Template for Simulation Patient Design

Template for Simulation Patient Design

Developed by Jeffrey M. Taekman, M.D.

Duke University

Made available through a Creative Commons License

Template for Simulation Patient Design

Jeffrey M. Taekman, M.D.

Director, Human Simulation and Patient Safety Center

Duke University Medical Center

Last Modified: December 2, 2003

Introduction

This document is written to help smooth the development of a patient / scenario for our human patient simulator. “Story-boarding” is a common practice in movie making and computer multimedia design. Story boarding involves scripting out on paper what you would like the final product to look like. We will use the story-boarding process in simulation module design and development.

We have found this process to be quite important in the simulation development. The following form was designed to help in the storyboarding process.

Template

The first component of the template is the “Case Information”. This includes the educational rationale behind the simulation module, the reason for the simulation module, the objectives, the target audience, the developer’s names, the equipment and support components needed, etc.

The next part of the template, “Equipment and Supporting Objects” requires you to think through the equipment and multimedia elements needed in support of the simulation.

The next component of the template is the “Simulation Scenario Set-Up”. This is the information given to the learner in the debrief room (or at bedside) before they begin the simulation. On the latter part of this page, one should include information destined specifically for the facilitator, but not to be viewed by the learner.

There are actually two components to any simulation: the patient and the scenario. For instance we may run a Malignant Hyperthermia scenario on a “healthy” patient or a patient with severe co-morbidity.

The scenario represents how the simulation plays out over time. Each scenario should be broken down into mini-scenarios (called “states”). Each state represents a progression of the simulation. Stepping from state to state is caused by a “trigger.”. Triggers may be time, drugs, or specific learner actions. For instance, our malignant hyperthermia scenario might be broken down into baseline, mild, moderate, severe, and resolution states. Use of volatile agent in the simulation would “trigger” the mild MH state. Time might cause the trigger between mild, moderate, and severe MH. Finally, the use of Dantrolene in the simulation would trigger resolution state. Failure to give Dantrolene would strand the simulation in the “severe” MH state which would eventually lead to “death”.

The next component is the “Patient Background Information and Baseline Simulation State”. This should follow a traditional H and P format. The baseline state is the state the learner will find the simulation in at the beginning of the exercise. The baseline state for your simulation is developed by manipulating the simulator’s “perfect” 70kg, healthy physiology to resemble the patient you envision. You will need to also write down the “trigger” to move to the next state.

The next component is “Scenario DevelopmentStates 2-?”. For each state you should write down what you would like the learner to do, what happens to the patient (including vital sign changes, lab values, etc) and what the trigger would be to move to the next state. The table on the “Clinical Course for Scenario” page may be used in lieu of these pages if you prefer.

The final component of the template is the “Parameter Adjustment Form”. This should not be filled in unless you have scripted many cases. These tables will be used in the simulator programming process to keep track of the adjustments made to the simulator to achieve the “look” of the desired patient.

Case Information

Section 1: Demographics

Case Title:

Patient Name:

Scenario Name:

Simulation Developer(s):

Date(s) of Development:

Appropriate for following learning groups (circle all that apply)

Faculty:CME

Residents:(PGY)1234567

Specialties: AnesthesiologyNurse AnesthesiaSurgery

Critical CareEmergency MedicineObstetrics

Medical Students (yr): 1234

Nurse Anesthesia Faculty:CEU

Nursing Students (yr): 12

Other:______

Section 2: Curricular Information

Educational Rationale:

Learning Objectives: (ACGME Core Competencies: Medical knowledge (mk), Patient care (pc), Practice-based learning and improvement (pli), Interpersonal and communication skills (cs), Professionalism (pr), Systems-based practice (sbp))

• objective 1
• objective 2
• etc

Guided Study Questions:

• question 1
• question 2
• etc

References used (included PubMed ID when possible):

• reference 1
• reference 2
• etc

Didactics:

• powerpoint slide set
• web site
• etc

Assessment Instruments:

• Instrument name

Section 3: Preparation

Monitors Required:

Non-Invasive BP Cuff
Arterial Line
CVP
PA Catheter
5 lead EKG
Temperature Probe
Pulse Oximeter
Capnograph
BIS

Other equipment required:

Anesthesia Machine / ETT
Pumps / LMA
Brochoscope / Laryngoscope
Defibrillator
Hotline
Nerve Stimulator
Echo Machine and Probe

Supporting Files (cxr, ekg echo, assessment, handouts, etc)

1. file 1
2. file 2
3. etc

Time Duration

Set-up
Preparation
Simulation
Debrief

Case Stem

Case Stem (one to two paragraphs on pertinent patient and scenario information-this should be the stem for the learner and should include location, physician/help availability, family present, etc.):

Background and briefing information for Facilitator/coordinator’s eyes only:

Patient Data Background and Baseline State

Patient History (should follow standard H and P format):

Review of Systems:

CNS:

Cardiovascular:

Pulmonary:

Renal / Hepatic:

Endocrine:

Heme/Coag:

Current Medications and Allergies:

Physical Examination:

General:

Weight, Height:

Vital Signs:

Airway:

Lungs:

Heart:

Laboratory, Radiology, and other relevant studies:

HCT:

CXR:

EKG

Baseline Simulator State:What underlying alterations in physiology would this patient have when compared to “perfect” 70 kg man or woman? Include target numbers. This will comprise your baseline state:

Vitals:

Neuro:

Respiratory:

Cardiovascular:

Gastrointestinal:

Genitourinary:

Metabolic:

Environmental:

Template for Simulation Patient Design

Developed by Jeffrey M. Taekman, M.D.

Duke University

Made available through a Creative Commons License

State

/ Patient Status / Student learning outcomes or actions desired and trigger to move to next state
1. BASELINE / Learner Actions: / Operator:
Teaching Points:
Trigger:
2. / Learner Actions: / Operator:
Teaching Points:
Trigger:
3. / Learner Actions: / Operator:
Teaching Points:
Trigger:
4. / Learner Actions: / Operator:
Teaching Points:
Trigger: