Conducting Scenario-based Simulations Sandrijn van Schaik, MD PhD Jenna Shaw-Batista, CNM PhD Cynthia 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 6

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 7

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 9 Beaubien Qual 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 11

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 12

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 13

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 14

Active Participation Large groups: –Rotating leadership –(Active) observers –Plus-delta or interim debriefing technique 15

Exercise 2: Challenges and Pitfalls Think about how you would address unexpected developments that may occur during a simulation scenario 16

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 17

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 18