I have met many people in the simulation world. Some have been just starting off their journey and some have many years of experience under their belts. Something that often comes as a surprise to many of those people is my idea that there is more to writing a “scenario” than it first seems. Everyone is obsessed with how to debrief and often the scenario design and running itself is considered easy (or not considered at all!). I would like to use this month’s blog to try and explain why I think what I think about the importance of “scenario” design and running.
-Debriefing isn’t the only tricky part
The first thing you may have noticed is that I have used quotation marks. The reason for this is because what I am going to talk about is applicable to any of the activity part of simulation, which won’t always be an immersive scenario. Everything comes down to Constructive Alignment (Biggs, J. Tang, C. (2011) Teaching for quality learning at university, Fourth Edition, Open University Press). The “Constructive” part comes from constructivist theory; learners use the activity they participate in to construct learning as interpreted through their existing schemata. One of the reasons that simulation can be so efficient, stems from the ability of the simulation faculty to have tight ultimate control over the activity of the learner.
-Controlling the activity in simulation by specific design and running of a scenario gives the opportunity to (potentially!) control the resultant learning.
Start with the Learning Objectives
The “Alignment” part refers to aligning teaching and assessment to intended learning outcomes. Applying this to simulation, alignment should apply to the entire simulation based learning event. This means that the learning objectives are integral to the design, running and debriefing of the simulation. The debriefing conversation could be likened to formative assessment in terms of observation of a performance gap and facilitated discussion around how to close that gap. Ideally, this should be a facilitated self-assessment by the learners. A skilled debriefer will be able to direct the developmental conversation towards the intended learning objectives and this is much easier, and occurs more naturally when the entire activity has been designed around learning objectives.
-Everything needs to be directed to achieving the learning objectives
Finish with the Learning Objectives
At SCSC, we almost universally use Take Home Messages as an assessment of the debriefed simulation we have delivered. This final step of the learning event should answer the key question all educators must ask themselves “Did my simulated learning event deliver the learning outcomes I intended?” We simply ask something like “So what have you learned that you are going to implement tomorrow?” at the end of each debriefing. This is at the heart of constructivist theory; we only know what the learners have learned if we ask them (or test them!). At this point, if they don’t say the learning objectives you intended back to you (in some form that demonstrates they’ve “got it”) then you haven’t done your job. Something, somewhere along the line has gone wrong. Either the scenario wasn’t designed around the objectives, or you didn’t run it tightly enough, or you didn’t manage to facilitate the debriefing conversation to cover the objectives. If they haven’t got it at the end, its too late, there is no point in telling them what you think they should have learned from your simulation and debriefing. If you are going to do that, why not just save a lot of time and money and just tell them stuff in a classroom. This is similar to The Design Focused Evaluation Approach (Smith, C. D. (2008) Design-Focused Evaluation Assessment & Evaluation in Higher Education, 33(6), 631-645), which seeks learner feedback on the efficacy of the alignment between the intended learning outcomes and the teaching and learning activities students engage in during a course of study.
-Use Take Home Messages to assess whether you have done your job
So how do I do it?
The first step in designing any scenario should be to set learning objectives appropriate to the target learners. Although scenarios will often eventually resemble an actual real life scenario, it is important to resist the temptation simply to replicate the real event using simulation. By setting learning objectives first, the simulated scenario can be designed efficiently and effectively without including any of the extraneous content that is not aligned to the objectives. One way to do this is to design each state of the scenario around one simple learning objective. The scenario is then run according to a set plan, moving through scenario states that are mapped to learning objectives. The learner is guided through the scenario in a realistic way with prompts to help them perform. The prompts are minor physiology or faculty actions aimed at moving the scenario on, in the direction you have pre-planned without breaking the immersive psychological fidelity. The transition trigger for moving from one state to the next will be something that the learner must do in the scenario, which is often an action that is closely aligned to a learning objective. If your participants think they are managing a patient with an allergic reaction for the whole scenario, it will be quite difficult and appear strange for you to try to debrief around managing a patient with concealed haemorrhage, which was what the learning was supposed to be about! Avoid getting in to those situations by actively designing, driving and guiding the scenario along the lines it needs to go to cover the learning objectives.
-Designing and Driving is an active process
This is why I think what I think about simulation design and running. What do you think?
(Dr Al May, Educational Co-ordinator (Faculty Development))