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Content 0 – Introduction 1 - The importance of scenario writing 2 - Basic steps of scenario writing 2.1 - Identifying the learner(s) and their educational needs 2.2 - Target audience 2.3 - Learning objectives 2.4 - Short case description and involved participant information 2.5 - Scenario script including all characters 2.6 - Technical/medical equipment needed to perform the task(s) 2.7 - Scenario timeline 2.8 - Soft skills and technical skills to observe 3 - Lessons learned 3.1 - Identifying the learner(s) and their educational needs 3.2 - Target audience 3.3 - Learning objectives 3.4 - Short case description and involved participant information 3.5 - Scenario script including all characters 3.6 - Technical / medical equipment needed to perform the task(s) 3.7 - Scenario timeline 3.8 - Soft skills and technical skills to observe 3.9 - Recording of the scenario References Appendix Appendix1 - Scenario templates Appendix 2 - Common Scenario (Caring for the person with type 2 diabetes) Appendix 3 - Lessons learned (specified by each partner) | ||
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Foreword
This Guideline on how to write good scenarios aims to support teachers and trainers from healthcare and other vocational educational training (VET) colleges, interested in working with simulation, by providing them a detailed insight view, but also providing the practical tools in designing scenarios. Scenarios are fundamental in simulation; representing the backbone of the process and this is why special attention is required when designing them. Moreover, writing scenarios is not an easy task because it requires acting and directing skills on top of the pedagogical ones and the ones specific to the training field. This Guideline was created within the Erasmus project, entitled “E-(m)PACT”, and it was financed by the European Union for the period November 2017 until October 2019. Six institutions from many countries took part in the project: Fundatia Ecologica Green, from Iasi, Romania, as promoter, SOSU Østjylland from Aarhus, Denmark, EASO Politeknikoa from San Sebastian, Spain, Instituto Politécnico de Santarém from Santarém, Portugal, Kanuni Mesleki ve Teknik Anadolu Lisesi from Izmit, Turkey and ROC Drenthe College from Assen, the Netherlands, as partners. The project has been supported by Laerdal Denmark, represented in the activities by Mr. Henrik List, to whom we would like to express our gratitude and thanks. The Guideline is one of the tools created within the project and we recommend that this material should be used in association with the Handbook on How to Implement Simulation in any college and the Guide on How Media can Enhance and Document Simulation. The Guideline on How to Write Good Scenarios presents the three scenario templates, produced within the Erasmus project, describing all the rubrics of each template and offering indications on how to write a good scenario. Together with the guideline, there is a collection of 12 model-scenarios and short videos, filmed by the partners in the project, that come to illustrate the use of them and which may serve as inspiration. Even though the E-(m)PACT project was implemented in the healthcare field and the materials subsequently tested in this context, the method of simulation and all the tools created can be adapted to any other educational context. All the materials are free to use and can be downloaded from the project website page, available at: www.empact-project.eu.
The Project Team
Authors: Coordinator: Maria do Rosário Pinto, IPSantarém, Escola Superior de Saúde, Portugal. Kian Hald Jensen- SOSU Østjylland, Denmark. Hanne Hviid - SOSU Østjylland, Denmark Mihaela Catalina Neculau- Scoala Postliceala FEG Iasi, Romenia Iuliana Matei- Scoala Postliceala FEG Iasi, Romenia Ane Bastida Saiz - Easo Politeknikoa, Spain. Olatz Esnal Lasarte - Easo Politeknikoa, Spain. Mariska Spieard - Drenthe College, The Netherlands Heike van Zaal - Drenthe College, The Netherlands Ümit EMRE - Kanuni Vocational and Technical High School, Turkey
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0 - Introduction Simulation based learning involves essential elements in order to look for the success of the implementation of this student centred-learning, which is a successfully recognized strategy, in the most diverse areas of knowledge, but undoubtedly of high importance in the field of health care. This widely used method, by educators and learners, to acquire and mobilize prior knowledge and develop new competences in healthcare, either in academic or clinical contexts, requires knowledge of educational principles and good practices, in both simulation and clinical practice, along with thoughtful planning in order to achieve a successful learning accomplishment. Scenario design is a fundamental component of simulation-based education. Each simulation scenario is an event or situation that allows participants to apply and demonstrate their knowledge, technical skills, clinical skills and/or non-technical skills (Terrett, Cardinal, Landriault, Cheng & Clarke, 2012; Huffman, McNeil, Bismilla & Lai, 2016). Therefore, effective scenario design provides the basis for educators to meet specific learning objectives and provide a meaningful learning experience for the participants (Huffman et al., 2016). Consequently, the design, construction and development of the scenarios are key steps towards the success of this strategy, as this congregation will allow the integration of learning, and decision-making abilities, in a safe learning environment. Given its recognized importance, this is a subject that has been approached by several authors, who tried to provide not only an understanding of why the design process is important, but also rationales for making difficult design choices and approaches to designing scenarios, applicable to educator and learner needs (Huffman et al., 2016). The innovation proposed within the present Guide, in addition to theoretical/practical sustainability, results from the development of an international project that brought together different professional, cultural and educational dimensions that join distinct partner countries, with a large diversity of realities. The guidelines proposed in this handbook are a result of a reflexive analysis of existing theoretical support, applied in different educational levels from secondary to post-secondary and higher-education (from level 4 to level 6). They result from the involvement of a multicultural group of students and teachers, preparing the learners to develop distinct skills and competencies depending on the functions defined in each professional official regulation (which is different from level to level and from country to country), responsibilities to be assumed and even contexts where care will be developed (from out-of-hospital first approach to advanced life support care). In addition, throughout the development of the project, the technical and practical dimensions were discussed and analysed with some of the most recognized experts from a well known enterprise in the field. Although more specific, this approach cannot be dissociated from the global Project that is on its origin. This Guideline is structured and organized to address not only healthcare teachers or students, but everyone who would like to work with simulation in education and aspires to learn or improve their knowledge on how to write good simulation scenarios. Although, we assume it is more connected to healthcare reality. The contribution of this Guideline starts by summing up some key concepts, highlighting the importance of simulation based learning in all its dimensions, followed by the presentation of basic steps of scenario writing, aligned with the templates produced within the project. The analysis of the various dimensions of the lived experience(s) of all partners involved intends to be a proposal of guidelines to promote the improvement of the quality of the whole simulation based learning process throughout the most effective scenario design. | ||
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| 1 - The importance of scenario writing
Considering simulation as a strategy in which a particular set of conditions are created or replicated, to resemble authentic situations in real life (Gaba, 2004; Lopreiato, Downing, Gammon, Lioce, Sittner, Slot, Spain, 2016), when applied to the area of healthcare, it represents a technique that creates a situation or environment to allow persons to experience a situation of a real healthcare event for the purpose of practice, learning, evaluating, testing, or to gain understanding of systems or human actions (Lopreiato et al., 2016). It is evident that the design of the situation is a fundamental step to achieve success. Reminding that this simulation process is a three-step method (see Figure 1), it is important to point out the need for some didactic considerations about the need of a connection between the steps, with an interconnection between the learnings objectives, the content and the method, in order to make a good scenario design (Helleshoej, Johansen, Hansen & Selberg, 2015). Figure 1 - Simulation phases [Adapted from Helleshoej et al, 2015:50]
Figure 1 - Simulation phases [Adapted from Helleshoej et al, 2015:50] By definition, a scenario is a deliberately designed simulation experience (also known as a case) that provides participants with an opportunity to meet identified learning objectives. The scenario provides a context for the simulation and can vary in length and complexity, depending on the objectives (INACSL, 2016). Therefore, an effective scenario design should provide the basis for educators to meet specific learning objectives and ought to provide a meaningful learning experience for the participants. The first step in designing a scenario is identifying the target group, i.e. the learner(s) and their educational needs. This will be the basis for writing relevant objectives, by approaching the learning areas, needs and competences of the learners. The second step, the scenario content and context, must include the specification of the simulated environment to produce a realistic experience to maximize specific learning objectives within the confines of physical space, time and available resources (Terrett et al., 2012; Helleshoej et al., 2015). Nevertheless, a scenario should last no more than a few minutes - most literature suggests five minutes, with few learning objectives, as the rule of thumb in simulation is that the debriefing phase should be at least twice the length of the scenario. The third step, the connection to the debriefing, is an important moment of reflection on the lived-experience during the scenario implementation and development, from a learning perspective that enables to develop the best practice in a future similar situation. The use of video recordings of the simulation is known to enhance debriefing sessions by stimulating learning and self-reflection based on an accurate account of events that were experienced by the learner (Helleshoej et al., 2015). As a matter of fact, simulation scenarios can be designed for many purposes, even in specific healthcare areas. They can be intended as tools to teach and train individuals or teams, to test systems, in order to enhance efficiency or patient safety, to answer research questions or to perform assessments (McGaghie, Issenberg, Petrusa & Scalese, 2009). As we’ve been seeing, designing a high-quality simulation scenario involves many different factors. Terrett et al. (2012) have identified six key-steps to assist in making the process more efficient and effective. From those,it is important to highlight the significance of having the most profound knowledge of the target audience, in order to establish realistic and executable learning objectives, aligned with the learning stage of the students. This will provide the best scenario script, along with having a precise description of the case and environment, therefore aiming to be the most faithful reproduction of reality. It is fundamental the awareness of inherent needs, related to the adequate required environmental characteristics; to equipment and material to be used by the students during the procedure or to simulate a specific lesion or injury, for example; to a mannequin, a computer assisted simulator or an instructed figurant; to ponder the necessity to introduce adjuncts, such as complementary diagnosis tests results, patient charts or flow sheets. Often, elements that were not considered during the scenario’s first design, become blatantly apparent during practice run, which allows the identification of the need to make changes or clarifications, and ensures all necessary equipment, laboratory results and other adjuncts are appropriate for the scenario, meeting the participants’ educational needs (Huffman, et al., 2016). The reflection upon all the principles we referred above, potentiated by the interdisciplinary discussion between the project members and the practical/theoretical support of simulation expert, Mr. Henrik List (on Laerdal’s behalf), allowed the partners of the consortium to delineate their own templates, which is an organisational and structural proposal for the design of scenarios, aimed at teachers, students and other figurants, as can be seen in appendix 1. Main principles and orientations related to the basic steps of scenario writing, as proposed in the scenario templates, are presented and justified hereafter. | ||
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2 - Basic steps of scenario writing
Although our experience suggests to start with general thematic area definition, identifying the subject with a clear and appelative name/title will be the primary organiser of this dynamic process of scenario writing as it benefits from following an organisational structure, so all steps are covered, contributing to the success of the global process (see table one). Table 1 - Basic guidelines for the design of a scenario
As the reader can see when consulting the appendixes, these are main lines to take into account when designing a scenario for simulation-based learning that are more detailed below, but are not, in itself, the proposed template(s). The templates are the result of the integration of this information. 2.1 - Identifying the learner(s) and their educational needsHuffman et al. (2016) consider this step as a critical one, because the learners’ needs should be the basis for writing the objectives of the simulation and skipping this step might bring you to a simulation that doesn’t encounter the students’ level of learning. Teachers must foresee the profile of learners, before they start designing scenarios, to identify strong and weak points in order to recognize those which will have to be worked on its depth, to achieve the required learning outcomes. This information may be available on an established curriculum, but most of the time it is the result of a previous assessment of the characteristics of the learner group, involving factors like age, maturity, previous experiences, knowledge and already developed skills. All these must be considered while deciding the content for the scenario design and the definition of primary learning objectives, which is essential for participating in the simulation. Teachers have to identify the expected learning outcomes; a step that will contribute to ensure the most relevant organization and performance of the scenario. Learning objectives may be revised by peers, in order to analyse its applicability/adequacy to the learners needs in a transversal perspective. It is important to be aware of the relevance of flexibility. Although learning objectives defined are the main orientations for the whole process, especially during debriefing, teachers have to be flexible enough to participate in the reflection of the learners, even about issues identified by students, which may not be aligned with the planning, but they are key to the learning process. 2.2 - Target audience The target audience is the group of students who have the theoretical basis to encounter the learning objectives of the simulation. The target audience can be the class of students for which the simulation is designed. But, due to the fact that in many cases the learners’ profiles are very heterogeneous, the teacher can decide whether the target audience is the whole class or only a part of it. The main concern in selecting the students involved in simulation is taking into account the theoretical knowledge, the level and the practical skills developed by the students/learners. These two points can be analysed together, which in fact it is seen in most literature. From our experience, if the group addressed is significantly heterogeneous, it is useful to reflect upon each subject independently. In any case,it is important to guarantee that the knowledge the students should refresh or prepare before simulation development is correctly described and will be transmitted to them in due time. 2.3 - Learning objectives From our experience, this can be considered the most relevant phase of the whole process, although there may be several layers present when defining objectives, as Huffman et al. state (2016). In general, objectives can be divided into procedural or technical (knowledge, skills), behavioral or related to teamwork (i.e. communication, roles, resource utilisation, awareness). Some scenarios focus more on one area than others, but a mix of all objective subgroups often forms a well-structured scenario (Huffman et al., 2016). Nevertheless, it is imperative to have primary learning objectives, which are essential to the learning process and should be addressed during the debriefing. A list of items to evaluate, corresponding to the learning objectives, will help the visibility of the most important signs of learning. There may also be secondary objectives included in items to evaluate, although they must not constitute the most crucial learning signals. The learning objectives have to be clearly formulated, in order to assess more easily the scenario and the global simulation procedure. Therefore, its number has to be limited. Huffman et al. (2016) connect the complexity of simulation with the simulation modality, defending that if we use low-fidelity simulation we can follow a less complex scenario targeting, but, if we use high-fidelity simulation, the scenario will be complex, involving more learning objectives. In general, we propose two to four objectives (see appendix 2) that cover scenario and debriefing. If any other specific learning need(s) arises from participants, the original learning objectives should be re-examined to determine their effectiveness (Huffman et al., 2016). 2.4 - Short case description and involved participant information
This step will provide the student basic information about the case, so he/she can get familiar with what will be happening. including the initial case presentation, giving details like medical history, the simulation environment, the number of persons involved in the scenario (for example, family members or present observers/witnesses). This short storyboard tends to be based upon previous real cases, which enhances the realism and the feeling of being exposed to a real-life situation, although it does not have to be a rule. It is important to highlight that if real-life scenarios are used, privacy must always be ensured and informed consent may be necessary. Another important aspect is the presentation of the patient that should always include the name, age, gender and basic clinical information. Other information may be added, depending on the learning objectives. It can be necessary to give this information separately to all involved participants, meaning it should be carefully selected and written in different templates, so the teacher/facilitator has detailed information and students will just receive the information needed to perform the scenario, without compromising the development of critical thinking and/or decision making competencies. 2.5 - Scenario script including all characters Huffman et al. (2016) underline the importance of writing a detailed scenario, without misleading the student. All information should appear in the scenario, if relevant to the case description. Depending on the complexity of the scenario, there must be short or long written descriptions of the characters. We defend that the scenario outline should have the description of the entire scenario, not only the patient’s situation, but all factors involved, like: person(s) present, interruption(s), visitor(s) coming in, hazards, and anything else that may interfere within the learning experience. In line with this, we propose to take into consideration the use of the three templates, so the situation is described more thoroughly, assuring that we don’t lose details of the scenario students must perform. In the teacher’s template, we suggest to put all the information needed to follow the performing of the simulation, like: the patient clinical presentation, past medical history, allergies and vital signs, the precise role of the persons who are going to be involved in the scenario, and the location where the scene takes place (see our proposal on first template on appendix 1). The student’s template must have all the information mentioned above, validated by the teacher in line with the learning objectives, less the precise role being played of the other persons involved in the scenario. This aims to ensure that the situation can be as realistic as possible to the student, namely because of the inherent unpredictable interaction between people, one of the dimensions that should be manageable by the learner, promoter of the development of technical and soft skills (see our proposal on second template on appendix 1). The third template is the one for other intervenient, namely for the patient or figurant, which can have details about the way to act, in order to help the person who plays the role of the nurse/health worker to fulfil his/her intervention, not diminishing or potentiating the realism of the situation and the students’ performance (see our proposal on third template on appendix 1).
2.6 - Technical/medical equipment needed to perform the task(s)
The material/equipment needed to develop the scenario may have different approaches, depending on the learning objectives proposed. On one side, all technical and medical equipment needed for performing the tasks has to be described on the teacher’s template. This allows the teacher to easily identify some of the themes to introduce on debriefing. On the student’s template, the information does not have to be all written, once again, depending on the objectives. If they are supposed to have the knowledge to choose the materials they need, this item may be blank, with just a reference like “all materials/equipment is available on setting”. In this situation, while designing the scenario, it has to be taken in account the time students require to select the materials they may need. It is important that they use similar equipment to what the participants would use in their regular clinical practice in order to enhance the realism of the scenario. Using this kind of medical equipment also can contribute to the skills development of the student and raise their self confidence in using medical equipment in real life situations.
2.7 - Scenario timeline
The teacher has to start building a timeline with full descriptions of what is expected to happen from the beginning to the end of the scenario, like a script for a film. It is recommended that the length of the scenario be relatively short, in order to allow a very efficient debriefing (the longer the scenario and the more complex, the more aspects involved, tasks to be performed and it is more difficult to follow). If you are a novice in this area, it is suggested to begin with simple scenarios of two or three minutes, with simple learning objectives and gradually add complexity. Allow time to practice your scenario before implementation.
2.8 - Soft skills and technical skills to observe (according to learning objectives)
In this phase of the design of a scenario, one must remember that clinical simulations are used in teaching, learning and creating opportunities to practice new skills, without involving real situations and real patients. In fact, developing the ability to make decisions, to communicate, to increase students’ capacity to assess a situation from the clinical point of view, constitute the benefits offered by the simulation and address the students who already have theoretical knowledge and a minimum level of practical abilities/skills (Huffman et al., 2016). From a more operational perspective, this part is going to be only on the teacher’s template, because it involves the soft and the technical skills to be followed/developed during the scenario playing. And for this, we have to decide which are the skills that we are going to centre the reflection on, according to the learning objectives, and put them in an evaluation list, separating the soft and technical skills to be easier to follow (see our proposal on the first template on appendix 1). Debriefing analysis should focus on improve needs, highlighting the positive dimensions while promoting the reflexive process. | ||||||||||
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| 3 - Lessons learned Capturing learned lessons should be an ongoing effort throughout the project life span, to identify project management process improvements. As Rowe & Sikes (2016) defend, we learn from project failures as well as from project successes but most important is to implement good processes and practices to successfully complete existing and future work. For this reason, because this is also our point of view, we now share with you lessons learned throughout the development of this project, sharing as well the common scenario proposed (see appendix 3). 3.1 - Identifying the learner(s) and their educational needs Identifying the learner(s) and their educational needs is essential for designing a high-quality simulation scenario, that reproduces a realistic experience appropriate to the expected learning outcomes the students’ formation requires. Our partnership experience highlights the importance of being aware that students may come from different age groups, have distinct personal characteristics, global needs, strong and weak points, emotion expression and life experience, and diverse acquired skills or even educational levels. For these reasons, it is fundamental to prepare the students prior to simulation, both theoretically and practically, especially if the learning experience involves the previous need for basic knowledge or soft skills, which will help them having a more realistic global vision and will allow them to practice it through the development of the scenario. In all perspectives this is very relevant as the difficulty of bridging between theory and practice was identified in all healthcare realities and is fundamental for students to understand how their theoretical knowledge is a basis for clinical skills training, as a part of a scenario development. All partners agree that a main point of writing scenarios, that has a significant contribution for this first phase, is defining clear learning objectives adequate for target groups, so the students can identify the range of soft-skills and specific competencies they may achieve while briefing, scenario performing and debriefing. It is suggested to ask for a peer review from our colleagues when setting the learning objectives, to guarantee its adequacy. 3.2 - Target audience Regarding the target audience in healthcare education, all partners have different life experiences and age ranges. The educational background of our students is not homogeneous. Furthermore, the students have different experience within the field of health care and social care. Some students have worked several years in health and social care areas while other students have no experience at all. It becomes very important to adapt the complexity of the scenario to the level of training of the students, being in the same time, ready to accept different approaches to it. Their involvement in simulation can lead to different results. This mixture of competences and background of the students require careful consideration of the teacher/trainer, when selecting/writing learning objectives, as the learning objectives should apply to a wide variety in student competence and skills.
3.3 - Learning objectives The learning objectives in the context of simulation are linked to the curriculum stated learning objectives. Global learning objectives are institutionally defined with each curricular unit having its specific learning outcomes. In the context of simulation-based learning, objectives will differ, but always aligned with the curricular unit objectives and essentially in coherence with the subject, specific learning situation and competencies to be acquired or developed. However, teacher-created learning objectives always support the stated learning objectives of the curriculum but the teacher may also create specific learning objectives, targeting specific clinical situations, which are always clear, measurable and adequate to the learning needs and competences of the students. The learning objectives of simulation are specific and measurable, taking into account the needs and competences of the learners. Furthermore, it is recommended not to include too many learning objectives in a scenario so as not to overload the students. The learning objectives serve explicitly as a framework for the debriefing so students can assess their own performance, evaluating together with the teacher/facilitator, whether they reached the learning objectives or not. Depending on the legal framework, in some countries, the learning objectives are very deeply described in the curriculum by the institutions responsible (Ministry of Education, The Government, etc.) and can be used as learning objectives in simulations. | ||
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3.4 - Short case description and involved participant information The short case description is part of the briefing and is handed out to students prior to the scenario. According to the learning objectives in the scenario, a clinical situation will be created, then shortly described, in order to get the student introduced to the situation and the persons involved in the scenario. This includes a brief summary of the scenario and a short description of the setting, the situation and the role of the participants. They will get enough information before the scenario developing, while briefing, specific for the expected role. An oral interaction can allow the students to identify and clarify doubts or questions. It is important to give written instructions, especially if the learners need to organize the space or clinical material prior to the scenario. In some cases, after selecting the learning objectives, the teachers/facilitators of different subjects (psychology, technical training) can think of a situation or medical case whose realiation ensures that the students will work towards these objectives. When designing the practical case, in addition to thinking about what the situation will be, it is necessary to think about all the people involved in this case, that is, the patient or patients, relatives, friends, witnesses/observers, and emergency technicians who participate, giving a short description of the practical case. In other cases, the scenarios come from theory, according to the learning objectives, and the event and event-plot are designed together (the students and the teacher/facilitator) and the actors of the scenario can volunteer and get the roles distributed, after a short description of the situation. When more learners participate in the scenario in different roles, there must be a short description of each of the roles because the roles must be well defined. A scenario may require a specific patient behavior, e.g. the patient is expected to react in a certain way to a clinical procedure. In that case, a specific template for the patient is often required, informing the participant playing the patient of the expected behavior. Accordingly, this specific behavior is not described in the student template and will be instructed separately, following that specific template. These can be short descriptions of situations that come from nursing and basic health care theory lessons that the student can apply during the simulation. The healthcare institutions can also provide ideas with scenarios that the student has to deal with on a daily basis and in which the student can practice. Even if certain skills are expected from students, e.g. communication or certain nursing skills, the student must be well prepared so that he/she can strengthen their skills during the simulation. For example, a person who has a trachea obstruction and can't breathe (OVACE) and their 10-year-old son calls an emergency number for help .Tthe emergency health technicians (2) arrive at the home that does not have an elevator. 3.5 - Scenario script including all characters Scenario script includes all needed information, so the learners can assess the patient situation, plan and perform the intervention and, if expected by learning outcomes, assess the result of the actions performed by the student. Depending on the professional profile, the information should be more specific including patients’ personal data, family and social data, diagnosis, manifestations present, clinical specific data; the characterization of the environment (nursing, material/equipment organization/ location). In other cases, the students only will receive a basic medical information (without diagnosis, clinical specific data, etc.) and more specific environmental information (location description: dangers, unexpected situations, etc.) This description will be different from the one handed to the student playing the patient, so that the latter one knows how to react according to the scenario, without trying to make any suggestion or to help the student playing the health worker. For example, a person who has choked on food and can't breathe due to obstruction, their very nervous 10-year-old calls an emergency number for help. When the emergency health technicians (2) arrive at the house, the father is on the floor unconscious and his son is very nervous. Each participant has a description of their role and how they have to behave. | ||
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3.6 - Technical / medical equipment needed to perform the task(s) According to the scenario complexity and its learning objectives, the materials necessary for running the scenario can be clearly specified or you can ask students to pick up the right materials, from the ones previously given, provided that this is mentioned in the tasks to be performed. The teacher has to make sure that the materials needed are at hand for the students, in order not to create stressful situations. It is important to create a safe learning environment in the scenario. With this in mind, we can’t forget that professional uniforms and security equipment are a basic part of the materials. Also, correct recording equipment and the recording place are elements to take into account. For example, an emergency warning for choking can lead to an OVACE situation and, in this case, if the person is unconscious it could lead to a cardio respiratory arrest, for which the Health Emergency Technicians must anticipate what technical/medical equipment they need. 3.7 - Scenario timeline Our experience is in line with literature recommendations about the length of the scenario that should be relatively short, covering the minimum time to ensure learning objectives may be achieved and activities can be performed. In fact, the more complex the scenario is, the more difficult for the students to reflect upon and learn from it. So, although we have to keep in mind that complexity, learning objectives and technical skills should indicate the duration of the scenario, the experience of the teachers in the technical aspects and in the knowledge of the profile of their students have to facilitate the temporalisation of the scenario, not including too many learning objectives to keep the scenario timeline manageable. 3.8 - Soft skills and technical skills to observe (according to learning objectives) It is highly recommended, when writing scenarios, to create a checklist, corresponding to the learning objectives, for the soft skills and technical skills. The checklist serves as a process guide for the teacher/trainer and observers to evaluate if learning objectives and desired soft skills and clinical skills are performed during the scenario. The design of the checklist might be as simple as a “tick the box” of each of the described learning objectives or skills. This makes it easier for the observer to maintain an overview of the entire scenario. The checklist is excluded from the scenario script and from the student template, not to give away solutions or actions to the students performing the scenario. The most important point is how many learning objectives are successful and how many of them need improvement. The checklist serves as a guide for the basic care teachers and nursing technical skills to map out the student's progress. With this checklist, the teacher can see which scenarios at that moment fit the student's learning process. During the simulation, the teacher can use the checklist to follow the progression of skills executed. For example, the teacher and the student have an overview of what the student must master during the simulation and what he/she still has to work on. According to the selected learning objectives and based on the practical case, the teaching staff will select the skills to develop. In this case, it is advisable to detail these skills to the maximum and to make a checking list with YES/NO. Soft skills are transversal to healthcare competencies development while technical skills and competencies have to be increased from the first to last learning moments and observation is one of the best ways to verify its progression. A detailed checklist is an effective strategy to verify the execution/mobilisation by checking done/undone, observed/not observed, given a very useful instrument to use upon debriefing, as the one suggested on the table below. Table 2 - Example of a checklist
When the writing of the scenario is finished and learning targets are determined, designing of a learning model finishes. So, all things considered, we are now prepared to record the scenario, and to help with that, we leave you with some considerations . | |||||||||||||||||
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3.9 - Recording of the scenario Recording videos make the learners able to identify similar results as if it was a real process. Learners and teachers/facilitators/trainers can evaluate all the learning objectives by these results. This recording process should be a simple action to observe and evaluate the experimental learning activities. To realise the targets in healthcare education, learners should use technical-medical equipment, clothes and security equipment in a well prepared medical environment. Recordings should be short to be evaluated. It should take 5 to 10 minutes. Ipads and smartphones or basic skilled cameras can be useful and offer a cheap solution. Recordings must also be technically well done and interesting to be most effective and to ensure the audience experiences the best learning material. It is important to pay attention t some technical issues:
Now that we end this guide, the real benefit of simulation based learning is more clear to the authors, as we’ve experienced how simulation creates for the students a learning environment where mistakes are permitted and can be identified, without the pressure of the real life situations and how exercising the attitudinal, cognitive and practical abilities might allow the development of self-confidence, like Gordon & Buckley (2009) or Kaddoura (2010) have already demonstrated. We can say that this results from an experience, a route all partners have been traking along these two years of working together, learning with and from each other. We hope this will help others to journey along a similar path that allows for great success to be achieved by all. | ||
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| References Gaba, D. M. (2004). The future vision of simulation in health care. Quality and Safety in Health Care. 13:1, 2-10. Gordon, C. J. & Buckley, T. (2009). The effect of high-fidelity simulation training on medical surgical graduate nurses’ perceived ability to respond to patient clinical emergencies. Journal of Continuing Education in Nursing, 40(11), 491-498. Retrived from http://www.healio.com/nursing/journals/JCEN/{3D635087-13AB-4173-9D37-36DF465069EC}/The-Effect-of-High-Fidelity-Simulation-Training-on-Medical-Surgical-Graduate-Nurses-Perceived-Ability-to-Respond-to-Patient-Clinical-Emergencies. Helleshoej, H., Johansen, H.-H., Hansen, T. M. & Selberg, H. (2015). Simulation. I sundhedsuddannelserne [Simulation in Healthcare Education], Copenhagen: Munksgaard. Huffman, J.L., McNeil, G., Bismilla, Z. & Lai, A. (2016). Essentials of Scenario Building for Simulation- Based Education. In Grant, VJ & Cheng, A (Eds). Comprehensive Healthcare Simulation: Pediatrics, [ISBN: 978-3-319-24185-2], retrieved from http://www.springer.com/978-3-319-24185-2. Lopreiato, J.O. (Ed.), Downing, D., Gammon, W., Lioce, L., Sittner, B., Slot, V., Spain, A.E. (Associate Eds.), and the Terminology & Concepts Working Group. (2016). Healthcare Simulation Dictionary, retrieved from http://www.ssih.org/dictionary. INACSL Standards Committee (2016). INACSL standards of best practice: Simulation SM Simulation glossary. Clinical Simulation in Nursing, 12(S): S39-S47, doi.org/10.1016/j.ecns.2016.09.012. Kaddoura, M. A. (2010). New graduate nurses’ perceptions of the effects of clinical simulation on their critical thinking, learning, and confidence. Journal of Continuing Education in Nursing, 41(11), 506-516. Retrieved from http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=ad3b9a40-dad6-4962-8b41-0046e772e9eb@sessionmgr114&vid=8&hid=111 McGaghie, W.C., Issenberg, S.B., Petrusa, E.R., Scalese, R.J. (2010). A critical review of simulation-based medical education research: 2003– 2009. Med Educ, 44:50–63. Rowe, S. F. & Sikes, S. (2006). Lessons learned: taking it to the next level. Paper presented at PMI® Global Congress 2006—North America, Seattle, WA. Newtown Square, PA: Project Management Institute. Terrett, L., Cardinal, P., Landriault, A., Cheng, A., Clarke, M. (2012). Simulation scenario development worksheet (Simulation Educator Training: course material). Ottawa: Royal College of Physicians and Surgeons of Canada.
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Appendix 1 - Scenario templatesScenario template form for teachers Title/Name
Estimated duration: ___________________________ Items to evaluate grouped into: Technical (ex. measuring vital signs): General (ex. communication skills): ____ Unexpected actions Scenario template form for students Title/Name
2. Learning objectives
3. Short situation description (storyboard)
4. Patient information
5. Scenario outline (description of the entire scenario, not only the patient’s situation, but all factors involved, like: fire, persons presents, interruption, visitors coming in, hazards etc.)
6. Equipment needed to perform the task (to be filled in by student, if needed)
7. Scenario timeline - Estimated duration: ___________________________ Scenario template form for the patient/other figurants Title/Name of the scenario 1. Theoretical background (Knowledge the student should refresh/prepare before simulation)
2. Learning objectives
3. Patient information
4. Scenario outline (description of the entire scenario, not only the patient’s situation, but all factors involved, like: fire, persons presents, interruption, visitors coming in, hazards etc.) - describe what the patient/figurant has to do
Appendix 2 - Common scenario
Scenario template form for teachers Caring for the person with type 2 Diabetes 1. Target audience: defined by each partner 2. Theoretical background (Knowledge the student should refresh/prepare before simulation) Basic knowledge of diabetes, measuring the vital signs, measuring glucose, professional hygiene, professional protective equipment 3. Learning objectives
4. Short situation description (storyboard) During a routine visit, you find Johnny lying on the floor at his home; he is conscious but dizzy. You doubt the reasons for the fall 5. Number of participants 2 (one playing the nurse and one playing the patient) 6. Patient information
7. 7. Scenario outline (description of the entire scenario, not only the patient’s situation, but all factors involved, like: fire, persons presents, interruption, visitors coming in, hazards etc.) It is morning. The patient is in his living room near the sofa. He does not have any visible wounds. He is pale. His speech is unclear, and he is unable to remember and say if he took his medication. You have all the equipment you need available, including a mobile phone. 8. Equipment needed to perform the task
9. Scenario timeline - Estimated duration: 5 minutes Items to evaluate grouped into: Technical (ex. measuring vital signs):
The student is provided with information about the value of the glucose level (normal value).
General (ex. communication skills):
Unexpected actions
Appendix 3 - Lessons learned (specified by each partner)
2. Target audience
3. Learning objectives
4. Short case description and involved participant information
5. Scenario script including all characters
6. Technical / medical equipment needed to perform the task(s)
7. Scenario timeline
8. Soft skills and technical skills to observe (according to learning objectives)
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