February 2, 2026 · 11:30 am

Designing for Learner Success: 5 Ways of Ensuring Simulations are Effective Student-Centered Learning Environments

Soooooo, first off. Happy 2026 to you! I trust it is going well so far. I have been doing some studying about some of the learning theories and educational principles associated with simulation and higher education recently. As such, I have been making many new connections in my mind about the ways that healthcare simulation deeply connects to evidence and theory regarding higher education, and surprisingly to the K-12 education world. So this post is a bit more theoretical than usual, but it is representative of some of the course work that I am currently enjoying! I hope you share the same enthusiasm.

If you have worked in healthcare simulation for any length of time, you may have heard the phrase “guide on the side, not sage on the stage” which comes from Alison Kings 1993 publication (1) that suggested college level teaching move toward a constructivist theory design. Some argue she set the stage for the flipped classroom, where lecture content is moved outside the classroom to make room for active, guided learning during class time. It is often repeated, but do we truly practice it? In the rush to employ high-technology manikins or arrange the perfect clinical fidelity, it is easy to focus on the teaching rather than the learning.

To truly maximize the potential of our simulation center education programs, we need to shift our perspective toward Student-Centered Learning Environments (SCLEs) as described by Jonassen & Land (2). According to the learning sciences, SCLEs are not just about letting learners “figure it out” on their own; they are grounded designs where learners negotiate meaning, engage in authentic problems, and utilize scaffolding to bridge the gap between novice and expert where we serve as facilitators.

So then, how do we ensure our healthcare simulations function as true student-centered environments? Here are a few approaches that blend educational theory with practical simulation design.

1. Respect the “Learner’s Scenario”

In a previous post, I discussed how the word “scenario” means different things to different people. To the educator, it is a blueprint; to the operations specialist, it is a technical playbook. But to the learner, the scenario is the experience.

A core assumption of SCLEs is the “centrality of the learner”. While we may set external goals, the learner ultimately determines how to proceed based on their individual needs and the questions they generate. To support this, we must design scenarios that allow for agency. We must move away from linear, step-by-step exercises, which behaviorist theories might favor, and toward open-ended inquiry where learners identify gaps in their own knowledge and seek evidence to resolve them. After all, such design mimics the real-world practice of medicine and diagnostic processes in all of healthcare.

2. Recognize Scenarios as “Practice Fields” (But Mind the Cognitive Load!)

We often strive for realism, but we must be careful. Student-centered learning is rooted in “situated cognition,” meaning knowledge is inextricably tied to the context in which it is used. We want our simulations to act as “practice fields”, or environments where learners can engage in the authentic work of professionals. Think diagnosing a condition, managing a code, displaying empathy, or any other aspect of healthcare that we wish our learners to show us their abilities.

However, authenticity does not mean clutter. As I have written before, cognitive load is a currency that must be spent wisely. If we overload a scenario with irrelevant noise or “too much stuff” in the name of realism, we risk overwhelming the learner. A true student-centered design simplifies the authentic practice just enough to make it accessible, reducing the complexity without removing the core challenge. This allows the learner to focus on the learning objectives rather than processing extraneous details.

3. Anchor Learning in Prior Experience

You cannot center a curriculum on a student if you do not know where they are starting. Learners come to us with tacit, often naive beliefs rooted in their everyday experiences. Effective SCLEs use “anchored instruction” to connect new concepts to these familiar contexts.

In the absence of harboring true expertise in the needs of your intended learners, a robust needs assessment is the cornerstone of simulation design. As I have discussed in previous posts there are many pathways by which this can be accomplished. By gathering data through surveys or interviews, we identify the specific gaps between current outcomes and desired goals. This allows us to tailor the simulation to the learner’s “Zone of Proximal Development” ensuring the challenge is neither too boring nor too overwhelming. When we validate a learner’s prior experience, we empower them to take ownership of the inquiry.

4. Scaffolding: The Art of Optimal Guidance

There is a misconception that student-centered learning means “minimal guidance.” In reality, it requires optimal guidance. In the simulation world, we often provide this through scaffolding, or constructing the learner journey in a building block adventure that ultimately help learners manage the complexity of the task.

Scaffolding in simulation takes many forms:

  • Pre-Simulation Learning Assignments: Helps learners activate prior knowledge, identify gaps, and form initial mental models before entering the simulation. By establishing a shared baseline of concepts, terminology, and expectations, these assignments help level the playing field among participants, allowing the simulation itself to focus on higher-order reasoning,  and sensemaking rather than uneven content familiarity.
  • Conceptual Guidance: Helping learners organize their thoughts, perhaps through “argument structuring tools” or specific prompts that help them distinguish between conflicting ideas.
  • Debriefing: This is perhaps our most powerful scaffold. Using the HUMBLE approach (Humility, Understanding, Mindfulness, Balance, Learning, Engagement), we can guide learners to reflect on their performance. Reflection allows students to compare their internal ideas with the evidence generated during the simulation, leading to a more coherent understanding.

5. Leverage Multiple Perspectives

Deep understanding rarely emerges from a single point of view. It develops when learners are exposed to, and must reconcile, multiple perspectives. Well-designed simulation environments are uniquely positioned to support this kind of learning.

In healthcare simulation, perspective-taking happens at several levels. Within a single discipline, learners are often exposed to differing clinical interpretations, prioritization strategies, or communication styles. Two clinicians may look at the same evolving scenario and arrive at different conclusions about what matters most in that moment. Simulation creates a safe space for these differences to surface, be examined, and be discussed, without the risk of patient harm and through the operative lens of a safe learning environment. This kind of cognitive diversity encourages learners to move beyond “the right answer” and toward deeper clinical reasoning and judgment.

Interprofessional simulation amplifies this effect even further. When nurses, physicians, pharmacists, respiratory therapists, and other professionals train together, learners gain direct insight into how roles, responsibilities, and mental models differ across the care team. What one profession sees as a priority may not align with another’s perspective, and simulation makes those differences visible. Rather than flattening these viewpoints, effective SCLEs use them as learning assets.

From a student-centered perspective, the power of simulation lies in shifting knowledge construction from the individual to the group. Learners are not simply absorbing expert explanations; they are actively negotiating meaning with peers who bring different training backgrounds, experiences, and assumptions to the scenario. Over time, this shared sensemaking helps build a true learning community, one in which understanding is co-constructed and collective competence exceeds what any single learner could achieve alone.

Importantly, structured debriefing plays a critical role in solidifying this learning. When facilitators intentionally invite multiple voices into the conversation, asking “What were you seeing?” or “How did your role shape that decision?”, learners begin to appreciate not only what decisions were made, but why they differed. This reflective dialogue reinforces perspective-taking as a core professional skill, not an optional add-on.

In this way, simulation-based SCLEs mirror the realities of clinical practice itself: complex, collaborative, and shaped by multiple viewpoints. By embracing, not minimizing, these differences, simulation helps learners develop the adaptability, empathy, and team-based reasoning required for real-world patient care.

Conclusion

Transforming a simulation program into a student-centered learning environment (SCLE) requires more than just high-tech equipment. It requires a shift in mindset from the outset of the design. We must view the simulation ecosystem through the lens of the learner. By balancing authentic practice with cognitive load management, respecting prior experience, and providing robust scaffolding, we empower our learners to become autonomous, lifelong problem solvers.

Until next time, Happy Simulating!

  • (1) King, A. (1993). From sage on the stage to guide on the side. College Teaching, 41(1), 30–35.
  • (2) Jonassen, D. H., & Land, S. M. (2012). Student-centered learning environments (pp. 3–25). In D. H. Jonassen & S. M. Land (Eds.), Theoretical foundations of learning environments (2nd ed.). Routledge.

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October 23, 2025 · 8:03 am

What’s a Scenario? The Word That Means Many Things, To Many People in Healthcare Simulation

Definition of 'scenario' showing its etymology and meaning related to scripts and instructions.

If you’ve worked in healthcare simulation for any length of time, you’ve probably used the word “scenario” countless times. “Let’s build a new scenario.” “We’re running the sepsis scenario this afternoon.” “That scenario went great!”

But have you ever stopped to think about how differently that same word means to each person involved? The word “scenario” is a perfect example of how language in simulation can unite us, or possibly confuse us,  depending on our perspective. Additionally those creating said “scenarios” need to be keenly aware of these implications.

In truth, “scenario” represents something unique to different members of the simulation ecosystem: learners, educators, technicians, and administrators. Understanding these different lenses can help strengthen teamwork, communication, and the overall impact of our simulation programs.

The Learner’s Scenario: The Clinical Experience

For learners, the scenario is the experience itself. It’s the unfolding clinical-like moment that challenges their knowledge, judgment, and communication skills in an effort to improve.

In the learner’s mind, the scenario “is” the simulation. It’s what they see, hear, and feel—the patient’s distress, the team dynamics, the need to make decisions under pressure. The learner rarely thinks about the planning that went into it; they simply step into a space that hopefully they were well oriented, feels real enough and is relevant to their goals.


For them, the scenario represents an opportunity: a chance to act, reflect, and learn in a safe environment. When done well, it becomes a memorable and emotionally resonant learning event that bridges the gap between classroom knowledge and clinical performance along with providing a stimulus for self-improvement.

The Educator’s Scenario: The Blueprint for Learning

For the educator or faculty member, the scenario is not just an experience—it’s a design.

To the educator, the scenario is the blueprint for what the learner will encounter. It contains the story arc, learning objectives, key events, and expected actions. It guides how pre-learning will be incorporated or reinforced to prepare the learner, how the simulation unfolds, and how the debriefing reinforces the lessons afterward as well as how assessment strategies and tools are incorporated into the learning encounter.

A well-constructed scenario is both an art and a science. It is an instrument that balances operations with realism and  educational intent. It requires alignment between objectives, assessment, and debriefing. The educator’s scenario document might include everything from patient history and vital sign trends to faculty prompts, checklists, and suggested debriefing strategies and topics.

In this view, the scenario becomes a curricular instrument, a tool that translates educational goals into lived experience.

The Simulation Operations Team’s Scenario: The Technical Playbook

For the simulation operations specialist or technician, the scenario is a technical plan, a script for how to bring the educator’s vision to life.

This version of the scenario includes the logistics that make the experience possible, for example:
– Scheduling and room reservations
– Equipment and supply lists
– Simulator programming and physiological responses
– Audio-visual configurations
– Staffing assignments and role descriptions

For the operations team, precision is everything. A single oversight—an unplugged cable, a missing monitor, or a mistimed vital sign change, can derail the encounter and disrupt the learning flow along with the concentration of the learners and faculty alike.

Their scenario isn’t about learning objectives; it’s about execution. It ensures that the right tools, people, environments, and technology align perfectly at the right moment to make the educational magic happen. In many ways, their scenario is the stage directions that make the play run seamlessly. Or to borrow a piece from a previous blog post of mine, it is the music that plays to allow the learners to dance and be evaluated.

The Administrator’s Scenario: The Unit of Measurement

To program administrators and simulation center leaders, the word “scenario” carries yet another meaning.

From this vantage point, the scenario represents a unit of activity. Think of it as a quantifiable event tied to scheduling, staffing, and financial data. It’s a building block for understanding center utilization, cost recovery, and return on investment.

An administrator may see a scenario not only as an educational event but also as a data record in a management system: duration, participants, faculty hours, resource use, and consumables. From these data points come critical insights such as how much it costs to deliver a course, how often equipment is used, and where efficiencies or resource gaps exist.

This administrative view ensures that simulation programs remain sustainable, scalable, and aligned with institutional goals.

One Word, Many Worlds

The fascinating thing about the word “scenario” is that all these definitions are correct, utilized every day in the simulation world and essential. Each reflects a different dimension of the same phenomenon.

For the learner, it’s an experience.
For the educator, it’s a design.
For the technician, it’s an operation.
For the administrator, it’s a metric.

Together, these perspectives form the ecosystem that allows simulation to thrive. The most successful programs are those where these views overlap and inform one another—where educators appreciate the operational complexity, technicians understand the learning goals, and administrators recognize the educational and patient-safety impact that justify the resources.

When those perspectives align, the word “scenario” transforms from a simple script or event into a powerful tool for advancing healthcare education and safety.

Director’s Reflection

In my years of working with simulation programs around the world, I’ve learned that the strength of a simulation scenario isn’t found in just the documents or the technology’s, but it also in the shared understanding among the people who create, deliver, and learn from it.

A scenario is a bridge connecting intent to experience, vision to execution, and learning to improvement. Whether you’re writing one, running one, or analyzing its data, remember that every scenario represents a small but meaningful step toward better healthcare.

Until Next Time,

Happy Simulating!

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September 23, 2025 · 8:00 am

Debugging Simulation: How Alpha and Beta Testing Strengthen Scenario Success

In the world of healthcare simulation, our goal is to create meaningful learning experiences that improve the safety and quality of patient care. Achieving that goal requires careful planning, thoughtful design, and rigorous evaluation of our simulation scenarios. One concept borrowed from the world of software and technology development—but often overlooked in healthcare education—is the process of alpha and beta testing.

By understanding and applying these concepts to simulation scenario design, educators can significantly enhance the efficiency and effectiveness, and overall impact of their programs. Let’s take a closer look at what alpha and beta testing mean, why they matter in healthcare simulation, and how they can help elevate both the learner as well as the facilitators experience.

What Do We Mean by Alpha and Beta Testing?

The terms alpha testing and beta testing originate from the software development industry. Before an application is released to users, developers put it through multiple rounds of trials to identify problems, fine-tune functionality, and ensure that it behaves as intended. Healthcare simulation, while a very different domain, benefits from the same structured approach.

  • Alpha testing is the internal trial run. In the simulation context, this means running a new scenario with the development team or a small group of faculty before exposing it to actual learners. The purpose is to check for errors, gaps, or inconsistencies in the scenario design. Are the case details clear? Do the vital signs respond correctly to learner interventions? Does the simulator technology function as intended?
  • Beta testing is the external pilot run. This step introduces the scenario to a limited group of learners—often peers, or learners similar to those whom the scenario is intended. The purpose is to observe how real participants interact with the scenario. Do they engage in the way you intended? Do the prompts drive the critical thinking skills you were hoping to elicit? Are they interpreting the simulated aspects of the scenario in the manner which they are intended? Are the debriefing points aligning with your learning objectives?

When done well, these stages help identify potential pitfalls, correct technical issues, and refine educational flow before the simulation reaches a larger audience.

Why Alpha Testing Matters

Alpha testing is your chance to work out the “kinks” of a simulation in a controlled environment. Think of it as a rehearsal where mistakes are not only acceptable but expected.

Consider a scenario where learners are expected to diagnose sepsis in an unstable patient. During alpha testing, your faculty team might discover that the simulator’s vital signs do not update quickly enough when fluid resuscitation is administered. Or perhaps the timing of lab results makes it impossible for learners to reach the intended diagnosis within the allotted session. Identifying these issues before learners arrive saves both time and frustration. However, always remember that those who participated in the design often have developed a shared mental model and may miss the fact that some things are misinterpreted by actual intended learners.

Some examples of key questions to ask during alpha testing include:

  • Do the scenario instructions match the programmed mannequin responses?
  • Are embedded participants (e.g., a nurse or family member role) clear on their scripts?
  • Does the timing of critical events support the learning objectives?
  • Are there any “gotchas” that could derail learner engagement?
  • Did the pre-briefing take longer than expected?

By the end of alpha testing, the simulation team should have a scenario that is technically functional, logically sound, and aligned with its stated goals that runs in the approximate amount of time that it was designed.

Why Beta Testing is Crucial

Once the internal checks are complete, it is time to see how the scenario performs in the real world. Beta testing is the first opportunity to expose the simulation to actual learners, albeit on a smaller and more controlled scale.

Imagine your team has developed a scenario for emergency airway management. The alpha test confirmed that the mannequin responds appropriately to intubation attempts and that medications are available in the correct doses. During beta testing with a group of residents, however, you observe that they consistently miss an early cue about airway edema. This could mean your prompts are too subtle—or that your learners need more scaffolding. Either way, the feedback allows you to adjust before rolling it out widely.

Beta testing provides answers to questions such as:

  • Are learners engaging with the scenario in the way we anticipated?
  • Do the actions of participants align with the intended outcomes? competencies?
  • Does the scenario create opportunities for meaningful debriefing?
  • What unexpected challenges or learner behaviors emerge?

In essence, beta testing allows the scenario to “fail safely” in front of a pilot group so that the eventual cohort benefits from a polished and purposeful experience.

Lessons from Software Development

In software engineering, skipping alpha and beta testing is a recipe for disaster—think buggy apps, frustrated users, and poor reviews. The same risks apply to simulation. Without proper testing, scenarios can fall flat, confuse learners, or even undermine the credibility of your program.

Borrowing these terms reminds us that scenario design is not a one-and-done activity. It is an iterative process where feedback loops play a central role in quality improvement. Just as developers patch software bugs, simulation educators refine scenario elements until they function smoothly.

Practical Tips for Implementing Alpha and Beta Testing

  1. Schedule testing time. Don’t assume you can “test on the fly” before learners walk in. Build alpha and beta testing into your development timeline.
  2. Use checklists. Structured tools can help your team evaluate everything from simulator programming to alignment with learning objectives.
  3. Capture feedback systematically. During beta testing, request that observers take notes on learner behaviors, timing, and unintended outcomes. Post-scenario surveys can also capture learner perceptions.
  4. Iterate, don’t improvise. Resist the urge to “fix” problems on the fly during a live teaching session. Incorporate changes based on alpha/beta feedback before the full rollout.

How This Benefits Learners

Ultimately, alpha and beta testing serve a dual role about making faculty feel more comfortable as well as enhancing the learner experience. A well-tested scenario ensures that:

  • Learners are immersed in a coherent case that is relevant to their learning needs.
  • Technical glitches do not distract from critical thinking.
  • Debriefing discussions flow naturally from the scenario, rather than being forced or disconnected.

In other words, when educators invest in testing, learners reap the rewards through higher-quality education and, by extension, safer patient care.

Conclusion: Test Early, Test Often

Healthcare simulation has matured into a vital component of modern education. But as with any educational tool, its effectiveness depends on the rigor of its design. By embracing alpha and beta testing, simulation teams can identify weaknesses, refine strengths, and deliver scenarios that consistently meet their objectives.

The lesson from software holds true: the more you test before release, the fewer problems you encounter afterward. In healthcare simulation, that means fewer distractions, more meaningful learning, and ultimately better outcomes for patients.

So the next time you’re preparing to debut a new scenario, pause and ask: Have we really tested this? If the answer is no, it may be worth an extra round of alpha or beta testing. Your learners, as well as your participating faculty, and technical staff will thank you.

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April 8, 2025 · 9:51 am

Essential Steps for Effective Needs Assessment in Education

The Art and Science of the Needs Assessment in Simulation-Based Education

Introduction

In the realm of simulation-based learning, understanding the specific needs of your learners is paramount to crafting a curriculum that truly resonates and delivers impactful results. Conducting an effective needs assessment serves as the foundation for designing a successful educational program, enabling educators to identify gaps, align objectives, and tailor experiences that foster engagement and skill acquisition. This guide will walk you through the essential steps of executing a thorough needs assessment, empowering you to gather valuable insights and data that will help shape your simulation-based education curriculum. From stakeholder interviews to learner surveys, we will explore strategies to ensure that your curriculum not only meets the diverse needs of your students but also equips them with the confidence and competence to tackle real-world challenges. Here, I explore the art and science of needs assessment, discovering how to design an educational experience that inspires and equips future professionals for success.

1. The Importance of the Needs Assessment in Simulation-Based Education

Understanding the importance of needs assessment in education is the cornerstone of developing a simulation-based curriculum that truly meets the needs of learners and the demands of contemporary educational environments. A needs assessment is a process that identifies gaps between current educational outcomes and desired goals. By conducting a thorough needs assessment, educators can uncover specific areas where knowledge, skills, or competencies are lacking among students or professionals, ensuring that the curriculum is directly aligned with these identified needs.

The importance of needs assessment cannot be overstated; it empowers educators to make informed decisions based on data rather than assumptions. This evidence-based approach encourages the implementation of targeted strategies that enhance learning experiences and outcomes. Additionally, it fosters a curriculum design that focuses on what learners need to thrive in their respective fields.

In the context of simulation-based education, the stakes are high. By utilizing a needs assessment, educators can ensure that simulations are not only relevant but also realistic and applicable to real-world scenarios. This is especially important in simulation-based education, where resources are often limited and perceived as costly, making it critical to ensure that simulation is used judiciously and effectively to maximize educational value and impact.

2. Identifying Stakeholders and Gathering Data

Identifying stakeholders and gathering input are critical steps in conducting a needs assessment for a simulation-based education curriculum. Stakeholders encompass a broad range of individuals and groups, each bringing unique perspectives and insights that can significantly influence the design and implementation of your program. Begin by considering key stakeholders, including educators, students, healthcare professionals, employers, and administrators. Engaging these stakeholders early in the process ensures that you capture a comprehensive view of the needs and expectations that should guide your curriculum development.

To gather input, consider employing a variety of methods to ensure diverse voices are heard. Surveys can provide quantitative data, while focus groups and interviews allow for deeper qualitative insights. Organize workshops where stakeholders can collaboratively discuss their experiences and expectations, fostering a sense of ownership in the process.

As you compile feedback, look for common themes and concerns among your stakeholders. This will not only help you prioritize content and objectives but also highlight specific challenges that your simulation-based curriculum can address. By actively involving stakeholders in the needs assessment process, you set the foundation for a robust curriculum that meets the real-world demands of learners and the professions they aspire to enter, ultimately leading to more effective educational outcomes.

Another essential component of the needs assessment process involves searching for and analyzing existing data, such as performance on national or board examinations, as well as local assessments like past tests or quizzes, to identify trends, pinpoint gaps, and guide the development of targeted educational interventions. Additionally, review existing literature and curriculum standards relevant to your field to identify the best practices and gaps in current offerings.

3. Designing Effective Surveys and Interviews

Designing effective surveys and interviews is crucial for obtaining meaningful and actionable data during the needs assessment process. Surveys allow you to gather quantitative data from a large number of respondents quickly and efficiently. Focus on crafting straightforward, concise questions that address the key areas of interest identified during your stakeholder analysis. Utilize a mix of question types, such as multiple-choice, Likert scales, and open-ended questions, to capture a comprehensive view of the respondents’ perspectives.

Interviews, on the other hand, provide an opportunity to delve deeper into qualitative insights. Conduct one-on-one or group interviews with a representative sample of stakeholders to gain a deeper understanding of their experiences, expectations, and challenges. Prepare a flexible interview guide with open-ended questions that encourage discussion and reflection. Be attentive to the responses and probe further to uncover underlying issues or insights that might not emerge from surveys alone.

Combining the data collected from surveys and interviews will give you a robust understanding of the needs and expectations of your learners. Analyze the data to identify common themes, patterns, and gaps that could provide benefits as a result of your simulation-based curriculum. This approach ensures that the curriculum incorporates diverse perspectives and is designed to meet the practical needs of the educational environment.

4. Analyzing and Interpreting Data

Once data is collected, the next step is to analyze and interpret the findings. Data analysis involves organizing the information in a way that makes it easier to identify trends and insights. For quantitative data, use statistical methods to summarize the responses and highlight significant results. Graphs and charts can be useful tools to visualize the data and make it more accessible.

Qualitative data, gathered from interviews and open-ended survey responses, requires a different approach. Employ techniques such as coding to categorize the responses and identify recurring themes. Look for patterns and connections between various stakeholder groups to understand their collective needs and perspectives.

Interpreting the data involves deriving meaningful conclusions and actionable recommendations. Consider how the identified needs align with your educational goals and objectives. Prioritize the most critical gaps and challenges and consider how your simulation-based curriculum can effectively address them. Utilize the insights gained from the data to inform the development of targeted strategies and interventions that enhance learning outcomes.

5. Implementing Findings into Curriculum Design

With an understanding of the needs and expectations gathered from your assessment, the final step is to incorporate these findings into the curriculum design. Start by outlining the key objectives and learning outcomes based on the identified needs. Revisit assessing whether the objectives and learning outcomes would be best served through the implementation of simulation.

Design simulation activities that reflect real-world scenarios and challenges, fostering critical thinking and practical skills. Focus on areas that were recognized as unmet needs during your needs analysis.  Integrate feedback mechanisms to evaluate the curriculum’s effectiveness and adjust as needed. This will help foster a continuous quality improvement mindset within your program.

Summary

By conducting a well-structured needs analysis and implementing the findings into the curriculum design, you create a responsive and relevant educational framework that prepares both learners and your program for success. This evidence-based approach ensures that your simulation-based education curriculum is not only practical but also addresses the exact needs of your organization, providing the most effective and efficient deployment of scarce and/or expensive resources.

Until next time, Happy Simulating!

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November 21, 2024 · 8:39 am

Improving Interrater Reliability in Healthcare Simulation-Based Assessments: The RST Approach

Achieving high interrater reliability (IRR) is a cornerstone of any effective medium or high stakes assessment in healthcare simulation. Without consistent and dependable scoring across multiple raters, the validity of an assessment can be called into question. Interrater reliability ensures that evaluations are fair, objective, and truly reflective of the participant’s performance rather than the subjective biases or variability among raters.

For simulation-based assessments, however, maintaining IRR can be particularly challenging due to the complex, dynamic, and multifaceted nature of healthcare scenarios. This is where the RST approach—focusing on changes to the Rater, the Simulation, and the Tool—can offer a systematic and impactful framework for improvement. In this post I’ll walk you through this approach, providing insights and practical strategies for applying RST to your simulation programs.

The R in RST: Changing the Rater

One of the most straightforward avenues to improve IRR is addressing variability related to the rater. This is critical because raters bring their own perspectives, experiences, and biases to the evaluation process, all of which can affect their scoring.

Strategies for Enhancing the Rater’s Consistency:

  1. Rater Calibration Sessions
    Conducting rater calibration sessions is one of the most effective ways to ensure raters have a shared understanding of the evaluation criteria. These sessions involve reviewing sample performances as a group and discussing scoring rationales to align perceptions. This shared experience helps raters interpret assessment tools in the same way, leading to more consistent scoring.
  2. Rater Selection and Expertise
    Consider who is performing the assessment. Are they subject matter experts? Are they trained educators? Selecting raters with relevant expertise and familiarity with the assessment content can reduce variability. Alternatively, inexperienced or overly diverse rater pools may introduce inconsistencies.
  3. Addressing Rater Bias
    Even with calibration, unconscious biases can creep into assessments. Training raters to recognize and mitigate biases—such as favoring individuals who perform similarly to the rater’s own practice style—can improve consistency.
  4. Changing Raters
    If specific raters consistently show discrepancies in their scoring compared to others, it may be necessary to replace them or limit their participation in high-stakes assessments. Using multiple raters per simulation and averaging scores can also dilute individual biases.

The S in RST: Changing the Simulation

The second dimension of the RST approach involves modifying the simulation itself to make it more assessable. By carefully designing simulations to make critical behaviors, thought processes, and decisions more observable, you enhance the ability of raters to evaluate participants consistently.

Strategies for Simulation Adjustments:

  1. Prompting Observable Actions
    Simulations can be structured to encourage participants to verbalize their thought processes or articulate their decisions. For instance, during a scenario involving a critical diagnosis, asking participants to “think aloud” as they interpret clinical findings can provide raters with clear evidence of decision-making skills, making scoring more straightforward.
  2. Embedding Structured Checkpoints
    Building structured checkpoints into the simulation—such as specific moments when participants are asked to summarize their findings or outline their next steps—creates clear opportunities for assessment. This reduces ambiguity for raters.
  3. Standardizing Simulation Flow
    Variability in how simulations unfold can lead to scoring challenges. Using standardized patient scripts, consistent cues, and fixed timing for critical events ensures that all participants encounter the same conditions, making assessments more comparable. If high technology simulators are being used for the simulation, consider the use of preprogram scenario to ensure the physiology changes are consistent across all episodes of the same scenario.
  4. Revisiting Scenario Complexity
    While realism is a hallmark of effective simulation, excessive complexity can overwhelm raters and obscure key performance indicators. Simplifying scenarios to focus on specific competencies can improve the clarity and reliability of evaluations.

The T in RST: Changing the Tool

The assessment tool is often an overlooked factor in achieving IRR, yet it plays a pivotal role in how raters interpret and apply scoring criteria. A well-designed tool minimizes ambiguity and makes scoring intuitive, even for less experienced raters.

Strategies for Tool Optimization:

  1. Behavioral Anchors for Rating Scales
    Adding specific behavioral examples or descriptors to rating scale items helps raters apply the scales consistently. For instance, instead of a vague “Good” rating, an anchored descriptor like “Effectively communicates diagnosis and treatment plan to patient” provides clarity.
  2. Item Grouping and Ordering
    Organizing items logically—for example, grouping communication skills, clinical decision-making, and procedural skills separately—makes it easier for raters to focus on one domain at a time. A cluttered or disorganized tool can lead to confusion and inconsistent scoring.
  3. Simplifying Language
    Ensure that the language in the tool is straightforward and free of jargon. If raters struggle to interpret an item, their scoring may vary widely.
  4. Usability Enhancements
    Small changes, like improving the font size, using bullet points, or incorporating intuitive layouts, can significantly reduce rater fatigue and errors during scoring. A user-friendly tool ensures raters stay focused on the participant’s performance rather than grappling with the mechanics of the tool.
  5. Pretesting the Tool
    Conduct pilot assessments using the tool to identify problematic items or inconsistencies. This feedback loop allows you to refine the tool before deploying it in high-stakes simulations.

Putting It All Together: The RST Approach in Action

To illustrate how the RST approach works holistically, imagine a healthcare simulation designed to assess a participant’s ability to manage a cardiac arrest scenario:

  • Rater: You organize a calibration session where all raters review a sample video of a cardiac arrest scenario and agree on scoring criteria. You also ensure raters have experience in emergency medicine and provide bias-awareness training.
  • Simulation: The scenario is adjusted to include a structured moment where the participant is required to verbalize their reasoning for choosing a particular medication. Additionally, standardized cues are used to ensure all participants face identical conditions.
  • Tool: The assessment tool is revised to include behavioral anchors, such as “Identifies and administers epinephrine within 3 minutes” for procedural accuracy. The tool’s layout is simplified, grouping items under headings like “Clinical Judgment” and “Communication.”

With these changes, the IRR for this simulation-based assessment improves, as raters now have a shared understanding, participants’ actions are more easily observable, and the tool provides clearer guidance.

Conclusion: Adopting the RST Approach for Better Assessments

While I will agree, improving interrater reliability in healthcare simulation assessments is no small task, but the RST approach offers a structured framework to tackle the challenge. By focusing on the Rater, the Simulation, and the Tool, you can systematically address the factors that contribute to variability and ensure more consistent, fair, and accurate evaluations. For more on this see my previous blog post on interrater reliability.

Whether you are designing a new assessment or refining an existing one, considering how changes in these three areas might influence IRR is a worthwhile investment. With reliable assessments, we not only enhance the quality of simulation-based education but also uphold the integrity of our evaluations—ultimately contributing to better-prepared healthcare professionals.

Are you ready to elevate your simulation assessments? The RST approach is here to guide your journey.

Please like and comment if you would like to see more topics like this in my blog!

Until next time, Happy Simulating!

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August 15, 2024 · 9:00 am

Cognitive Load as a Currency: Spend it WISELY in Simulation Scenario Design

In the world of healthcare education, we know that simulation-based training is a powerful tool, allowing students to experience real-life scenarios in a controlled environment. Simulation not only bridges the gap between theory and practice but also builds confidence and competence in a safe space. However, as with all educational tools, there’s a delicate balance to maintain regarding design decisions, particularly when it comes to the concept of cognitive load.

Cognitive Load: A Precious Resource

Cognitive load refers to the amount of mental effort being used in the working memory. It is, in essence, the currency of the mind—a finite resource that, when spent wisely, can lead to effective learning and retention. But, just like any currency, it can be squandered if not managed properly.

In our healthcare simulations, participants are asked to perform tasks that mimic real-life situations. They must think critically, make decisions quickly, and often work under pressure—all while processing the simulated environment around them. Every element in a simulation scenario demands a portion of the participant’s cognitive load. When this load becomes too heavy, it can overwhelm the learner, leading to confusion, errors, and, ultimately, a less effective educational experience.

The Hidden Costs of Over-Designing Simulations

In an effort to make simulations as realistic as possible, educators sometimes introduce elements that, while seemingly beneficial, can actually detract from the learning experience. These can include irrelevant information, extraneous equipment, or overly complex scenarios that do not directly contribute to the learning objectives. While the intention is often to enhance the realism of the scenario, the reality is that these additional elements force participants to expend cognitive energy on processing what is simulated and why it is being simulated.

For example, consider a scenario designed to teach students how to manage a patient in cardiac arrest. The core learning objectives might include recognizing signs of cardiac distress, performing CPR, and administering appropriate medications. However, the students might find themselves distracted if the scenario also includes irrelevant background noise, additional non-essential equipment, or extraneous patient history that doesn’t contribute to the learning objectives. They may spend valuable cognitive resources trying to process this irrelevant information rather than focusing on the critical tasks at hand.

The Art of Simplification: Less is More

To maximize the effectiveness of simulation, it’s essential to streamline scenarios, focusing on the elements that directly support the learning objectives. This doesn’t mean stripping away all realism, but rather, carefully curating the scenario to include only those aspects that enhance understanding and practice of the targeted skills. The goal is not to make it real but to make it real enough. Our goal is not to recreate reality but to provide an environmental milieu that supports the tasks at hand and allows the scenario to achieve intended objectives.

When designing a simulation, ask yourself:

– What are the primary learning objectives?

– What elements of the scenario directly support these objectives?

– Are there any elements that, while realistic, do not contribute to the learning goals and could potentially distract or overwhelm the students?

By answering these questions, you can begin to design scenarios that are both effective and efficient, ensuring that students’ cognitive resources are spent on mastering the intended skills rather than getting bogged down by unnecessary details.

A Practical Approach to Cognitive Load Management

1. Clear Objectives: Begin with a clear understanding of what you want your students to learn. Every element of the simulation should tie back to these objectives.

2. Essential Information Only: Include only the information and equipment necessary to achieve the learning goals. Avoid adding extras that don’t directly contribute to the scenario’s success.

3. Sequential Learning: If multiple skills need to be practiced, consider breaking them down into separate scenarios. This allows students to focus on one set of objectives at a time, reducing cognitive overload.

4. Debrief Thoughtfully: Use the debriefing session to reinforce learning objectives and clarify any confusion. This helps students consolidate what they’ve learned and understand the relevance of each element in the simulation.

5. Feedback and Iteration: Regularly gather feedback from participants and use it to refine your scenarios. What seems beneficial in theory might not always work in practice, and being open to adjustments is key to effective simulation design. Further, I fstudents stumble in the same point in the scenario, look for potential design flaws or elements that might be adding confusion.

Conclusion: Design the Scenarios to allow the participant to Spend Wisely

Cognitive load is a valuable resource that must be managed carefully in healthcare simulation design. By focusing on what is essential and stripping away the non-essential, educators can create scenarios that are not only realistic but also aligned with the primary learning objectives. This approach ensures that students can devote their cognitive energy to mastering the skills that matter most, leading to more effective learning and better outcomes in real-life situations.

In the end, the key to successful simulation design is not in how much you can add, but in how much you can refine and simplify. By spending cognitive load wisely, you enable your students to thrive in a simulated environment, fully prepared to face the challenges of the real world.

Until Next Time, Happy Simulating!

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July 26, 2024 · 10:38 pm

Too Much Stuff! Strike a Balance For Effective Learning Through Scenario Design

Simulation scenarios are powerful tools for learning and development, offering immersive experiences for learners to demonstrate the application of knowledge. However, there is a common temptation to include too many elements in these scenarios in an attempt to make them as realistic as possible. I like to say when designing scenarios people like to try to stuff 8 pounds of potatoes in a bag designed to hold 5 pounds!

While the intention behind this is often to enhance learning, it can lead to the opposite effect—overloading the learner’s brain, causing confusion, and ultimately, potentially diminishing the effectiveness of the training.

Over-Realism

When designing simulation scenarios, the allure of creating an overly realistic environment is strong. Developers and educators often believe that the more realistic the scenario, the more beneficial it will be for the learner. This belief stems from the notion that real-life complexity should be mirrored in training to prepare learners for every possible eventuality they might face in their roles.

However, this approach can backfire. Overloading scenarios with excessive detail and too many learning points can overwhelm learners, leading to cognitive overload. This saturation of information makes it challenging for learners to focus on the key objectives and absorb the intended lessons.

Cognitive Overload

Cognitive overload occurs when the amount of information presented exceeds the learner’s capacity to process it effectively. In a scenario packed with numerous variables, tasks, and details, learners may struggle to prioritize and integrate the key lessons. This confusion can hinder their ability to apply the knowledge in real-life situations, which is the ultimate goal of any training program.

Focusing Content

To design effective simulation scenarios, it’s crucial to focus on a few well-defined learning objectives. Start by identifying the core skills and knowledge you want the learners to acquire. Once these objectives are clear, design the scenario to specifically target these areas, avoiding the temptation to add extraneous details that do not directly contribute to the learning goals.

By narrowing the scope of the content, you can create a more streamlined and manageable learning experience. This focused approach allows learners to engage deeply with the material, enhancing their understanding and retention of the key concepts.

Striking the Right Balance

The key to successful simulation design lies in striking the right balance between realism and focus. Scenarios should be realistic enough to engage learners and provide context, but not so complex that they become overwhelming. Here are some tips for achieving this balance:

1. Define Clear Objectives: Start with a clear set of learning objectives. Ensure that every element of the scenario aligns with these goals.

 2. Simplify the Environment: Avoid unnecessary complexity. Include only the elements that are essential for achieving the learning objectives.

3. Iterative Design: Test and refine your scenarios. Gather feedback from learners to identify areas of confusion and adjust the content accordingly.

4. Chunk Information: Break down the content into manageable chunks. This approach helps learners to process and retain information more effectively.

5. Provide Support: Offer guidance, support and appropriate clues and feedback throughout the scenario to help learners navigate complex tasks and reinforce key lessons.

 Conclusion

While the temptation to create overly realistic simulation scenarios is understandable, it’s important to resist this urge in favor of a more focused and efficient design approach. By concentrating on narrow, well-defined learning objectives and avoiding cognitive overload, you can create scenarios that are both effective and engaging. This design mentality not only enhances the learning experience but also increases the efficiency and effectiveness of your training programs.

In summary, maintaining a balance between realism and focus ensures that simulation scenarios are powerful tools for learning, equipping learners with the skills and knowledge they need without overwhelming them with unnecessary complexity. This approach leads to better learning outcomes and a more streamlined development process.

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February 20, 2024 · 9:00 am

Simulation Program Leaders – Pay Attention to the Right Customer!

In the dynamic world of healthcare education, simulation centers stand as innovative beacons of learning, offering practical, immersive experiences that prepare learners for the complexities of real-world medical scenarios. However, the effectiveness of these centers hinges not just on state-of-the-art equipment or meticulously designed scenarios but also on a deep understanding of who the true customers of these centers are. Contrary to initial impressions, the most pivotal customers are not the learners themselves but the faculty teaching the programs. Recognizing and supporting this critical customer base is the cornerstone of creating impactful, simulation-based education programs.

Customer satisfaction survey form on clipboard with red pen

Before the haters start hating, please, at least, hear me out………..

At first glance, identifying the primary customers of healthcare simulation centers might seem straightforward—the learners or students who engage directly with the simulations. However, this perspective overlooks a crucial element of the educational ecosystem: the faculty. These dedicated educators are the linchpins of simulation-based learning, bridging theoretical knowledge with practical application. Their role transcends mere instruction; they craft the educational experiences that shape future healthcare professionals.

When simulation centers prioritize faculty needs and integrate their expertise into the development and execution of simulation programs, they unlock unprecedented levels of educational efficacy. The more the simulation program focuses on the needs and potential of the faculty, the better the resulting programs can be. Creating tools that can enhance the capabilities of the delivered simulation encounters, accompanying materials, as well attempting to reduce the administrative overhead incurred by the faculty will enhance the total potential outcomes of the center. Don’t we want our faculty to practice at the top of the license or capabilities? Doing administrative tasks that can be automated or delegated, will certainly contribute to that as a goal.

The most effective staffing model for simulation centers is inherently collaborative, leveraging a dual-expertise approach. This model marries the simulation center staff’s proficiency in simulation, education, curriculum development, and operations with the subject matter expertise of clinical professionals. By doing so, it creates fertile ground for the development of highly effective, simulation-based education programs. This arrangement / strategic positioning can exist whether the program directly employs its teaching faculty or not.

The simulation center’s staff is the learning environment’s operational backbone. They often bring specialized knowledge in simulation technology, educational theory, curriculum design, and day-to-day operations. Their expertise ensures that the center’s infrastructure, from technology to program scheduling, runs smoothly and effectively. This operational excellence sets the stage for high-quality educational experiences. Their collaboration with the clinical subject matter experts sets the stage for high-quality simulation encounters.

Subject matter experts, such as faculty with clinical experience and expertise, are the heart of the center’s educational offerings from a clinical-facing content perspective. They infuse simulation scenarios with real-world complexity, authenticity, and relevance. Their clinical insights ensure that simulations are technically accurate and deeply resonant with the practical realities of healthcare. This clinical expertise is critical in designing scenarios that challenge learners meaningfully, preparing them for the nuances of actual patient care. They can often provide insight through knowledge and experience of understanding what people struggle with on the front lines of patient care.

When simulation center staff and subject matter experts collaborate closely, the result is a synergistic blend of operational efficiency and clinical authenticity. This partnership enables the development of simulation-based education programs that are logistically sound and educationally rigorous. By aligning the technical, operational, and administrative capabilities of the simulation staff with the clinical acumen of faculty, simulation centers create a win-win combination that can provide high-quality programs most efficiently.

The premise is straightforward: when faculty are well-supported by the simulation program, they are better equipped to deliver exceptional educational experiences. This support manifests in various ways, from providing faculty with the latest simulation technology to involving them in curriculum development processes and creating tools and methods that remove accompanying administrative tasks. When faculty feel empowered and valued, their teaching becomes more effective, benefiting the learners.

Learners engage with more meaningful learning encounters, receive higher-quality feedback, and ultimately enjoy a richer, more productive learning experience. Thus, they benefit as well via a primary focus on the faculty.

Understanding that the actual customers of healthcare simulation centers are the faculty who teach the programs is not just an academic distinction—it’s a strategic insight that should be adopted by the simulation program that can significantly enhance the quality and impact of simulation-based education. Enhancing a collaborative staffing model that harnesses the strengths of simulation center staff and clinical subject matter experts can create powerful educational experiences that prepare learners to succeed and excel in the fast-paced, ever-evolving world of healthcare.

The goal is clear: to support faculty so that they and their learners thrive, fostering a future where healthcare professionals are as compassionate as they are competent.

And yes, I love learners, too!

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August 24, 2023 · 3:11 pm

What is Simulation? The question that caught me off guard!

I was having an exit interview meeting with one of my graduating simulation fellows, and he asked me an interesting question for his last day. He said, “Dr. Paul, what is simulation?” I thought this was perplexing after a year-long intense study of simulation with us at our Institute! It was quite insightful, though. One of his observations was that there are many ways to do simulations right. He had many experiences throughout the year, visiting other simulation centers, attending international meetings, and teaching with us at different facilities. He realized many different vantage points, missions, visions, and purposes for implementing healthcare simulation.

I took a deep breath, thought about it, and said, “Simulation is a methodology by which we re-create a portion of the healthcare delivery experience with a goal of education and/or assessment of people, groups of people, teams, and/or environments of care.” Then, I drew a rough sketch of my vantage point of simulation that divided into two major subgroups, including methods/modes on one side and primary purpose on the other. I recreated it in the accompanying figure.

Methods/Modes

I think of the methods or modes of simulation based on the primary simulator technology employed to generate the goals of an intended program. Of course, mixed modality simulations often incorporate a spectrum of technologies.

I don’t mean this list to be exhaustive by any stretch of the imagination, and some may argue an oversimplification. The general categories that come to my mind are as follows:

  1. High-technology manikins generally presents the form factor of an entire human being complemented with electronics, pneumatics, and computer equipment that helps the manikin represent various aspects of anatomy and or physiology. (As you have undoubtedly heard me opine in the past, the word FIDELITY does not belong in any descriptor of a simulator. It muddles the water and confuses the overall strategies associated with simulation, although it is a popular industry buzzword that has somehow worked its way into academic definitions inappropriately.)
  2. Low-technology manikins generally have the form factor of an entire human being but with significantly less electronics or infrastructure to allow physiologic or anatomic changes that occurred during the simulation encounter.
  3. Standardized people/patients, meaning live people playing various roles ranging from patients, family members, and other healthcare team members to help bring a simulation encounter to life.
  4. Task trainers represent a re-creation of a portion of the human being oftentimes created to accomplish goals of completing skills or procedures. Depending on the purpose, they may or may not have a significant amount of augmenting technology.
  5. Screen-based simulations are computerized case or situation representations of some aspects of patient care that change in response to the stimulus provided by participants.
  6. Role-play includes designs that utilize peers and/or select faculty to engage in a simulated conversation or situation to accomplish learning outcomes.
  7. Virtual reality/augmented reality are high technology recreations or supplements that re-create reality through the lens of a first-person engaging in some sort of healthcare situation and have the capacity to change in response to the stimulus provided by the participant or participants.

Primary Purpose/Goals

Again, looking at a given simulation’s primary purpose and goals will lead one to quickly find overlaps and that the categories did not exist in complete isolation. However, for this discussion, it helps to think of the different categories of intent.

Education

When I think of simulation programs primarily focusing on education, it comes down to helping participants gain or refine knowledge, skills, competence, or other measures that allow them to become better healthcare providers. In general, a teaching exercise. This can apply to simulation scenarios that are directed at one person, groups of people (all learning the same thing), or perhaps teams that have learning goals of competencies associated with the interaction between the groups of people similar to that that occurs in the care of actual patients in the healthcare environment.

Assessment

The simulation encounter is primarily designed as an assessment. This means there is a more formal measurement associated with the performance of the simulation, often employing scoring tools, with the primary focus of measuring the competency of an individual, groups of individuals, or similar to the above teams of individuals functioning as teams. Further, assessment can measure aspects of the environment of care and/or the systems involved in supporting patients and the healthcare workforce.  (For example, an in-situ code blue response simulation may measure the response of the local care team, the response of a responding team, the engagement of the hospital operator, the location and arrival of necessary equipment, etc.)

Research

There are many approaches to the use of modern healthcare simulation in research. At a crude level, I subdivided into looking at the outcomes of the simulation; meaning did the simulation encounter help to improve the participant’s performance? At the next level, you can evaluate if the simulation improves patient care.

The next category is using simulation as a surrogate of the patient care environment but not measuring the effect of the simulation. For example, we might set up an ICU patient care environment for human factors experiments to figure out the ideal location of a piece of equipment, the tone of an alarm, the interaction of caregivers with various equipment, etc. Such an example of simulation often helps to determine optimal environments and systems of care in the primary planning stages or the remodeling of healthcare delivery processes and procedures.

So, the next time I orient an incoming simulation fellow, I will start with this discussion. I am thankful that my fellow who just graduated provided such a simple but deeply probing question to help wrap his arms around the various simulations he has been experiencing over the last year while he studied with us.

Having put some more thought into this, I think it’s a useful exercise for those of us in leadership positions within the simulation world; it is probably good to stop and think about this a couple of times a year to refresh, reset, and ensure that we are remaining mission-driven to our purpose.

Until next time, Happy Simulating!

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August 8, 2023 · 11:07 am

HUMBLE: Six Traits That Will Make You a Better Simulation Educator and Lead Effective Debriefings

HUMBLE: Six Traits That Will Make You a Better Simulation Educator and Lead Better Debriefings

Excelling as a educator in the healthcare simulation field goes beyond just imparting knowledge; it requires a unique set of qualities that can truly make a difference in students’ learning experiences. The acronym HUMBLE focuses on six key traits that can help educators better design, facilitate, and lead more effective debriefings. These traits include Humility, Understanding, Mindfulness, Balance, Learning, and Engaging. In this blog post, I will delve into these traits and explore how they can enhance your abilities as an educator, ultimately leading to more impactful and engaging debriefing sessions.

H – Humility

This is one of my favorites and the most important in my humble opinion! Approaching teaching responsibilities in simulation from a perspective of humility goes a long way. Instructors, with humility, acknowledge that they don’t know everything and remain open to continuous learning. This attitude is also imparted to the participants, encouraging them to adopt the same approach throughout their careers.

An instructor who demonstrates humility creates a more approachable and non-threatening atmosphere, allowing students to feel comfortable admitting to and learning from their errors. This also contributes to a milieu that helps maintain a safe learning environment and a perspective of a level playing field that helps to allow participants of the simulation to share their thoughts. This, in turn, gives us as faculty a privileged glimpse into their thought processes. Interestingly, it is also well-known in business literature that leaders who demonstrate humility are often perceived as more credible and trustworthy.

U – Understanding

Understanding the fact that each participant of your simulation is a person that has their individual lives, challenges, successes, experiences, and strong and weak skills is key to understanding the fact that there are varying amounts of knowledge and/or abilities for the person to apply that knowledge in the simulated session. In other words, many factors contribute to why someone knows something or can apply knowledge in each situation. We should maintain an understanding that everyone has gaps in knowledge and attempt to remain nonjudgmental as to why those gaps exist.

M – Mindfulness

It is incredibly important that we are mindful of our presence during the simulation as well as the debriefing. Educators need to be attentive, focused, immersed, and committed to the learning objectives to expertly facilitate and then lead a high-quality debriefing that contributes to the learning outcomes. We need to work to identify tips and challenges that help maintain our mindfulness, focus, and attention during these activities.

While I am not suggesting a prescriptive approach, it is important to introspect and determine how you enhance your mindfulness associated with the simulation-based education process. For some, it means being well rested; for others, it means appropriately titrated doses of caffeine, and yet for others, exhaustive preparation the day before. Reflect on your performance by thinking about when your concentration may have waxed and waned and what you can do to improve. I find it particularly challenging to remain cognitively sharp throughout the entire series when running the same scenario repeatedly with different groups of learners!

B – Balance

Creating the mindset of balance in any one simulation session helps participants discover what they need to improve upon and what they did well in each simulation encounter. There is an old saying, “The negative screams, while the positive only whispers….. ” that I think you would agree applies when we are facilitating a simulation and about to go into the debriefing. If you think about it from the learner’s perspective, exploring a laundry list of their failures without recognizing the contributions that went well can be demoralizing and interfere with the faculty/participant relationship. While I’m not suggesting that we gloss over egregious errors, it is important to find a balance between those activities that went well and those that need improvement.

L – Limited, Lifelong Learning

This may be my second favorite! When conducting the debriefing, faculty should avoid trying to comment or debrief on every single thing in every scenario. It is important to remember that the journey of healthcare, whether in a simulated environment, attending lectures, attending workshops, or generating experiences by taking care of real patients, is a lifelong learning process. Each encounter along the way provides the potential for learning, albeit limited by the amount of cognitive transfer that can occur at a given time. During simulation, there is a natural tendency to want to cram everything into every scenario. I think this emanates from the fact that we are so excited about the simulation modality and get a small opportunity with each participant! Admittedly, I need to keep myself in check during such encounters. It’s important to think of the human brain as a sponge. Once it is saturated, the sponge cannot effectively take on more water.

E – Engagement

Engaging the learners in the conversation, as well as designing the scenarios to engage learners actively, is part and parcel of the basis of the idea that simulation, through active learning, is a high-quality opportunity. Think about this during the design process of your scenarios as well as the debriefings, insofar as how you assign roles, what your observers are required to do, and how you rotate people in and out of the scenario.

During the debriefing, remember that engaging your learners so that they are responding to the prompts you provide during the debriefing will elicit the responses. As the learners are engaged in the conversation, you can listen to their thought processes and make evaluations of the depth of their knowledge around a particular topic. Additionally, you can identify gaps that exist, either in knowledge or the application of knowledge, that can help them improve for the future. So often, when training others in debriefing, I observe faculty members dropping into a mode of “mini-lecture” during what is supposed to be a debriefing. This deviates from active cognitive engagement and sometimes transcends into (a well-intentioned) one-way conversation. It is important to remember that if your participants are not engaged, you are potentially squandering some of the learning opportunities. At a minimum, you are giving up the ability to hear what they are thinking.

In summary, as you continue to develop your skills as a healthcare simulation educator, I invite you to use HUMBLE as an acronym that helps to reflect upon positive traits, actions, and good guiding principles, that provide learners with an optimized environment for improvement.  I truly think that healthcare simulation educators have powerful opportunities for assisting with the transfer of knowledge, and experience and creating opportunities for reflection, and by being HUMBLE we can ensure a more effective and empathetic learning environment for all participants.

Until Next Time,

Happy Simulating!

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