1. 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

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

3. 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

4. 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

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

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

7. 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!

8. 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!

9. 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?

10. 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?

11. 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

12. 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)

13. 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?

14. 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?

15. 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

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

17. 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

18. 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

19. 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

20. 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

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

22. 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?

23. 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

24. 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?

25. 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

26. 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?

27. 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?

28. 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