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The First Four Steps of Healthcare Simulation Scenario Design

How can you make your scenario design process more consistent and efficient? One way is by following a step-by-step method to create your masterpieces!

In this post I cover the first four steps of a proven scenario design process.
There are four core steps that must be done in order. After the first four are accomplished you can branch out and be a little bit more variable in your approach to scenario design.

4 Success Steps, business concept

Step One: Pick A Topic

Picking a topic may seem like common sense but there is a lot to think about.

In healthcare simulation we have many topics to choose from. But in step one we want to a little bit specific and figure out that the major topic is that will be covered. We may be cover the teaching of physiologic, diagnostic or treatment where people are going to be making critical decisions, ordering medications, and other therapy, or perhaps our primary focus going to be on team training, teamwork, communications, team leadership. You get to pick!

Step Two: Define the Learner(s)

This is really important because in order to go to the next step which is designing the learning objectives we have to understand our learner population. For example, what do you expect of a fourth-year medical student what you expected them in terms of being able to evaluate and treat a simulated patient that is complaining of chest pain? Now contrast that to if your learners are medical students that are in the second year of medical school and haven’t had any clinical experience. In other words, we can take the same topic but as applied to two different populations, our expectations and what we are going to be evaluating from them is very different.

Step Three: Designing  the Learning Objectives

This is where you want to go into detail, great painstaking detail, about what you’re trying to accomplish with the simulation scenario. It is very important to take time on this step. Many people tend to gloss over this step which can create confusion later.

Let’s take a topic example. Let’s say asthma in the emergency department. When you think about asthma in the emergency department there could be many sub topics or areas from which to choose. It could be focused on competence of managing a minor asthma attack, or it could be a first-ever asthma attack, or it could be management of chronic asthma, or it could be major could be a life-threatening situation.

Carefully consider what do we want this learner group that we have defined in step two. Do you want them to diagnose? To treat? To critical compare and contrast it to other cases of shortness of breath in an acute patient? You get to choose!

Perhaps we want to focus on the step-by-step history presentation or the physical exam or maybe we want to see the learners perform treatment. Or maybe we want to see the overall management or the critical thinking that goes on for managing asthma in the emergency department. There are many possibilities, largely driven by your intended learner group demographics.

So, in other words were taking the big topic of asthma and we are going to cone it down to answer the question of what exactly we want our learners to accomplish by the end of the scenario. We can’t just assume that what is supposed to happen in the real clinical environment will or should happen in the simulation environment. That rarely works. We actually want to later engineer the story and situation to allow us to be able to focus on the learning objectives.

Step Four: Define the Assessment Plan

How are you going to assess that each objective defined in step three was accomplished? That is the fundamental thought process for step four.

What are you going to be watching for when you the creator of this simulation scenario are watching the participants do their thing? What are you going to be focusing your attention on that you’re going to bring into the debriefing? What are you picking up on that you might be filling out assessment tools?

Define your assessment plan with specificity of what you’re looking for. This is different than designing the assessment tools that could come later. Or perhaps not at all. It is important that you remember every simulation is an assessment of sorts. See Previous Blog Post on this!

This doesn’t mean that every simulation needs assessment tool like a checklist, rating scale or formal grading scheme. It simply is referring to consideration of how to focus the facilitating faculty member, or teacher, or whatever you call them, who are observing the simulation. Remember, that to help the learner(s) of the simulation get better, the faculty need to be focused on certain things to ensure that the goals of the scenario are accomplished for our selected learner group, associated with the topic we chose in step one.

Lastly, what I want to point out to you is that you should notice something missing. The story!

The story comes later. Everybody wants to focus on the story because the story is fun. It’s often related to what we do clinically. It’s replicating things that are fun that brings in the theatrics of simulation! But what we really want to do is bring the theatrics of simulation to cause the actors on the stage (the participants) to so some activity. This activity gives us the situation to focus our observations on the assessment of the performance. This in turn allows us to accomplish the learning objectives of the scenario and help the participants improve for the future!

Until next time, Happy Simulating!

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There is a lot of disEHRandSim'cussion recently about incorporating electronic health record (EHR) into simulations. Which vendor? Which product? What features are needed? The disturbing thing about most of these discussions in my mind is that no one is talking about what they are trying to accomplish with the inclusion of electronic health records into the simulation environment.

What is the purpose of the EHR in it in a simulation? Is it simply to provide realism? If so, is the EHR that is implemented likely to be the one in the practice environment experienced by the student? Because if not, it is missing the mark likely adding confusion as well as increasing the orientation time necessary for a given simulation. Is the EHR supposed to provide crucial information that will help make healthcare decision during the simulation encounter? Is the entire simulation designed around an efficient query for specific information of a patient’s history? Are entries in the EHR made by the participants of simulation going to be analyzed for knowledge or critical thinking regarding a case? There are so many possibilities! I would argue however that integrating the EHR into the simulation simply for reality will likely be a colossal waste of time.

Much like any other component included in simulation the EHR should be included thoughtfully and carefully driven by needs analysis based on the learning objectives of the educational encounter. EHR technology can be overwhelming by itself to understand and navigate, combined with the fact that there are many different types of systems for different practice environments make it unwieldy to become expert in all brands, systems or examples.

Similarly, it if you have successful implementation of the EHR into your simulations I would recommend that you carefully decide for each and every simulating counter whether you need to include it or not. Again, this decision should rest upon the learning objectives and the intended educational outcomes of the event. Interacting with the EHR can be a time-consuming, frustrating part of the delivery of healthcare and it is up to the creator of the educational encounter to determine the usefulness and necessity of such integration.

The thoughtful use of EHR into select simulated encounters can significantly lead to increased observations of critical thought process, attention to detail, as well as overall understanding of the depth and breadth of understanding of a given case. Additionally it could serve as another avenue for assessment. If the integration of the EHR is predicated around these efforts and clearly the addition of the EHR component is both worthwhile and necessary. Additionally, simulations involving workflow and human factors can possibly benefit from such integration knowing that in today’s delivery of healthcare the interaction with the EHR is a daily reality.

I must close however with reminding the simulation community it is not our job to re-create reality, it is our job to create an innovative educational encounter from which we can form opinions to engage in discussions to help healthcare providers on their quest towards excellence.


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