Developing Simulated Learning Experiences

Picture of Jeff Carmack
Re: Students Taking Simulatons Seriously
by Jeff Carmack - Tuesday, March 8, 2016, 9:57 PM

Nicole and Katherine,

I am going to try and hit the high points in a single post.  It always catches me off guard when these posts takes on new life years later.  However, despite the changes I have made and been a part of in this time, the relevance is still clear.  There is a Manikin Bill Rights out there somewhere.  One of the big South Carolina simulation centers had a good one.  But maybe you want something a bit more personal.  

Many of our local medical facilities have a patient bill of rights.  This is an excellent starting point, as you read through the document, how would the manikin feel?  I agree, it is a strange question.  As an example, Manikins have a right to understand treatment options and take part in decisions about their health care.  We are saying that you have to listen to the manikin to know these things, they should expect the caregiver to explain procedures, and if the manikin says no, then no is the answer.  This is just one way to frame the experience.  It seems less "because I said so".   

You could simply place a line in the rubric that addresses calling the manikin a "dummy" for example, or cover it with your professional behavior standards and the points associated with this evaluation point. If you want a more direct approach.  

One major thing has changed, and ironically enough this was the conversation in a meeting today.  In our program we are discussing reducing the points earned in simulation.  We are considering this for several reasons.  First, and foremost, our students have recognized the value of the simulation setting. We see it on evaluations, we hear it anecdotally, and we are all working hard to measure it empirically.  If the product (simulation in this case) has value in the eyes of the participants, they will do it for the experience.  Our labs have been doing simulation since 2008, and in 2010 we felt the students were not taking it seriously.  So we decided to make simulation worth the same points as a clinical day. It worked, we got buy in and engagement.  

At the same time we invested heavily in faculty.  Immersion training and faculty support is a major factor.  We started slowly, sending one person when we could, it took years to get funding, but last year we sent our second group of two.  When we talk about manikins in the briefing covering the limitations, we deliberately refer to them as simulators and call them by the brand name (SimMan Classic, SimMan essentials...).  As we end this section, we remind our participants that "There are no dummies in simulation. The simulators know a lot, just as you came prepared...". 

Debriefings have to move from plus/Delta.  This was our approved model from 2007- 2012.  It leads to lecturing, failing to understand or to uncover the gaps, and we can all cite the known failures.  The last thing that I think changed our students perception was the fact that we flipped the pre-briefing (I know this is not what we need to call them, but we do a pre-briefing where we cover meds, disease process, and teaching before me move to the labs where we hold a faculty lead briefing).  Our faculty often walk into a room of 30 participants, and just start by going down the line, "So I have just been told I have X, what do I need to know...".  We have points in our rubric that cover preparation, and this is where points will be deducted. Word spread like wildfire.  

I am sure you do most if not all of these exact same things, and as students become better consumers of simulation, I hope your efforts pay off and you see a more positive understanding of the value of simulation by your learners. It took time, but simulation is a pedagogy for engaged learning. 

Katherine, I will send you a rubric, let me know if it helps or if there are question I can help with.