Class presentation on

SIMULATION
AS A METHOD OF
TEACHING

SUBMITTED TO SUBMITTED BY
MADAME DEBJANI MUKHERJEE AYANTIKA BHOWMIK
NURSE EDUCATOR [Link]. NURSING,1st YR
TATA MEDICAL CENTER SESSION: 2024-2026
SUBMITTED ON:10.12.2024 TATA MEDICAL CENTER

SIMULATED TEACHING
INTRODUCTION: Simulation is a role playing in which the process of teaching is
enacted artificially and an effort is made to practice some important skill of communication
through this. Under this, the student-teacher and the students simulate a particular role and
try to develop an identity with the actual classroom environment. Thus, the whole simulated
teaching program becomes training in role perception and role playing.

Definition of Simulation:
1. R Wynn (1964): "Simulation is an accurate representation of realistic situation".
2. WR Fritz (1965): "Simulation may be considered as a dynamic implementation of model
representing a physical or a mathematical system".
3. DR Cruickshank (1966): "Simulation is the creation of realistic games to be played by
participants in order to provide them with like problem-solving experiences related to
their present or future work".
Definition of Simulation in Education: The International Dictionary of Education defines the
term as, "teaching technique used particularly in management education and training in
which a 'real life situation' and values are simulated by 'substitutes' displaying similar
characteristics". It also means "Techniques in teacher education in which students act out or
role play teaching situations in an attempt to make 'theory' more 'practically oriented and
realistic."

Objectives of simulation:
The objectives of simulation in nursing education and healthcare can be categorized into
several areas:

Educational Objectives
1. Knowledge acquisition: Reinforce theoretical concepts and principles.
2. Skill development: Develop and refine clinical skills, such as assessment, medication
administration, and wound care.
3. Critical thinking and problem-solving: Encourage critical thinking, decision-making, and
problem-solving in a safe and controlled environment.
4. Communication and teamwork: Foster effective communication, collaboration, and
teamwork among healthcare professionals.

Clinical Objectives
1. Patient safety: Improve patient safety by reducing medical errors and promoting evidence-
based practice.
2. Clinical judgement: Enhance clinical judgment and decision-making skills in complex and
dynamic patient care scenarios.
3. Risk management: Identify and manage potential risks and complications in patient care.
4. Quality improvement: Promote quality improvement and patient-centred care.

Research and Evaluation Objectives

1. Research and development: Test new equipment, technologies, and procedures in a
simulated environment.
2. Evaluation and assessment: Assess the effectiveness of simulation-based education and
training programs.
3. Quality assurance: Ensure that simulation-based education meets established standards
and guidelines.

Operational Objectives
1. Cost-effectiveness: Reduce costs associated with traditional training methods, such as
equipment maintenance and patient actor fees.
2. Increased efficiency: Improve the efficiency of training programs by allowing for repeated
practice and scenario customization.
3. Flexibility and accessibility: Provide flexible and accessible training opportunities for
healthcare professionals with varying schedules and locations.

TYPES OF SIMULATION:
Norman has identified the following types of simulation.
1. Identity simulation: this simulation focuses on simulating the behaviour of a specific
system or process.
2. Replication simulation: this simulation focuses on simulating the underlying mechanisms
and processes that govern a system’s behaviour.
3. Laboratory simulation: In this replication is employed in the laboratory, with features of
the real system with the use of a computer.
4. Computer simulation: This type of simulation is an abstract representation of the real
system with the use of a computer.
5. Analytical simulation: This type of simulation uses mathematical modes and attempts to
get solution by analytical means.
6. Simulation can occur on video tape in which learner respond to specific question related
to the content.
7. Simulation can be live, in which the learner has specified roles with objective outcomes.
For example, sociodrama, role playing, etc.

CHARACTERISTICS OF SIMULATED TEACHING

Simulated teaching, also known as simulation-based education, has several key
characteristics that distinguish it from traditional teaching methods. Here are some of the
main characteristics of simulated teaching:
1. Realistic and Immersive: Simulated teaching environments are designed to mimic real-
world scenarios, making the learning experience more engaging and immersive.
2. Controlled and Safe: Simulation environments allow for controlled and safe learning
experiences, reducing the risk of harm to patients, students, or equipment.
3. Interactive and Dynamic: Simulated teaching environments are interactive and dynamic,
allowing students to practice and apply their knowledge and skills in real-time.
4. Customizable and Adaptable: Simulation scenarios can be customized and adapted to
meet the specific learning needs and objectives of students.
5. Repeatability and Replicability: Simulation scenarios can be repeated and replicated,
allowing students to practice and refine their skills multiple times.
6. Debriefing and Feedback: Simulated teaching environments provide opportunities for
debriefing and feedback, allowing students to reflect on their performance and identify
areas for improvement.
7. Multidisciplinary and Collaborative: Simulated teaching environments can be designed to
promote multidisciplinary and collaborative learning, allowing students from different
disciplines to work together and develop teamwork and communication skills.
8. Cost-Effective and Efficient: Simulated teaching environments can be more cost-effective
and efficient than traditional teaching methods, reducing the need for equipment, supplies,
and patient actors.
9. Evidence-Based and Research-Informed: Simulated teaching environments are often
designed based on evidence-based practice and research-informed principles, ensuring that
students learn from the latest research and best practices.
10. Student-Centred and Focused on Learning Outcomes: Simulated teaching environments
are designed to be student-centred and focused on learning outcomes, ensuring that
students achieve the desired knowledge, skills, and attitudes.

Simulation technique/Steps:
Randers recommends the following steps

1. Selecting the role players: A small group of four or five members are selected. They are assigned
different letters in an alphabetic order A, B, C, D, etc. the role assignment is rotated within the group
to give chance to everyone.

2. Selecting and discussing skills: The skills to be practiced are discussed, and topics of conversation
that fit the skills are also suggested.

3. Planning: It has to be considered who will start the conversation, who will stop the interaction.
4. Deciding the procedure of evaluation: The procedure of evaluation, kind of data to be recorded
and the method of recording etc are decided.

5. Conducting practice session: First practice session is conducted and the actor is provided with
feedback on his performances. If necessary, the procedure of the second session is altered in order
to improve the training procedure.

6. Prepared to change the procedure: If need arises, one should be prepared to change the
procedure and the topic and move on to the next skill so as to present a meaningful challenge to
each actor to keep his interest as high as possible.

Stages of simulation
There are the three stages of simulation namely
Brief/Pre-brief
Briefing is a foundational part of the simulation experience that helps to prepare and orient
learners to the simulation experience. It promotes experiential learning. The pre brief also
introduces learners to the concept of simulation, orients them to the simulation
environment equipment and embedded participants. The facilitator discloses learning
objectives of the simulation scenario, establishing a fiction contract (expectation setting for
performance) with learners, providing logistic details about the session, and pledging to
respect the learners. It allows for confidentiality and creates psychologically safe
environment for the learners which will enable to optimize their experience in the
simulation lab.
Scenario
A scenario is an outline or model of the simulated sequences of events that can be used for
an exercise or to support scenario-based training. It can be written as a narrative or depicted
by an event timeline. Simulation scenarios are designed to assess, educate, and help
learners to self-identify gaps in their understanding of material or application of knowledge.
It provides the contest for the simulation based on actual or potential situations and
includes the objectives, target population, description and progress of the situation, action
expected from the students.
Debriefing
"Debriefing is the heart and soul of simulation-based training.’’
post event debriefings in healthcare are defined as an after-event discussion regarding
performance and thought processes of the team during the scenario to promote reflective
learning and improve clinical performance.
It is a facilitated or a guided reflection in the cycle of experiential learning. Debriefing
should be based on the pre-set learning outcome. 80% of learning takes place in this phase.
It should allow for progression to the identified phases of debrief reaction, analysis and
summary. A psychologically safe environment must be established in debriefing stage. It
allows people to share and reflect their feelings, assumptions and opinions. This further
helps in discussing difficult topics.

Stages of debriefing:

REACTIONS ANALYSIS SUMMARY

Clear the air and This is the bulk of the debrief. Review what happened.
guide the initial spending time to understand “what what was discussed and
discussion happened and deeper meaning try to apply it to the
into why it happened.” content.

Question like “so Try to understand the frame of You could say something
how did you feel mind of participants, their mental like” let us identify some
this case went” models. take home points from this
case for future practices.”

Goals of the Debrief

[Link] enable the participants to become aware of their reactions during a crisis.
[Link] help them develop tools for evaluating and analysing.
[Link] affect a positive change in their behaviour

Advantages of Debriefing
[Link] learning point.
[Link] key issues to participant for further dialogue.
[Link] into strategies and processes that lead to good results, not just result themselves.
4. Participants can begin to develop their own evaluative skill for future critical event.
Method of simulation
The following mechanism of simulated teaching as given by JC Aggarwal is given in a
Flowchart below:

Selection of Demonstration
Orientation with
specific skill of lession by
the concept
educator

Follow up for
Formation
further
of groups
modification

Delivering Determining the Assignment of

the lesson procedure & roles of student
technique & teacher

Here are some common methods of simulation:

Physical Simulation Methods

1. Mannequin-based simulation: Uses lifelike mannequins to simulate patient care scenarios.
2. Task trainer simulation: Uses specialized equipment to simulate specific clinical tasks, such
as inserting IV lines or performing surgical procedures.
3. Simulation labs: Dedicated spaces equipped with simulation equipment and technology to
mimic real-world healthcare environments.

Virtual Simulation Methods

1. Virtual reality (VR) simulation: Uses immersive VR technology to simulate patient care
scenarios.
2. Augmented reality (AR) simulation: Overlays virtual information onto real-world
environments to simulate patient care scenarios.
3. Computer-based simulation: Uses software programs to simulate patient care scenarios,
often with interactive elements and decision-making exercises.

Hybrid Simulation Methods

1. Hybrid simulation: Combines physical and virtual simulation elements to create a more
immersive and realistic learning experience.
2. Mixed reality simulation: Combines elements of VR, AR, and physical simulation to create
a highly immersive learning experience.

Live Simulation Methods

1. Standardized patient simulation: Uses trained actors to portray patients in simulated
scenarios.
2. Live simulation drills: Conducts simulated emergency scenarios, such as code blues or
natural disasters, with live participants.

Other Simulation Methods

1. Case study simulation: Uses written or video-based case studies to simulate patient care
scenarios.
2. Gaming simulation: Uses interactive games and simulations to teach healthcare concepts
and skills.
3. Screen-based simulation: Uses interactive software programs or apps to simulate patient
care scenarios

Reasons for the Use of Simulation Technique

NA Fattu (1966) gives the following reasons for the use of simulation:
1. When an environment cannot be duplicated exactly, then it may be made as realistic as
possible.
2. When a process is to be examined systematically, it may yield information through
developing and operating a situation.
3. When a system is too difficult to manage, simulation may suggest a way of breaking it
down into sub-systems. Then it may be noted how the skills and the information required
may be pooled.
4. When a difficult problem is confronted beyond a teacher's ability. Simulation may help
him synthesize and infer a good solution.
5. Cost may be reduced by simulating rather than by alternative forms of experimenting.
6. Simulation may also indicate which variables in a complex operation or system are
important and how they are related to each other.
7. The amount of time accomplished is controllable by the simulator.

Advantages of Simulation
[Link] helps to build confidence in the student-teacher.
2. It bridges the gulf between the theory and practice.
3. It enables the learner to learn directly from experience.
4. It promotes a high level of critical thinking.
5. It develops in the students an understanding of the decision-making process.
6. Role playing enables the individual to empathize with the real-life situations.
7. It provides feedback to the learners on the consequence of actions and decisions made.
8. Simulation technique motivates students by making real-life situations exciting and
interesting.
9. post-simulation analysis enables teachers and learners to assess the realism of the
situation by uncovering misconceptions.

Disadvantages of Simulation
1. The beginner participants may face some difficulty in asking different kinds of questions. A
simple task such as 'open' and 'closed questions may provide a introductory challenge.
2. It is quite possible that during an exercise, the observer may record incorrectly.
3. The most common error in serious skill training is the misconception that adults can play
the role of pupils.
4. Simulation attempts to portray real situations in a simple way and which is very difficult.
5. There is a tendency to use the results of a single simulation as the sole basis of
generalization.
6. Commercially developed simulation games are expensive.

Role of a teacher in simulation

In simulation-based education, the role of a teacher is crucial in facilitating learning,
ensuring student engagement, and promoting effective knowledge transfer. Here are some
key roles of a teacher in simulation:

Pre-Simulation Roles
1. Learning Objectives: Clearly define learning objectives and outcomes for the simulation.
2. Simulation Design: Design the simulation scenario, including the environment, patients,
and equipment.
3. Pre-Briefing: Prepare students for the simulation by providing context, explaining the
scenario, and establishing expectations.

During Simulation Roles

1. Facilitation: Facilitate the simulation, providing guidance and support as needed.
2. Debriefing: Conduct debriefing sessions, encouraging students to reflect on their
experiences and identify areas for improvement.
3. Feedback: Provide constructive feedback to students, highlighting strengths and
weaknesses.

Post-Simulation Roles
1. Debriefing Analysis: Analyse debriefing sessions to identify common themes, areas for
improvement, and best practices.
2. Evaluation: Evaluate student performance, providing feedback and assessing learning
outcomes.
3. Curriculum Development: Use simulation data to inform curriculum development,
ensuring that learning objectives are met.

Additional Roles
1. Mentorship: Provide mentorship and support to students, helping them develop critical
thinking and problem-solving skills.
2. Technical Support: Ensure that simulation equipment and technology are functioning
properly.
3. Safety: Maintain a safe learning environment, ensuring that students are aware of
potential risks and take necessary precautions.
By fulfilling these roles, teachers can create a rich and immersive learning environment,
helping students develop the knowledge, skills, and attitudes necessary for success in their
chosen profession

Conclusion
To conclude it can be said that simulation can be made a powerful tool in solving some of
the problems that hinder effective teaching and it can also impart training of certain skills
which are necessary for teaching and its effectiveness. Needles to mention that simulation
exercises can be improved by a systemic experimentation around it.

Bibliography
1. Sodhi. K. Jaspreet, Comprehensive text book of Nursing Education. New Delhi;
Jaypee;2017. pg. 74-76.
2. R. Pramila, Nursing Communication and Educational technology,jaypee;[Link].276-
278.
3. Munday, Rebecca. Types of Simulation in Nursing education.
Nursejournal.15.11.2022.[Link]
4. Jones, Amy. The role of the teacher in simulation. Clinical simulation in Nursing.
October 2012.[Link]