Summary

At the heart of any healthcare simulation experience are the scenarios that drive the learning activities. A well-designed scenario provides a realistic clinical context with a clear storyline and specific learning objectives. Crafting immersive, relevant scenarios aligned with intended outcomes is both an art and a science.

The Scenario Fundamentals

A healthcare simulation scenario is essentially a detailed patient case aimed at enabling targeted learning goals for participants. It combines a clinical situation or condition with a defined sequence of events over time. The scenario should present challenges that require participants to apply their knowledge, skills and behaviors to manage the simulated patient crisis or condition.

Establishing clear, measurable learning objectives is the critical first step. The objectives define the purpose of the scenario and drive all other design decisions. Objectives may focus on specific medical knowledge and procedures, teamwork skills like communication and leadership, or a blend of clinical and behavioral competencies.

Scenario Flow and Events

With learning goals established, the next step is mapping out the scenario flow – the sequential states the patient will progress through and the associated clinical data like vital signs. This timeline of events incorporates decision points where participant actions will trigger different branches. Techniques like tables, graphs or the SimCanvas approach can be used to visually depict the scenario progression.

The scenario flow should have an appropriate level of difficulty, complexity and realism for the target learners. It must be possible to complete within the allotted time. Overly obvious or obscure conditions should be avoided unless directly aligned with objectives. Scenarios requiring effective teamwork and closed-loop communication tend to be most effective.

The Learning Environment

Designing an authentic, immersive scenario environment is critical for establishing the “fiction contract” – the participants’ willing suspension of disbelief that the simulation is real. The scenario space, equipment, props, and personnel like confederates playing roles must be carefully considered. The degree of physical and emotional realism should match learning needs while avoiding psychological overload.

Flexibility and Backups

Even meticulously planned scenarios rarely unfold exactly as scripted. Participants may take unexpected actions or struggle with certain objectives. Scenarios should build in flexibility to adapt to changing circumstances during the simulation. “Lifeline” options like new information from confederates can help reorient participants. Having backup strategies is essential when core learning objectives are not being met.

An Iterative Process

Developing high-quality scenarios is an iterative process of design, implementation, evaluation and refinement. After initial drafts, scenarios benefit from pilot testing to identify gaps and areas for improvement. Based on findings from actual implementations, learning objectives, environmental details and event sequences can be modified for an optimal experience.

Scenario design is both a challenge and an opportunity in healthcare simulation. When done well, it provides a robust, standardized experience that safely immerses learners in realistic clinical situations. With thoughtful planning and flexibility, scenarios can consistently deliver valuable learning in line with defined objectives.

Some tips to design an effective scenario are:

• Start with clear, relevant learning objectives that are achievable, measurable, and free of internal contradictions.
• Choose an appropriate level of difficulty that challenges learners but doesn’t overwhelm them.
• Ensure the scenario can be realistically completed within the allotted time.
• Build in flexibility to adapt if participants take unexpected actions.
• Plan “lifesaver” options like new information from confederates to reorient participants.
• Test complex scenarios beforehand to identify any issues with setup or achieving learning goals.
• Consider setup and reset times when designing environmentally rich scenarios.
• Use an iterative cycle of design, implementation, evaluation and refinement.
• Adhere to the “fiction contract” by acknowledging simulation isn’t reality but treating it as such.

Here there are some pitfalls to avoid while designing a scenario:

• Rare or obscure clinical conditions – Unless training on that specific rare condition is the objective, these make for poor scenarios as they are not representative cases.
• Overly obvious scenarios with only one course of action – These turn into more of a skills trainer rather than facilitating effective team training and decision-making.
• Relying too heavily on subtle physical findings – Simulators may not replicate certain findings realistically, leading to frustration.
• Scenarios that are emotionally overwhelming – Excessive emotional stress can inhibit learning if not balanced with psychological safety.
• Letting the simulated patient die unnecessarily – This can feel like a “trick” unless dealing with death is an explicit objective.
• Internal contradictions in learning objectives – For example, being extremely thorough yet very fast creates an impossible scenario.

References

• Scenario canvas template