Scenario Design – 2/27/15

Photo Credit: Umpqua via Compfight cc

Photo Credit: Umpqua via Compfight cc

Comparative effectiveness of instructional design features in simulation-based education: Systematic review and meta-analysis. DAVID A. COOK. Medical Teacher. 2013; 35: e867–e898

Simulation in healthcare education: A best evidence practical guide. AMEE Guide No. 82 IVETTE MOTOLA. Medical Teacher. 2013; 35: e1511–e1530
This best evidence practical guide for simulation in healthcare education is highly recommended reading for educators. It is part 2 of the Guide, and is focused on “the educational principles that lead to effective learning.” Curriculum integration, feedback and debriefing, deliberate practice, mastery learning, capturing clinical variation, individualized learning, and finally approaches to team training are discussed. Each topic is defined and explored in relation to its effective use in simulation with practical implementation points and challenges that may be encountered


Developing High-Fidelity Health Care Simulation Scenarios: A Guide for Educators and Professionals Guillaume Alinier. Simulation & Gaming
2011. 42(1) 9–26

This is a conversational piece on important considerations in scenario design that concludes with a sample scenario design template. It’s a good article for prompting new simulation educators (or just disorganized people like myself (-:) to think through how we build scenarios to address specific objectives and challenge learners in specific ways. Figure 1 depicts general courses of action and prompts the educator to think about actions or conditions that result in a change in patient condition as the scenario unfolds. It’s a good synthesizing graphic.
The section on “Preparing Scenarios in an Organized Manner” is particularly helpful as a practical guide to planning a smooth running scenario.  The Salas article (see SMARTER 2 articles down) and the TEACH Sim article resonate better with me and reflect the human factors and observational assessment orientation, but this is easily digestible and says much of the same stuff in different ways.

The Template of Events for Applied and Critical Healthcare Simulation (TEACH Sim) A Tool for Systematic Simulation Scenario Design. Benishek & Salas et al. Sim Healthcare 10:21-30, 2015.

The authors review and compare five existing scenario design templates and then feature their own design TEACH Sim. This is a great evidence- based tool for designing simulation scenarios. In fact, we were so impressed that we have already started using it (with permission from Eduardo Salas, PhD). It has a logical flow that is easy to understand and with the addition of our own simulation operation flow chart for high fidelity scenarios includes all the components for effective scenario design. Instructions for their template are also included.

 A Measurement Tool for Simulation-Based Training in Emergency
Medicine: The Simulation Module for Assessment of Resident Targeted
Event Responses (SMARTER) Approach.  Rosen, MA et al, Sim Healthcare 3:170–179, 2008

An event based approached to training and measurement, assesment and feedback. Systematic fashion to do several things: “1. Develop and maintain links between simulation scenario events, performance measures, and ACGME core competencies, 2. generate diagnostic measurement that feeds the processes of providing corrective feedback to accelerate kill acquisition and provide learning outcomes data rooted in the ACGME core competencies, 3. to provide opportunities to perform that are structured to maximize learning and assessment opportunities”

8 step process.

Each scenario designed to sample a specific part of the core competencies’ content (can’t measure everything at once — but can do multiple sims or have multiple different observations not using sim that can triangulate on the components of the core competency that you are trying to grade.)

A practical guide – with well delineated examples at multiple areas of the process of scenario creation – that are focused on EM and maybe critical care cases – but could be abstracted to other disciplines in formation/generation of scenarios.

Personal thoughts: Why didn’t I read this 7 years ago.. Check out for some nice examples from the Academic Life in Emergency Medicine crew of simulation cases linked to ACGME core competencies.