Simulation Participants Research Articles

The Use of Simulated Participant and Virtual Reality Simulation to Enhance Nursing Students’ Communication Skills in “End of Life Care” - A Single-Arm Repeated Measures Study

BackgroundIncreasing demand for palliative care necessitates effective training for nursing students in end-of-life (EOL) and advanced care planning (ACP). Conventional teaching methods often fall short. MethodsA single-arm pre-post design involved 219 nursing students in VR and SP simulations. Quantitative measures and qualitative feedback were obtained. ResultsStatistical analysis revealed significant improvement post-intervention (p < 0.001). Qualitative feedback highlighted realism, interactivity, and skill development. Challenges included emotional intensity and scenario repetition. ConclusionsCombining virtual reality (VR) and simulated participant (SP) simulation significantly enhances nursing students' confidence and communication for end-of-life (EOL) conversations, offering a realistic educational experience. Further research is recommended in understanding this teaching method.

Demystifying simulators for educators in healthcare

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.

Simulated Participants' Experiences and Challenges With Online and Face-to-Face Interactions During COVID-19: A Case Study in UAEU.

Direct patient contact is essential when training health professionals for future patient-centered interactions. Simulated participants (SPs) play a critical role during training; however, limited information is available about their personal perspectives. This study explored SPs at the College of Medicine and Health Sciences experiences, adaptations, and preferences regarding online and face-to-face encounters. After ethical approval, a qualitative research study using structured in-depth interviews was conducted online with 16 SPs, applying critical incident narratives and storytelling. Interview data were transcribed and encoded using thematic framework analysis, after which member checking was conducted to increase credibility. All SPs acknowledged the benefits of online delivery models during the pandemic, including the convenience of working from home, continued clinical skills training, and personal protection from COVID infection. Participants preferred face-to-face delivery over online encounters, except for one SP, who saw no difference. Challenges included technical issues, communication problems, and lack of realism. Although these results cannot be generalized, all participants acknowledged the relevance of online portrayals during the pandemic. Most preferred face-to-face delivery models for improving role-playing and enhancing personal communication to achieve better patient outcomes, while one SP had no preference. The use of concurrent online and face-to-face methods may more effectively engage SPs in simulation-based education. Before restructuring programs, further research is needed, including a deeper exploration of students' and educators' perspectives.

Training to Transition: Using Simulation-Based Training to Improve Resident Physician Confidence in Hospital Discharges.

Hospital discharge is a highly critical and complex process that is prone to medical errors, poor communication, and ineffective synchronization of transitional teams. Improving safety during postacute care transitions has become a national focus. Simulation-based training is an underutilized method of instruction for medical resident transitions of care education. As an integral part of a transitions curriculum, 36 PGY 1 residents from internal medicine and transitional year residency programs underwent a discharge simulation utilizing a trained simulated participant (SP) and a lay caregiver. The objective of the training was to implement a simulation-based education intervention to improve transition practices and discharge communication in graduate medical education. A faculty observer used a case-specific discharge rubric to standardize feedback to the resident and observed the resident navigate the electronic medical record (EMR) for discharge orders. Pretest and posttest surveys assessing resident attitudes and confidence regarding specific areas of the discharge process were distributed to all participating residents for completion. Thirty-six internal medicine and transitional year residents (100%) completed an observed discharge simulation with an SP and a separate encounter with the EMR discharge navigator. All 36 residents (100%) completed the pretest survey, and 23 (63%) completed the postsurvey evaluation. Postsurvey results showed residents agreed (92%, p < .05) that the simulation increased their confidence in safely discharging a patient. Simulation encounters are an effective adjunct to postacute care transition education.

Older adults as simulated participants: a scoping review

Simulated participants (SPs) can support development of competencies associated with person-centred care of older adults. There is limited information and understanding about working with older adult SPs and those who support them to create authentic, safe and effective simulations. This review aimed to review simulation literature focused on the care of older adults to explore and summarize what is known about working with older adults as SPs in healthcare providers’ education. This scoping review followed Arksey and O’Malley’s five-stage approach, involving identification, selection, charting, collating, summarizing and reporting on results. Databases searched included MEDLINE, PsychINFO and EBSCO. To capture additional articles, we hand-searched the reference lists of articles selected for inclusion, MedEdPORTAL and Google Scholar. From the initial 816 citations identified, 12 articles were in scope. Articles were either research or educational guides. Findings related to general characteristics of articles, description of SPs, conceptualization of SP role/scenario, SP preparation and scenario implementation. Older adult SPs contribute to healthcare provider training in authentic, engaging, safe and effective ways. This scoping review provides a foundation on which to further develop older adult SP practices by highlighting their well-being and safety (both physical and psychological), promoting ways to increase diversity and inclusion, and emphasizing that the words we use matter. Improved reporting details of articles involving older adult SPs will facilitate the identification of effective practices.

Promoting moral imagination in nursing education: Imagining and performing.

Moral imagination is a central component of moral agency and person-centred care. Becoming moral agents who can sustain attention on patients and their families through their illness and suffering involves imagining the other, what moral possibilities are available, what choices to make, and how one wants to be. This relationship between moral agency, moral imagination, and personhood can be effaced by a focus on task-driven technical rationality within the multifaceted challenges of contemporary healthcare. Similarly, facilitating students' moral agency can also be obscured by the task-driven technical rationality of teaching. The development of moral agency requires deliberate attention across the trajectory of nursing education. To prepare nursing students for one practice challenge, workplace violence, we developed a multimodal education intervention which included a simulated learning experience (SLE). To enhance the realism and consistency of the educational experience, 11 nursing students were trained as simulated participants (SP). As part of a larger study to examine knowledge acquisition and practice confidence of learners who completed the SLE, we explored the experience of being the SP through interviews and a focus group with the SP students. The SP described how their multiple performances contributed to imagining the situation 'on both sides' prompting empathy, a reconsideration of their moral agency, and the potential to prevent violence in the workplace beyond technical rational techniques, such as verbal de-escalation scripts. The empirical findings from the SP prompted a philosophical exploration into moral imagination. We summarise the multimodal educational intervention and relevant findings, and then, using Johnson's conception of moral imagination and relevant nursing literature, we discuss the significance of the SP embodied experiences and their professional formation. We suggest that SLEs offer a unique avenue to create pedagogical spaces which promote moral imagination, thereby teaching for moral agency and person-centred care.

‘How can we help the students learn?’ A grounded theory study of simulated participants as educators

Purpose Despite the demonstrated value of simulated participant (SP) feedback, we are only beginning to understand how to optimize SPs’ feedback practices for communication skills and strengthen their role as educators. SPs portray roles and engage in feedback practices to support simulated-based learning for communication skills training. SPs come to their role with diverse experiences, knowledge, and training, such as (a) professional actors, (b) lay people, and (c) health professions educators. This study explored what factors influenced SPs’ role as educators, including their preparation, training, and approach to role portrayal and feedback practices and how these aspects were influenced by SPs’ backgrounds. Methods Using grounded theory methodology, we collected and analysed data iteratively from 16 semi-structured in-depth interviews. We identified key concepts, using constant comparison and by exploring how concepts were related , to develop a conceptual model of SPs as educators. Results The SP role as educator was shaped by several interrelated dualities which spanned both the SP and learner roles and contributed to the identity formation of both SP and learner: (a) building competence (SP competence as educator and learner competence as healthcare professional), (b) engaging in reflective practice (SPs prompting learner reflection and SPs reflecting on their own role), and (c) establishing a safe space (SP needing to feel safe in their role to create safety to support learner engagement). SPs’ backgrounds influenced how they learned to portray roles and how they engaged in feedback practices, both in-action, through in-role prompts and cues, and on-action, through post-scenario feedback discussions. Conclusion Our conceptual model about SPs as educators informs SP selection and training. Further, this model enables practical suggestions for SP educators and faculty who involve SPs in teaching. Enhanced feedback practices have the potential to improve learning from simulated encounters.

Simulated patient perceptions of telesimulation education

Perspectives of simulated participants (SPs) as stakeholders in simulation education are under-represented. With rapid increase in virtual education and anticipation of post-pandemic continuation it is important to establish best practices. This work aims to determine SP perceptions of telesimulation. In-depth semi-structured interviews determined SP opinions of participation in telesimulation. Thematic analysis utilizing an inductive and semantic iterative coding process was performed. SPs completed a survey of their demographics, experience and prior SP training, both virtual and in-person. Data sufficiency occurred after 16 interviews (10 females/6 males; 15 White/1 Black/African American). Median age was 56 years (range 37–72). Median number of in-person simulation experiences was 100 (range 6–300) and 27 telesimulations (range 3–100). Thematic analysis identified five themes: (1) students behave differently (distracted, less professional, less prepared for ‘real life’, less nervous), (2) my performance – some things are easier and some harder (increased cognitive load, coming out of role more, difficulties with non-verbal aspect, more standardized performance), (3) it’s harder to connect with learners (different cues, less of a personal connection), (4) safety for all in telesimulation (as psychologically safe as in-person, appreciate opportunity to continue to educate/work, personal safety), (5) future applications of telesimulation (telehealth training, better access to education for learners). SP perceptions of telesimulation education revealed appreciation of the educational modality and identified potential benefit in telehealth education. SPs were concerned about learner participation, professionalism and resultant preparation for clinical practice. Incorporating SP feedback into telesimulation education may be important to ensure high quality.

Content validity test of a safety checklist for simulated participants in simulation-based education in the United Kingdom: a methodological study

Simulation training is an ever-growing means of healthcare education and often involves simulated participants (SPs), commonly known as actors. Simulation-based education (SBE) can sometimes endanger SPs, and as such we have created a safety checklist for them to follow. This study describes how we developed the checklist through a quality improvement project, and then evaluated feedback responses to assess whether SPs felt our checklist was safe. The checklist was provided to SPs working in an acute trust simulation service when delivering multidisciplinary SBE over 4 months. Using multiple plan–do–study–act cycles, the checklist was refined by reflecting on SP feedback to ensure that the standards of the safe simulation were met. We collected 21 responses from September to December 2021 after SPs completed an SBE event. The responses showed that 100% of SPs felt safe during SBE when using our checklist. The average “confidence in safety” rating before using the checklist was 6.8/10, which increased significantly to 9.2/10 after using the checklist (P<0.0005). The checklist was refined throughout the 4 months and implemented in adult and pediatric SBE as a standard operating procedure. We recommend using our safety checklist as a standard operating procedure to improve the confidence and safety of SPs during safe and effective simulations.

Co-constructive Veterinary Simulation: A Novel Approach to Enhancing Clinical Communication and Reflection Skills.

Interpersonal communication is critical in training, licensing, and post-graduate maintenance of certification in veterinary medicine. Simulation has a vital role in advancing these skills, but even sophisticated simulation models have pedagogic limitations. Specifically, with learning goals and case scenarios designed by instructors, interaction with simulated participants (SPs) can become performative or circumscribed to evaluative assessments. This article describes co-constructive veterinary simulation (CCVS), an adaptation of a novel approach to participatory simulation that centers on learner-driven goals and individually tailored scenarios. CCVS involves a first phase of scriptwriting, in which a learner collaborates with a facilitator and a professional actor in developing a client-patient case scenario. In a second phase, fellow learners have a blinded interaction with the SP-in-role, unaware of the underlying clinical situation. In the final part, all learners come together for a debriefing session centered on reflective practice. The authors provide guidelines for learners to gain maximal benefit from their participation in CCVS sessions and describe thematic possibilities to incorporate into the model, with specific case examples drawn from routine veterinary practice. Finally, the authors outline challenges and future directions toward implementing CCVS in veterinary medical education toward the ultimate goal of professional growth and co-evolution as veterinary practitioners.

78 Simulation Integrating Deliberate Practice Method for Developing Assesors of Competence

In response to COVID-19, our organization expanded the critical care beds capacity; however, the number of critical care nurses was insufficient to meet expansion demands. Therefore, non-critical care nurses were deployed to COVID-19 critical care units. The deployed nurses lacked experience and training in critical care. To ensure patient safety, the nurses were assigned to assessors who evaluated their fitness to practice after receiving upskilling training through simulation-based education (SBE). However, due to the massive expansion and rapid deployment process, there was a shortage of competency assessors, highlighting an urgent need to use SBE to develop more assessors. We developed additional competency assessors through simulation embedding deliberate practice and rigorous assessment. Deliberate practice in simulation is described as progressive learning, which includes repetitive performance and rigorous assessment The aim of the study was to explore the effectiveness of simulation embedding deliberate practice in developing nurse competency assessors.Eleven assessor candidates were asked to perform competency assessments under simulated conditions. During the simulation, simulated participant (SP) roles were assigned as a bedside nurse and patient relative; the patient was a high-fidelity patient simulator. The assessor candidates were asked to perform a competency assessment of the bedside nurse who should perform the required critical care skills on the patient in the presence of the patient’s relative. The candidates used a valid observation rubric to complete the assessment. Using deliberate practice strategies, after each competency assessment, a debriefing session was conducted in which the SPs provided constructive feedback on the assessor’s performance. The assessor repeated the competency assessment under the same simulation conditions and attended debriefing sessions until they mastered the competency assessment process. Post simulation evaluation collected data to evaluate the candidates’ perception of the training.Eleven nurses completed the simulation developmental programme and were assessed as competent to become assessors. The questionnaire findings revealed that all nurses perceived themselves as competent assessors; however, 90% reported the need for frequent exposure to the competency assessment process over time, in the clinical setting, to enhance their competence and confidence levels.The hybrid simulation modality of SP and patient simulator embedding deliberate practice method was deemed to be an effective fast track method to develop competency assessors. However, practice of competency assessment in real clinical settings is essential to confirm competence.

‘It’s like a shot in the arm’: evaluating the experiences of older simulated participants in structured virtual meetings during COVID-19

Introduction Simulation is an effective educational strategy to train those caring for older adults (persons over 60 years old). Working with simulated participants (SPs), well people trained to portray others, is an appropriate modality when learning objectives relate to behavioural skills. The COVID-19 pandemic has disrupted every aspect of society. At our simulation programme, we implemented a weekly, virtual, 1-hour meeting modelled on a framework that incorporates effective practices in simulation and working with older adults. In this paper, we explored older volunteer SPs’ perceptions of the shift from in-person to virtual meetings and its impact on their well-being and SP skill development. Methods This was a qualitative exploratory study of older adult SPs’ experiences within the virtual SP meetings. Thirteen volunteer older SPs consented to participate in audio recorded focus groups where they were asked to describe their experiences with the virtual SP meetings. A collaborative, inductive coding approach was adopted, followed by thematic analysis, aligned with the methods described by Braun and Clarke. Ethics approval was obtained. Results Four primary themes were identified: fostering meaningful and cohesive group connections; gaining personal benefits; enhancing SP skills and competence; and appreciating structure. Discussion A structured, regularly occurring virtual meeting is beneficial to the building and maintenance of SP skills for older adults and their well-being. This approach could be applied to other groups of SPs with the proviso that facilitators are skilled, and a framework is in place featuring the basic tenets of effective simulation.

"This Is Me!" Perceptions of Older Adult Simulated Participants in an Aging and Injury Simulation Experience.

Older adults played the role of frail and prefrail geriatric trauma patients in a frailty-focused communication workshop for nurses. Although subjects played a role (acting) as simulated participants (SPs) for simulation, workshop content and role-play also applied to them personally. We aimed to explore the effect that learning frailty-focused content, scripts, and portrayal of prefrail and frail older adults has on older adult SPs. Qualitative focus group. Participants included older adults older than 70 years (N = 6). Focus group questions pertained to (1) the SP experience, (2) thoughts and emotions throughout the SP experience, and (3) applicability of workshop content and SP experience to personal life. The focus group lasted 90 min, was digitally recorded, and transcribed verbatim. Authors independently coded transcripts to identify categories and supporting quotations. Categories and subcategories were condensed and modified through iterative discussions. Descriptive content analysis was utilized for data analysis. Six categories and 2 subcategories emerged, including (1) inevitability of aging: not playing a role (sub: inevitability of death), (2) shifting perceptions: how aging impacts thought and actions, (3) time as a factor: getting information sooner, (4) changing behavior/safety: mental recalibration, (5) attitude as a determining factor (sub: loss of independence), and (6) sharing information with others. The study supports the use of frailty-focused communication with older adults to prompt contemplation of aging and frailty and eventual decline/death. Providing information earlier in the aging trajectory enables time for behavior change that can prevent and delay frailty and mitigate untoward outcomes (falls, hospitalizations).

Reliability in Healthcare Simulation Setting: A Definitional Review.

The construct of reliability in health professions education serves as a measure of the congruence of interpretations across assessment tools. When used as an assessment strategy, healthcare simulation serves to elicit specific participant behaviors sought by medical educators. In healthcare simulation, reliability often refers to the ability to consistently reproduce a simulation and that reproducing a simulation setting can consistently expose participants to the same conditions, thus achieving simulation reliability. However, some articles have expressed that simulations are vulnerable to error stemming from design conceptualization to implementation, and the impact of social factors when participants interact and engage with others during participation. The purpose of this definitional review is to examine how reliability has been conceptualized and defined in healthcare simulation, and how the attributes of simulations may present challenges for the traditional concept of reliability in health professions education.Data collection and analysis was approached through a constructivist perspective and grounded theory strategies. Articles between 2009-2019 were filtered applying keywords related to simulation development and design. Data winnowing was structured around a framework viewing simulation as a social practice where participants interact with simulation setting attributes.Healthcare simulation setting reliability is not directly defined but described as errors introduced by the interactions between simulation design attributes and tasks performed by simulated participants. Based on the ontology of simulation’s design attributes believed to introduce setting errors, lexical terms related to reliability suggest how simulated participants are trained to refine or maintain their performance tasks that aim to mitigate errors.To achieve reliability in health professions education (HPE) and healthcare simulation, both domains seek to assess the consistency of a construct being measured. In HPE, reliability refers to the consistency of quality measures across a range of psychometric tests used to assess a participant’s medical aptitude. In healthcare simulation setting, reliability refers to the consistency of a simulated participant (SP) performing a task that is tailored to mitigate errors introduced by simulation design attributes. Consequently, inconsistencies in SP performance subject participants to setting errors exposing them to unequal conditions that influence competency achievement.What is already known on this subject: Performance competency assessment using healthcare simulation is increasingly common. The types of design attributes incorporated into a simulation setting. The use of incorporating simulated participants into a simulation setting. Simulated participants require training prior to simulation setting implementation.What this paper adds: Identifies attributes of a simulation setting that are most commonly thought to interfere with setting reliability. Identifies the relationships among setting attributes and simulated participant performances that influence setting reliability. Identifies terms tied to the achievement of simulation setting reliability. Examines simulated participant training processes aimed to mitigate errors introduced by simulation design attributes.

Simulated participant methodology in paediatric surgical training: Exploring contemporary practices

Surgical training is long and complex. At the core of clinical practice is communication. Voice is central to relationships of care. Communication and other person-centred competencies are well articulated in surgical training programs. Simulated participant (SP) methodology has seen significant development over its contemporary history. Most commonly in paediatrics SPs portray the roles of parents. However, children and adolescents as SPs are increasingly employed to support the development and assessment of the complex concept of voice. There are specific considerations in all phases of SP-based work, and these are heightened for children and adolescents. This article explores contemporary SP practices in health professional education with a focus on paediatric surgery training.

Values and value in simulated participant methodology: A global perspective on contemporary practices

This article has been written for the 40th year of the publication of Medical Teacher. While we celebrate the contribution of simulated participants (SPs) to health professions education through values and value-based learning, we also offer critical reflection on elements of our practice, commencing with language. We argue for the use of the term simulated rather than standardized and acknowledge the dominant role of the SP as patient and the origins of the methodology. These shifts in terms and their implications in practice reflect changes in the conceptualization of SP-based methodology. Recently published standards for those who work with SPs (SP practitioners) are noted as an important milestone in our community’s development. We consider contemporary practices addressing the complex notions of values and value in SP-based learning. We simultaneously refer to the work of SPs and SP practitioners. Phases of educational design including identifying learning objectives, scenario design, implementation, feedback and debriefing are used to illustrate methodological shifts. Within each of these phases, there are relational issues that have to date often gone unchecked and are under reported in literature. Finally, using the metaphor of a murmuration, we celebrate contemporary practices of the global SP practitioner community.

Two-Year Experience Implementing a Curriculum to Improve Residents’ Patient-Centered Communication Skills

Surgery milestones from The Accreditation Council for Graduate Medical Education have encouraged a focus on training and assessment of residents' nontechnical skills, including communication. We describe our 2-year experience implementing a simulation-based curriculum, results of annual communication performance assessments, and resident evaluations. Eight quarterly modules were conducted on various communication topics. Former patient volunteers served as simulation participants (SP) who completed annual assessments using the Communication Assessment Tool (CAT). During these 2 modules, communication skills were assessed in the following standardized scenarios: (1) delivering bad news to a caregiver of a patient with postoperative intracerebral hemorrhage and (2) primary care gallstone referral with contraindications for cholecystectomy. SP-CAT ratings were evaluated for correlations by individual and associations with trainee and SP characteristics. Surgical patient experience surveys are evaluated during the curriculum. Independent academic medical center surgical simulation center. Twenty-five surgery residents per year in 2015 to 2017. Residents have practiced skills in a variety of scenarios including bad news delivery, medical error disclosure, empathic communication, and end-of-life conversations. Residents report positive learning experiences from the curriculum (90% graded all modules A/A+). Confidence ratings rose following each module (p < 0.001) and in the second year (p < 0.001). Annual assessments yielded insights into skills level, and relationships to resident confidence levels and traits. Communication scores were not associated with resident gender or postgraduate year. Over the course of the curriculum implementation, surgical patients have reported that doctors provided explanations with improved clarity (p = 0.042). The simulation-based SP-CAT has shown initial evidence of usability, content validity, relationships to observed communication behaviors and residents' skills confidence. Evaluations of different scenarios may not be correlated for individuals over time. The communication curriculum paralleled improvements in patient experience concerning surgeons' clear explanations. An ongoing surgery resident communication curriculum has numerous educational, assessment, and institutional benefits.

Applying the Theory of Stanislavski to Simulation: Stepping into Role

This article examines how the approach of Russian theatre practitioner Constantin Stanislavski (1863-1938) can inform and guide simulated participants (SPs) such as simulated/standardized patients and confederates to step into role, or character, and authentically engage health care trainees. We will address concepts related to SP role portrayal, including role play and realism, and then present a model for creating characters based on aspects of Stanislavski's theory, including origins, an overview and selected features. Finally, applications to SP role portrayal in health care will be explored. A systematic and person-centred experiential training process for role portrayal that incorporates elements of Stanislavski's approach, such as proposed by Nestel, Fleishman, and Bearman (2015), can optimize the impact of SP engagement.