The Society for Simulation in Healthcare (SSH), an organization dedicated to reducing errors in patient care by promoting the use of simulation, describes “simulation” in the following terms:

“Simulation is the imitation or representation of one act or system by another”

This act of “imitation” makes the process of simulation a great teaching aid, and simulation-based learning environments (SBLEs) in healthcare are one of its major beneficiaries. Two very effective components to SBLEs in a healthcare setting include Role-play/scenarios and Gamification. We’ll touch upon how instructional designers can leverage both these concepts to create powerful, impactful, interactive and engaging training content.

Essentials of healthcare SBLEs

To produce quality learning outcomes from simulation training, instructional designers must include a few basic ingredients into the content they produce. Essential components of effective simulation training include:

  • Participation: The content must enable healthcare learners to actively participate in the training, as opposed to being passive observers/listeners. SBLE’s are therefore different from multi-media presentations or audio and text-based learning environments
  • Interactivity: To accomplish your simulation training outcomes, your content should permit 2-way interaction – between learners and the content, and vice versa. The two components (learner and simulated solution) must communicate with each other
  • Environmental considerations: The act of “imitation” (discussed earlier) must include mimicking not only learner actions but also a virtual simulation of the real-world environment in which healthcare delivery is to take place
  • Uncertainty & variation: Instructional developers must ensure that the simulated content isn’t always predictable. If, for instance, learners aspire to master delivering healthcare to trauma victims, the training course should present various practical applications – and not just repeat a single application. For instance, you might unpredictably expose practitioners to treating a gunshot wound on one iteration of the training, a car accident on the next, and burn victims on yet another

Finally, instructional designers must create dynamic content for any SBLE. For instance, training scenarios and roles should adapt based on the learner’s interaction with the course/session. Similarly, when using game-based training content, you should present new problems each time a player enters the gaming environment, vary solutions to a medical challenge, and even allow for multiple correct conclusions (e.g. when diagnosing an ailment).

Role-playing, scenario solving and gamification have all these elements, and that’s what makes them great features of any SBLE in healthcare settings.

Role-play/scenarios

A recent exercise in roleplaying, where students took on the roles of various “actors” in the U.S. healthcare system, such as nurses, doctors, patients, and other support workers, underscores the value that this approach brings to healthcare training. As instructional designers creating content for targeted healthcare applications, you could also leverage the use of tools such as the S-ICD System training program developed for Boston Scientific by KDG.

As with the S-ICD approach, consider providing learners a down-loadable version of the training tools so they can rehearse the scenarios and replay the roles often, on their own time.

When creating role-playing scenarios for healthcare-related SBLE, instructional designers might do well to heed the advice laid out by University of Queensland, Australia doctors Beres Joyner and Louise Young. In their paper, “Teaching medical students using role play: twelve tips for successful role plays”, the veteran healthcare practitioners suggest making the ground rules for the scenarios clear to all participants.

It is also essential that you spread your roleplaying sessions over an acceptable amount of time, and include adequate opportunity for participating learners to reflect on the outcomes and offer feedback. Although Drs. Joyner and Young wrote the paper with medical students in mind, these guidelines hold equally true for more seasoned professionals attending skills upgrade training.

Gamification

Gamification of healthcare delivery situations is a great way to motivate participants in the learning process. As an instructional designer, the objective must be to create learning content that’s not only appropriate for the audience but which is engaging to use.

Multi-player gaming is a good way to stimulate interest in multidisciplined teams of healthcare professionals. The game might simulate performing a specific surgical procedure in a busy OR, with multiple players taking on unique roles on the surgical team.

It is important for the game to have defined milestone events, such as intubation within 9 seconds of patient arrival; discover entry wound in 2 minutes, stop bleeding in under 3 minutes, etc. And to keep learners motivated, you could assign badges or points when a milestone is accomplished.

Virtual-world healthcare simulations

Whether you are creating healthcare delivery content using roleplaying/scenarios or through gamification, the focus must be on making the experience real life-like – or as close to it as possible. The CESIM healthcare simulation center in Brest, France, for instance, uses simulated role-playing in a virtual health care setting to train cross-functional teams of healthcare professionals in complex care delivery and management.

Leveraging role playing and scenarios

While you may use professional actors to enact specific parts of the scenario, such as a trauma victim or someone suffering from serious burns, it’s essential to include as many healthcare delivery roles as possible – first responders, nurses, residents, physicians, anesthetists, and surgeons – to make the simulation real-world-like.

This type of simulation not only builds participant skills in basic healthcare procedures, such as putting on a plaster cast or suturing wounds but also helps them hone more advanced skills such as complex diagnosis and performing sensitive procedures like anesthesia. With the help of this type of simulation, instructional designers can create situations that practitioners are likely to face in the real-world, albeit enacted in a virtual world.

Abbott Medical Optics’s (AMOs) partnership with KDG, to help create a comprehensive software simulated training program for its Vision For Life technologies, is a good example of how instructional designers can create real-life SBLEs for healthcare professionals. It exposes sales professionals to several scenarios in a virtual setting, that they will likely encounter in the real world. The training also incorporates elements of interaction with physicians and helps the sales team address objections that healthcare providers might raise about the technology being recommended.

When scripted to closely relate to real-world experiences, you can also use virtual-world simulations to help train healthcare professionals in mastering various soft skills required for better patient outcomes. This includes how to better manage the patient-provider relationship, as well as improving provider-provider (e.g. nurse-physician) communications. For instance, the CESIM simulator helps a practitioner deliver “bad news” to a patient suffering from cancer – a real-world skill that is best learned in a simulated virtual world.

Virtual world games

Instructional designers, creating SBLEs for healthcare, can also leverage other “intelligent” devices, tools and props around which real-life-like games are designed in a virtual-world setting. For example, when teaching healthcare professionals to make effective use of medical data and other electronic medical record (EMR) systems, consider incorporating tools like the KDG-TriNetX platform into the training.

Participating professionals can use the KDG created training modules to learn how to navigate complex support systems, access data in real-time, and understand how to query medical records when diagnosing a patients’ condition or considering a course of treatment.

When developing gaming solutions for real-world healthcare training in SBLEs, instructional designers can also leverage other “intelligent” devices, tools and props around which you then create real-life-like gaming content designed in a virtual-world setting. As part of your simulated content, you could, for instance, build gaming scripts around devices such as Simulab’s TraumaMan – a surgical trauma training manikin.

Teams of healthcare providers, comprising of nurses, IV support staff, physicians and surgeons can be pitted against each other to perform a variety of critical surgical procedures. By leveraging realistic anatomical features of such devices, such as life-like skin and bleeding tissue, instructional designers can use virtual-world gaming to prepare novice healthcare providers for what’s to come in the real-world.