August 4, 2020By Lance Baily

Educational Constructs in Healthcare Simulation, A Guide For Technical Staff

Healthcare Simulation course design is a complex process and requires the input of a diverse team and a variety of resources to produce high-quality learning experiences. While it is the responsibility of the clinical simulation educator to design and develop simulation course content in a medical simulation program, the healthcare simulation technology specialist (HSTS) plays a crucial role in the planning and implementation of this curriculum and will need to work closely with the educator in preparing and executing the simulation activities. To help us better understand this unique educational process, we turn to the new book Comprehensive Healthcare Simulation: Operations, Technology, and Innovative Practice, a new leading resource for professionals starting or expanding their use of the emerging methodology to improve learning, training, and patient safety outcomes. Here we focus our excerpt on Chapter 12 entitled “The Healthcare Simulation Technology Specialist and Audio/Video Technology”, which was was written by SimGHOSTS Executive Director Kirrian Steer.

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The healthcare simulation technology specialist’s role during the course planning phase is to assist and advise the educator on technological issues. This allows the educator and HSTS to match the educational objectives to the capabilities of the simulation center equipment and staff. The term instructional design has been used to name a process, a profession, and a field of study. To reduce confusion, the process of instructional design is often referred to as instructional systems design, or abbreviated to ISD. There are many theories of ISD that are used to guide the process of education and/or training from planning through evaluation; however, none have been devel- oped specifically for healthcare simulation instructional design.


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The most commonly known model of ISD is ADDIE, which is an acronym for “Analysis, Design, Development, Implementation, and Evaluation.” The ADDIE model was used as part of the conceptual basis for medical education curriculum development with Kern’s six-step approach [4]. The US Navy developed a modification of ADDIE, known as PADDIE+M that is well suited to simulation-based education as it incorporates two extra steps that are invaluable additions to a simulation program: planning and maintenance.

Start with an Assessment

The starting point for any course design is to define the goal of the course by completing a needs assessment or similar process. It is important to identify not only the need for the course, but also how it integrates with the overall curriculum or organizational strategy. The need for a course may arise through situations such as curriculum or strategic plan redesign, a quality or safety issue, a performance issue, changes to accreditation, registration or licensure standards, changes to guidelines, policies or procedures, changes to equipment or environment, or changes to job roles.

The second step is to define the performance expectations of the learner(s) in order to satisfy the course goal. This should detail the knowledge, skills, behaviors, tools or equipment, and information resources (such as guides, handbooks, instructions, reports, regulations, forms, and publications) related to the course topic.


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The third step is to review the existing resources available and using this to recommend the delivery method (simulation modality and supporting course materials). Additionally, the existing resources assist with determining the instructional methodology to design, develop, and deliver a learning experience that will meet the course need. In the interest of efficiency, existing training resources, whether internal or from other organizations, should be used or revised wherever possible. This includes equipment, courses, scenarios, and E-learning content.

Begin to Analyze the Data, and Consider the Opportunities

The primary focus of the analysis phase is to comprehensively define the expected learner performance in order to complete the course goal(s). The analysis phase extends to the development of learning objectives and outcomes once the learner characteristics have been analyzed. The analysis phase is mostly performed by those in educator roles, but healthcare simulation technology specialists may be required to assist with compiling documents and resources to be analyzed. An in-depth analysis of the resources and documents collected during the planning phase is conducted, along with systems analysis, review of quality improvement pro- grams and patient safety goals, and the survey of stakeholders, learners, clinicians, and/or educators. The next step is to conduct an analysis of the learner characteristics. Learner characteristics include the learner discipline or job role, their level of study or employment, and the typical experience level(s) of the learners. Using this information, the educator is able to guide the development of learning objectives and desired outcomes.

Design the Learning Content to Specifically Address the Needs

The first step in the design phase is to organize the course objectives and out- comes into groups and sequences that provide the most efficient use of training resources. This is where the subject matter expert is able to work with the instructional designer(s) and educator(s) to identify the most effective combinations of objectives and outcomes. These can then be sequenced in increasing difficulty or complexity so that the learners are continually challenged as they progress through the course. On occasion, it is not appropriate to reveal the learning outcomes to the learner prior to participation in the simulation activity as it may reveal important detail about the scenario and compromise the quality of the learning. In this case, it is appropriate to provide learners with a broad learning objective that provides them with a general understanding of what is expected of them in the simulation without compromising their learning opportunity.

From the course design plan, a course outline can be developed. The parent organization or simulation program is likely to have a template to record the course outline. This outline should describe the modules or lessons to be completed by the learners and include the time allocated to each module or lesson. The course’s instructional methodology and delivery method that was drafted during the planning phase is now refined using a theoretical or conceptual framework appropriate to the learning objectives and intended learners. Examples of the most common frameworks used in simulation are adult learn- ing theory and experiential learning theory.

Kolb’s Experiential Learning Theory describes a cyclical learner process of having a learning experience, reflecting on the experience, forming conclusions or hypotheses, and then applying the new learning. The theory states that not only are all four steps required for learning, but the learners must also have an awareness of, and engagement in, all four steps in order for experiential learning to occur. Simulation is an example of Kolb’s experiential learning cycle in that learners complete or observe an experience and then participate in a debrief in which they undergo a process of reflection and learning which can then be applied in the clinical setting. The final step in the design phase is to document the method for content delivery required. The primary delivery method will be the simulation modality, with supplementary media in the form of preparatory materials such as readings, audio or video recordings, animations, and e-learning resources. As with all elements of course design, the selection of a delivery method should have a theoretical basis.

Most simulation learning experiences include a scenario. The simulation scenario is a framework that positions the learner(s) in a relevant context in which they can apply their skills, knowledge, and experience. The scenario macro-narrative is the overarching story or construction of events that provides context, establishes realism, and increases immersion for the learners.

Develop the Associated Learning Materials Needed for the Scenario

The goal of the development phase is to produce all of the resources required for the course. This phase primarily involves the HSTS, the educator, and the subject mat- ter expert. The educator is responsible for development of the assessment and evaluation resources, the subject matter expert is responsible for development of the learning resources, and the HSTS is responsible for organizing and developing resources to achieve realism.

The HSTS may also be required to assist with the development of audiovisual resources, such as demonstration videos, and upload of materials to the simulation program learning management system (LMS). One of the end products of the development phase is the simulation scenario. This is a framework that positions the learner in a relevant context and is the blue- print for others to follow in order to reproduce the complete learning experience. In simpler terms, it is a recipe for combining instructional design and theatrical production.

Most simulation programs have at least one template to use for documentation of the simulation scenario. A single best-practice simulation scenario template does not exist, as the template needs to be flexible enough to meet the individual requirements of each simulation center. The final step in the development phase is to validate the scenario by conducting a course pilot. All of the scenario documentation and materials should be provided to a third party to trial the scenario. The purpose of this is to establish that the scenario meets the intended purpose and provides a quality learning experience. The participants should be representative of the intended learners if possible, and all involved in the pilot should provide feedback regarding any confusing, insufficient, or omitted elements of the course. The feedback can then be used to improve the course design and materials before full course implementation.

Implement the Learning Material Into The Curriculum

Implementation of a simulation course should only occur after the development and revision of course materials following the course validation process. The role of the HSTS in the implementation phase may include scheduling of rooms, equipment and personnel, preparing the simulation environment, orienting learners to the simulation environment, assisting with simulation delivery, contributing to the debrief, and restoring the simulation environment. Implementation of simulation courses should include preparatory learning activities, a learner pre-brief, the simulation experience, and debrief. Preparatory activities may include reading, viewing multimedia content, practicing psycho- motor skills, or other learning activities. The pre-brief is used to address psychological and physical safety issues, describe the expectations of learners in the simulation, establish the simulation context, and explain the approach to learning in a simulation environment.

The simulation scenario is initiated and concluded by the facilitator. The facilitator will issue instructions to the simulation team that will guide the sequence of scenario events and ensure the quality of the learning experience. The HSTS will oversee the operation of the simulation manikin and other simulation equipment with the aim of delivering cues to learners that will assist them to interpret and respond to scenario events. A simulation debrief may occur during the scenario or immediately following the scenario. The simulation debrief is a discussion to explore and reflect on the events and experience of the simulation with the aim of identifying means to improve future performance. The debrief is widely accepted as the aspect of simulation providing the greatest contribution to learner development.

Evaluate the Learning Experience to Validate Outcomes, and Maintain

The goal of the evaluation phase is to assess the value and effectiveness of the course for the purposes of quality control, academic integrity, research, and cost-effectiveness. Evaluation takes place throughout the instructional design process as the course designers are considering how the effectiveness of the training can be improved, how the learning materials can be enhanced, how the course design corresponds to the learning need, and how to best demonstrate the value of the course. The course pilot or validation provides valuable information to aid in evaluation of the course design and materials.

The final phase of the PADDIE+M process is lifecycle maintenance of the course. For a simulation course, this involves regular review (surveillance) for clinical accuracy and to identify areas for improvement based on evaluation results, changes in technology, and facility capabilities. Surveillance situations that would indicate a need for course review are change in curriculum, change in operating procedures or policy, change in clinical guidelines, change in job duties, updated standards, or change of equipment, technology, or environment. In the absence of any of the above events, a course should be reviewed after 2–3 years as a quality improvement initiative.

Previously We Shared Chapter Excerpts on:

More Key Take Aways From Latest Simulation Operations Book Include:

  • Practical guide helps prepare professionals for the broad scope of simulation in healthcare
  • Defines the domains of medical simulation operations
  • Focuses on the development of the healthcare simulation technology specialist
  • Written and edited by leaders in the field of clinical simulation

Written and edited by leaders in the field, Comprehensive Healthcare Simulation: Operations, Technology, and Innovative Practice is optimized for a variety of learners, including healthcare educators, simulation directors, as well as those looking to pursue a career in simulation operations as healthcare simulation technology specialists. Grab your copy today through our affiliate commissioned links:

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