It can be a daunting task to write a medical simulation cases. Regardless of prior experience in simulation, writing cases is a different skill set than programming or working a high fidelity simulator. It’s more similar to writing a play-- at times an impromptu play!
What is a Medical Simulation Case?
It usually entails a patient encounter with a healthcare provider (learner) where an event occurs, and the learner is expected to perform actions. After some time, or after certain actions are performed, the facilitator stops the simulation, and debriefing ensues.
Important Components of Simulation Case
1. Objectives: Medical and Teamwork
Decide on medical and teamwork objectives. Without a foundation of objectives, the entire simulation case is like a house of cards-- vulnerable to collapse. This will drive all the decisions in the simulation case.
2. Learners
Understand who your learners are and their learning needs. Novice and expert learners have different baseline knowledge and procedural skills. Nursing students and medical students may have different learning objectives even in the same simulation.
3. Location
Choose the simulated practice environment. Cases can happen literally anywhere: clinics, hospitals, elevators, rural locations, urban locations, mass casualty situations, resource poor situations, etc - limited only by your imagination and learning objectives.
4. Patient(s)
Specify your patient's age, gender, and ethnicity. Multiple patients can also be used such as a mass casualty event (to assess triage methods) or a difficult delivery requiring maternal and neonatal resuscitation.
5. Equipment
This is important to list, regardless if you have the benefit of working in a fully stocked simulation center, or if you have to piece everything together yourself. Important equipment to consider:
This is important to list, regardless if you have the benefit of working in a fully stocked simulation center, or if you have to piece everything together yourself. Important equipment to consider:
- Type of manikin or task trainer
- Monitor
- Defibrillator
- Intubation equipment
6. Moulage
Moulage means the art of applying mock injuries according to Wikipedia. Costume makeup, applying bandages, or splints are examples of moulage. Note that commercial-grade moulage can be expensive.
7. Confederates
A confederate is a person who is a part of the simulation as an “inside man”. This person may hold vital information that the learners need to extract. S/he can guide learners through difficult cases. They can also serve as distractors and add to the difficulty of the case.
8. Supporting Files / Media
Your case may require showing important ancillary data such as EKGs, bedside US images, or CT scans. You want to be prepared so that they can be incorporated and given in real time during the case.
9. Case Synopsis
Write a short, big picture paragraph on how you anticipate the case flow so that you don’t get lost in the maze of details. Share this with others who are helping to organize.
10. Case Timeline / Flow
This is a minute by minute playbook of the simulation case (see my next blog post). This playbook details the case's nuances and potential learner actions. For example, what if the learner does not intubate the critically ill patient, should you as a facilitator then make the patient crash? How you write the timeline will also be discussed in the next blog post.
11. Assessment Tools
Tools and checklists can standardize how learners are evaluated. For example, you can apply the ACLS algorithms as a checklist. However, you may decide that this is not an important part of your simulation case and therefore not needed.
This long list of important components illustrates the complexity of what goes on behind the scenes of a successful simulation case. Please feel free to share with me any of your additions, thoughts, ideas, criticisms!
Stay tuned to next week’s blog post on how to write the simulation case timeline and flow.
Cheers!
Great list Nikita. A must have for the medical educator. Looking forward to next week's post.
ReplyDeleteThanks Javier! These are all the little bits that are easy to forget in a sim case, but oh so important!
ReplyDeleteI can't stress enough the importance of detailed objectives, moulage and preplanning for the "what ifs?" Nothing frustrates learners more than when the physical exam findings they should be seeing aren't present. Get creative! When you can't, get pictures!
ReplyDeleteAnd you've got to decide ahead of time how to react to various situations. A patient in shock who they think is septic, yet you wrote the case as hemorrhagic? Are you going to redirect them, or go with it? This depends entirely upon your educational objectives - is this case about "differentiation and management of a patient in shock" or about "management of hemorrhagic shock?" Will they meet the objectives if they go down the wrong pathway?
Thanks for the comments Corey! I agree completely that everything has to go back to your educational objectives. It is also difficult when trying to predict human nature and to try to anticipate all the actions your learners will take. Some of the many challenges of creating effective simulation cases!
ReplyDelete