Evan Stiger

    Simulation is a favored teaching methodology in healthcare education. As discussed in our previous posts, “What is Simulation” and “Why Use Simulation,” simulation allows students to build hands-on experience in a risk-free, safe environment. For all its benefits, adopting simulation can be difficult. The following best practices should be considered when adopting or refining simulation for a program.

    Incorporating Simulation into Curricula

    Prior to implementing a simulation program, the following questions should be examined:

    • What are the learning outcomes? Simulation is a methodology, not a goal. It is used to support students’ learning objectives. Students and staff should have a clear idea of their learning objectives; in order to evaluate success, key metrics need to be measured.
    • Is simulation right for the program? Simulation isn’t the appropriate method for every institution or program. Consider the merits of simulation versus alternative teaching methods like lectures, problem-based learning, clinical experience, peer-assisted learning, and multimedia learning.
    • Where should simulation be integrated? Integrating simulation into a four-year curriculum from nothing is an ambitious undertaking. If an institution is adopting simulation for the first time, implementing it in a single module or course may be a better option. Faculties with some simulation experience can expand incrementally.
    • Who is the simulation team? An ideal simulation team includes one or more instructors, content experts, and simulation technicians. Smaller programs may have fewer faculty members available. Before an instructor can adopt simulation, they must buy into its usefulness and be trained on best practices.

    Once the plan is defined and implemented, progress can be monitored based on learning outcomes. Continue to test new ways to run scenarios to find the most effective strategy.

    Designing a Scenario

    Scenarios should be designed based on what resources a facility has available. For example, if students are learning to identify heart and lung sounds with a stethoscope, the instructor will have to assess whether to use an auscultation trainer or manikin, or standardized participants (SPs).

    The scenario should be formatted based on the desired learning outcomes. Can the skill be safely and consistently learning through clinical immersion? Are students able to practice independently using a computer program?

    Well-designed scenarios share common elements. The following should be considered during the design stage:

    • Context: The scenario must mimic the complexity of a clinical situation. Script a comprehensive backstory for the patient’s file or practitioner inquiry. Touchpoints should be prepared to advance the scenario and react to participant actions.
    • Progress: Scenarios must be completed in a reasonable amount of time. Develop time frames to facilitate progression.
    • Standardization: Some elements will change between scenarios, but it’s the instructor’s responsibility to maintain a similar experience among students. For example, dialogue should remain consistent for all participants.
    • Metrics: Review key actions for the given scenario. Assign values to participant actions for a consistent comparison of student performance. Establish measures to verify the effectiveness of the simulation.

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    Running a Scenario

    Before students arrive for class, they should be prepared with an independent assignment that reviews the knowledge, skills, attitudes, and behaviors expected of them.

    Prior to beginning the scenario, students should get a pre-brief of the simulation. Pre-brief should include two key elements: (1) expectation setting for the scenario itself and (2) preparing participants to use equipment, technology, and the simulation space. The goal is to test student’s abilities to perform tasks, not operate a manikin.

    While running the scenario, the instructor should offer guidance based on the experience of the participants. The more knowledgeable the students, the less guidance needed from the instructor. Instructors will monitor progress and record each participant’s correct and incorrect interventions for the debriefing session.

    Simulation scenarios should also be followed by a debriefing session. Instructors should review the notes recorded during the scenario, and compare each student’s performance to the standards set in the planning phase. Students should be required to participate in debriefing discussions; this keeps them engaged. Student actions can be defined as appropriate or inappropriate to patient care by linking them to industry standards and end results. Using student perspectives and iterative testing will help evaluate the effectiveness of the simulation. Instructors are expected to note how scenarios can be improved in the future.

    This post is part three of our Simulation in Healthcare Education: What, Why, and How series. You can read “Simulation in Healthcare Education” here and “Why Use Simulation in Healthcare Education” here. Why do you use simulation in your healthcare education program? What have been some of the biggest benefits to using simulation? How have you integrated it into your curriculum?


    INACSL Standards Committee, “INACSL Standards of Best Practice: SimulationSM Simulation Design,” Clinical Simulation in Nursing, December 2016. https://www.nursingsimulation.org/article/S1876-1399(16)30126-8/fulltext

    Matola, I., et al. “Simulation in healthcare education: A best evidence practical guide.” AMEE Guide No. 82, Medical Teacher. https://www.tandfonline.com/doi/full/10.3109/0142159X.2013.818632