Tag Archives: education

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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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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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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May 26, 2023 · 1:17 pm

Simulation Professionals: Don’t let the Vocal Minority Get You Down!

The social psychologist Barbara Fredrickson coined the phrase, “The negative screams while the positive only whispers.” I don’t know about you, but this is extraordinarily true when reviewing course evaluations after simulation-based education programs!

Post-course evaluations are essential in measuring the program’s effectiveness and participant perceptions and are a tool to help with quality improvement initiatives. However, the feedback from vocal minorities can sometimes overshadow the opinions of the silent majority. After pouring blood, sweat, and tears into creating what you believe to be a successful simulation-based program, it can sometimes be a blow to your motivation when you receive negative evaluations.  At times the feedback can be pithy and personal and can sting.

Receiving negative feedback can be challenging for many reasons. First and foremost, it can feel like a personal attack on the hard work and effort you’ve put into a project or program. It’s natural to feel defensive or upset when someone criticizes something you’ve put so much time and energy into creating. Additionally, negative feedback can be difficult to process and use constructively. It’s easy to get caught up in the moment’s emotions and feel overwhelmed by the criticism. This can make it difficult to see the feedback as an opportunity for growth and improvement rather than a setback or failure.

This can be problematic as the feedback may not accurately represent the actual experiences of most participants, but it can certainly feel that way. It is also important to recognize the opportunities that come with critical feedback that could help you improve your program. It can help educators and course designers to identify areas for improvement and develop strategies for addressing these areas. Particularly when it is delivered constructively, and with a focus on improvement, negative feedback can be a powerful tool for enhancing the quality of simulation-based education programs and developing resilience in educators and learners alike. Critical feedback can help to identify areas for improvement, develop new strategies, and implement changes that can benefit future participants.

It is also important to remember that most participants with positive experiences may not feel the need to provide feedback. In contrast, those who have negative experiences may be more inclined to do so. So, I challenge you to go back and look at the designs of your course evaluation tools. It’s important to remember that the silent majority can be an important ally in the success of your program. By actively seeking out their feedback and insights, you can ensure that your program is meeting the needs of all participants, not just the most vocal. I’m not suggesting that we ignore the critical feedback; we just must find a way to balance it into a healthy model that contributes to resilience.

Developing a growth mindset is essential for developing resilience for those running simulation programs. It involves embracing challenges and staying motivated even when things get tough. Instead of seeing failures and setbacks as signs of inadequacy, individuals with a healthy mindset view them as opportunities for growth and learning. One powerful tool I use is remaining patient-centric in the decisions made regarding our simulations. Thinking about the downstream benefits that help raise the quality-of-care patients receive because of our efforts helps to keep my eye on the ball.

Lastly, remember that we can’t be all things to all people. While we remain excited and recognize the power of simulation-based education, not everyone will share our enthusiasm. As we move forward, remember that we can learn from the naysayers and the people unhappy that they are required to participate in some of our programs. Try to avoid the negative screaming in your ear, and you mistakenly believe that it represents the majority opinion. Stay focused on the idea that patients will benefit from our efforts, and many participants likely perceive value from our efforts.

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September 21, 2021 · 4:28 pm

Five Tips for Creating Hybrid Curricula for Simulation Based Learning

For the purposes of this discussion, we will assume that hybrid curriculums in simulation combine online educational materials in advance of on-site activities involving (in person) simulation into one curriculum.  

Why Hybrid?

There are things that we want the student to obtain knowledge on from a perspective of knowing things, or cognitively loading, for an upcoming education event. This often lends itself to carefully created on-line course work.

The in-person side of the equation is best used for when we want to see people doing things, particularly doing things with an understanding of the knowledge that they had already studied during the pre-work described above.  Combining these two facets, or hybrid learning, are some of the most efficient and effective designs for simulation programs.

Accompanying Video Discussion

Advantages

It allows students to be fully prepared from a knowledge perspective before the simulation encounters. This will allow you to conduct your simulation encounters at a much higher level by “raising the tide” of the knowledge of the learners in advance.  Such a design can potentially reduce unnecessary (costly) time in the simulation center. It also allows for students to assimilate the knowledge portion of your program at their own pace on their own time. Further, it helps to set the expectations of what the learners will need to incorporate when they participate in the simulations. Conducting the online portion as pre-work allows the student to seek out additional instruction mediums to help enhance their knowledge base understanding of the materials.

Disadvantages

Curriculum planning will require more effort. It’s more complicated than just deploying a simulation or just creating online education in isolation. You’re doing both! Combining the two which means that there is a time investment in creating the online materials that didn’t exist before we decided to move into a hybrid curriculum. There may be additional skills or resources needed associated with the creation of the materials and/or the administration of some sort of learning management system to make the online curriculum available to your learner population.

Students may not do the work online and prepare like they should before they come to your simulation center. Thus, you need to consider building incentives into the program that creates a compelling reason to do the work.

Tip 1: Begin with the End in Mind

Start with a detailed list of exactly what we want them to know and exactly what they want them to do. Yes, folks it is creating learning objectives, just like we’re designing simulations. Then carefully decide what is knowledge, what is skills and what is application of skills to help parse out which of the curriculum can benefit from on-line (pre) learning.  

Tip 2: Create High Quality Learning Materials

You want your students to take the online materials seriously. So, it is important to ensure they are of high quality, contribute to the learning, and not distracting. Not everything in your pre-learning needs to be Hollywood quality. Many people now do cell phone or mobile phone videos, and that’s fine! However, I want to caution you on the audio. You must make the audio or sound as good as the picture looks. If not, it is distracting, and your students may not take things seriously.

Tip 3: Create Active Learning for the Pre-Course Material

Try to create components of active learning in your online materials. Just because it’s online material and delivered asynchronously doesn’t mean there can’t be an active component. Resist the urge to simply regurgitate one of your old lectures and then toss it up online!

Find small opportunities to have them DO something. It might be as simple as asking them to write out a list of the steps of a procedure, drawing a diagram that they see on the screen, or maybe connecting social media so that they are communicating and learning from and/or with their peers. Lastly, having them taking an on-line assessment or quiz can serve as an effective tool.  

Tip 4: Ensure Learner Expectations and Consequences are Clear

Make sure your learners are clear on their responsibilities associated with the completion of the online materials, and what the consequences are if they don’t. Additionally, ensure the learners understand how the pre-course content is linked to the expectations that will be encountered when they arrive for the simulation sessions.

Some design examples include having the learners take a written pretest when they arrive at the simulation center and determine whether they have adequately prepared for the simulation or not. Other examples make it clear that they will be called on and expected to know the answers for the content contained in the pre-course materials.  It is important that we are fair to the student, with hybrid education, we need to ensure that the learner expectations and consequences are very clear.

TIP 5: Link Your Online Materials Directly to Your Simulations

Work to create an integrated continuum of learning that carries forward from the online materials through the expectations that the learners will encounter during the simulations. This can be emphasized through the direct inclusion of online materials into your simulation sessions. 

Consider including exact diagrams, exact pictures, exact phrases and themes utilized during the online learning during your face-to-face instruction. It might be in the form of a mini lecture. It might be audio/visuals that are incorporated during the debriefing process that can trigger in their mind the lessons that were learned from the online material and how it’s being applied to the simulation session learning outcomes.

Conclusions

The words online and hybrid can cause educators to become nervous because of the amount of work that’s involved as well as not understanding how to make those linkages between the pre-course materials and the simulation sessions. Admittedly, it is more work, but I would argue that the outcomes are far superior then either modality alone. Think of it as an investment. Things that can be moved to the online portion of hybrid design can prepare the learners so the valuable on-site time with the faculty can be conducted at a higher level.

I think that by incorporating good hybrid design with these tips, you will find that you will be creating exceptional learning environments for your students.

Until the next time, happy simulating!

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November 5, 2019 · 8:36 am

Simulation, Music, and Dancing

Many of you know of my crazy thoughts and ideas to try to connect things together with contrasts and comparisons to help people understand concepts and ideas. Well…. Here goes another one of them!Dance

I find that people continuously struggle with understanding the true relationship of the scenario (defined as the collective information, tools, and techniques that are presented to participants of simulations) to the outcomes of the simulation. The confusion arises from the fact that people get inappropriate messaging during the formative times of their simulation careers.

People gain the idea that the scenario must be as real as possible, or perfect mimic some aspect of real life in healthcare in order to be effective instead of recognition that the sole purpose is to create a script and stage that allows participants to perform. Some people believe that the overall goal of simulation is to recreate reality. The sad part is, those misguided thoughts often lead to over-production of the scenario and that the scenario is the primary focus of the activity. This can lead to the unintended consequences of increasing the workload of the simulation relative to the value of performance improvement and/or introduce confusion to the participants of the scenario.  Neither of which are desirable.

It occurred to me recently that a terrific analogy can be made by evaluating the relationship of music, to competitive dance. As it turns out the scenario is simply the music.

Thinks about it. When a dancer or group of dancers are going to compete, a number of things must be in place. First, there is an understanding that the dance will be carried out with the playing of music. The activity will last a certain length of time, involve one or more people who are supposed to do certain things at certain times and that various details will be assessed or evaluated along the way. At times the evaluation maybe be structured to focus on improvement (formative) and perhaps feedback is shared along the way (deliberate practice preparing for a competition), while other times may it may be a high-stakes evaluation (summative) resulting in only a score (the actual competition).

Now let’s focus on the music. What is its purpose in a dance competition? If you think about it, the music providers the framework or backdrop against which the dancing activity occurs. It helps to coordinate the tone, the tempo, and the activities associated with the dance. If the objective is to assess a pair of dancers doing a waltz, then a waltz is played. So the learning objective would read, at the conclusion of this five minute activity, the participants will demonstrate the ability to perform a waltz. If we wanted to evaluate a Latin dance, we would play Latin music and have an appropriate assessment criterion by which to guide the improvement of the activity.

While it is technically possible for the assessment to occur in the absence of the music, it would be awkward for the participants and the evaluators as well. Further, a piece of music may be specifically chosen to encourage a certain dance move that would facilitate the evaluation of the activity, let’s say a twirl or a flip. If we needed to evaluate or score how well one performed a flip, a flip would need to occur during the dance.

When using the methods of simulation in the healthcare world, we need to see people dance. The dance we need to see is often a complex one involving the delivery of healthcare, but it is a dance none the less involving specific movements, communications, and other activities toward a specific goal There are times that we need to see individuals dance, other times teams.

If we are to evaluate a certain element of healthcare, then we must have carefully composed the music that propagated the desired activity to have occurred during the dance. As they dance, we perform an assessment with a goal of helping them improve through various feedback mechanisms. Such feedback may occur through active reflection and facilitated discussion (debriefing), self-reflection, peer to peer engagement, or perhaps in the delivery of a more formal score in the case of summative feedback.

The bigger point is, the scenario is constructed and executed (composed) to provide the background milieu to form the basis of the dance, i.e. have participants perform the activity that we wish to assess. We choose different types [of music] to play that is concordant with the activity we wish to evaluate. At times we play a tune that accentuates the evaluation of critical thinking skills, perhaps the performance of a complex skill, or maybe one that allows a whole team to dance together requiring teamwork that will benefit from feedback.

So, the next time you are composing your scenario, give careful consideration to the moves that you desire to evaluate. The music that plays should allow/encourage your dancers to perform the steps and activities that will be evaluated and turned into useful information to facilitate improvement.

Compose, have people dance and help them get better!

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August 19, 2019 · 11:50 am

Five Pearls for Debriefing 

Sharing some practical considerations to help you with your debriefing efforts!

 

Shell with a pearl

1. Before you begin attend to learner readiness 

Before you begin ensuring the emotional readiness of your learners will be a huge benefit. Learning during a debriefing can be enhanced by reducing distractions. Such distractions can occur from many possible origins. If learners are particularly stressed, angry or perhaps sad after a simulation experience it is best to let them process their emotions or otherwise emotionally and mentally prepare themselves to be able to focus on the content of the debriefing. So, taking a few minutes to observe, or perhaps even directly asking, “Are you ready?” may go a long way. Also, another tool that I use after a stressful simulation is to just acknowledge that there may be stress with a statement such as “Wow. That looked stressful. Are you guys ready to talk about it?” 

2. During the debriefing, listen to the learners, analyze their thoughts and understanding 

A structured debriefing should provide the opportunity to listen to learners. This allows the debriefer to analyze if the learners have a command of the facts and understanding of the intended learning associated with the simulation. It is easy to become impatient with the process and start telling the learners what they need to know. Once this occurs, it is difficult to assess what the learners do know and understand. As you listen to learners during the debriefing think about what you need to ask next, or where you need to take the conversation to be able to analyze the next area of content you wish to explore during the debriefing. So another tip is shift your thoughts to how can I discover if my learners know….. as opposed to the normal transmittal of information that comes from thinking I need to tell them X, Y and Z so that they understand. 

3. What went right is as important as what went wrong 

There is a saying that the negative screams and the positive whispers. This could not be truer when it comes to debriefing. It is far easier to remember what people did wrong during a scenario, then what they did right. But if you sit back and think about it, they are equally as important. Learners leaving a debriefing understanding that they did correctly and why it was correct, paired with an understanding what they did wrong and why it was wrong is critically important for improvement to occur. If the right things are not debriefed, it may be that they were done out of habit or luck and that the learners don’t understand it at all! Or worse yet, they could be perceived as unimportant. So a good tip is to jot some noted down of things that went correctly during a scenario. Trust me, you’ll remember all those mistakes which will be screaming! 

4. Keep the debriefing focused 

A challenge for anyone conducting a debriefing is to keep things focused. Learners love to talk about what learners want to talk about. However, it’s important as the facilitators of the conversation that we have the learners talking about what they need to be talking about. What learners need to be talking about should be driven by the learning objectives of the scenario. This direction needs to come from the debriefer. There is a delicate relationship that exists between the learners and the debriefer so carefully thinking about how to maintain this but being able to gently nudge the conversation back to the right pathway is a skill worth concentrating on. A tip is to develop some scripts that you are comfortable using when such nudging need to occur.  

Consider this example, “I agree that the exact dosage of the medication is critically important, but for this scenario and debriefing we are tasked with focusing on the effectiveness of the communications within the team. So, who can give me an example of effective communications that occurred during the scenario?”  

 5. Bring out summary/take home points 

Every simulation has a plethora of opportunities for learning. It is the job of the debriefer to ensure that the primary learning objectives of the simulation are covered. During complicated cases or cases with multiple learning objectives it is possible to cover a lot of ground along with many topics and facts during the time when you are analyzing the learners grasp of the content. It is important to close with summary points that are crucial take home messages. This can be challenging for some, and often turns into a mini lecture. And remember when you start lecturing to the learners, you are sacrificing the ability to ensure understanding where the learner is at that point and time. Concluding or beginning the wrap up of the debriefing by asking leaners to give one or two things that they think went well during the scenario along with what they would  change next time can be an effective probe into understanding that the learners took away the big learning messages. It also serves as the time to allow you to shape the discussion with further questions that drive home the intended take away points. Always think to yourself what are the two or three things that I want them to remember most from this experience a month from now. 

Well that’s is for now. Remember debriefing gets better with practice, feedback and experience. So, get out there, debrief, get some feedback and debrief again! 

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