Abstract
For simulation to be effective and achieve long-term sustainability as an educational strategy, institutions must have adequate and ongoing availability of training resources, trained educators, and curricula. This chapter explores stakeholder considerations in adoption and implementation of simulation programs. The chapter then discusses the cost considerations of manikin-based and virtual simulations, revenue generation, and return on investment. Ultimately, the widespread use of simulation education at the pre-service and in-service training levels is driven by health professional schools, hospitals, accreditation bodies, and health professional associations. This chapter discusses the role of faculty development and outcomes-based research in the global dissemination of simulation education.
TopBackground
To better understand the aspects that healthcare stakeholders and decision-makers must consider, the following section reviews the key implementation elements or dimensions of simulation education.
Dimensions of Simulation Education
The key considerations for implementing simulation can be classified into 11 dimensions described by Gaba and in part by Miller (Gaba, 2007; Miller, 1990):
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The aims of the simulation activity. These may range from education to performance assessment and research.
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The participation unit. The participation unit in the simulation can be described as individual, team, or organization (for systems simulations).
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The experience level. Experience of participants ranges from undergraduate level learners to continuing education and training for in-service health professionals.
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The healthcare domain. This refers to the setting in which the simulation scenario occurs and can be described as in-hospital, clinic-based, intensive care, public health, etc.
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The profession of the learner. Learners may be of various disciplines including nurse, physician, manager, technician, etc. or multiple professions may participate in an interprofessional simulation.
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The knowledge, skill, attitudes, or behaviors addressed. The focus of the simulation may range from technical skills or decision-making skills (meta-cognition) to attitudes and behaviors (teamwork).
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The simulated patient. Patient characteristics drive the content and tempo of the scenario and may range from newborns to geriatric patients.
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The applicable technology. Scenarios may require minimal to no technology (verbal role playing or low-fidelity task trainer) or high technology (high-fidelity manikin, screen-based virtual simulation, virtual or augmented reality simulator).
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The simulation site. The location where the learner experiences the simulation can be described as home, classroom, simulation laboratory, or clinical environment (in situ).
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The participation level. The level of learner participation refers to the extent of direct participation which may range from minimal direct participation through remote viewing of the simulation event with no interaction, to significant direct participation through in person, hands-on participation.
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The feedback method. The approach to learner feedback may be of various types from automatic, individualized feedback from the simulator to real-time or delayed instructor feedback or video-based debriefing and feedback of individuals or groups (Gaba, 2007; Miller, 1990). See Figure 1.
Figure 1. Dimensions of healthcare simulation
Key Terms in this Chapter
Augmented Reality: Computer generated holographic images can be viewed by the learner in the physical environment using a mobile device or specially designed headset.
Low-Fidelity Manikin: This is typically a low cost, low technology manikin with minimal features.
Telesimulation: Telesimulation is a process by which telecommunication and simulation resources are utilized to provide education, training, and/or assessment to learners at an off-site location.
Teledebriefing: Teledebriefing describes a process in which learners who are participating in a simulation scenario undergo debriefing with a facilitator located at an off-site location.
Simulation Facilitator: A simulation instructor who guides the learners through the scenario with the goal of meeting learning objectives.
Telefacilitation: The conduct of a telesimulation by a remote facilitator.
Objective Structured Clinical Examination (OSCE): An approach to assessment that involves defined objectives and anticipated actions, often with an accompanying checklist for assessment.
Virtual Reality: Computer generated 3D images viewed by a learner in a virtual environment using a low-cost or high-end head mounted display.
Video-Assisted Debriefing: The practice of using video captured during simulation sessions for reflective discussions on learner and team performance.
High-Fidelity Manikin: This term refers to a technology-enabled manikin with features such as mechanical respiration and heart rate.
Simulation Debriefer: A simulation instructor who leads the learners through a reflective analysis of simulation events.
Simulation Technician/Specialist: An individual who supports the practice of simulation through setting up and managing simulation manikins and supplies.
Virtual Environment: 3D computer generated objects that can be viewed on a screen or in a head-mounted display.