By: Sue Forneris and Beth Hallmark with Susan Justice and Jenny Roye
Every good story has elements that capture our attention, pull us in, help us to relate. Meet Jenny Roye and Susan Justice, nursing simulation educators from the University of Texas at Arlington (UTA). Jenny is the assistant dean of simulation and technology and oversees simulation at both UTA and the UTA Smart Hospital. Susan is lead faculty, responsible for the UTA prelicensure psych mental health curriculum, campus based and online. Jenny, Susan, and their students are the main characters in this story about tapping into experiential learning using synchronous simulation.
The story begins in Susan’s office with a long-standing conversation focused on how to better enhance students’ learning experiences in addressing the community health care needs of the area’s vulnerable mental health population. Although meeting this population’s unique care needs is critical – as is the learner’s ability to develop strong communication and assessment skills – students often struggle with learning encounters. The plan is to develop experiential learning in a safe container to provide students with opportunities to experience varied mental health conditions and help them transition into a real-life community mental health care clinical.
The plot unfolds as Susan, with her expertise and years of caring for vulnerable populations, begins developing simulated patient roles with detailed scripts creating unique stories for 10 varied mental health diagnoses (schizophrenia, depression, eating disorder, obsessive compulsive disorder, addiction, post-traumatic stress disorder, anxiety, bipolar, borderline, dissociative identity disorder). The scripts become progressively standardized so that each student has the same experience. The goal is to help students understand the important relational and communication needs essential in working with and caring for these individuals. Susan works closely with the simulated patients (SPs) to train them to carry out the roles and nuances of these representative patients. It is important that SPs appropriately respond to students’ inquiry as they work through communication and health assessments across this vulnerable population.
The plot twists…
Over a condensed period of time, Susan needs to operationalize the opportunity for each student to have multiple diagnostic learning encounters, working across multiple patients. This means tight simulation rotation logistics to include a reflective debrief. Susan works closely with Jenny and the Smart Hospital team to operationalize a simulation experience in which each student rotates through short 1:1 simulation encounters with each SP. Student learning outcomes focus on communication and mental health assessment.
Encounters last approximately 12 minutes followed by a very short 1:1 debrief for each student with a clinical faculty member to unpack the learning experience. Rotations are carefully timed and monitored with clinical faculty observing each student encounter. Susan shares students’ reaction to this simulated learning encounter. “This is an incredible experience” is typical. Susan further shares the comments of students who have progressed to live clinical rotations: “I was able to feel comfortable and focused working with these patients. I knew how to carry out my mental health assessment.”
The plot thickens…
Pleased with the success of these simulated experiences for on-campus students, Susan is concerned about meeting the learning needs of students who are distance learners. How will she provide online students with the same experiential learning opportunity? The solution is … synchronous simulation!
Using the same simulated patient stories and the same SPs, Susan again works closely with Jenny and the Smart Hospital team to arrange a synchronous telehealth simulation experience for distance learners focused on the same student learning outcomes: communication and mental health assessment. Using a distance learning computer platform, virtual patient rooms are set up for SP encounters. Students are given the online link into a virtual room to meet with the SP. After the encounter, the student logs out of the room and logs into a 1:1 debrief room to debrief the encounter 1:1 with a clinical faculty member. Following this debrief, the student is virtually linked to the next SP encounter, and so forth.
Virtual rotations also require careful timing and monitoring by faculty, with logistics the same as for working through a complete experience with an average group of approximately 35 students. After completing the sequence of virtual encounters, students meet in a synchronous virtual classroom for a reflective experience. SPs also engage in this discussion, providing some overall feedback.
The end of the story…
Susan reports that feedback given by online students mirrors the feedback of students who take part in face-to-face simulations. Synchronous simulation enhances the comfort level of students and prepares them for the actual clinical environment, approaching and interacting with patients. For this story, the overall experiential nature of the synchronous simulation makes a difference in shortening students’ response time to develop the skill set needed for live clinical encounters.
Epilogue to the story – lessons learned:
- Evaluation tools for both SPs and students are essential. Clinical instructors need to monitor each encounter with their students using a clinical evaluation tool. Students need this same tool to self-report their learning outcomes. Together students and instructors can then compare and discuss the learning encounters in their 1:1 debrief.
- The clinical instructor should be able to hear what is going on with each simulated patient encounter to redirect with SP cues and assist the student in staying on track to achieve learning outcomes.
- The more time SPs prep, the higher their comfort level and ease with thinking on their feet. SPs require close solid coaching before and during the simulation. This includes clear patient histories and synopses. Prep may need to include video examples of the different diagnostic types for better understanding of patient dynamics.
- Technology is an added dimension. Challenges and resources with technology and a smart hospital require advance “tech checks” to ensure that all computers are working properly.
- Planning, planning, planning – good written instructions for both SPs and students in understanding the flow are imperative.
- Prebriefing is a must – students need to be prepared, engaged and understand the safe container.