By: Tonya Schneidereith
The International Nursing Association for Clinical Simulation and Learning (INACSL) has published eight Standards of Best Practice: SimulationSM. These standards were reviewed by multiple health care organizations and, although they originated through a nursing organization, reflect evidence-based best practices that should be included in health care simulations, regardless of the discipline.
The focus of this blog is the Standard of Best Practice: SimulationSM: Facilitation, specifically Criterion 1 (INACSL Standards Committee, 2016). This criterion reads that a facilitator must have specific skills and knowledge of simulation pedagogy in order to be effective. This means that the facilitator should have foundational knowledge gained through formal coursework, targeted work with an experienced mentor, and from participation in faculty development. This is extremely important. We know that consequences of not following this standard include impaired student engagement and decreased opportunities to meet objectives (INACSL Standards Committee, 2016). It is also understood that a lack of thorough training in the use of simulation can be a barrier to full implementation (Adamson. 2010).
There are multiple ways to acquire foundational knowledge through simulation organizations, such as INACSL, the Society for Simulation in Healthcare (SSH), and the National League for Nursing (NLN). However, not all faculty and staff have the financial resources to join these organizations or to attend expensive conferences (Hallmark, 2015). To circumvent some of these issues, and to provide more affordable solutions, statewide alliances have been formed in six states – California, Florida, Maryland, Oregon, Tennessee, and Virginia.
The Bay Area Simulation Collaborative Model has four levels of faculty development and follows a Novice to Expert framework (Waxman, 2016; Waxman, Nichols, O’Leary-Kelley, & Miller, 2011; Waxman & Telles, 2009). Level 1 includes basic technical skills; Level 2 contains simulation methodology; Level 3 involves an apprenticeship; and Level 4 creates sustainability through a train-the-trainer model for Levels 1 and 2.
The Maryland Clinical Simulation Resource Consortium (MCSRC) also has a scaffolded approach for faculty development, where faculty self-identify as Simulation Education Leaders (SEL) 1 – Novice, or SEL 2 – Competent. The curriculum includes foundations, theory, curriculum integration, advanced debriefing, and leadership, among other topics (Beroz et al., 2019). The MCSRC also creates sustainability through a train-the-trainer model.
While these examples of statewide initiatives provide blueprints for faculty development, they vary in content and approach. There is no consistency in what is considered “foundational knowledge” through formal coursework. Should there be a standard?
Another aspect of Criterion 1 is targeted work with an experienced mentor, but what constitutes an “experienced” mentor? The University of Alabama, Birmingham, has a tiered approach to mentoring, with specific requirements to advance through levels of Simulation Expert 1, Simulation Expert 2, and Simulation Expert 3 (Peterson, Watts, Epps, & White, 2017). Mentors must have taken part in the University’s faculty development program and must be Simulation Experts 3. This provides consistency in the knowledge and skills required to provide mentorship. However, this model is unique to this University and not one that has been formally adopted by simulation organizations. Should this be part of a standard?
Finally, Criterion 1 requires participation in ongoing faculty development to strengthen the skill set. What constitutes ongoing faculty development? Who can provide it? Should certification as a Healthcare Simulation Educator (CHSE) be required in order to provide ongoing faculty development? Again, should there be a standard?
As our field is growing exponentially, I wonder if it is time to develop a standard related to faculty development in simulation? Can we standardize the foundational knowledge to include theories, standards of best practice, debriefing frameworks, evaluation, and a clear understanding of the National Council of State Boards of Nursing results and guidelines?
Can we provide recommendations for scaffolding as facilitators gain experience and skill? Should novice facilitators teach only in their areas of content expertise? Should we require CHSE certification after the minimum requirement of two years in simulation?
For advanced facilitators, should there be a recommendation to align the skills of facilitators with the complexity of scenarios? Can we create complex scenarios when there are more highly skilled facilitators? Should we save emotional scenarios for more experienced facilitators? It is also important that simulation organizations provide opportunities to develop knowledge and skills for advanced facilitators. While I appreciate that foundational knowledge is more appropriate for larger numbers of conference attendees, our facilitators are growing in experience and need a place to sharpen their skills, deepen their knowledge, and practice more complex debriefing.
For now, we must identify the essential components of foundational knowledge for simulation facilitators. Otherwise, there will be little consistency and limited opportunity to collect the evidence needed to develop a new Standard of Best Practice. We need to identify how to best provide faculty development that will create a consistent message across all simulation settings and also consider how to provide faculty development opportunities for the advanced simulation educator.
What are your thoughts? Do we need a standard?
Beroz, S., Schneidereith, T., Farina, C. L., Daniels, A., Dawson, L., Watties-Daniels, D., & Sullivan, N. (2019). A statewide curriculum model for teaching simulation education leaders. Nurse Educator, Publish Ahead of Print. doi:10.1097/nne.0000000000000661
Hallmark, B. F. (2015). Faculty development in simulation education. Nursing Clinics of North America, 50, 389-397.
INACSL Standards Committee. (2016). INACSL standards of best practice: SimulationSM: Facilitation. Clinical Simulation in Nursing, 12 (S), S16-S20. doi:10.1016/j.ecns.2016.09.007.
Peterson, D. L., Watts, P. I., Epps, C. A., & White, M. L. (2017). Simulation faculty development: A tiered approach. Simulation in Healthcare, 12(4), 254-259.
Waxman, K. T. (2016). Sustaining a statewide simulation alliance. Clinical Simulation in Nursing, 12(10), 448-452. doi:10.1016/j.ecns.2016.07.001
Waxman, K. T., Nichols, A. A., O’Leary-Kelley, C., & Miller, M. (2011). The evolution of a statewide network: The Bay Area Simulation Collaborative. Simulation in Healthcare, 6(6), 345-351. doi:10.1097/SIH.0b013e31822eaccc
Waxman, K. T., & Telles, C. L. (2009). The use of Benner’s framework in high-fidelity simulation faculty development: The Bay Area Simulation Collaborative Model Clinical Simulation in Nursing, 5, e231-235.