Simulation-Based Training: Beyond the Bells and Whistles!

➣ By Eduardo Salas & Megan E. Gregory

The use of simulation-based training (SBT) is becoming more and more prolific in healthcare. Simulations can include anything from role-playing standardized patients (SPs) to high-fidelity, full-functioning advanced mannequins. Simulations have unique benefits as they accelerate expertise by allowing trainees to practice infrequent or dangerous procedures in a safe and controlled setting. But what makes simulation work? What features facilitate learning? What do we know from the science of learning? How do we go “beyond the bells and whistles”?

We know that simulation itself does not cause learning. Rather, it is the instructional features embedded into it that produce learning outcomes. In order to be effective, an SBT system needs to follow the science of learning. There are seven key components (see Figure 1) that maximize the effectiveness of an SBT system.

First, an effective simulation system involves defining the task requirements and the learning objectives of the training. Previous performance history (if available) and skills currently possessed by trainees are determined in order to shape the training. The next step involves deciding what tasks and competencies – the knowledge, skills, and attitudes (KSAs) needed to perform the task – the SBT system will address. This helps determine the learning objectives for training.

The scenarios are then designed using the competency information and learning objectives as guides. Effective scenarios contain “trigger” events that lead to an opportunity for trainees to perform the desired competencies and tasks. For example, in order to train an intern on the recognition of hypertension, an abnormal vital sign showing high blood pressure (the “trigger”) could be embedded into the scenario. Alternatively, the SP could complain of headache, dizziness, blurry vision and nausea. Effective scenarios are always realistic.

The next component is to determine how to measure the events. Without measurement, there is no learning. Measures and metrics are needed to evaluate both outcomes (e.g., successful completion of an intubation) and processes (e.g., choosing the correct procedure to perform on the patient), at the individual and team levels. Considerations are given to both task (e.g., applying sutures) and team (e.g., mutual support) outcomes and processes. Observational protocols are developed. In an effective simulation, measures are always developed with training objectives in mind.

The next step of an effective SBT system involves actually measuring the simulation, observing and diagnosing performance. The measures created earlier are put to use. The information collected in this step allows for determining the impact of the training. Additionally, this step serves to govern what feedback will be given to trainees. Lastly, diagnostic feedback is given, and given in a timely manner. In an effective SBT system, trainees are debriefed after each simulation.

Simulation can be beneficial in many areas of healthcare. One example of where its use should be considered is to supplement medical team training. For instance, an operating room team may undergo a simulated operation scenario in order to practice team skills and processes that are vital to performing a successful surgery, such as coordination, back-up behavior, and strategy formulation. While this one example is used to illustrate the use of SBT in healthcare, simulation can be adapted to almost any aspect of healthcare training and team training.

SBT creates learning only if the system is designed, planned, and implemented properly. By following the components mentioned previously, you will help ensure that the training is impactful, and that you have gone “beyond the bells and whistles.”

Eduardo Salas, Ph.D.
Megan E. Gregory, B.S.
Department of Psychology,
Institute for Simulation & Training
University of Central Florida
Orlando, Florida
esalas@ist.ucf.edu