Getting Ready for Simulation-Based Training: A Checklist for Nurse Educators

In the field of nursing, simulation training is one of the most effective ways to increase efficiency and familiarize student nurses with daily and rarely occurring medical scenarios. Nurses engage in simulation training to get master chief procedures such as inserting a catheter or tube. They are expected to perform similarly delicate tasks with great competency in highly demanding environments. Simulation training can help prepare for such scenarios. As per Christine Park, M.D. the 2017 President of the Society for Simulation in Healthcare, simulation training has three core benefits that include, “competency in technical skills, integrating cognitive and psychosocial skills into patient care, and enhancing team communication skills in a clinical environment.”      

RFS Studio
Simulation using models, drawings and mannequins help students succeed in real-world medical settings

To understand better, simulation training is an educational approach wherein a real-life experience is replicated or amplified in a controlled environment. It makes for an interactive and immersive learning experience through practical application of learned theories. The first mannequin was built in 1911 to train nurses to perform physical tasks such as dressing, turning, and transferring patients. Over time we have progressed to  computerized mannequins that can imitate the body’s physiology. Simulation training has also been integrated in numerous nursing programmes such as those for  mental health specialization or  end-of-life care, etc. Anatomical simulation is an area of virtual reality that allows students to visualize patient anatomy by ‘virtually dissecting’ them.  Immersive virtual reality is currently represented by two major companies, Oculus, which makes the Oculus Rift, and HTC, which makes the Vive. Simulation training has also been integrated in numerous nursing programmes such as those for  mental health specialization or  end-of-life care, etc. Nursing institutes have started incorporating digital and game based simulation techniques such as Bodhi Health’s MEDGAMES and MEDLEARN virtual simulation platform for nursing students to practice procedure-based skills or conduct skill-based assessments.

Doctor in operation room
Simulation based surgeries allow students to gain practical knowledge of their theoretical study

A well-constructed simulation training programme can help student nurses experience “what if” scenarios, attain a problem solving attitude, manage crisis better, and observe the effects of techniques employed – all without repercussions. For the aforementioned reasons and more, simulation training plays a central role in nursing education. To ease out the process, we have created a reference checklist before you initiate simulation training for student nurses:-

Ensure You Have Secured the Required Permissions 

Simulation testing demands professional and ethical behaviour. Educators need to ensure that there is mutual respect, confidentiality, willingness to accept and share constructive feedback, and that the performance is consistent with the institution’s policies. Prepare a fiction contract  that outlines the importance and mutual  agreement of performing as if in a real clinical situation for the benefit of fostering an engaging learning experience. A talent release is a mandatory legal document you require to receive consent of photography and videography during the training.     

Nurse taking blood from the body.
Simulation increases a medical student’s adeptness at performing delicate and critical tasks
Define the Purpose of Your Simulation 

Healthcare simulation scenarios are created to address specific learning needs. Before creating a simulation, it is important to decide what information is needed and which part of the operation should be replicated to meet the objective. As stated by the International Nursing Association for Clinical Simulation and Learning (INACSL) the first step in scenario development is the completion of a need’s assessment. INACSL’s simulation design standard provides a sequential checklist for scenario development which can be used by clinical facilities, medical schools, and in postgraduate medical education. Once the learning objectives are clarified, it becomes easier to attain them through simulation training. Make sure that the objectives identified are limited in number and are specific or they might frustrate the learner and make the assessment complicated.        

Doctor checking pulse
Simulation training helps build a medical student’s ability to be more empathetic, patient and caring
Define the Metrics for Evaluation and Assessments

Simply creating a simulation lab space does not ensure that the best training practices are incorporated. While self-confidence can be argued as a measure of assessment, there are other methods to enhance effectiveness of the education strategies. Kirkpatrick model of training effectiveness is the most commonly used evaluation framework which includes four levels of assessments: 

  • Reaction: The satisfaction derived from the training
  • Learning: The increase in the skills and knowledge of the student
  • Behaviour: The observed changes in the behaviour of the participants 
  • Results: The outcome of the simulation

Applying the aforementioned framework can help an educator measure how well the simulation training worked  and how much it improved the learner’s knowledge, skills, ability in a medical setting. Training facilities could also create a survey to measure the effectiveness of the simulation training.     

Conduct Pre-briefing and Debriefing sessions

Efficient communication is the cornerstone of every learning experience. To enhance the effectiveness of the simulation-based training, conduct a pre-briefing session prior to the hands-on lesson through orientation tasks and learning engagement activities. This would enhance learner satisfaction, participation, and effectiveness of simulation practice. 

Debriefing sessions are conducted after the simulation to underline the thought process which would help improve future performance. Incorporating this practice as a habit would help both learners as well as educators to re-examine the simulated case experience, share their mental model, and foster the reasoning behind their clinical judgment.    

Prepare the Instructors and the Learners

To ensure a seamless learning experience, it is important to prepare the instructors before the simulation. Organize simulation review materials such as learning objectives, equipment setup, expected interventions, vocal scripts, debriefing points, etc.

Discuss the expectations from the simulation training scenario with the learners. This includes assigning roles and responsibilities such as the lead medic, PC operator, facilitator and the team members who would assist. Remind them to treat the simulator as they would a real patient – with respect and empathy. Explain to them that while the simulation would largely imitate a life-like scenario, some things may appear artificial, however, for the sake of learning, they are to be overlooked.       

Consider the Disadvantages 

Constructing a healthcare simulation from scratch is a daunting task that can get complicated with limited funding. Nursing state boards and other accrediting bodies expect simulation programmes to follow recognised national standards, which can be hard to get right in the first go. As discussed, it is also  difficult to measure the results from simulation training to gauge whether it was successful or not.

However, despite these initial hiccups adopting simulation training far outweighs its drawbacks. The trial-and-error approach through simulation training followed by analysis of training sessions, identification of errors, and discussions of emotions and feelings that influenced the trainees can help enhance their learning experience exponentially.

“Written by Siddhi Latey (Weloquent)”

Virtual or Augmented Reality : Which technology should you invest in for your next medical education challenge?

Growing number of learners at medical schools and teaching hospitals are training through computer-generated simulations thanks to VR and its cousin, augmented reality (AR). These sophisticated tools allow learners to plunge safely into life-or-death scenarios, peel away layers of human anatomy, walk through a virtual heart, and more. As technologies from the gaming industry improve and costs decline, leaders in academic medicine are increasingly exploring the place of such simulations in medical education.

Early adopters note the varied benefits of AR and VR, including the opportunity for real-life experiences without real-life consequences.

Let us start by explaining what each one actually means

Virtual Reality

Virtual reality is an entirely computer-generated view of a world — that is, purely virtual. Everything the user sees is manufactured but as close to experiencing it in real life as you can get.

Augmented Reality

Augmented reality, by contrast, superimposes computer-generated images and sounds onto the real world. In medicine, this includes simulated internal organs overlaid on a real manikin.
It bridges the gap between role-playing and high-fidelity simulation.”

Virtual Reality vs Augmented Reality:

AR vs VR

Click here to read the articles about Virtual reality in medical education.

Who are the Early adopters of these technologies and what areas have they identified for these technologies?

  • Children’s Hospital Los Angeles (CHLA): Handling emergency situations

  • Stanford University School of Medicine: Use of VR for training in its Neurosurgical Simulation and Virtual Reality Center. There, a platform called Surgical Theater fuses several types of brain scans from a real patient to achieve greater specificity and verisimilitude.
  • Mayo Clinic: Instructors use AR for various purposes at Multidisciplinary Simulation Center, to teach students how to interpret ultrasound imaging. As students look at a standard ultrasound view, AR adds images of underlying tissues, bone structures, blood vessels, muscles, and nerves for a deeper understanding of the ultrasound visualization.
  • UC Irvine School of Medicine: Faculty recently launched an AR pilot project for fourth-year students and emergency medicine residents. There, a computer app superimposes a hologram of a patient over a manikin to produce a much more lifelike and responsive simulation

What the early adopters are saying about their experience using these technologies?

“The beauty of this is really that you can appreciate in three dimensions what the structures look like.”
Gary Steinberg, MD, PhD
Stanford Medical School

“You don’t get that feeling of adrenaline through a written test,” says White. “You get it through experiencing it, and I think this is as close to experiencing it in real life as you can get.”
Todd Chang, MD, MAcM,
Director of research and scholarship at CHLA

“Wearing my technologist hat, this is an incredibly exciting time. … But my physician side is a little more cautious in thinking that we shouldn’t jump headfirst into every new technology that comes out.”
Warren Wiechmann, MD
Associate Dean of Clinical Science Education and Educational Technology
University of California Irvine School of Medicine

So who is winning the race VR or AR?

Let us start by saying that this is definitely not a race but an opportunity in our future that needs to be taken seriously by all the stakeholders involved, including the learners and patients.
As prices fall, the capabilities of the technology grow, and developers create new teaching modules, a trend toward greater use of virtual and augmented reality in teaching and training seems almost guaranteed.