Developing Simulated Learning Experiences

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What do students do when not in simulation
by Jenn Gable - Monday, November 28, 2016, 11:35 AM


I'm curious about how other schools manage the student time during an on campus clinical day.  I have a 2 room simulation lab and currently have students scheduled for simulations that run during their clinical day, usually 4-6 hours in length.  With one high fidelity simulator, I find I have groups of 3-4 nursing students in the high fidelity simulation at a time.  I struggle at times with what to do with the other students, who are not in the high fidelity simulation.  We will set up stations for practicing certain skills but that works for only so long.  I am a one woman sim coordinator with 1-2 clinical faculty (often adjunct or uncomfortable in the sim role faculty) at the simulations.  I'm looking for what others have their students do to stay productive during the slotted clinical time.  We are a 1:1 for simulation to clinical time. 

Thanks for anything you have to offer,

Jenn Gable MSN, RN, CCRN-K

Grand Rapids Community College

Picture of Danett Cantey
Re: What do students do when not in simulation
by Danett Cantey - Monday, November 28, 2016, 1:46 PM
If it's OK for Remaining students to observe....or if you have 2 sim scenarios to run, remaining students could observe and fill out an "Active observer" form and utilize them and their comments/notes during the debrief. We have a form that ask the observer if they noticed hand hygiene being done on entrance and exit, if the students introduced themselves, did the learner identify the pt with 2 identifiers, how was the communication within the group, to the pt/family member, and to the health care provider.

Remaining students could review a premade Chart (H&P, labs, progress notes, orders, etc. ). But this works better if you have 2 scenarios to run (opposite groups can look up needed info for their sim scenario prior to starting their sim).

Also, remaining students could work on a care plan or concept map of some sort depending on what semester/level the learners are.

Danett Cantey, MSN, RN, CNE
Clinical Nurse Educator, Center for Nursing Discovery
Duke University School of Nursing 
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Re: What do students do when not in simulation
by Kelly McMunn - Wednesday, March 8, 2017, 1:18 PM

My clinical group (10 students) complete a pre-sim activity in 1 room while I am setting up the scenario in the simulation lab. I then assign half of the group to complete concept maps for topics relevant to their course work at the time while the other half completes a scenario (about 3 hours). Then the half who has not simulated completes the same scenario while the other half now prepares a 1-page teaching handout for topics relevant to their course work. After both groups have completed the scenario portion, we meet as a whole and discuss the 2 sets of projects. I make copies of all of the concept maps and handouts that were created and give them to each student when we are done.

Kelly McMunn MSN Ed, RN, CMSRN


We re-orient to the lab then pre-brief the entire clinical group.

Depending on the level of student (foundations) no team leader -a team leader is  identified and gives report to  team one ; the remainder of the students observe via a live feed into a separate  room.

While observing, they are given the task of taking down observations on a white board divided into a plus and a delta column .

After 20 min or so group one gives report to group 2, and they rotate like this until all the teams have rotated through the Sce. So there are always observers looking at what is going well, what are potential missed opportunities or things that if could be done over they would change , while keeping in mind team interactions and how the team is communicating with the patient, safety finder s, what was done that should not have been done and was was not done that should have been done.

After each team gives report they are also documenting in an educational ehr which is reviewed at the end of debriefing. 

M. Morris

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Re: What do students do when not in simulation
by Jenn Gable - Thursday, March 9, 2017, 9:13 AM


How many students do you have in the group (as a whole)?  And you are debriefing as a large group? 


Jenn Gable


The group is the clinical group and maxes out at 8 students. The debrief is all the students in the one clinical group. This semester my smallest group was 5, my largest 9.

Our OB sims are larger as we combine groups and the largest was 23. Three clinical groups .

All divided into small teams with the sim beginning with a mom having labor pains, then post partum hemmorage. The format of orientation, prebrief, observations of the teams with multiple handoffs (we use I-SBAR-R) and then debriefing as a group.



We bring each clinical group from the clinical

site- 2 groups at a time (for me it's every Thursday and Friday) I run one group in the morning and one in the afternoon.

While one group is in sim the other is typically at a bedside in the skills lab with an unfolding case study.



Our students come to the simulation lab for 2 hours every other week for the entire 4 semester program.  The are involved in the sim or observing to give feedback.  After half the group does the sim they switch and the observers do their sim.  Then there is a joint debrief.  There is no time that the students are in the lab that they are not directly involved with the simulation.  Simulations are designed to reinforce concepts from what they are studying in class and clinical in the concept based curriculum in the given week.  We do not see simulation time as a skills lab (although skills are included as they pertain to the actual simulation).  The students have other time in the lab for skills during the program. Students in the group are not necessarily in the same clinical group as simulation time is not scheduled during clinical time.  Students observing have a guided reflection sheet to fill out and share at debrief. Students also come with a written prep sheet that includes general information that would be helpful for the sim but not actually "give it away".

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Re: What do students do when not in simulation
by john master - Saturday, April 29, 2017, 7:30 AM

How can you manage these two groups?How many students yoou manage at a time?


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Re: What do students do when not in simulation
by Jenn Gable - Thursday, March 9, 2017, 9:32 AM

Thanks for the responses all-

I think sometimes my struggle is keeping all learners engaged- and I feel that falls on me (playing the martyr here).  I also find that my faculty tend to want all the clinical groups to come for the simulation day on one clinical day, so I have 20-40 students (depending on level and how many days clinical is- TW & ThFri).  I feel it's very challenging to keep all students engaged as we get larger amounts through the lab.  I really need to continue to push the idea that simulation is not a "wasted" clinical day.. even though my faculty have embraced the value of simulation overall, they still fall back on that mindset. 

I play around with adding additional simulations into the day but that requires faculty to brief, run and debrief and I'm already shorthanded... enter another discussion thread about the harm we do to our students when they participate in a simulation that is poorly run and facilitated....

We have been using the Creighton (CCEI) for evaluating students and have been giving it to the observers to use but I find they aren't really using it and are actually more engaged when they are in the simulation room with their classmates as opposed to the observation room or the classroom where I can stream the sim in.  I also have started using what I call the "pause feature" in my simulations. At any point in a simulation the actively involved (2 bedside nurses) can call a timeout or pause and for 1 minute the scenario stops and during that minute anyone who is a student can participate and help move the nurses forward.  So here the observers have to be engaged in order to help.  It's really awesome to hear them think out loud and determine as a group their priority and how to keep progressing.  When the observers are in the room, they can move around a little to see the monitor, check the documentation, see drugs, etc.  As I've had observers in the sim room, the students have recognized they are getting more comfortable with the "being watched" feeling. 

I have used the concept map/care plan idea as well but this is a challenge if they have not completed the simulation and only know what they were briefed on. 

I'm always looking for new strategies and ideas for optimizing the learning, so thank you.  Now, if I could clone myself and further convince my leadership to hire more of me. (c: (We are close to this)

Jenn Gable

Picture of Kelly McMunn
Re: What do students do when not in simulation
by Kelly McMunn - Tuesday, March 14, 2017, 11:14 AM

The program I am currently working for has decided to use simulation as an "off-site" so I get 1 group of 5 students for 4 hours plus they had to do about 2 hours of pre-sim activity work. We are using a 2:1 ratio in this set up. I then simulate 2 different clinical groups per day across several clinical areas (Med-Surg, Critical Care, and OB). It takes 2 weeks for 1 clinical group to complete the same scenario.

At my past employer, I had all 10 students for a 6 hour clinical day. Here, I asked for a copy of the didactic syllabus and assigned concept maps and teaching projects relevant to the conditions that were being covered in theory, not necessarily the sim scenario itself. The pre-sim case study was the only sim scenario related project, and all of the students completed it before they rotated through the lab.

In both schedules, I use the pause option, but I actually call it the time-out/time-in process with my students. They use the "code word" time-out and everyone works together on the issue that resulted in the time-out to progress back to a time-in so that the scenario can progress and the students learn in the moment rather than through hindsight. Debriefing then focuses on the reactions and understanding phases.

I hope this clarified a few things!



We begin with an "open your mind concept mapping activity" for 30 minutes, relating and interrelating concepts to the simulation theme. We scaffold out the big picture identifying concerns about the exemplar (ie. diabetes) and then the simulation report is given. Students take the objective and subjective data and identify the concept problems, develop goal outcomes and go into the simulation with a "caring concept bundle" which provides a structure of focus for the group. We have 5 student, sometimes six per simulation which run no longer than 20 min. The debriefing is about 40 minutes beginning with outcome discussions and the bundle plan, the strengths and weakness of the team, meeting the predetermined objectives and each student discusses if they could do it all over again what would change and what would the team do differently. Then we do the simulation again adding those components, leaving the students feeling good about the experience and all report learning took place. We are able to complete all the activity within a 3 hour window.  Any student/s that had difficulty with the psychomotor skills goes into our low fidelity lab and reviews (ie. mixing two insulins) practices with an instructor for a refresher.  I am the simulation instructor in our center for an associate degree program that has a concept curriculum.



Large groups

If we have large groups we are using the View & Do method of simulation. We divide the large group into small groups. We have one of the small groups participates as "Doers" and the rest of the group "Viewers" actively watch the scenario live. We then bring them back together and debrief as a whole. We facilitate the viewers doing the debriefing and we add any items they may have missed. Using this we find we are able to engage the participants in more simulated learning experiences. 

Medium groups

We use a modified View & Do method. We divide the group into groups of 7 or 8. The ones who are not in simulation are completing modules they have assigned from the program. The groups that are participating in the simulation are further divided into viewers and doers. In this modified version the viewers are also the code response team. They actively view the simulation live until the doers call a code. The viewers & doers will debrief together. In the second scenario the viewers & doers switch places.

Small groups

One or 2 participants are brought into simulation and the rest of the group who are not in simulation are completing modules they have assigned from the program.

 Marrice King MSN, RN-BC, CNOR


You have to make groups of students and schedule the time of groups that will be easy for you. Groups are the best solution of your problem. 


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Re: What do students do when not in simulation
by Diana Breed - Thursday, October 5, 2017, 9:37 AM

I understand your frustration with lack of faculty.  It is hard to keep everyone engaged when you aren't in the room.  You might want to try what we call --- lengthened, interactive simulations. We have a larger lab room with vita sims and one high fidelity patient.  This process has worked for 5-8 hours with 10-12 students.  

1.  Report:  We give report to the entire group, as if going off shift.  They take report on blank sheets of paper, then transfer to a "report" or "brain" sheet of their choice

    a.  Situational Awareness Moment (all students participate in the discussion):  What was important to write down?  What priorities do you know based on report?  What is now on your to do list? Does your report sheet work, what is it missing? (if more than one patient - Who do you need to see first?)

    b.  Documentation:  Students are then allowed to sign into their electronic health care record (we use DocuCare by Lippencott) and determine important information - they have limited time (we clock them) so they have to focus on priorities.

2.  Patient Care (step 1):  Each student is assigned a number.  We draw from a hat and two students go to the bedside and care for the patient - the rest are watching from the tables and are documenting what is happening (this makes for a rich discussion later as they fill in the many vital signs and assessments to go along with the lab results we release)

    a.  Situational Awareness Moment (first two student sit with the group and we start discussion)  What is happening with the patient?  What assessment findings did we get?  Which ones do we need to react to?

    b.  ISBARR -  the students from the bedside role-play their report to the LIP, orders are given.  

    c.  Situational Awareness Moment (all students participate):  critiquing report, correcting any issues.  Then the group prioritizing the orders and with the more advanced students we discuss what we can "delegate" to other members of the healthcare team.  

3.  Patient Care (step 2):  Next set of students provide care -- taking over where the last left, implementing the orders, reassessing.  

    a.  Situational Awareness Moment - and the care just continues.....

Let me know if you have any questions.  The students stay engaged the whole time, there is no misconceptions in the "viewing" room, because they have them answered each time we stop and evaluate our next steps.   We have had good luck with this - even though it takes time and a larger room, we only need one or two people to run it.  Diana