Matching Simulation Modality to Learning Objectives
It is important to consider the goals and objectives prior to determining the type of simulation required. CSTAR staff will work with you during the planning meeting to determine the best modality for your learning needs.
Fidelity is the extent to which appearance and behavior match to real life, and must take into consideration more than just the simulated patient. You need to tailor the fidelity to the desired learning objectives while being careful to focus on the objectives and not “clutter” the simulation. There is a danger of having too much going on for both learner and instructor. Consider what is necessary to engage the learners and allow them to suspend disbelief; and for transfer of learning to the clinical environment.
- Physical fidelity considers how much the environment matches to the real world – includes room set up, equipment, mannequin, the “feel” of a task trainer – important for developing kinesthetic and procedural skills, physical assessments, testing the environment, etc.
- Conceptual fidelity incorporates the responsiveness to interventions and flexibility of the simulation – how much it behaves like real life – therefore the if-then reaction needs to be the same as in practice. It is important for diagnostic skills, clinical reasoning and problem-solving.
- Emotional or Psychological fidelity occurs when the participants have feelings and emotions generated from the decisions they make, and from their interactions with, and relationships to, others in the simulation. It is important for training complex processes that involve emotion and cognition and works best when multidisciplinary team members are involved and cases are based on real events.
Examples of matching modality to objectives:
|Learning Objective||Simulation Modality|
|Procedural skill development (e.g. inserting a central line, intubating a patient)||Task trainer|
|Critical thinking (e.g. managing a deteriorating patient)||High fidelity mannequin with responsiveness to interventions|
|Soft skills (e.g. patient education, communicating bad news)||Standardized patient, or confederate as family member|
|Teamwork skills (e.g. communication, role clarity)||Interprofessional, could be either mannequin or standardized patient|
|Crisis resource management skills||Need to consider physical, conceptual and emotional fidelity|
|Testing out a new process or space configuration||In situ with mannequin, interprofessional|
|Identifying process issues or knowledge gaps||In situ with mannequin, interprofessional|
The specifics of scenario design are often under-appreciated in the field of health simulation. A well-designed scenario is crucial to ensure objectives are reached in a way that is meaningful and valid to the participants, instructors, and researchers whether the goal is for learning, stimulating discussion, process improvement, conducting research or assessing performance. It is also important to have scripts for the patient; any embedded simulation personnel; and the simulation technician who will be operating the mannequin to ensure consistency and maintain flow of the simulation. See the tools section below for suggested templates you can use.
A Standardized or Simulated Patient (SP) is a person who is trained to accurately and consistently take on the characteristics of a real patient providing an opportunity for the student to learn and / or to be evaluated on learned skills in a simulated clinical environment. When using an SP you will need a script for them to follow with a detailed patient history and responses to questions the learner will ask.
Embedded simulation personnel (ESP) or confederates are individuals designated to play roles in the scenario other than the patient or the learners. The role may be a family member or another member of the healthcare team. They are there to add to the realism of the scenario and can be played by an instructor, one of the alternate learners, an SP or a staff member in that role. The ESP will need to be aware of the scenario and any cues or information they need to share with the learners.
- CSTAR Simulation Scenario Template
- Sample Script Template for Standardized Patients
- Sample Cue Card for Embedded Simulation Personnel / Confederates
- Clinical Skills Development Program - The Schulich School of Medicine and Dentistry, Western University: for recruitment of Standardized Patients
- Designing a Simulation Scenario, Douglas W. Harrington; Leslie V. Simon.
- Simulation Scenario Design, Chris Nickson, Ian Summers and Stuart Marshall, Sep 16, 2020
- Utilization of Embedded Simulation Personnel in Medical Simulation, Tanna J. Boyer; Sally A. Mitchell.
- An Approach to Confederate Training Within the Context of Simulation-Based Research. Adler, Mark D. MD; Overly, Frank L. MD; Nadkarni, Vinay M. MD; Davidson, Jennifer RN; Gottesman, Ronald MD; Bank, Ilana MD; Marohn, Kimberly MD; Sudikoff, Stephanie MD; Grant, Vincent J. MD; Cheng, Adam MD; For the International Network for Simulation-Based Pediatric Innovation, Research and Education (INSPIRE) CPR Investigators*
- A Difficult Patient Encounter: Using a Standardized Patient Scenario to Teach Medical Students to Treat Medication-Seeking Patients. J. Chase Findley, MD, Dawnelle Schatte, MD, Jim Power
Knowing when and how to use moulage will allow you to deliver the correct level of realism to your simulation. While extensive moulage is fun and engaging, it can be time consuming and even detrimental to your participant’s learning. Sometimes, all you need is a printed picture of a wound taped to the mannequin or simulated patient; other times, complex moulage that includes realistic looking wounds and fluids can be a worthwhile addition.
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