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Healthcare Simulation Standards of Best PracticeTM Simulation Design

      Abstract

      KEYWORDS

      As the science of simulation continues to evolve, so does the need for additions and revisions to the Healthcare Simulation Standards of Best Practice. Therefore, the Healthcare Simulation Standards of Best PracticeTM are living documents.

      Standard

      Simulation-based experiences are purposefully designed to meet identified objectives and optimize the achievement of expected outcomes.

      Background

      Standardized simulation design provides a framework for developing effective simulation-based experiences for participants. The method of simulation-based experiences incorporates best practices from adult learning
      • Clapper T.C.
      Beyond Knowles: What those conducting simulation need to know about adult learning theory.
      , education,
      • Kolb A.Y.
      • Kolb D.A.
      • Passarelli A.
      • Sharma G.
      On becoming an experiential educator.
      ,
      • Shinnick M.A.
      • Woo M.A.
      Learning style impact on knowledge gains in human patient simulation.
      instructional design,
      • Anderson J.M.
      • Aylor M.E.
      • Leonard D.T.
      Instructional design dogma: Creating planned learning experiences in simulation.
      ,
      • Robinson B.K.
      • Dearmon V.
      Evidence-based nursing education: Effective use of instructional design and simulated learning environments to enhance knowledge transfer in undergraduate nursing students.
      clinical standards of care,
      • Barsuk J.H.
      • Cohen E.R.
      • Feinglass J.
      • McGaghie W.C.
      • Wayne D.B.
      Use of simulation-based education to reduce catheter-related bloodstream infections.
      ,
      • Draycott T.
      • Sibanda T.
      • Owen L.
      • Akande V.
      • Winter C.
      • Reading S.
      • Whitelaw A.
      Does training in obstetric emergencies improve neonatal outcome?.
      and simulation pedagogy.
      • Foronda C.
      • Liu S.W.
      • Bauman E.B.
      Evaluation of simulation in undergraduate nurse education: An integrative review.
      • Schmutz J.
      • Eppich W.J.
      • Hoffmann F.
      • Heimberg E.
      • Manser T.
      Five steps to develop checklists for evaluating clinical performance: an integrative approach.
      • O'Brien J.E.
      • Hagler D.
      • Thompson M.S.
      Designing Simulation Scenarios to Support Performance Assessment Validity.
      • Zendejas B.
      • Brydges R.
      • Wang A.T.
      • Cook D.A.
      Patient outcomes in simulation- based medical education: a systematic review.
      , and simulation pedagogy
      • Alinier G.
      Developing high-fidelity health care simulation scenarios: A guide for educators and professionals.
      • Gore T.
      • Lioce L.
      Mastering Simulation: A handbook for success.
      • Issenberg S.B.
      • McGaghie W.C.
      • Petrusa E.R.
      • Gordon D.L.
      • Scalese R.J.
      Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review.
      • Jeffries P.R.
      • Rodgers B.
      • Adamson K.
      NLN Jeffries Simulation Theory: Brief narrative description.
      • Waxman K.T.
      The development of evidence-based clinical simulation scenarios: Guidelines for nurse educators.
      Purposeful simulation design promotes essential structure, process, and outcomes consistent with programmatic goals and institutional mission and strengthens their overall value in all settings. All simulation-based experiences require purposeful and systematic yet flexible and cyclical planning. To achieve expected outcomes, their design and development should consider criteria that facilitate their effectiveness. Following this standard supports development of relevant/ educationally sound simulation-based experiences.
      Criteria Necessary to Meet this Standard
      • 1
        Simulation-based experiences (SBE) should be designed in consultation with content experts and simulationists knowledgeable in best practices in simulation education, pedagogy, and practice.
      • 2
        Perform a needs assessment to provide the foundational evidence of the need for a well-designed simulation-based experience.
      • 3
        Construct measurable objectives that build upon the learner's foundational knowledge.
      • 4
        Build the simulation-based experience to align the modality with the objectives.
      • 5
        Design a scenario, case, or activity to provide the context for the simulation-based experience.
      • 6
        Use various types of fidelity to create the required perception of realism.
      • 7
        Plan a learner-centered facilitative approach driven by the objectives, learners’ knowledge and level of experience, and the expected outcomes.
      • 8
        Create a prebriefing plan that includes preparation materials and briefing to guide participant success in the simulation-based experience.
      • 9
        Create a debriefing or feedback session and/or a guided reflection exercise to follow the simulation-based experience.
      • 10
        Develop a plan for evaluation of the learner and of the simulation- based experience.
      • 11
        Pilot test simulation-based experiences before full implementation.
      Criterion 1: Simulation experiences should be designed in consultation with content experts as well as simulationists who are knowledgeable and competent in best practices in simulation education, pedagogy, and practice.
      Required Elements:
      • Simulation designers should have formal or informal training in simulation pedagogy and practices.
      • Suggested methods for developing competency include (but are not limited to):
        • Joining professional simulation organizations.
        • Incorporating the Healthcare Simulation Standards of Best PracticeTM (HSSOBPTM).
        • Literature survey and review.
        • Mentorship and networking.
          • Watts P.I.
          • Hallmark B.F.
          • Beroz S.
          Professional Development for Simulation Education.
          ,
          • Paige J.B.
          • Graham L.
          • Sittner B.
          Formal training efforts to develop simulation educators: An integrative review.
        • Formal coursework or certification.
          • Paige J.B.
          • Graham L.
          • Sittner B.
          Formal training efforts to develop simulation educators: An integrative review.
          ,

          Park, C. S., Murphy, T. F., & the Code of Ethics Working Group (2018). Healthcare simulationist code of ethics. Retrieved from http://www.ssih.org/Code-of-Ethics

        • Simulation conference attendance or workshops.
          • Watts P.I.
          • Hallmark B.F.
          • Beroz S.
          Professional Development for Simulation Education.
          ,
          • Paige J.B.
          • Graham L.
          • Sittner B.
          Formal training efforts to develop simulation educators: An integrative review.
        • Continuing education offerings focusing on pedagogy or andragogy.
      • Be knowledgeable of ethical standards of simulation-based experiences and adhere to the Healthcare Simulationist Code of Ethics

        Park, C. S., Murphy, T. F., & the Code of Ethics Working Group (2018). Healthcare simulationist code of ethics. Retrieved from http://www.ssih.org/Code-of-Ethics

        (Follow the HSSOBPTM Professional Integrity).
      • Content experts should have a general knowledge of simulation and scenario design principles, debriefing methods, and evaluation approaches.
        • Paige J.B.
        • Graham L.
        • Sittner B.
        Formal training efforts to develop simulation educators: An integrative review.
      • Follow the HSSOBPTM Professional Development.
      Criterion 2: Perform a needs assessment to provide the foundational evidence of the need for a well-designed simulation-based experience.
      Required Elements:
      • The needs assessment may include analysis of:
        • Underlying causes of concern (e.g., root cause or gap analysis).
        • Organizational analysis (e.g., Strengths, Weaknesses, Opportunities and Threats analysis).
        • Surveys of stakeholders, learners, clinicians, and/ or educators.
        • Outcome data (e.g., from pilot testing; certification or licensure exams, previous simulation-based experiences; aggregate health care data; patient safety data).
        • Standards (e.g., certifying bodies, rules and regulations, practice guidelines).
      • The needs assessment includes examining knowledge, skills, attitudes, and/or behaviors of individuals; organizational initiatives; systems analysis; clinical practice guidelines; quality improvement programs; and/or patient safety goals.
      • Use the needs assessment results to guide the development of an overarching goal or broad objective for the simulation, which directs the designer(s) in the development of simulation-specific objectives (Follow the HSSOBPTM Objectives and Outcomes).
      • Use the results of the needs assessment to create relevant, innovative, and interactive simulation-based experiences that aim to:
        • Enhance curriculum in the classroom and/or clinical areas.
        • Provide just-in time training in the clinical practice setting.
        • Provide opportunities for standardized clinical experiences.
        • Address relevant and identified competencies.
        • Improve the quality of care and patient safety.
        • Promote readiness for clinical practice.
      Criterion 3: Construct measurable objectives that build upon the learner's foundational knowledge.
      Required Elements:
      • Develop broad and specific objectives to address identified needs and optimize the achievement of expected outcomes. These objectives provide a blueprint for the design of a simulation-based experience.
      • Use broad objectives to reflect the purpose of the simulation-based experience and are related to organizational goals.
      • Create specific objectives for learner performance measures.
      • During the design phase, determine which objectives will or will not be available to the learner(s) before the experience. For example, it may be appropriate to disclose general information and context for the learner (care of a postoperative patient), but specific critical actions (interventions for sepsis) may not be disclosed until the debriefing session. Objective disclosure will be determined by the overall purpose of the simulation-based experience.
      • Follow the HSSOBPTM Objectives and Outcomes.
      Criterion 4: Build the simulation-based experience to align the modality with the objectives.
      Required Elements:
      • Develop the simulation-based experience format based on the needs assessment, resources available, learning objectives, the targeted learners, and the type of assessment or evaluation method.
      • Choose a theoretical and/or conceptual framework
        • Morrow M.R.
        Monograph Review: The NLN Jeffries Simulation Theory (2016), edited by Pamela R. Jeffries.
        • Nestel D.
        • Bearman M.
        Theory and simulation-based education: Definitions, worldviews and applications.
        • Rooney D.
        • Hopwood N.
        • Boud D.
        • Kelly M.
        The role of simulation in pedagogies of higher education for the health professions: Through a practice-based lens.
        based on the identified purpose and the targeted learners (e.g., adult learning, inter-professional teams.
        Interprofessional Education Collaborative
        Core competencies for interprofessional collaborative practice: 2016 update.
      • Select the appropriate modality for the simulation-based experience. The modality is the platform for the experience and includes simulated clinical immersion, in situ simulation, computer-assisted simulation, virtual reality, procedural simulation, and/ or hybrid simulation. These modalities may incorporate, but are not limited to the following: standardized patients, manikins, haptic devices, avatars, partial task trainers, and so forth.
        • Alinier G.
        A typology of educationally focused medical simulation tools.
      • Develop all simulation-based experiences to include a starting point, structured learner activities, and an endpoint.
        • The starting point represents the patient's initial circumstances or situation when the learners start their engagement in the simulation-based experience.
        • Structured activities are designed for learner engagement (e.g., a simulated case or an unfolding scenario, and/or psychomotor skill teaching/evaluation).
        • The endpoint is the stage at which the simulation-based experience is expected to end; usually, when desired learning outcomes have been demonstrated, time is exhausted, or the scenario can proceed no further.
      Criterion 5: Design a scenario, case, or activity to provide the context for the simulation-based experience.
      Use a process to design a scenario, case, or activity that ensures the content's quality and validity and supports the objectives and expected outcomes.
      • Rutherford-Hemming T.
      Determining content validity and reporting a content validity index for simulation scenarios.
      • Benishek L.E.
      • Lazzara E.H.
      • Gaught W.L.
      • Arcaro L.L.
      • Okuda Y.
      • Salas E.
      The template of events for applied and critical healthcare simulation (TEACH Sim): A tool for systematic simulation scenario design.
      • Fosey-Doll C.
      • Leighton K.
      Simulation champions: Fostering courage, caring, and connection.
      Required Elements:
      • Design the scenario, case, or activity to include:
      • A situation and backstory to provide a realistic starting point from which the structured activity begins.
        • The complete picture of this context may be given verbally to the learners, found in the patient's file, or be revealed if requested through adequate inquiry.
      • A script for a scenario or case is developed for consistency and standardization to increase scenario repeatability/reliability.
        • Variation from the planned dialogue may add distractions that could interfere with the objectives and affect the validity and/or reliability of the scenario or case, especially when the activity is expected to be run with consecutive groups of learners.
      • Clinical progression and cues provide a framework for the advancing of the clinical case or scenario in response to learner actions, including standardization of cues to guide the learner(s).
        • Cues, if used, should be linked to performance measures and used to refocus learners when they stray from the intended objectives.
          • Dieckmann P.
          • Lippert A.
          • Glavin R.
          • Rall M.
          When things do not go as expected: Scenario life savers.
        • Cues can be delivered to learners in a variety of ways, including verbally (e.g., through the patient, provider, or embedded participant, visually (e.g., through changes in vital signs on a monitor), through additional data (e.g., new laboratory results), and so forth (Follow the HSSOBPTM Facilitation).
        • Planned time frames serve to facilitate the progression of the scenario and ensure that there is a reasonable time to achieve the objectives.
          • Alinier G.
          Developing high-fidelity health care simulation scenarios: A guide for educators and professionals.
      • Identification of critical actions/performance measures that are required to evaluate achievement of scenario objectives.
        • Rosen M.A.
        • Salas E.
        • Silvestri S.
        • Wu T.S.
        • Lazzara E.H.
        A measurement tool for simulation-based training in emergency medicine: The simulation module for assessment of resident targeted event responses (SMARTER) approach.
        • Each measure should be evidence-based. Use content experts to strengthen validity of the simulation scenario and the critical performance measures.
      In the case of a purely procedural or psychomotor activity:
      • A clear and concise scripted explanation provides the context for the activity to be undertaken.
      • A setting represents the clinical environment so the learner(s) can practice or undertake the task in an ergonomics matching the experience in the actual clinical setting.
        • Spruit E.N.
        • Band G.P.
        • Hamming J.F.
        • Ridderinkhof K.R.
        Optimal training design for procedural motor skills: A review and application to laparoscopic surgery.
      • Identification of critical actions/performance measures that are required to evaluate achievement of the activity objectives.
        • Sawyer T.
        • White M.
        • Zaveri P.
        • Chang T.
        • Ades A.
        • French H.
        • Anderson J.
        • Auerbach M.
        • Johnston L.
        • Kessler D.
        Learn, see, practice, prove, do, maintain: An evidence- based pedagogical framework for procedural skill training in medicine.
      Criterion 6: Use various types of fidelity to create the required perception of realism.
      Required Elements:
      • Design the simulation through attention to physical, conceptual, and psychological aspects of fidelity that can contribute to the attaining objectives. Specifically, this is less about specific “reality” and should instead focus on representing stimuli and cues that would typically be present to drive decision-making and action.
        • Tun J.K.
        • Alinier G.
        • Tang J.
        • Kneebone R.L.
        Redefining simulation fidelity for healthcare education.
        These aspects of fidelity must be considered from the perspective of the learners.
        • Aarkrog V.
        The mannequin is more lifelike’: The significance of fidelity for students’ learning in simulation-based training in the social-and healthcare programmes.
        • Huffman J.L.
        • McNeil G.
        • Bismilla Z.
        • Lai A.
        Essentials of scenario building for simulation-based education.
        • Muckler V.C.
        Exploring suspension of disbelief during simulation-based learning.
        • Nestel D.
        • Krogh K.
        • Kolbe M.
        Exploring realism in healthcare simulations. Healthcare Simulation Education: Evidence, Theory and Practice.
        • Schoenherr J.R.
        • Hamstra S.J.
        Beyond fidelity: Deconstructing the seductive simplicity of fidelity in simulator-based education in the health care professions.
        • Physical (or environmental) fidelity relates to how realistically the physical context of the simulation-based activity compares to
          • Hontvedt M.
          • Øvergård K.I.
          Simulations at work—A framework for configuring simulation fidelity with training objectives.
          the actual environment in which the situation would occur in real life. Physical fidelity includes such factors as the patient(s), simulator/manikin, standardized patient, environment, equipment, embedded actors, and related props.
          • Carey J.M.
          • Rossler K.
          The How When Why of High Fidelity Simulation.
          • Chiniara G.
          • Clark M.
          • Jaffrelot M.
          • Posner G.D.
          • Rivière É.
          Moving beyond fidelity.
          • Engström H.
          • Hagiwara M.A.
          • Backlund P.
          • Lebram M.
          • Lundberg L.
          • Johannesson M.
          • Sterner A.
          • Söderholm H.M.
          The impact of contextualization on immersion in healthcare simulation.
        • Conceptual fidelity ensures that all elements of the scenario or case realistically relate to each other so that the patient makes sense as a whole to the learner(s) (e.g., vital signs are consistent with the diagnosis). To maximize conceptual fidelity, cases or scenarios should be reviewed by the content expert(s), and pilot tested before use with learners.
          • Carey J.M.
          • Rossler K.
          The How When Why of High Fidelity Simulation.
          ,
          • Chiniara G.
          • Clark M.
          • Jaffrelot M.
          • Posner G.D.
          • Rivière É.
          Moving beyond fidelity.
        • Psychological fidelity maximizes the simulation environment by mimicking the contextual elements found in clinical environments. Some examples include an active voice for the patient(s) to allow realistic conversation, noise and lighting typically associated with the simulated setting, distractions, family members, other health care team members, time pressure, and competing priorities. Psychological fidelity works synergistically with physical and conceptual fidelity to promote learner engagement.
          • Carey J.M.
          • Rossler K.
          The How When Why of High Fidelity Simulation.
          ,
          • Chiniara G.
          • Clark M.
          • Jaffrelot M.
          • Posner G.D.
          • Rivière É.
          Moving beyond fidelity.
        • Develop the simulation using the appropriate types of fidelity that create the required perception of realism that will allow learners to engage in a relevant manner.
          • Aarkrog V.
          The mannequin is more lifelike’: The significance of fidelity for students’ learning in simulation-based training in the social-and healthcare programmes.
          ,
          • Nestel D.
          • Krogh K.
          • Kolbe M.
          Exploring realism in healthcare simulations. Healthcare Simulation Education: Evidence, Theory and Practice.
          ,
          • Schoenherr J.R.
          • Hamstra S.J.
          Beyond fidelity: Deconstructing the seductive simplicity of fidelity in simulator-based education in the health care professions.
          ,
          • Carey J.M.
          • Rossler K.
          The How When Why of High Fidelity Simulation.
          ,
          • Findik Ü.Y.
          • Yeşilyurt D.S.
          • Makal E.
          Determining student nurses’ opinions of the low-fidelity simulation method.
          • Singh D.
          • Kojima T.
          • Gurnaney H.
          • Deutsch E.S.
          Do fellows and faculty share the same perception of simulation fidelity? A pilot study.
          • Stokes-Parish J.B.
          • Duvivier R.
          • Jolly B.
          Investigating the impact of moulage on simulation engagement—a systematic review.
          • Stokes-Parish J.B.
          • Duvivier R.
          • Jolly B.
          Does appearance matter? Current issues and formulation of a research agenda for moulage in simulation.
        • Fidelity should also be broken down to focus on patient, facility, and scenario. This framework would be used in conjunction with the concepts of physical, conceptual, and psychological fidelity to create the highest possible fidelity in each element of the simulation.
      • As appropriate, use moulage to replicate features or characteristics of the patient situation and when possible, select manikins that respectfully represents the race and culture of the patients in the scenario to promote the sensory perceptions of learners and support the fidelity of the scenario.
        • Stokes-Parish J.B.
        • Duvivier R.
        • Jolly B.
        Investigating the impact of moulage on simulation engagement—a systematic review.
        • Stokes-Parish J.B.
        • Duvivier R.
        • Jolly B.
        Does appearance matter? Current issues and formulation of a research agenda for moulage in simulation.
        • Stokes-Parish J.
        • Duvivier R.
        • Jolly B.
        Expert opinions on the authenticity of moulage in simulation: A Delphi study.
      • It is important to reiterate the distinction between fidelity and modality or technology. These terms are independent of one another and need to remain so.
        • Tun J.K.
        • Alinier G.
        • Tang J.
        • Kneebone R.L.
        Redefining simulation fidelity for healthcare education.
        ,
        • Carey J.M.
        • Rossler K.
        The How When Why of High Fidelity Simulation.
        High-technology does not necessarily equate to high-fidelity, and any single modality (manikin, task trainer, etc.) may or may not be high-fidelity without caveat. Not every simulation requires the highest fidelity of realism. Determinations about the degree of fidelity and the implementation of this fidelity need to be determined through the examination of several factors.
        • Aarkrog V.
        The mannequin is more lifelike’: The significance of fidelity for students’ learning in simulation-based training in the social-and healthcare programmes.
        ,
        • Nestel D.
        • Krogh K.
        • Kolbe M.
        Exploring realism in healthcare simulations. Healthcare Simulation Education: Evidence, Theory and Practice.
        ,
        • Schoenherr J.R.
        • Hamstra S.J.
        Beyond fidelity: Deconstructing the seductive simplicity of fidelity in simulator-based education in the health care professions.
        ,
        • Carey J.M.
        • Rossler K.
        The How When Why of High Fidelity Simulation.
        ,
        • Findik Ü.Y.
        • Yeşilyurt D.S.
        • Makal E.
        Determining student nurses’ opinions of the low-fidelity simulation method.
        • Singh D.
        • Kojima T.
        • Gurnaney H.
        • Deutsch E.S.
        Do fellows and faculty share the same perception of simulation fidelity? A pilot study.
        • Stokes-Parish J.B.
        • Duvivier R.
        • Jolly B.
        Investigating the impact of moulage on simulation engagement—a systematic review.
        • Stokes-Parish J.B.
        • Duvivier R.
        • Jolly B.
        Does appearance matter? Current issues and formulation of a research agenda for moulage in simulation.
        These factors may include, but are not limited to:
        • Learner level
        • Learning objectives
        • Available time and resources
        • Available equipment
        • Desired learning outcomes
        • Clinical significance
      Criterion 7: Plan a learner-centered facilitative approach driven by the objectives, learners’ knowledge and level of experience, and the expected outcomes.
      Required Elements:
      • Facilitators who have formal training in simulation-based pedagogy.
      • Determine the planned facilitative approach during the simulation in the design phase and include preparatory activities.
        • Leighton K.
        • Mudra V.
        • Gilbert G.E.
        Development and psychometric evaluation of the facilitator competency rubric.
      • If the plan is to have more than one facilitator, applying a structured approach to preplan certain aspects of the prebriefing and debriefing session.
        • Cheng A.
        • Palaganas J.
        • Eppich W.
        • Rudolph J.
        • Robinson T.
        • Grant V.
        Co- debriefing for simulation-based education: a primer for facilitators.
      • Facilitators should incorporate evidence-based components of cultural diversity within the simulation design or scenarios.
      • Use a level of facilitator involvement that is appropriate to the learner's knowledge, competency and experience.
        • Forstrønen A.
        • Johnsgaard T.
        • Brattebø G.
        • Reime M.H.
        Developing facilitator competence in scenario-based medical simulation: Presentation and evaluation of a train the trainer course in Bergen, Norway.
        ,
        • Coggins A.
        • Zaklama R.
        • Szabo R.A.
        • Diaz-Navarro C.
        • Scalese R.J.
        • Krogh K.
        • Eppich W.
        Twelve tips for facilitating and implementing clinical debriefing programmes.
      • Predetermine the delivery of cues as part of the facilitation planning to be delivered during the simulation activity.
        • Thomas C.M.
        • Kellgren M.
        Benner's novice to expert model: An application for simulation facilitators.
      • Facilitators should be aware and mindful of the learners’ diverse cultural differences, values and responsibilities and consider that during the simulation design phase.
        • Foronda C.
        • Baptiste D.-L.
        • Reinholdt M.M.
        • Ousman K.
        Cultural humility: A concept analysis.
      • Facilitators should refer to the Healthcare Simulationist Code of Ethics with respect to confidentiality, mutual respect, and creating a safe educational environment.

        Park, C. S., Murphy, T. F., & the Code of Ethics Working Group (2018). Healthcare simulationist code of ethics. Retrieved from http://www.ssih.org/Code-of-Ethics

      • Follow the HSSOBPTM Facilitation
        • Sittner B.J.
        • Aebersold M.L.
        • Paige J.B.
        • Graham L.L.
        • Schram A.P.
        • Decker S.I.
        • Lioce L.
        INACSL Standards of Best Practice for Simulation: Past, Present, and Future.
        and Professional Integrity.
      Criterion 8: Create a prebriefing plan that includes preparation materials and briefing to guide participant success in the simulation-based experience.
      • Page-Cutrara K.
      Prebriefing in nursing simulation: A concept analysis.
      • McDermott D.S.
      The prebriefing concept: A delphi study of CHSE experts.
      • Page-Cutrara K.
      Use of prebriefing in nursing simulation: A literature review.
      • Tyerman J.
      • Luctkar-Flude M.
      • Graham L.
      • Coffey S.
      • Olsen-Lynch E.
      Pre- simulation preparation and briefing practices for healthcare professionals and students: a systematic review protocol.
      • McDermott D.S.
      Prebriefing: A Historical Perspective and Evolution of a Model and Strategy (Know: Do: Teach).
      Prebriefing activities are intended to establish a psychologically safe learning environment by:
      • 1)
        Situating the learners into a shared mental model and preparing participants for the simulation-based experience's educational content (preparation).
      • 2)
        Conveying important ground rules for the simulation-based experience (briefing).
      Required Elements:
      • Prebriefing should be developed according to the purpose and learning objectives of the simulation-based experience.
        • Page-Cutrara K.
        Prebriefing in nursing simulation: A concept analysis.
        • McDermott D.S.
        The prebriefing concept: A delphi study of CHSE experts.
        • Page-Cutrara K.
        Use of prebriefing in nursing simulation: A literature review.
        • Tyerman J.
        • Luctkar-Flude M.
        • Graham L.
        • Coffey S.
        • Olsen-Lynch E.
        Pre- simulation preparation and briefing practices for healthcare professionals and students: a systematic review protocol.
        • McDermott D.S.
        Prebriefing: A Historical Perspective and Evolution of a Model and Strategy (Know: Do: Teach).
      • Consider the experience and knowledge level of the simulation participant when planning the prebriefing.
        • Page-Cutrara K.
        Prebriefing in nursing simulation: A concept analysis.
        • McDermott D.S.
        The prebriefing concept: A delphi study of CHSE experts.
        • Page-Cutrara K.
        Use of prebriefing in nursing simulation: A literature review.
        • Tyerman J.
        • Luctkar-Flude M.
        • Graham L.
        • Coffey S.
        • Olsen-Lynch E.
        Pre- simulation preparation and briefing practices for healthcare professionals and students: a systematic review protocol.
        • McDermott D.S.
        Prebriefing: A Historical Perspective and Evolution of a Model and Strategy (Know: Do: Teach).
        • Rudolph J.W.
        • Raemer D.B.
        • Simon R.
        Establishing a safe container for learning in simulation: The role of the presimulation briefing.
      • Develop preparation materials to assure that participants are prepared for the experience and can meet the scenario or procedural objectives based on the experience's needs assessment and purpose.
        • Page-Cutrara K.
        Prebriefing in nursing simulation: A concept analysis.
        • McDermott D.S.
        The prebriefing concept: A delphi study of CHSE experts.
        • Page-Cutrara K.
        Use of prebriefing in nursing simulation: A literature review.
        • Tyerman J.
        • Luctkar-Flude M.
        • Graham L.
        • Coffey S.
        • Olsen-Lynch E.
        Pre- simulation preparation and briefing practices for healthcare professionals and students: a systematic review protocol.
        • McDermott D.S.
        Prebriefing: A Historical Perspective and Evolution of a Model and Strategy (Know: Do: Teach).
        ,
        • Josephsen J.
        Cognitive load measurement, worked-out modeling, and simulation.
        ,
        • Nielsen B.
        • Harder N.
        Causes of student anxiety during simulation: What the literature says.
      • Convey important information to participants regarding expectations, agendas, and logistics before beginning the simulation-based experience.
        • Page-Cutrara K.
        Prebriefing in nursing simulation: A concept analysis.
        • McDermott D.S.
        The prebriefing concept: A delphi study of CHSE experts.
        • Page-Cutrara K.
        Use of prebriefing in nursing simulation: A literature review.
        • Tyerman J.
        • Luctkar-Flude M.
        • Graham L.
        • Coffey S.
        • Olsen-Lynch E.
        Pre- simulation preparation and briefing practices for healthcare professionals and students: a systematic review protocol.
        ,
        • Rudolph J.W.
        • Raemer D.B.
        • Simon R.
        Establishing a safe container for learning in simulation: The role of the presimulation briefing.
        ,
        • Josephsen J.
        Cognitive load measurement, worked-out modeling, and simulation.
      • Conduct a structured orientation to the simulation-based learning environment including the modality.
        • McDermott D.S.
        The prebriefing concept: A delphi study of CHSE experts.
        ,
        • Page-Cutrara K.
        Use of prebriefing in nursing simulation: A literature review.
        ,
        • Josephsen J.
        Cognitive load measurement, worked-out modeling, and simulation.
      • Establish a psychologically safe learning environment during the prebriefing.
        • McDermott D.S.
        The prebriefing concept: A delphi study of CHSE experts.
        ,
        • Tyerman J.
        • Luctkar-Flude M.
        • Graham L.
        • Coffey S.
        • Olsen-Lynch E.
        Pre- simulation preparation and briefing practices for healthcare professionals and students: a systematic review protocol.
        • McDermott D.S.
        Prebriefing: A Historical Perspective and Evolution of a Model and Strategy (Know: Do: Teach).
        • Rudolph J.W.
        • Raemer D.B.
        • Simon R.
        Establishing a safe container for learning in simulation: The role of the presimulation briefing.
      • Follow the HSSOBPTM Prebriefing: Preparation and Briefing.
      Criterion 9: Create a debriefing or feedback session and/or a guided reflection exercise to follow the simulation-based experience.
      Required Elements:
      Identify the most appropriate debriefing, feedback, or reflective method for the simulation-based experience during the design phase.
      • Ahmed M.
      • Sevdalis N.
      • Paige J.
      • Paragi-Gururaja R.
      • Nestel D.
      • Arora S.
      Identifying best practice guidelines for debriefing in surgery: A tri-continental study.
      ,
      • Ulmer F.F.
      • Sharara-Chami R.
      • Lakissian Z.
      • Stocker M.
      • Scott E.
      • Dieckmann P.
      Cultural prototypes and differences in simulation debriefing.
      • Use a planned debriefing, feedback session, or a guided reflection exercise to enrich learning and contribute to the consistency of the simulation-based experiences for learners and facilitators.
        • Secheresse T.
        • Lima L.
        • Pansu P.
        Focusing on explicit debriefing for novice learners in healthcare simulations: A randomized prospective study.
      • Debriefing and feedback are different, but both are critical elements that should be structured using best practices. In the case of a skills-based or testing simulation activity, debriefing may be replaced by feedback, so the learners are guided to improve further or confirm their practice.
        • Oriot D.
        • Alinier G.
        • Alinier G.
        Pocket book for simulation debriefing in healthcare.
        ,
        • Kim Y.-J.
        • Yoo J.-H.
        The utilization of debriefing for simulation in healthcare: A literature review.
      • Guided reflection is an intellectual and affective activity that explores the critical elements to gain understanding and insight. It can be integrated with debriefing or accomplished after the event through journaling or open discussions.
        • Oriot D.
        • Alinier G.
        • Alinier G.
        Pocket book for simulation debriefing in healthcare.
      • Debriefing facilitators should have formal training in debriefing techniques.
        • Oriot D.
        • Alinier G.
        • Alinier G.
        Pocket book for simulation debriefing in healthcare.
        ,
        • Fey M.K.
        • Scrandis D.
        • Daniels A.
        • Haut C.
        Learning through debriefing: Students' perspectives.
      • Follow the HSSOBPTM The Debriefing Process
      Criterion 10: Develop a plan for evaluation of the learner and of the simulation-based experience.
      Required Elements:
      • Determine the assessment and evaluation processes in the design phase to ensure quality and effectiveness of simulation-based experiences.
        • Fosey-Doll C.
        • Leighton K.
        Simulation champions: Fostering courage, caring, and connection.
      • Consider an assessment framework to guide the selection and/ or development of a valid and reliable tool to measure expected learner outcomes.
        • Prion S.
        • Haerling K.A.
        Evaluation of simulation outcomes.
      • Ensure that participants understand the method of assessment (formative, summative, and/or high stakes) before or at the onset of the simulation.
      • Follow the HSSOBPTM Evaluation of Learning and Performance.
      • Plan an evaluation process to determine the quality or effectiveness of the simulation- based experience Use evaluation data for continuous quality improvement. Include feedback from participants, peer clinicians and educators, stakeholders, and simulation program faculty and staff
        • Prion S.
        • Haerling K.A.
        Evaluation of simulation outcomes.
        • Leighton K.
        • Mudra V.
        • Gilbert G.E.
        Development and psychometric evaluation of the facilitator competency rubric.
        • Adamson K.A.
        • Kardong-Edgren S.
        • Willhaus J.
        An updated review of published simulation evaluation instruments.
        in the evaluation process.
      Criterion 11: Pilot test simulation-based experiences before full implementation.
      Required Elements:
      • After the design is complete, pilot test the entire simulation-based experience to ensure that it accomplishes its intended purpose, provides opportunity to achieve objectives, and is effective when used with learners.
      • Select a participant similar to the target learner group for the optimal test environment.
      • Select any tool(s), checklists, or other measures to assess for validity and to ensure consistency and reliability (i.e., content validity, expert review, inter-rater reliability).
      • During pilot implementation, identify any confusing, missing, or underdeveloped elements of the simulation-based experience.
      • Make improvements based upon the pilot and revise before the full implementation of the simulation-based experience.
      • Recognize that it may not always be possible to pilot test simulation-based experiences prior to facilitation (For example, just in time training or with limits to time and resources).

      Original INACSL Standard

      Lioce, L., Meakim, C. H., Fey, M. K., Chmil, J. V., Mariani, B., & Alinier, G. (2015). Standards of best practice: Simulation standard IX: Simulation design. Clinical Simulation in Nursing, 11(6), 309-315. http://dx.doi.org/10/1016/j.ecns.2015.03.005.

      Subsequent INACSL Standard

      INACSL Standards Committee (2016, December). INACSL standards of best practice: SimulationSM: Simulation design. Clinical Simulation in Nursing, 12(S), S5-S12. http://dx.doi.org/10.1016/j.ecns.2016.09.005.

      About the International Nursing Association for Clinical Simulation and Learning

      The International Nursing Association for Clinical Simulation and Learning (INACSL) is the global leader in transforming practice to improve patient safety through excellence in health care simulation. INACSL is a community of practice for simulation where members can network with simulation leaders, educators, researchers, and industry partners. INACSL also provided the original living documents INACSL Standards of Best Practice: SimulationSM, an evidence-based framework to guide simulation design, implementation, debriefing, evaluation, and research. The Healthcare Simulation Standards of Best PracticeTM are provided with the support and input of the international community and sponsored by INACSL.

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