Scenario Design

Learning objectives

Prior to creating a simulation storyboard, it is important to have a few key learning goals and objectives in mind. Try to limit this to 2 or 3, as unanticipated learning points will undoubtedly reveal themselves during or after the simulation. When writing learning objectives, the SMART template can be a helpful tool:

S. Specific – what is the specific goal; for which target audience and why?

M. Measurable – how can progress or achievement of the goal be measured?

A. Achievable – set realistic goals that the learner can achieve through simulation.

R. Relevant – make objectives that are relevant or important to the profession.

T. Timely – can the objective be met in the time allotted for the scenario?

It is from these learning objectives that a case narrative central to the objectives, and based on clinically important medical cases, is made.

Storyboards and Scripts

A storyboard is a flow diagram that represents the overall story and progression of the simulation. It is used to map out the baseline and changing physiology as the case progresses. Arrows are used to indicate movement and represent “prompts” or “triggers”, key events or decisions made, that advance the simulation forward. A simulation can follow a linear plot, or one with multiple paths and different outcomes (in which case, it is important to anticipate the different directions one can take and write appropriate responses). Generally, storyboards help with planning the flow of the scenario and the setting, props, confederates that may be required. See a sample storyboard template below:

Following creation of the storyboard outline, one can begin developing the specifics:

Baseline physiologic state
- The first set of vitals given and parameters surrounding the situation

Trigger/Prompt
- What causes transition to the next stage
- Can be based on an event, a certain amount of time elapsed, or even at the facilitator’s discretion

First (and subsequent) stages
- Next phase where vitals and physiology change over a set amount of time
- Generally, the point where the patient may decompensate, and learner intervention is required
- This will propel them into the second stage or, perhaps, one of various second stages depending on the scenario – anticipate and prepare responses accordingly

Conclusion
- A logical end to the scenario once reaching a stable state after further interventions
- In the event the learner is fixating, misunderstanding the situation, or not managing appropriately, prepare an “escape” to end the scenario realistically and without the patient magically getting better. Utilize interjected script to redirect the learner in the right direction. For example, “I can’t hear breath sounds on the right side. He might have a tension pneumothorax. Do you need a chest tube?”

Once the storyboard is finished, next steps include creating a summary of the scenario, outlining the setting (location, mannequin, monitors, props, task trainers, confederates, etc.), writing facilitator notes, and providing scripts for the voice of the mannequin and any embedded actors to help guide learners through the simulation.

Pre-briefing

Finally, a method of setting the stage and creating a safe learning environment should always be considered and planned during the development stages. This conversation is typically referred to as the “pre-brief” and serves as an introduction to the simulation for learners. Aside from setting the tone and establishing a safe learning environment, it also helps to garner “buy-in” to the simulation experience and to promote the suspension of disbelief.

Clarify expectations

Clarify the objectives, environment, roles, expectations, and confidential nature of the entire process. This gives learners a certain sense of control and can make them more likely to engage.

Establish a “fiction contract”

Acknowledge the limitations of the mannequin and the scenario design. Convey that the quality of the learning experience is partially dependent on the learner’s willingness to participate and seek a voluntary commitment from the learners to act as if everything is real.

Attend to logistic details

Acknowledge the timing of the exercise, components involved, and recognize that the learners may have other competing duties.

Commit to psychological safety

Express concern and declare a commitment to maintaining psychological safety throughout all portions of the exercise. Convey the importance of the learner’s perspective.

Sample Template

The following link provides a great example of a very logically organized and thorough template for designing a high-fidelity simulation.

Children’s of Alabama Pediatric Simulation Center – Scenario Template Guide

https://www.uab.edu/simulation/images/Scenario_Template_GUIDE_COA_logo_ver_01.02_Sept192014.pdf

References

Harrington DW, Simon LV. Designing a Simulation Scenario. In: StatPearls. Treasure Island (FL): StatPearls Publishing; October 1, 2021.

Rudolph JW, Raemer DB, Simon R. Establishing a safe container for learning in simulation: the role of the presimulation briefing. Simul Healthc. 2014 Dec;9(6):339-49.

So HY, Chen PP, Wong GKC, Chan TTN. Simulation in Medical Education. Journal of the Royal College of Physicians of Edinburgh. 2019;49(1):52-57.