International Journal of Healthcare Simulation - Subject

Twelve steps to design meta-simulation game worlds to foster the next generation of healthcare practitioners: the example of ‘The Carthage Codex’

2025-12-12T00:00

This article introduces the concept of ‘meta-simulation game world design’ for healthcare education. This innovative approach integrates multiple evidence-informed instructional strategies into a curated series of integrated and progressively complex simulation experiences (a meta-simulation) set within an immersive game world – a simulated, fictional universe governed by its own rules. Drawing on our experience designing The Carthage Codex, a meta-simulation game world for long-term care specialization, we outline our method and detail the 12 design steps, from initial planning to evaluation. Each step is illustrated with practical examples to guide and inspire readers in developing their own meta-simulation game worlds. Additionally, we emphasize the importance of ethical, cost-effective and reusable design practices to maximize educational impact and sustainability. This article aims to advance the integration of simulation, game-based learning and storytelling by presenting a flexible 12-step approach for designing immersive and impactful healthcare learning experiences.

Development of professionalism through simulation: the need for a common language

2024-07-29T00:00

All healthcare educational curricula aim to foster the development of safe and professional clinicians. The professional values and behaviours of clinicians determine how team members interact and support each other. They are crucial for safe and effective patient care. Simulation provides a unique opportunity for learners to demonstrate and observe professional attitudes and behaviours, and to explore and reflect on their own underlying values. However, as healthcare educators, we often lack the basic vocabulary and consistency in terminology to support learning conversations. The Generic Professional Capabilities Framework (GPCF) published by the General Medical Council in the United Kingdom gives a detailed description of essential capabilities that underpin professional medical practice. Specific descriptors relating to professionalism are essential when addressing the challenges of communicating and developing complex professional behaviours. They are helpful when diagnosing and supporting learners or clinicians in difficulty and fundamental in the identification and promotion of positive professional behaviours. In this article, we highlight key opportunities in using such frameworks in simulation-based education to explore and champion a focus on professionalism. They also provide accessible terms and phrases that will aid healthcare educators and clinical supervisors to introduce consistent professionalism-specific terminology into their everyday practice, for simulation design and delivery, and for clinical debriefing and feedback.

Using Forum Theatre techniques in teaching and learning about professionalism and communication in healthcare

2024-07-17T00:00

Translating Healthcare Simulationist Code of Ethics into Urdu: bridging gaps in Pakistani healthcare simulation

2024-06-13T00:00

This paper detailed the translation process of the Healthcare Simulationist Code of Ethics from English to Urdu, Pakistan’s national language, addressing the need for healthcare simulation in the country’s native language. Pakistan, a lower–middle-income country, faces challenges accessing healthcare education in Urdu. The systematic translation by bilingual simulation and social sciences experts considered linguistic and cultural nuances by combining translation by committee and back-translation of selected text. Bilingual experts in linguistic research and healthcare practice verified this translation from healthcare, healthcare simulation and linguistics perspectives. This research contributes to the theoretical understanding of ethical values in healthcare simulation, positively influencing healthcare professionals and educators in Pakistan. The translation sought to enhance access to responsible healthcare training initiatives, specifically targeting remote regions and underserved rural communities. This includes health workers, who serve as the primary conduits for health-related initiatives in these areas.

Embracing discomfort and vulnerability: cultivating brave learning spaces within simulation-based nursing education

2024-05-20T00:00

Evolving evaluation methods and the changing pedagogical landscape of nursing education offer the opportunity to re-examine learning spaces in simulation. Psychological safety is an established standard within simulation-based experiences; however, limiting learning spaces exclusively within the construct of safety competes with shifting pedagogical practices in simulation within pre-licensure nursing programmes. Conflations of safety and comfort are pervasive in higher education. Shifting language from a place of safety towards one of courage and bravery holds the potential to better promote learning environments which foster agency and meaningful growth when discomfort is experienced. Brave learning spaces recognize discomfort and vulnerability as an essential component of learning and transformation, while also aligning with key principles of psychological safety to optimize learning experiences. Discourse exploring alternatives to safe learning spaces in simulation is notably absent in the current nursing simulation literature propelling the need for this discussion.

The ASPiH Standards – 2023: guiding simulation-based practice in health and care

2024-05-14T00:00

The ASPiH Standards 2023 provide a common framework within educational and healthcare sectors, bolstering quality assurance for simulation providers, regulators, professional bodies and commissioners. They endeavour to meet the current needs of simulation practitioners and learners, reflect the evolution of simulation practice, and account for emerging technologies. Therefore, they are applicable to any modality of simulation-based education and training as well as to translational and transformative simulation interventions, including the use of simulation for quality improvement processes, whether carried out at education centres, simulation facilities or at the point of care.

The standards encourage adherence to core values of safety, equity, diversity and inclusion, sustainability, and excellence. They provide guidance for all simulation practitioners, highlighting key principles for planning, facilitation and evaluation of simulation activities, as well as recommendations for optimum resource management.

Implementation of these standards will require consideration of how they apply to each individual context, and what outcome measures are most meaningful to demonstrate alignment.

Technology-enhanced training for central venous catheter insertion training: a reflective essay

2024-04-19T00:00

With the advancement of innovative technology, healthcare professionals stand to benefit from adjustments to procedural skills training/assessment introduced during the COVID-19 pandemic. In this essay, we reflect on the development of a virtual reality (VR)-based training programme to support medical and nursing staff in procedural skills for central venous catheter (CVC) insertion, related communication skills and situation awareness. The remote delivery was a direct response to the impact of the pandemic and is likely to remain as an educational strategy on our centre.

Shaping buildings to shape learning: building pedagogical theory into the design of a simulation centre

2022-10-27T00:00

Simulation centres across the world are increasingly being recognized as pivotal in health profession education. More than just physical space to locate learning, they should also be a space and place that enhances learning. The built and physical environment of a simulation centre has the potential to further enhance educational dynamics. Despite the importance of such resource-intensive settings for learning, how the built environment can help shape learning (i.e. built pedagogy) in simulation centres is a much-neglected entity. This essay explores how learning theories may be used to shape the design process of a health professions simulation centre. Drawing upon our experiences of being involved in the design of a simulation centre and the importance of social interactions on learning, we discuss how sociocultural learning theories may guide this process, and positively influence the physical design and build of a simulation centre.

Spoonful of sugar: a case for stress-reduction interventions in medical simulation

2022-10-27T00:00

In recent years simulation has gained popularity as an educational tool to shield learners from real-world consequence. However, the inherent risks levied upon those involved have largely remained unaddressed; psychological stress being one of the most potent. Research over the last two decades has shown us that an increase in simulation-related stress goes hand-in-hand with diminishing performance. It is, however, becoming more apparent that there is a solution to this problem, namely in the form of stress-reduction interventions. As educators the time has come to stop abandoning our learners at the edge of their limits, but instead support them in an environment free of the anxieties, stresses and worries that are all too real in the world around them.

Improving team effectiveness using a program evaluation logic model: case study of the largest provincial simulation program in Canada

2022-11-22T00:00

Historically simulation-based education (SBE) has primarily focused on program development and delivery as a means for improving the effectiveness of team behaviours; however, these programs rarely embed formal evaluations of the programs themselves. Logic models can provide simulation programs with a systematic framework by which organizations and their evaluators can begin to understand complex interprofessional teams and their programs to determine inputs, activities, outputs and outcomes. By leveraging their use, organizational leaders of simulation programs can contribute to both demonstrating value and impact to healthcare teams, in addition to establishing a growing culture of evaluation at any health system level. This case study describes a complex program evaluation for improving team effectiveness outputs and outcomes across more than one simulation program, discipline, speciality, department in the largest health authority in Canada and provides considerations for other simulation programs globally to advance the science of program evaluation within the SBE community.

‘They didn’t do anything wrong! What will I talk about?’

2023-04-08T00:00

Simulation educators are often unsure of how to conduct a debriefing when learner performance meets or exceeds the expected standard and no significant errors have occurred. Similar to patient safety practices in clinical settings, simulation educators frequently focus on debriefing errors. Indeed, much debriefing training focuses on developing skills needed to conduct the “difficult conversations” that involve giving feedback on errors that occurred. Many simulation educators have not been taught an approach to debriefing positive performance. This manuscript provides such an approach. The approach applies the principles of Cognitive Task Analysis, a technique used in human factors research, to debriefing positive performance. The steps of knowledge elicitation, knowledge representation, and data analysis and synthesis can guide debriefers as they help learners discuss their positive performance, with the goal that the same positive practices will be repeated in future clinical practice.

Entrustable Professional Activities for simulation faculty?! A novel approach to standardizing mentorship and faculty development for healthcare simulation programs

2023-03-02T00:00

Simulation-based education (SBE) literature emphasizes debriefing frameworks, with little discussion on developing SBE competencies. Introduced in 2005 by the Royal College of Physicians and Surgeons of Canada, Entrustable Professional Activities (EPAs) offer a robust curriculum development and assessment process for workplace-based assessments. There is paucity of literature on EPAs related to simulation and how simulation faculty move from novice to independent practice. The objective of this curricular innovation project was to develop standardized EPAs and milestones to assess the independence of simulation faculty by the end of mentorship. Using a modified Delphi technique, the team identified expert faculty to rate the level of importance for each EPA and milestone. Five EPAs were identified: Technology; Scenario Design; Simulation Facilitation; Prebriefing and Debriefing. EPAs provide a structured framework for tracking progress, targeting areas for formative feedback and offering opportunities for advancements and transformation of faculty development for simulation programs.

Maximizing opportunities during a simulation fellowship

2023-04-10T00:00

Simulation fellowships are 1- to 2-year posts during which intensive training and experience occur. Making the most of opportunities presented during this short time is essential. This paper describes methods for maximizing such opportunities based on the collective experience of previous simulation fellows and supervising faculty. These are organized within four categories: (1) expectations and feedback (clarify the fellowship objectives, have an organized approach, work effectively with your supervisor, ask for feedback), (2) simulation activities (learn how to design simulation activities, learn how to develop simulation activities, curate a collection of resources), (3) scholarship (get involved in research, present and publish projects, undertake a qualification, network and collaborate) and (4) professional development (develop your professional identity, maintain clinical skills, continue the simulation journey). These tips may aid the professional development of simulation fellows and assist mentors in providing support to fellows.

Decision-making for scarce critical care access: using simulation and human factors to proactively test critical care triage

2023-09-15T00:00

During the height of the COVID-19 pandemic, healthcare systems globally experienced immense strain and uncertainty. Preparedness was essential to manage the worst-case scenario of overwhelmed critical care capacity and potentially prevent having to choose which patients should receive life-saving critical care. The developed critical care triage (CCT) framework was evidence-informed and provided a framework to guide and execute systematic clinical decisions; however, the operationalization of the CCT framework presented several challenges. Hence, proactive testing of the CCT framework was essential. Simulation and human factors teams collaborated with provincial clinical experts in critical care to develop online facilitated scenarios and identify potential latent safety threats. Using simulation-based education and human factors in the novel methodology of testing a CCT framework revealed key insights and learnings, which were subsequently embedded into the iterative updates following the simulation. The outcomes from these simulations informed organizational learning on the highest risk and highest impact recommendations to be prioritized.

Epistemology and simulation-based healthcare education: the good, the bad and the ugly

2023-12-12T00:00

Over the years, simulation has grown in popularity as a means to construct safe, but realistic environments in which to train healthcare professionals. Whilst many well-established guidelines have been put in place to ensure optimal educational outcomes, the lens through which those developing said guidelines see the world is often left undiscussed. Is it then possible that our assumptions and beliefs can act as a filter through which our reality is observed?

The California Simulation Alliance and the Victorian Simulation Alliance: a Trans-Pacific partnership

2023-12-06T00:00

With the rapid changes in health professional education internationally, various types of simulation have emerged, evolved and infiltrated health professional education [1]. Effective state-wide, national and international collaboration is integral to the ongoing development and implementation of sustainable simulation-based health professional education. The development of simulation-based education (SBE) within health professional education has been actively supported by the establishment of several professional societies and ‘communities of practice’. This paper outlines the genesis of the ‘Trans-Pacific Alliance’, an international ‘community of practice’ developed through a partnership between the California Simulation Alliance, United States, and Victorian Simulation Alliance, Australia. The alliances provide a platform for faculty and programme development through resource creation, sharing and collaborative projects and research.

Call for an interprofessional, experiential, performance-based model for health professions education

2024-01-30T00:00

Medical errors are cited among the leading causes of death in the United States, resulting in devastating consequences for patients and their families, besides adding substantial costs to healthcare. Communication within and between teams is cited as a major contributing factor to patient deaths due to preventable medical errors. Although Universities and Academic Health Centers aim to graduate competent healthcare professionals who are effective healthcare team members, the importance and degree of emphasis given to interprofessional education (IPE) across health professions accreditation organizations is variable. To ensure a highly skilled, efficient and confident health professions workforce, an interprofessional, experiential, performance-based model for health professions education is proposed. This transformational model must be relevant for this high-risk, data-driven and increasingly technological medical era. Finally, it must revolve around patient safety and well-being as patients traverse through the levels of the healthcare system and upon the safety and well-being of professionals providing them care.

Learning in healthcare virtual communities of practice; let’s rethink how we connect and grow

2023-12-21T00:00

Being both a healthcare worker and a healthcare educator can sometimes be a lonely endeavour and opportunities to improve our craft may not be accessible. Medical education courses and conferences abound, often at high price points and in locations a long way from home. Healthcare virtual communities of practice (HvCoP) offer readily accessible information, connection and community, and opportunities for growth on our most ubiquitous accessory – our phone. How can we as a thoughtful, concerned, healthcare community improve accessibility and provide sustainability for our friends and colleagues to the latest literature, most recent practices, evidence-informed materials and provide a truly supportive and evolving environment where we all feel safe to share and connect? This essay started as a first-person reflection of one clinician’s journey (BS), including the highlights, and challenges in developing and sustaining HvCoPs and was then guided and edited by the second author (KW’s) reflections, who has co-facilitated several HvCoPs abroad. Within this essay, BS’ original, personal reflections are signalled in italics, whereas standard text indicates the joint reflections of both authors.

Demystifying simulators for educators in healthcare

2024-02-14T00:00

When entering the world of simulation development and scenario design for the first time, healthcare educators are often confronted with the perplexing diversity of simulation, which includes a vast array of educational experiences for learners. This essay seeks to demystify the growing number of technologies and simulators (commonly known as simulation modalities). Simulators can be classified as computer-based simulation, simulated participants (SP), simulated clinical immersion or procedural simulation, in addition to ‘mixed’ and ‘hybrid’ simulations. Each modality has intrinsic benefits and limitations, but ultimately their use must be guided by the desired learning outcomes of the learning experience, together with the appropriate realism required for the simulation. No matter the simulator being used, the ultimate experience of the learner is still arguably wholly dependent on good curriculum development, instructional design and scenario delivery.

The Canadian Alliance of Nurse Educators using Simulation: supporting excellence in simulation education and research

2024-02-01T00:00

The Canadian Alliance of Nurse Educators using Simulation (CAN-Sim) aims to connect nurse educators and allied health partners from across Canada and internationally to share knowledge, resources and expertise in areas of simulation research and education. This paper will describe the creation, evolution and core values of CAN-Sim. Our success is founded on a shared vision for improving simulation-based education. CAN-Sim values and promotes collaboration, mentorship, innovation and scholarship as it advances excellence in simulation education and research through networking. Sharing our experience and processes can encourage nurse educators and allied health partners within other geographical locations to develop their own collaborations or join us in impacting the future of simulation.

Personalizing simulation-based medical education: the case for novel learning management systems

2022-11-22T00:00

Simulation-based medical education (SBME) is often delivered as one-size-fits-all, with no clear guidelines for personalization to achieve optimal performance. This essay is intended to introduce a novel approach, facilitated by a home-grown learning management system (LMS), designed to streamline simulation program evaluation and curricular improvement by aligning learning objectives, scenarios, assessment metrics and data collection, as well as integrate standardized sets of multimodal data (self-report, observational and neurophysiological). Results from a pilot feasibility study are presented. Standardization is important to future LMS applications and could promote development of machine learning-based approaches to predict knowledge and skill acquisition, maintenance and decay, for personalizing SBME across healthcare professionals.

Simulation for social integration

2023-05-20T00:00

Social integration may be divided into three categories: absorption of newcomers, merging of two or more groups and increased group cohesion. This essay presents four case studies which layer pertinent conceptual frameworks to explore how four immersive simulation programmes might influence social integration: the refugee doctors’ programme, an interprofessional programme for trainee pharmacists and medical students, an internal medicine trainee bootcamp and an in situ simulation programme for primary care. It describes some of the features of immersive simulation that may be linked to improved social integration, such as attention to psychological safety, flattening of hierarchy, co-experience of positive affect, cultural compression, social learning and constructive alignment of intended learning outcomes. It is hoped that by presenting these theoretical concepts and making the links explicit, this essay may inspire further research targeting the potential for immersive simulation to both explore and enact social integration.

Developing a strategic plan for a healthcare simulation facility

2022-12-22T00:00

A strategic plan defines an organization’s strategy, or direction, and supports decisions on how to allocate resources in order to best pursue key goals. The need for a simulation facility to have a strategic plan is recognized by the Society for Simulation in Healthcare and the Association for Simulated Practice in Healthcare. A strategic plan is also relevant to the professional standards for accreditation outlined by the Society for Simulation in Europe. However, specific guidance on how to develop a strategic plan for a simulation facility is lacking. This report describes a five-stage process for developing a strategic plan for a simulation facility: (1) define the mission, vision and values; (2) strategic formulation; (3) operational planning; (4) assessing the results; and (5) reformulating the strategy. It is not suggested that this is the only method for developing a strategic plan. However, it is important that whatever approach used is systematic, rational, justifiable and draws upon input from all of the stakeholders in the simulation facility.

Novel do-it-yourself low-cost abdominal laparoscopy entry simulator for gynaecology trainees

2022-01-04T00:00

Introduction

The COVID-19 pandemic has affected gynaecology trainees in the United Kingdom by reducing operating theatre experience. Simulators are widely used for operative laparoscopy but not for practising laparoscopic-entry techniques. We devised a low-cost simulator to help trainees achieve the skill. Our aim was to pilot this low-cost simulator to perform Royal College of Obstetricians and Gynaecologists (RCOG) supervised learning events.

Methods

A single-centre pilot study involving six gynaecology trainees in a structured training session. Interactive PowerPoint teaching was followed by trainees’ demonstration of laparoscopic entry for a supervised learning event and personalized feedback. Participants completed pre- and post-course questionnaires.

Results

All the trainees found the training useful to the score of 10 (scale of 1–10) and recommended this to be included in Deanery teaching. Personalized feedback was described as the most useful. The simulator was rated as good as a real-life patient relative to the skill being taught.

Discussion

Gynaecology trainees are affected by lack of hands-on experience in the operating theatre for performing laparoscopic entry. A low-cost abdominal laparoscopy entry simulator can help deliver the RCOG curriculum, enabling trainees to achieve required competencies.