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Frequently Asked Questions

It’s important to ask the right questions when using the SimLEARN website site to learn more about simulation in healthcare. So we’ve separated the answers to commonly asked SimLEARN questions into sections. For in-depth information about specific topics, please review the appropriate section of this website.

If you don’t see your question here, please let us know or go to our Contact Us page for more options.

General questions simulation and SimLEARN

1.   Virtual Patient: What is a "virtual patient"?

"A working definition of a virtual patient is: an interactive computer simulation of real life clinical scenarios for the purposes of medical training, education, or assessment. Users may be learners, teachers, or examiners."

Source: Ellway, R. Candler, C, Greene, P and Smothers, V. MedBiquitous Virtual Patient Working Group (with additional input from the MedBiquitous Technical Steering Group. "An Architectural Model for MedBiquitous Virtual Patients, Draft White Paper, September 11, 2006

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2.   Standardized Patient: What is a standardized patient?

"The Simulated/Standardized Patient (SP) is a person who has been carefully coached to simulate an actual patient so accurately that the simulation cannot be detected by a skilled clinician. In performing the simulation, the SP presents the gestalt of the patient being simulated; not just the history, but the body language, the physical findings, and the emotional and personality characteristics as well."

From HS Barrows Simulated (Standardized) Patients and Other Human Simulations, 1987 Source: aspeducators.org (Website of the Association of Standardized Patient Educators)

"In the health and medical sciences, SPs are used to provide a safe and supportive environment conducive for learning or for standardized assessment. SPs can serve as practice models, or participate in sophisticated assessment and feedback of one's abilities or services. The use of simulated scenarios involving humans is rapidly expanding to meet the needs of many high-risk service fields outside of human health care."

Source: Gayle Gliva-McConvey, BA, Director, Theresa A. Thomas Professional Skills Center, Chair, Standards of Practice Committee Eastern Virginia Medical School.

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3.   Mannequins: What is the difference between high fidelity and low fidelity mannequins?

Industry typically defines human simulators as low, intermediate or high fidelity. The functionality of the mannequin increases along a spectrum from low to high fidelity.

High fidelity mannequins body or part of a body to physically represent the patient, and have physiologic and pharmacologic models that direct real time computer programmed autonomous reactions to interventions and therapies.

Typical high fidelity functions being:

  1. Pupils that automatically dilate and constrict in response to light
  2. Thumb twitch in response to a peripheral nerve stimulator
  3. Automatic recognition and response to administered drugs and drug dosages
  4. Variable lung compliance and airways resistance
  5. Automatic response to needle decompression of a tension pneumothorax, chest tube drainage and pericardiocentesis
  6. Automatic control of urine output

(Source: Meti.com)

Intermediate fidelity or instructor-driven partial or full body mannequins may interact with the user in limited ways, but the bulk of responses are created by the instructor through computer controls.

Low fidelity mannequins can be used effectively for preliminary instruction and do not have autonomous reactions or computer controls.

A number of studies have been published comparing high and low fidelity mannequins for clinical performance training and assessment. Results from these studies are mixed based on the scenario.

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4.   Integrator: What is an "integrator"?

Typically, the integrators capture video, simulator log files, session annotations, and evaluations. Integration technology is used to centralize and automate the recoding and management of simulation learning sessions.

Most integrators:

  1. record multiple feeds digitally
  2. handle instructor annotation and support debriefings
  3. integrate with multiple types of simulators
  4. build searchable participant portfolios automatically to support learning management records

Some integrators provide tools for scenario and checklist creation and generate multiple types of usage, session and aggregate reports.

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5.   Value: What is the value of clinical simulation?

The major advantages of learning skills in a simulated environment are that each procedure can be practiced repeatedly until the proficiency has been achieved. Most importantly, because the procedure is performed using simulated, virtual, or standardized patients, no real clinical harm is done when the user has a procedural or judgmental error.

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6.   Getting Started Now: Our medical center wants to get started in clinical simulation right now. Where can I go now to learn the techniques of clinical simulation education?

Many academic and non-academic organizations offer training in clinical simulation education principles and simulation technologies. You may wish to research options through the Society for Simulation in Healthcare, contacting your affiliate, contacting key accreditation organizations (e.g., ACS, ASA, etc.) or other colleagues involved in simulation education and training.

The key question to ask yourself is whether you are interested in the key principles of simulation education or whether you are more interested in principles in training of a particular type of scenario. Certainly starting with the principles of clinical simulation training would be foundational to your program. The particular scenario specialization at your medical center should then be driven by your clinical education priorities in which simulation is a preferred education modality.

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7.  If you're a vendor: I am a vendor who would like to talk with SimLEARN leadership about our new technology and how it would benefit the program. Who should I speak to?

You should send an email outlining your interests and providing any marketing information you have available to VASimLEARNGeneralInformation@va.gov. SimLEARN staff will contact you for further information. Requests for appointments can be sent to this same address, but should be accompanied with detailed information on the product or services.

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8.  SimLEARN representative: Who is my VISN SimLEARN champion? What is their role?

SimLEARN champions have been identified by each VISN. Attached is a list of those names and their contact information.

Their role is to:

  • Champions will serve as leaders, coaches, and expert consultants in their respective networks for simulation training, education and research to ensure local success in simulation education and training.
  • Champions will collaborate with the SimLEARN program to advise on the translation of nationally developed simulation curricula to the local level.
  • Champions will serve as the central points of contact between the SimLEARN program and the VISN and its facilities to actively communicate simulation information from the national program office to the appropriate subject matter experts in the field.

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9.  How to be a simulation learner or instructor - Experience level: Why is information for different experience levels mixed together in these pages?

So much of simulation in healthcare training is about learning in context. So simLEARN feels it's important to place simulation information and resources in context of related information. Instead of isolating information based on who you are or what you do, the SimLEARN website places resources and information with related materials so that context is maintained.

In addition, by providing users with related, contextual information, SimLEARN gives them the opportunity to explore other simulation experiences and resources that they may not have known about.

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10.  Old information: Where is the information that used to appear in the "How to be a Simulation Learner" and "How to be a Simulation Instructor" section?

Two things may have occurred. One, this information may be archived in the SimLEARN Library section. Two, the SimLEARN subject matter experts may have either incorporated it with other similar information or they may have determined that it was outdated or no longer relevant.

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11.  Debriefing a clinical simulation: What is the intent of the debriefing?

Debriefing clinical simulation experiences serves to explore, analyze and synthesize learners' actions, thought processes, emotional states and other information to improve performance in real situations. Optimal debriefing maintains psychological safety and gives accurate evaluative feedback. It is characterized by providing feedback on any observed mismatch between actual and desired performance (advocacy); investigating the basis for the mismatch (inquiry); and helping to close the performance gap through discussion and didactics.

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12.  Curriculum for individual practitioners and for team-based learning - Teams vs. individuals: Why are there two distinct sections for curriculum?

Simulation in healthcare training is about learning in context. Sometimes the training deals with how healthcare practitioners work with others. Sometimes simulation training is focused on the context of a specific discipline. SimLEARN provides curricula for these two broad categories of context.

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13.  Job is not listed: What do I do if my role or position is not listed in Profession-Specific Learning?

It may be that your role as a healthcare practitioner is covered in a related curricula. Or the specific curriculum you're looking for is still under development. If your feel the information you are looking for is not represented in the SimLEARN website, please contact us.

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14.  Crisis Resource Management: Why teach Crisis Resource Management and team training?

Emergent, complex medical events are nearly always managed by multidisciplinary teams. Typically problems stem from human factors errors such as failure to plan, failure to cross monitor actions of team members, poorly designed work processes, fixation, etc. During a crisis, care givers' physiology changes and their ability to process information is affected. Deliberate practice is critical to the development of highly functioning teams and optimizing clinical outcomes.

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15.  Standardized national curricula: Will SimLEARN develop simulation curricula for field use? Will these curricula be mandated?

SimLEARN will develop standardized national curricula for VA use in prioritized clinical topic areas. The curricula will not be mandated, but the field will encouraged to use the curricula to drive evidence based practice.

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16.  Topics in curricula: How will the priorities for clinical topics be established?

 The priorities will be driven by consideration of a number of factors, including (but not limited to):

  • opportunities for improvements in high volume or high risk procedures
  • opportunities for synergies with nationally recognized patient safety initiatives (e.g., 5 million lives campaign)
  • the need for curricula to address the unique clinical needs of veterans (e.g., PTSD, exposure related diagnoses, compensation and pension examinations)
  • the development of new technologies or procedures that would be more effectively implemented with system wide simulation training
  • the ubiquitous need for improved team communications in all types of clinical settings

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17.  Simulation modalities: What type of simulation modalities will be used?

Simulation modalities typically considered to support curricula include:

  • standardized patients
  • virtual patients
  • virtual environments
  • mannequin based training
  • computer simulations (e.g., typically, but not always, for process modeling)
  • task trainers

The modality used will depend on the clinical topic addressed in the curricula. The intent is to use the most appropriate and effective modality and may actually include a blend of simulation and non-simulation approaches.

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18.  Your clinical priorities: How can I make sure the our clinical priorities are considered as a priority for the development of national curricula?

 Your input is welcome and invited. This can be as simple as a thoughtful email to (insert hyperlink). Note that the most helpful recommendations are those that include information about:

  • The evidence or data that supports the need for national curricula (e.g., quality gap as documented by clinical measures or external evidence from the clinical literature; need for training in a condition unique to veterans; etc.)
  • A short discussion of why you think simulation is the most appropriate modality for addressing the gap
  • A short discussion of how the organization could evaluate the success of the intervention
  • Information about others that have expressed interest or support (e.g., is this a local interest? Is the interest VISN-wide? Does the Network Director support this request?)

 This information will be reviewed by the SimLEARN Steering Committee and SimLEARN staff as they establish priorities for the program.

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19.  Schedule for curricula: How soon can we expect to see national curricula released to the field from SimLEARN?

A curricula development cycle, with prioritized topics, will be established and published after development of the strategic plan in FY 2010. The opportunities will be numerous, the challenge will be in the prioritization process. This is why stakeholder involvement is critical to the process.

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20.  General questions about this website - Accessibility: How does the SimLEARN website comply with the guidelines of the Americans with Disabilities Act?

The designers and developers of the SimLEARN comply with Section 508 guidelines when drafting the pages within this site. All pages are tested in-house using technology and human assessment. In addition, the SimLEARN website follows VA Directive 6102. This directive provides procedures and interaction guidelines for internet and intranet sites for which the VA is responsible.

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21.  Contributing to web pages: If I have information or a best practice that I think would fit on the SimLEARN website, where do I send it?

Thank you for your interest in helping to grow the SimLEARN website. Please contact us through our General Information email. Other contact information is available on the Contact Us page.

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22.  Edits & errors: Who do I alert if I find an error in the text or a technical problem with the SimLEARN website?

Thank you for alerting us to the problem. Please contact our SimLEARN Webmaster. Other contact information is available on the Contact Us page.

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23.  Extra VA information: Why does this site feature non-simulation VA links and information?

The Department of Veterans Affairs wants to ensure consistency across all of its websites. It has instituted a template for interface, links, resources, and technical aspects which are common to all VA internet web pages. VA policy requires the use of this web page template to maintain this consistency.

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24.  Updates: Can I be alerted when new content, articles or information appears on the SimLEARN website?

Yes. Several of our pages that have information which changes frequently. These pages give you the option to receive RSS updates. Look for the orange RSS icon for more information on how to activate this useful feature.

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25.  Website availability: Is this website available outside of the VA firewall?

Yes. Though some of the resources on the site are naturally VA-specific, the main body of information is available to everyone.

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If you don’t see your question here, please let us know or go to our Contact Us page for more options.