Simulation Center
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Simulation Center Last Review Date: Scenario Name: Author: Concept(s): Content Expert Reviewer: Disease(s): Learner Group: ie: Nursing, RC, RD, Resident Course Number(s): Main Focus/Desired Learner Take Aways 1 What are the main points of the scenario 2 3 4 Scenario Synopsis Brief description of what the scenario is about & what is to be accomplished.
Facilitator Information Outcomes/Performance Measures/Learning Objectives 1 Cognitive List concrete, measurable, easily definable objectives. The number of objectives can vary based on the simulation. 2 3 4 5 6 Behavioral 7 8 9 10 11 Technical 12 13 14 15 Learner Roles and Staging Role Timing Learner #1 When do the learners come into the scenario? Learner #2 Learner #3 Confederate Roles and Scripting Role Tone Timing Lines/Comments Confederate When do the #1 confederates come into the scenario? Confederate #2 Confederate #3 Imbedded Challenges 1 Desired challenges, but be careful that challenges 4 are not distracters from the objectives. 2 5 3 6
4/7/2018 Name of Scenario 1 *Template Adapted from Medical Simulation Design, Inc.
Simulation Center
Learner Information – Faculty may choose not to provide learners with pre-simulation prep materials. Patient demographics and a “report to learners” should be provided just prior to start of the simulation. Patient Name: Allergies: Weight: Age: Code Status: Height: Gender: Major Support: Diagnosis
History of Present Illness
Past Medical History/Surgical History
Current Medications
Significant Lab Values/Diagnostics
Social History
Facilitator Report to Primary Learner(s) to Start Scenario
Pre Simulation Learner Prep Learning Outcomes/Objectives (Faculty may choose not to provide to learners as part of pre-simulation prep)
Lecture
Readings
Media
Websites
Other
4/7/2018 Name of Scenario 2 *Template Adapted from Medical Simulation Design, Inc.
Simulation Center
Sim Tech Staging Information Manikin/Standardized Patient Manikin/Standardized Patient Gender: Clothing: Type: Position: Moulage:
Setup Ready for Learner Use Environment
Safety
Hospital Equipment
IV
Medications
Labs/Xrays
Chart Records
Other
4/7/2018 Name of Scenario 3 *Template Adapted from Medical Simulation Design, Inc.
Simulation Center Physician Orders
PATIENT’S NAME: ______ALLERGIES: ______
Date Time Order Signature
Admitting Diagnosis: Vital Signs:
Diet:
Activity:
Diagnostic Tests:
Medications:
IV Therapy:
Treatments:
4/7/2018 Name of Scenario 4 *Template Adapted from Medical Simulation Design, Inc.
Simulation Center
Sim Tech Scenario Progression Information Manikin Actions Desired Learner Actions Prompts 0-5 Minutes HR: R: BP: Temp: SPO2: Auscultation Sounds Lungs: Heart: Bowel: Manikin Vocals Mental Status: Vocal Examples:
Other:
5-10 Minutes HR: R: BP: Temp: SPO2: Auscultation Sounds Lungs: Heart: Bowel: Manikin Vocals Mental Status: Vocal Examples:
Other:
10-15 Minutes HR: R: BP: Temp: SPO2: Auscultation Sounds Lungs: Heart: Bowel: Manikin Vocals Mental Status: Vocal Examples:
Other: 4/7/2018 Name of Scenario 5 *Template Adapted from Medical Simulation Design, Inc.
Simulation Center
If/Then Table for Events IF Cardiac Respiratory Diagnostics Other 1 What will happen with the manikin/other if learners provide an intervention
2
3
4
4/7/2018 Name of Scenario 6 *Template Adapted from Medical Simulation Design, Inc.
Simulation Center
Debriefer Information Outcomes/Performance Measures/Objectives Debriefing Prompt Opening Initial group discussion/facilitation How do you think things went? Can someone give me a quick summary of the scenario? What did you see? How was that?
Cognitive Objectives come from the first page under “Facilitator Information”
Behavioral
Technical
Closing Wrap up group discussion What would you do differently next time? What are some things from this experience that will stick with you? Any additional questions?
4/7/2018 Name of Scenario 7 *Template Adapted from Medical Simulation Design, Inc.
Simulation Center
Role Cards
Role Cues
Role Cues
Role Cues
4/7/2018 Name of Scenario 8 *Template Adapted from Medical Simulation Design, Inc.