If you think about it an agreement needs to exist between those whom facilitate simulation and those who participate. Facilitate the purposes of this discussion is referring to those who create and execute simulation based learning encounters. Sometimes the agreement is more formal other times more implied. This phenomenon has been described in many ways over the years
having been branded by such descriptors as fiction contract, psychological contract, or learning contract.
Why does this need to be the case? A contract or agreement is generally called for when two or more parties are engaging in some sort of collaborative relationship to accomplish something. Often times these type of contracts spell out the responsibilities of the parties involved. If you think about simulation at a high level the facilitator side is agreeing to provide learning activities using simulation to help the participant(s) become better healthcare providers. The participants are engaged at the highest level because they want to become better healthcare providers. While not trying to hold a comprehensive discussion, let’s explore this concept and the responsibilities of each party a bit further.
Facilitators are designing simulation activities with a variety of tools and techniques that are not perfect imitators of actual healthcare. They are crafting events for which the participant to a greater or lesser extent immerse themselves in, or at a minimum simply participate. Some of these activities are designed to contain diagnostic mystery, some demand specific knowledge, skills and attitudes be known or developed to successfully complete the program. Facilitators are also putting participants in situations that the must perform in front of others and that can create feelings of vulnerability. So all toll, the role of the facilitator comes with enormous responsibility.
Facilitators are also asking the participants to imagine part of what they are engaging in is a reasonable facsimile of what one may encounter when providing actual healthcare. Therefore another tenet of the agreement is that the facilitator will provide an adequate orientation to the simulation environment pointing out what is more and less real including the role that the participant may be playing and how their role interacts with the environment outside of the simulation, if at all. (I.e. define any communications that may occur during the simulation between the participants and the facilitator.
Facilitators trained in simulation know that mistakes occur sometimes due to a lack of knowledge, incorrect judgement or unrelated issues such as a poorly designed simulation. Facilitators thereby commit to not judge the participant in anything other than their performance during the simulation. While diagnostic conundrums are inevitable in many types of simulations the facilitator should not try to unnecessarily trick or mislead the participant in any way that is not directly contributing to helping the participant(s) improve. The facilitator must attempt to use the time of the participants wisely and responsibly.
The role of the participant shares responsibilities as a part of the agreement as well. Participants agree to a commitment to become better healthcare providers through continuous learning and improvement. This is inherent in a professional, but there are some likely good reasons
to remind participants of this important premise.
Participants must agree to the use of their time to participate in the simulation. The participants are also agreeing to an understanding that they know the environment of the simulation is not real, and that there will be varying levels of realism employed to help them perform in the simulation. But to be clear they agree to this tenet predicated on the trust that that facilitators are having the participant experience simulations that are relevant to what they do, with an underlying commitment to help them get better. In simulations involving multiple participants, they must also agree to similarly not judge others on what occurs in the simulation, as well as keeping the personal details of what they experience in the simulation confidential.
So in closing, successful simulation or other immersive learning environments require an agreement of sorts between those who create and execute the simulation based learning environments as well as those who participate in them. Each party brings a set of responsibilities to the table to help to ensure a rich learning environment with appropriate professional decorum and commitment to improvement. The agreements range from implicit to explicit, but when they exist and are adhered to will continue to allow the recognition of value that can arise from simulation to help improve the care ultimately delivered to our patients. After all, isn’t that our highest goal?
Thanks Paul. For me the explicit reason for the contract (The Sim program will do this… and you will agree to do this…) is to emphasize to the learner the importance of preparation for the scenario session, but too often faculty or clinical educator do little to prepare their learners for the scenario itself. While “on the fly” operation of a simulator doesn’t mean that the scenario isn’t planned carefully or that it is—but too often the reality “on the fly” is that it is not planned and objectives are not fully defined, and if they are defined, they are easily abandoned for whatever “might” occur during the scenario. The problem is that too often, educators are overwhelmed with many other responsibilities, and that simulation is often an inconvenience to their other duties, or simply is too convenient when other clinical activities are not possible. In either case, we need to see a professional, career path, appropriate education/continuing-education and certification for using simulation. Too many times, faculty demands dilute what is possible in the simulation lab. We need simulation experts in the lab, designing scenarios, programming scenarios, operating the simulators, setting up the spaces. Simulation is no longer an adjunct to program curriculum, but an integral part of a successful undergraduate pre-licensure clinical program.