Simulation Learning

Simulation-based education must be purposefully designed to achieve specific objectives, using evidence-informed approaches and theoretical models. 

Choose your objectives based on a needs assessment to identify gaps in knowledge, practice issues, and/or system-based concerns. Simulations are generally created to meet needs related to one (or more) domain(s): 

• Cognitive (Knowledge): May include recollection of facts and application of concepts. 
• Psychomotor (Skill): Refers to the performance of skills, or ‘doing.’ Technical skills are commonly done with the use of task trainers, however there are many other applicable modalities. 
• Affective (Attitude): Learning in the affective domain may include objectives related to essential values, attitudes, and beliefs as they relate to professional practice. For example, communication with family members during a simulation.  

(Wilson & Wittman-Price, 2019) 

Simulation design is not a novice skill. Simulations should be designed in consultation with subject matter experts and simulationists knowledgeable in best practices in simulation pedagogy. Developing simulation design skills may include both formal and informal training. There are many open access ready-made scenarios available online that can be modified to meet your learning objectives. This section will provide a brief overview of simulation design but is not meant to replace training.

The Healthcare Simulation Standards of Best Practice™ on Simulation Design describe the following criteria necessary to successfully meet this standard: 

1. Design simulation-based experiences (SBE) in consultation with content experts and simulationists knowledgeable in best practices in simulation education, pedagogy, and practice. 
2. Perform a needs assessment to provide the foundational evidence of the need for a well-designed simulation-based experience. 
3. Construct measurable objectives that build upon the learner’s foundational knowledge.  
4. Build the simulation-based experience to align the modality with the objectives.  
5. Design a scenario, case, or activity to provide the context for the simulation-based experience.  
6. Use various types of fidelity to create the required perception of realism.  
7. Plan a learner-centred facilitative approach driven by the objectives, learners’ knowledge and level of experience, and the expected outcomes.  
8. Create a prebriefing plan that includes preparation materials and briefing to guide participant success in the simulation-based experience.  
9. Create a debriefing or feedback session and/or a guided reflection exercise to follow the simulation-based experience.  
10. Develop a plan for evaluation of the learner and of the simulation-based experience.  
11. Pilot test simulation-based experiences before full implementation.  

(Watt et al., 2021) 

©2021 INACSL. Used with permission.

Listen to the following podcast on designing simulation cases: 

Learning outcomes and objectives guide the development of simulation-based experiences. Bloom’s Taxonomy is a tool used to help create learning objectives, based on a continuum of learning from remembering (simple) to creating (more complex). Simulation is well positioned to assess learning at the ‘apply’ level and above.

Bloom's Taxonomy by Vanderbilt University Center for Teaching is licensed CC BY 2.0.

Learning objectives must be clear and specific. Learners should have a clear understanding of what they should accomplish by the end of the simulation. Using the SMART can help you to meet these goals. SMART objectives are:

• Specific 
• Measurable 
• Attainable (Achievable)  
• Relevant 
• Time-bound (has a realistic timeframe) 

Educators must consider the number of problem-solving/decision-making components to incorporate in a simulation scenario, with a recommended maximum of 3-4 SMART learning objectives. More information on creating learning objectives using these tools can be found in the following article:

Healthcare Simulation Standards of Best Practice™ describe the following criteria necessary to meet the Outcomes and Objectives standard:  

1. Establish learner outcomes influenced by accreditation, program, curriculum and/or patient care needs that are measurable and appropriately scaffolded to learner knowledge, skills, and attitudes. 
2. Create objectives for the simulation-based experience to meet defined outcome based on formative or summative evaluation.  
3. Identify appropriate simulation modality to meet the learning objectives/outcomes.  
4. Identify appropriate fidelity to meet the learning objectives/outcomes.  
5. Establish guidelines for facilitation of SBE to meet objectives.  

(Miller et al., 2021)

Using a simulation template is encouraged. There are many different types of templates and you should use one that best meets your specific needs. You may create your own or modify an existing one. Here are some examples:

Principles of equity, diversity, and inclusion (EDI) should be purposefully incorporated into the design phase of a simulation scenario, case or activity. The designer may include EDI aspects in the back story for realism if it is applicable to the scenario.

• Consider including the following principles when predesigning simulation scenarios and during review of existing scenarios for design updates:
  • gender identity
  • cultural practices
  • religious belief systems
  • family health decision dynamics

(Alrimawi et al., 2024)

• Use sensitive and appropriate language, including in the naming of cases and patients in the scenarios.
• When learning objectives are specific to EDI, subject matter experts and those with lived experiences should be consulted to ensure scenarios are realistic, accurate, and to minimize harm to learners. It is important to avoid stereotypes and tokenism.

The HSSOBP™ criteria for simulation design can help you to integrate EDI principles into each step of your simulation, in a meaningful way. (Nakajima et al., 2022).

As mentioned previously, simulation design is a complex skill requiring experience, education, and training. Consulting experts is recommended whenever possible. Consider these tips when designing a simulation:

• Have content experts and simulation experts peer review the design to ensure evidence-based practices are integrated. 
• Determine if the simulated activity is a formative, summative, or high-stakes assessment. For more information, see the Evaluation and Feedback page of this subject guide.  
• Consider the physical and psychological safety of everyone involved. If working with simulated patients (SP), training related to the specific scenario may include:
  • reviewing previous videos
  • detailed scripts
  • practicing the scenario in advance

For more information on best practices when working with SPs, read the article:

• When creating an interprofessional simulation, make every effort to include representation from the different professions in all components of the simulation, including simulation design.  
• Consider the availability of required resources, such as:
  • equipment
  • space
  • personnel (e.g., operator, tech support, facilitators)
• Decide on the appropriate level of fidelity (realism) needed to meet the learning objectives. 
• Use the most appropriate modality (type) to best meet the learning objectives (e.g., task trainer, SP, high fidelity manikin). A hybrid approach may be needed. 
• Consider how the scenario will flow. What cues will be used to transition participants throughout the phases of the simulation? For example, if the patient’s pain is not being addressed, the SP or a family member may repeatedly ask about pain medication.  
• Pilot (practice run) your scenario before you run it for the first time with learners.  

This self-directed learning module resource may support your learning in simulation design: