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How We Use Simulation at SMU

Simulation is used for both teaching and assessment across SMU's entire curriculum.

The cast of a simulation scenario at SMU.

When outside experts inquire about the use of simulation at Samuel Merritt University (SMU), their first question is usually this: Do you use simulation for teaching, assessment, or both? The answer is "Both, absolutely!" While all simulation centers teach, and some do testing, at SMU's Health Sciences Simulation Center (HSSC), we give students ample opportunity to practice and demonstrate their skills.

Simulation for Teaching at SMU ↑ 

The Circle of Learning identifies five modes of learning and illustrates an ongoing process for achieving competence.

SMU is committed to simulation-based education (SBE) because of its power to improve the quality of patient care and patient safety. Simple simulations solidify proficiency. Complex scenarios prepare students for the unexpected. Both serve to increase students' confidence when they enter the clinical setting. The vast majority of the SBE that faculty provide in the HSSC is formative in nature; that is, the focus for the student is on learning and practicing, discovering and reflecting.

Multi-Modal Approach ↑ 

In their teaching, SMU faculty are encouraged to alternate traditional lecture or discussion formats with immersive demonstrations and group or individual activities. The HSSC's Multi-Purpose Training Rooms were specifically designed and equipped for this approach. As we are a Laerdal Center of Educational Excellence and a Laerdal Certified Training Partner, we utilize their framework of the Circle of Learning when we work with faculty to integrate SBE into their teaching.

Clear Learning Objectives ↑ 

Just before a simulation scenarios, the team leader (holding paper) conducts a pre-briefing to make sure everyone is clear about their learning objectives.

Educators know that well designed educational activities are always built around a clear set of learning objectives. All simulation scenarios at SMU have their own set of primary and secondary learning objectives.

  • Broad-based primary objectives come either from the academic program's required student learning outcomes or from a set of standards set by the profession's accrediting body or professional organization/society.
  • Secondary objectives are more specific; they address either course-level learning objectives or the specific objectives established for a workshop, continuing education course or in-service session.

We encourage faculty who are designing simulation-based activities to establish a common thread of patient safety in all their learning activities. This involves a particular emphasis on communication. There is clear evidence that most errors made in patient care are caused by failures in communication. When designed appropriately, simulation scenarios can provide powerful lessons for healthcare providers in how to communicate effectively and appropriately with patients, family members and their own colleagues on the healthcare team.

Modular Objectives ↑ 

Every scenario has a set of modular level objectives: key points the supervising faculty must observe during a performance to confirm that the learning objectives are being met.

Tailored Learning ↑ 

From the control room an instructor observes the students actively learning as they move through the simulation. The faculty closely monitors each student's behavior and capabilities while evaluating performance.

From the control room, faculty members facilitate — and sometimes add surprises to — scenarios.

Although the scenarios are mostly pre-planned and pre-programmed, the faculty can make thoughtful changes while events are in progress, to challenge the students or to support them through a difficult situation. For example, the faculty might interject a new symptom or an error message on a monitor, or provide the active learners in the scenario with new information about the patient. Thus students learn to think fast on their feet, manage the unexpected, and work as a team to solve problems and take appropriate actions.

Debriefing ↑ 

The debriefing process lies at the core of all SBE. In fact, experts say this is the most important part of the simulation experience. At SMU, we strive to make every debriefing a powerful and positive experience for learners.

After the scenario but before the debriefing, the simulation team confers to discuss the major teaching points that will becovered during the reflective process.

Immediately after every scenario in the HSSC, students and instructors adjourn to a nearby conference room for an expertly facilitated performance review, which is usually video-assisted. An open discussion of errors, patient and provider safety concerns, and exemplary behavior reinforces and deepens the lessons. Performance gaps are identified and addressed.

"Teachable moments" captured on video during the performance become an opportunity for the students themselves to reflect on all the actions and behaviors, and critique them so that everyone "does better next time," whether that next time is in the simulation center or in a real healthcare situation.

Learners and and faculty gather in the conference room for a post-scenario debriefing.

Debriefing is definitely a learned skill and an art. The HSSC faculty is well versed in this skill, and our goal is to ensure that all instructors who facilitate debriefings are qualified to do so. To learn more about training for effective debriefing, please contact the HSSC Operations Manager.

Simulation for Assessment at SMU ↑ 

The use of simulation for assessment purposes is widely debated in the simulation community and across the healthcare disciplines. While many questions remain unanswered (e.g., what evidence exists to support the use of certain simulation-based techniques as a primary form of assessment?) there is no doubt that — given the paradigm shift toward outcomes-based healthcare education and a parallel focus on enhancing the competencies of even the most experienced healthcare providers — reliable and valid simulation-based assessment methods and tools are a top priority for researchers, educators and practitioners.

All SMU academic programs employ simulation-based methods (SBM) for various levels of assessment. Some programs use them at a high-stakes, competency level; for example, Standardized Patient Objective Structured Clinical Examinations (OSCEs) are used in SMU's Physician Assistant and Podiatric Medicine programs.

Other SMU programs utilize SBMs for progression through key components of the curriculum; for example, the Program of Nurse Anesthesia uses various simulation activities to establish a student's preparedness for the clinical curriculum. Still other programs, such as pre-licensure Nursing, are in the development stages for consistent use of SBM for competency assessment purposes.

Templates ↑ 

A simulation scenario template is essentially a lesson plan for a learning activity that uses some form of simulation-based method, whether with manikins or standardized patients. At SMU, we believe strongly in the use of scenario templates to create and implement simulation sessions. How to access templates.

Consistent use of templates gives all students the same experience and holds each individual accountable to equal criteria for evaluation. A properly completed template also helps HSSC faculty to:

  • program the manikin software appropriately;
  • identify whatever resources (sounds, actors, props) would make the scenario more realistic;
  • orient/prepare Standardized Patients;
  • Orient/prepare learners for the simulation experience.

At SMU we use a scenario template that has been specifically designed to leverage all our educational tools and methods to achieve and demonstrate true educational effectiveness. We also use scenario templates that have been developed for commercial distribution (e.g., by Laerdal and the National League for Nursing), and those developed and distributed by the Bay Area Simulation Collaborative.

How to access SMU templates ↑ 

Any member of the SMU faculty may access the HSSC template via the HSSC Blackboard site and receive guidance from HSSC faculty in the completion and use of the template. The HSSC's community clients must access the template directly from HSSC faculty. To learn more about our simulation scenario template, please contact our Operations Manager.