<p> 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.</p><p>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</p><p>4/7/2018 Name of Scenario 1 *Template Adapted from Medical Simulation Design, Inc.</p><p>Simulation Center</p><p>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 </p><p>History of Present Illness</p><p>Past Medical History/Surgical History</p><p>Current Medications</p><p>Significant Lab Values/Diagnostics</p><p>Social History</p><p>Facilitator Report to Primary Learner(s) to Start Scenario</p><p>Pre Simulation Learner Prep Learning Outcomes/Objectives (Faculty may choose not to provide to learners as part of pre-simulation prep)</p><p>Lecture</p><p>Readings</p><p>Media</p><p>Websites</p><p>Other</p><p>4/7/2018 Name of Scenario 2 *Template Adapted from Medical Simulation Design, Inc.</p><p>Simulation Center</p><p>Sim Tech Staging Information Manikin/Standardized Patient Manikin/Standardized Patient Gender: Clothing: Type: Position: Moulage:</p><p>Setup Ready for Learner Use Environment</p><p>Safety</p><p>Hospital Equipment</p><p>IV</p><p>Medications</p><p>Labs/Xrays</p><p>Chart Records</p><p>Other</p><p>4/7/2018 Name of Scenario 3 *Template Adapted from Medical Simulation Design, Inc.</p><p>Simulation Center Physician Orders </p><p>PATIENT’S NAME: ______ALLERGIES: ______</p><p>Date Time Order Signature</p><p>Admitting Diagnosis: Vital Signs: </p><p>Diet: </p><p>Activity: </p><p>Diagnostic Tests: </p><p>Medications: </p><p>IV Therapy: </p><p>Treatments: </p><p>4/7/2018 Name of Scenario 4 *Template Adapted from Medical Simulation Design, Inc.</p><p>Simulation Center</p><p>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:</p><p>Other: </p><p>5-10 Minutes HR: R: BP: Temp: SPO2: Auscultation Sounds Lungs: Heart: Bowel: Manikin Vocals Mental Status: Vocal Examples:</p><p>Other: </p><p>10-15 Minutes HR: R: BP: Temp: SPO2: Auscultation Sounds Lungs: Heart: Bowel: Manikin Vocals Mental Status: Vocal Examples:</p><p>Other: 4/7/2018 Name of Scenario 5 *Template Adapted from Medical Simulation Design, Inc.</p><p>Simulation Center</p><p>If/Then Table for Events IF Cardiac Respiratory Diagnostics Other 1 What will happen with the manikin/other if learners provide an intervention</p><p>2</p><p>3</p><p>4</p><p>4/7/2018 Name of Scenario 6 *Template Adapted from Medical Simulation Design, Inc.</p><p>Simulation Center</p><p>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?</p><p>Cognitive Objectives come from the first page under “Facilitator Information”</p><p>Behavioral</p><p>Technical</p><p>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?</p><p>4/7/2018 Name of Scenario 7 *Template Adapted from Medical Simulation Design, Inc.</p><p>Simulation Center</p><p>Role Cards</p><p>Role Cues  </p><p>Role Cues  </p><p>Role Cues  </p><p>4/7/2018 Name of Scenario 8 *Template Adapted from Medical Simulation Design, Inc.</p>