Scenario Based Learning

 

At a very basic level, as seen on most First Aid courses with an element of Practical Observation, practical activities allow repetition of an event to develop an automated response.  This follows the basic behaviourist premise that behaviours that are rewarded are repeated (1).  For example, the practice of CPR during simulation of a cardiac arrest using a mannequin; if a student meets the assessment criteria, they are rewarded with a First Aid certificate. 

This process is profoundly limited in its application to dynamic situations and also the candidate’s potential to apply rather than simply repeat.

Scenario Based Learning is an experiential learning tool that can finely hone advanced skills, develop critical thinking, problem-solving and, perhaps most importantly, behavioural change (2-4).

 

The Effectiveness of Scenarios

  • Contextualised scenarios allow candidates to transfer skills to other contexts, allowing flexibility and the ability to adapt (3)

  • Scenario training has the ability to fundamentally alter the learners’ behaviours (3)

  • Studies have shown that simulation improves learning (5-8) with particular application in a medical context (9-14) and has been shown to be one of the most effective methods of developing teamwork and leadership (15).

  • Skill proficiency increases confidence in real-world actions (16-19)

    • Students who have undertaken simulation training for neonatal resuscitation are 2.5 times more likely to deliver optimum care during CPR than those who don’t, indicating a direct relationship between simulation training and improved patient outcomes in a clinical setting (16) and significantly higher rates of ability (14)

  • Scenario training reduces errors (8, 20-23) by either staging errors so the unintended outcomes become apparent or allowing candidates to make errors in a safe and controlled way (2, 24).

    • There is a 60% observed reduction in the frequency of harmful actions taken by those who have received CPR training with simulation compared to traditional training (16).

  • Scenarios allow multiple objectives within a single course. (25)

  • Scenario Training affords the ability to provide feedback, repetitive practice, curriculum integration and the ability to range the difficulty levels (26) 

 

What makes an effective Scenario?

Location

Scenario training is not just running a practical exercise outside or in the workspace. 

In-situ training provides learners with a more realistic training environment and can be focused on the development of individual or team-based skills (27-29), but simply delivering a practical exercise or observation outside is just delivering a practical exercise or observation outside. 

Scenarios that are planned and delivered in the real-world environment have the capacity to greatly enhance learning experiences, understanding and behavioural change when done in a meaningful way (30-38)

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Moulage

Scenario training is not just adding fake blood to a practical assessment.

The use of moulage consistently appears in the literature as a training aid (39-44).  As a result, moulage has been shown to assist in content, validity, transfer of skills and knowledge retention (29).   Comparative studies of moulage versus no moulage demonstrated improved learner performance and immersion in their scenario, becoming more urgent and allowing them to engage their critical thinking skills and decision making earlier in the interaction. (45).  

Moulage, as the with the location, has to be applied in a meaningful way; inappropriate moulage which is just there for ‘shock factor’ or poorly applied moulage which does not accurately reflect the injury pattern it is intended to, can cause learners can become confused as to what the real diagnosis of their simulated patient is, leading to a disintegration of the simulation scenario. (46,47)  

When moulage is used simply for dramatic effect or to the extent that the moulage overshadows the purpose of the scenario, this can disadvantage learners by placing unnecessary stress on them (48) or degrading the scenario to a mere make-up demonstration.

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Context

Context is critical to meaningful scenarios.

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Contextualising the scenario is more than simply deciding on what scenario would fit the location:

  • The context should consider the candidates’ normal operational role, skill level and scope of practice.

  • The scenarios should be mapped to Learning Outcomes directly relevant to the training, rather than simply running through ‘fun’ scenarios or repeating fixed scenarios you are familiar with.

  • Where possible, the location should be contextualised and utilised as a part of the scenario, rather than simply a backdrop.

  • A balance should be achieved between enough stress to challenge the candidates without it being too easy or so far-fetched it is unrealistic.

  • Where and when will you debrief? Hot debriefs immediately following the scenario are powerful but if the location is too uncomfortable, will the candidates be receptive to feedback?

  • Have the casualties been briefed on how to behave, not just on how they present during the initial assessment by the Responder but how their signs and symptoms may change as a result of the treatment they receive?

  • Have the candidates received a full and accurate briefing before the scenario? Candidates should not need to ask the trainer / assessor “Can I use X?” or “Am I on my own or are those people really there?” during the scenario.

  • Have you formalised the assessment for consistency and continuity between scenarios and trainers / assessors? Scenario Cards like these can be invaluable.

Real First Aid are experts in developing meaningful Scenarios which:

  • Actively involve the candidate in the experience.

  • Afford the candidate the opportunity to reflect on the experience.

  • Encourage the candidate to use analytical skills to conceptualize the experience.

  • Support decision making and problem-solving skills in order to use the new ideas gained from the experience.

Working closely with you we can plan, organise, deliver and debrief a bespoke event, unique to your organisational needs, environment or working practices for:

  • Film & TV

  • MAJAX training

  • Incident response training

  • Health Promotion

  • First Aid refresher training days

  • Health & Safety workshops

  • NGOs and Primary Health Care

Contact us to find out how we can bring something powerfully effective to your organisation.

 

References

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  2. Rosenthal ME, Adachi M, Ribaudo V, Mueck T, Schneider RF, Mayo PH.  (2009)  “Achieving house staff competence in emergency airway management using scenario based simulation training”.  Chest.  129(6):1453-8 

  3. Lateef F.  (2010)  “Simulation-based learning: Just like the real thing”.  Journal of Emergency Trauma Shock.  3(4):348- 52

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  14. Rosenthal ME, Adachi M, Ribaudo V, Mueck T, Schneider RF, Mayo PH.  (2009)  “Achieving house staff competence in emergency airway management using scenario based simulation training”.  Chest.  129(6):1453-8

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  27. Kurup V, Matei V, Ray J.  (2017)  “Role of in-situ simulation for training in healthcare: opportunities and challenges”.  Current Opinion in Anaesthesiology.  30:755–760.

  28. Goldshtein D, Krensky C, Doshi S, Perelman VS.  (2018)  “In situ simulation and its effects on patient outcomes: a systematic review”.  BMJ Simulation and Technology Enhanced Learning.  6:3–9.

  29. Rosen MA, Hunt EA, Pronovost PJ, Federowicz MA, Weaver SJ.  (2012)  “In situ simulation in continuing education for the health care professions: a systematic review”.  The Journal of Continuing Education in the Health Professions.  32:243–254.

  30. Sullivan NJ, Duval-Arnould J, Twilley M, Smith SP, Aksamit D, Boone-Guercio P, Jeffries PR, Hunt EA.  (2015)  “Simulation exercise to improve retention of cardiopulmonary resuscitation priorities for in-hospital cardiac arrests: A randomized controlled trial”.  Resuscitation.   86:6–13.

  31. Patocka C, Cheng A, Sibbald M, Duff JP, Lai A, Lee-Nobbee P, Levin H, Varshney T, Weber B, Bhanji F.  (2019)  “A randomized education trial of spaced versus massed instruction to improve acquisition and retention of paediatric resuscitation skills in emergency medical service (EMS) providers”.  Resuscitation.  141:73–80.

  32. Patocka C, Khan F, Dubrovsky AS, Brody D, Bank I, Bhanji F.  (2015)  “Pediatric resuscitation training-instruction all at once or spaced over time?”  Resuscitation.  88:6–11.

  33. Kurosawa H, Ikeyama T, Achuff P, Perkel M, Watson C, Monachino A, Remy D, Deutsch E, Buchanan N, Anderson J, Berg RA, Nadkarni VM, Nishisaki A.  (2014)  “A randomized, controlled trial of in situ pediatric advanced life support recertification (“pediatric advanced life support reconstructed”) compared with standard pediatric advanced life support recertification for ICU frontline providers”.  Critical Care Medicine. 2014; 42:610–618.

  34. Di Tulio A, Anzelon K, Terada K, Oliver C, Ho HC, Speck C.  (2011)  “In situ, multidisciplinary, simulation-based teamwork training improves early trauma care”.  Journal of Surgical Educucation.  68:472–477.

  35. Clarke SO, Julie IM, Yao AP, Bang H, Barton JD, Alsomali SM, Kiefer MV, Al Khulaif AH, Aljahany M, Venugopal S, Bair AE.  (2019)  “Longitudinal exploration of in situ mock code events and the performance of cardiac arrest skills”.  BMJ Simulation and Technology Enhanced Learning.  5:29–33.

  36. Rubio-Gurung S, Putet G, Touzet S, Gauthier-Moulinier H, Jordan I, Beissel A, Labaune JM, Blanc S, Amamra N, Balandras C, Rudigoz RC, Colin C, Picaud JC.  (2014)  “In situ simulation training for neonatal resuscitation: an RCT”.  Pediatrics.  134:e790–e797

  37. Saqe-Rockoff A, Ciardiello AV, Schubert FD.  (2019)  “Low-Fidelity, In-Situ Pediatric Resuscitation Simulation Improves RN Competence and Self-Efficacy”.  Journal of Emergency Nursing.  45:538–544.e1.

  38. Katznelson JH, Wang J, Stevens MW, Mills WA.  (2018)  “Improving Pediatric Preparedness in Critical Access Hospital Emergency Departments: Impact of a Longitudinal In Situ Simulation Program”.  Pediatric Emergency Care.  34:17–20

  39. Pywell MJ, Evgeniou E, Highway K, Pitt E, Estela CM.  (2016)  “High fidelity, low cost moulage as a valid simulation tool to improve burns education”.  Burns.   Jun;42(4):844-52.

  40. Swan NA. (2013)  “Burn moulage made easy (and cheap)”.  Journal of Burn Care and Research.  Jul-Aug;34(4):e215-20.

  41. Hernandez C, Mermelstein R, Robinson JK, Yudkowsky R.  (2013)  “Assessing students' ability to detect melanomas using standardized patients and moulage”.  Journal of the  American Academy of Dermatology.  68(3):e83-8.

  42. Shiner N, Howard ML.  (2019)  “The use of simulation and moulage in undergraduate diagnostic radiography education: A burns scenario”.  Radiography (Lond).  Aug;25(3):194-201.

  43. Zorn J, Snyder J, Guthrie J.  (2018)  “Use of Moulage to Evaluate Student Assessment of Skin in an Objective Structured Clinical Examination”.  The Journal of Physician Assistant Education.  Jun;29(2):99-103.

  44. Rabionet A, Patel N.  (2017)  “Much More Than Movie Magic-Dermatologic Applications of Medical Moulage”.  JAMA Dermatology.  Mar 01;153(3):318.

  45. Mills BW, Miles AK, Phan T, Dykstra PMC, Hansen SS, Walsh AS, Reid DN, Langdon C.  (2018)  “Investigating the Extent Realistic Moulage Impacts on Immersion and Performance Among Undergraduate Paramedicine Students in a Simulation-based Trauma Scenario: A Pilot Study”.  Simulation in Healthcare.  Oct;13(5):331-340.

  46. Stokes-Parish J, Duvivier R, Jolly B.  (2019)  “Expert opinions on the authenticity of moulage in simulation: a Delphi study”.  Advances in Simulation. (Lond). 2019;4:16.

  47. Stokes-Parish JB, Duvivier R, Jolly B.  (2017)  “Does Appearance Matter? Current Issues and Formulation of a Research Agenda for Moulage in Simulation”.  Simulation in Healthcare.  Feb;12(1):47-50.

  48. Felix HM, Simon LV.  (2020)  “Moulage in Medical Simulation”. [Updated 2020 Oct 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK549886/