Improve Simulation Learning Outcomes With These Pre-Production Tips


Blog post by SimGHOSTS President Dr. Scott Crawford

Live simulation as a demonstration and educational tool is a powerful application for group learning and interaction. This concept has been demonstrated as a competitive art form in the style of SimWARS. This is a specialized form of in-situ simulation and audio visual needs take on a special importance. I have run a series of toxicology simulations in this form and want to share some of the important features for improved performance if others choose to add this to their repertoire of simulation education opportunities.

This type of simulation activity fully crosses the line from educational activity to theatrical experience. But Marshall McLuhan, Canadian English professor and communications thought leader of the 20th century, purported the following: "Anyone who tries to make a distinction between education and entertainment doesn't know the first thing about either." It is the engagement of learners that will enhance the retention of knowledge.

As with any simulation activity, identifying the objectives and reason for performing the activity must be carefully considered and planned so that the activity matches that need. These toxicology sessions were used to provide an engaging case-based teaching activity for an interprofessional audience. Clinical care providers, pharmacists, and poison center toxicology specialists each have a different viewpoint for these types of cases. Cases included cardio-toxic medications, pesticide exposures, environmental exposures to heavy metals, radioactive materials, and envenomation. Each scenario required coordination of care, and this type of simulation exposure allowed all members to join in the simulated care of these patients. This type of simulation may seem backwards to many, because your primary target is the audience rather than the direct participant. Think of creating an engaging lecture with simulation as the backbone.

Who needs to be heard? 

The first AV need for this type of simulation activity is audio and mic’ing. Often this type of live simulation is conducted on a stage or in a conference room setting. The usual choir mics or boundary microphones available in a high-fidelity simulation room may not be available. Fewer participants or multiple wireless microphones may be required to meet your needs. Having too many people talking or interacting is likely to be a distraction to the audience and will detract from the overall educational aspects being demonstrated. If you are trying to cover a larger area, consider adding choir microphones using an overhead ceiling attachment or tall microphone stand that will have a larger pickup area. The next problem, is where do you place your speakers? Place them as far in front of the performers and microphones as possible and angle them away from the stage to avoid audio feedback. If you have limited audio capabilities, focus on the visual aspect of your simulation by requiring physical tasks and movement of people or equipment to improve the audience experience.

What needs to be seen, and by whom?

Consider designing the simulation so that communication and patient interaction are the focus if you have a large setting or minimal video options and can clearly transmit the audio. If you are trying to use a projector for vital signs or video reproduction, keep in mind that increased lighting on your subjects may wash out any video screen in use. The vital signs monitor as a projection object is an easier subject than video of people because high resolution is not needed and most simulators already have a high-contrast scheme for the numbers and tracings. The constant movement of an EKG strip also serves as an engaging focus for the audience. If you want to record video of the personal interactions or stream this to a display, IV poles, microphone stands and body-mounted cameras such as a GoPro can enhance the point of view of the audience members. If you are using a standard video camera on a tripod run to a projector, consider over-exposing the scene to keep people and faces visible, especially if there is a video screen projected behind them. This will help the view of the subject because cameras will by default focus on the brightest object in the field of view.

A/V enhancements:

Radiology images, EKGs or pictures of physical exam findings will help to keep the audience engaged with the case. Consider broadcasting heart and lung sounds if that is a component of the expected physical exam.

While having a full team of staged performers as confederates is an option, it is still possible to use naïve learners as the stars of the show. Pre-briefing becomes even more important because they may feel vulnerable being on display. Scenarios in which they are expected to excel would be best. Be sure to give them the resources to succeed; this will be more enjoyable for the participants and the audience. We don’t go to the circus to watch people fall; in general, we want to watch people perform well.

When scripting this type of scenario, keep it light-hearted and entertaining. Confederates and distractors should be capable to keep it fun to watch, but also help the learners stay on track.

Plan to do a run through.

If you are planning to perform his type of scenario, a run-through is even more important than at your simulation center. Plan to bring all of your own equipment. It is much harder to trust the audio or network infrastructure when you are on the road, even if it is just across the hall from your usual simulation equipment. Many networks at conference centers, for your protection, block the usual network sharing and connection ports used by simulators and for computer-to-computer file sharing. A portable router can make all the difference to a functional setup.