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.

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

Achieving Practical Simulation

Practical Simulation Defined: Practical Simulation is a term used by HCSSC to describe a level of simulation with the following characteristics:

Practical Simulation Pyramid of Success

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 Instructor

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.

Expert Curriculum

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.

Complexity

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.

Start Scenario

Start Scenario

Running Scenario

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.

Pie Chart
  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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.

Roles in the Simulation Learning System

Practical Simulation requires several supporting roles. These roles may be fulfilled by one or more persons in a full or part-time capacity.

Other important roles in offering simulation educational opportunities include:

Barriers to Achieving Practical Simulation

There are three major obstacles that can prevent a nursing program from achieving Practical Simulation.

  1. 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.
  2. 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.
  3. 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:

Standardization across multiple teachers