and the type of simulation planned. Additional information, not categorically included, may be added in the other section depending on the needs of the activity.

Rationale: Clear behavioral objectives set the stage for a good sim activity. In this section, explicitly create goals and objectives that orient designers, learners, and evaluators. Use actionable verbs, such as those in Bloom’s taxonomy.

Rationale: Briefly write a description of the context. What is the setting for this activity? Simulations in an operating room versus ones in a sim lab require different considerations. The clinical context section helps stakeholders orient to the activity and determine if the stated objectives are appropriate for the intended setting.

Rationale: In this section, indicate the necessity of your intended learning exercise. When simulation resources (time, money) are scarce, you want to have a good case for why you need this activity. Additionally, indicate how this exercise expands upon previous learning activities. If it is their first exposure to the target topic, simulation may not be appropriate, but if it is, elaborate on how you will introduce students to the topic before or during the exercise.

Rationale: Link your learning objectives to the relevant competencies of your discipline’s professional governing bodies. Coordinating multiple objectives under the same umbrella reduces redundancies and connects learning to program requirements. Stakeholders and simulationists should also find this section helpful to contextualize the sim event. We adopted this portion from Children’s Hospital of Philadelphia. In their template, they easily map objectives to residency program outcomes (CHOP, 2009). Skip this section if it does not apply to your program.

Rationale: With competencies and learning objectives identified, you will now map onto the relevant knowledge and skills used to meet that objective. Inspired by and adopted from the TEACHS template (Benishek et al., 2015), we include an attitudes (A) portion that should spell out more details on the audience. Learner groups have different preferences and needs; you want to be aware of those attitudes, perspectives, and preferences before you build a simulation environment. 

Rationale: This section will be the most extensive and time-consuming to create, but it’s one of the most important. Here, detail the events of the case, preferably in chronological order. Document the learner’s responses mapped to KSAs and objectives listed in the previous section. Case and Events promotes effective design, observation, and evaluation.

Rationale: After you build the details of the case, write a brief history and physical for the simulated patient. This section can be short or detailed, depending on assessed needs and the specifications of the simulator. Standard components of an H&P are provided to help organize facts, but add and omit components at your discretion.

Rationale: Equipment and props the operations specialist should gather or program for the sim event. Again, adapt this section based on your simulation context.

Rationale: There are countless debriefing methods available. In this section, consider factors from the particular sim event that may direct you to use one method over another. We recommend Debriefing with Good Judgement (Rudolph et al., 2007) and PEARLS (Bajaj et al., 2018). Both allow you to explore events of the simulation and reflect on the learners’ experience. A plus-delta approach might be applicable when time is brief (Dismukes, 2000).

Conclusion

The proposed template is intended to be comprehensive, user-friendly, and interdisciplinary. Certain parts will require more or less detail and should always be informed by the needs of the simulation designer, educators, and learners. Apply your own clinical and education judgment when deciding whether to use all or some of the parts of this template.  

Simulation education is relatively new and rapidly evolving, dictating a need for further evolution of simulation templates. Additional research, trials, and proposals are needed to further develop and validate all templates.

Appendix

Simulation Template

Simulation Details

Title:
Date:
Location:
Expected duration:

Type of learning activity:

• High-fidelity simulator
• Low-mid fidelity mannequin
• Standardized patient
• Role play
• Other:

Sim designers:
Sim facilitators:
Sim audience:

Objectives

What objectives does this learning exercise attempt to meet? Ensure the learning objectives are specific, goal- and action-oriented, realistic, achievable, and measurable.

Clinical Context

What is the clinical context for this learning activity? Provide a short description. 
Ensure your clinical context is appropriate for the stated objectives.

Learning Activity Needs Assessment

State two guided study questions for this activity. Briefly elaborate on the need and use of this learning activity. If relevant, state three references that support the need and use for this learning activity. What content have learners been previously exposed to prior to this learning activity?

ACGME Competencies

• Patient Care that is compassionate, appropriate, and effective for the treatment of health problems and the promotion of health
• Medical Knowledge about established and evolving biomedical, clinical, and cognate (e.g., epidemiological and social-behavioral) sciences and the application of this knowledge to patient care
• Practice-Based Learning and Improvement that involves investigation and evaluation of their own patient care, appraisal and assimilation of scientific evidence, and improvements in patient care
• Interpersonal and Communication Skills that result in effective information exchange and teaming with patients, their families, and other health professionals
• Professionalism, as manifested through a commitment to carrying out professional responsibilities, adherence to ethical principles, and sensitivity to a diverse patient population
• Systems-Based Practice, as manifested by actions that demonstrate an awareness of and responsiveness to the larger context and system of health care and the ability to effectively call on system resources to provide care that is of optimal value
• Other:

Knowledge, Skills, and Attitudes:

Please list the knowledge, skills, and attitudes (KSA) that are specific to this context and indicate which learning objectives are met through these. Each objective should have at least one corresponding KSA, with more than two being recommended.

Examples:

• Asks open-ended questions
• Acknowledges patient’s questions, concerns, and possible hesitations
• Ensures patients have modest draping during examination

Case and Events

• State the scenario details.
• List the events during the case that the learner is involved in. Events consist of incidents that prompt the learner to respond (if the student does not respond to an intended incident, please document as well). Events can also involve various information gathering skills, physical examination maneuvers, and orders placed by the learner.
• State what KSAs and learning objectives are relevant to the stated event.
   

History and Physical

• HPI
• PMH
• PSH
• Meds
• Allergies
• SH & FH
• ROS
• PE
  • Vitals
  • General, HEENT, Resp, Heart, Abd, GU, Ext, Skin, Neuro

Equipment and Props

• Airway
• Labs
• EKG
• US
• Monitoring devices
• Blood products
• Imaging
• TLDs
• Medications
• Etc.:

Guided Debrief

• Decide how you’d like to debrief (individual vs group)
• Set the ground rules for debriefing
• What materials do you need for debriefing?
• What questions would you like to use?
  • Did the scenario meet the intended purpose and objectives?
  • What worked well?
  • What can be improved upon?
• Did this simulation inspire future ones?

References

Bajaj, K., Meguerdichian, M., Thoma, B., Huang, S., Eppich, W., & Cheng, A. (2018). The pearls healthcare debriefing tool. Academic Medicine, 93(2), 336. https://doi.org/10.1097/acm.0000000000002035.  

Benishek, L. E., Lazzara, E. H., Gaught, W. L., Arcaro, L. L., Okuda, Y., & Salas, E. (2015). The template of events for applied and critical healthcare simulation (teach sim). Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 10(1), 21-30. https://doi.org/10.1097/sih.0000000000000058.

Children’s Hospital of Philadelphia. (2009). Scenario development worksheet. Template used at Children’s Hospital of Philadelphia’s Center for Simulation, Advanced Education, and Innovation.

Dismukes, R. K. (2000). Facilitation and debriefing in Aviation Training and Operations. Ashgate.

INACSL Standards Committee. (2016). INACSL standards of best practice: Simulation^(SM) Simulation Design. Clinical Simulation in Nursing, 12. https://doi.org/10.1016/j.ecns.2016.09.005.  

Rudolph, J. W., Simon, R., Rivard, P., Dufresne, R. L., & Raemer, D. B. (2007). Debriefing with good judgment: Combining rigorous feedback with genuine inquiry. Anesthesiology Clinics, 25(2), 361-376. https://doi.org/10.1016/j.anclin.2007.03.007.