Simulation offers UMSON students an authentic experience in state-of-the-art facilities to practice in a safe space, preparing them for excellence in the workplace.
Working in health care can be intense, exciting, and emotional. The dramatic moments that occur especially in acute-care settings are regularly chronicled in popular television shows and movies. Yet rarely do nursing students get to participate in the kind of high-stakes cases that have made TV shows such as “ER” and “Grey’s Anatomy” so watchable.
However, students at UMSON do get to play a role in various important care scenarios through simulation, a learner-centered, interactive teaching strategy. Sometimes there’s even a professional actor playing the role of a patient or family member.
The School’s simulation teams, both in Baltimore and the Universities at Shady Grove (USG) in Rockville, Maryland, include 17 staff, clinical educators, and faculty members who create these simulated experiences, including critical events that students may encounter upon graduating into various roles in the workforce.
Clinical educators and faculty use simulation to create realistic learning and testing environments to build confidence and decision-making abilities with an emphasis on patient safety. “Simulation, including the manikin, standardized patients, class-based simulation, and virtual reality, offers an authentic experience for our learners to become more ready for practice as they strive for clinical competence,” says Dawn Mueller-Burke, PhD ’07, MS ’98, CRNP, NNP-BC, assistant professor and chair of UMSON’s taskforce for aligning its curriculum with the American Association of Colleges of Nursing (AACN)’s Essentials, an updated framework for nursing education. The Essentials emphasize competency-based education, or “students demonstrating that they have learned the knowledge, attitudes, motivations, self-perceptions, and skills expected of them,” according to AACN.
These authentic experiences include using an immersive virtual reality (IVR) scenario to ensure that all students can participate in caring for a pregnant woman with a health condition that students may not observe during their obstetrics clinical rotation, says Patricia “Pat” Schaefer, DNP, RN, CNE-cl, CHSE, CNE, assistant professor and director of simulation at USG. In that scenario, the students slip on a virtual reality (VR) headset that displays a realistic, artificially intelligence-powered patient. Students then conduct a physical examination on the virtual patient, place an external fetal monitor on her, observe changes in her condition, and respond appropriately.
UMSON uses simulation to allow students to practice multiple competencies in AACN’s Essentials — clinical reasoning, implicit bias, equitable treatment, and communication with diverse populations — in safe, supervised experiences before applying those skills in direct patient care.
Developing these high-quality and high-fidelity experiences for students takes a surprising amount of behind-the-scenes work, says Amy L. Daniels, PhD ’18, MS ’12, BSN ’89, RN, CHSE-A, assistant professor and director of the Baltimore clinical simulation labs. “It’s really important to align with curriculum objectives and not just find a patient case that’s exciting and try to create a scenario,” she says. “There’s a whole pedagogy behind it.”
Debriefing is an integral part of the experience, too. After the simulation activity is completed, the educator facilitates a conversation using a theory-based debriefing approach to unpack observations and understand the student’s perspective during the learning experience. “It’s more than saying, ‘I saw you do this, you should have done that,’” Daniels says. “It’s about giving specific details of what the educator saw, sharing the educator’s perspective on that action, and curiously inquiring about the student’s perspective on that action.”
Behind the Scenes
Simulation technologists are the sometimes-unseen champions behind the cutting-edge simulation experiences that UMSON offers. “Their role is essential — you really can’t run a large sim program like we have without them,” Schaefer says.
That large program includes 33 simulation labs between Baltimore and USG that replicate realistic practice environments and feature hospital, critical care, operating room, pediatric, maternity, and home care settings, as well as dedicated debriefing spaces. USG recently completed an $8.2 million renovation that added a five-bed Hospital Suite to its three floors of lab space.
The simulation technologists oversee all the technology that’s used in a scenario, such as audiovisual equipment, computers, and medication administration machines, while also providing operations support. They prepare the rooms and provide the necessary materials for a clinical scenario, including a headwall with oxygen and suction tools, an IV pole, and a patient monitor to display vital signs. The simulation technologists select the appropriate manikin to support the learning objectives, voice the patient, and maintain and update all the equipment.
Kevin Harris, an IT telecommunications associate at USG, has worked as a technologist in the simulation labs in Baltimore and USG for 16 years.
“I like to think of simulation as a one- or two-act play,” Harris says. “We develop a script that’s based on the objectives and curriculum in the course and the things we want the student to learn. The student script is based on their coursework and clinical experience, and they bring that into the play.”
Sim techs have a variety of backgrounds and come from different disciplines, including theater arts, film production, and IT, as well as health care.
Harris is passionate about simulation and how it helps develop nurses. “It’s really super fulfilling to know that in a small way, I’m helping thousands of people I’ll never meet because I helped their nurse,” he says.
A High-Fidelity Learning Experience
Jenina Sheppard, a Bachelor of Science in Nursing student, is one of those nurses that Harris and the USG simulation team have helped. She’s always wanted to be a labor and delivery nurse and was heavily influenced by the birth stories depicted in “Birth Day,” a TV series that documents the labor and delivery process.
She’s been enthusiastic in her evaluations of simulation. “Unlike an actual clinical setting on a hospital floor, you have your classmates working right along with you for support — it’s a team effort,” Sheppard says. “It’s a calm environment with these instructors, which allows students to focus on the goal of the scenario without added stressors.”
Sheppard and her classmates have participated in several scenarios featuring medication administration. In one experience, Sheppard and two other students used a provider-ordered sliding scale and performed a drug calculation in response to lab results. The students interpreted the results and followed the physician’s orders to make correct dosage decisions. In the School’s simulation Hospital Suite, students pull appropriate medications from a hospital-grade medication dispensing machine in a designated medication room.
“Medication delivery mimics clinical practice to improve student confidence in interpreting doctor’s orders, pulling medications, and administering them safely,” Schaefer says. “The fidelity of medication administration keeps patient safety at the forefront of simulation activities to enhance students transitioning to the actual clinical setting.”
A simulation is essentially a live performance starring nursing students. “Instructors watch us, see what we did right, see what we did wrong, help us to correct our mistakes and learn from them, and talk about it afterwards,” Sheppard says. “Debriefing is essential to the simulation process because it’s better to see mistakes and correct them now than to make a mistake that could cost someone’s life in the real world.”
The Human Element
The School’s realistic, high-fidelity manikins are impressive, and donning a VR headset to interact with AI-powered patients is undoubtedly cutting edge. But the human element of simulation provided by the Standardized Patient Program (SPP) is equally important.
The SPP was developed in 2001 as a collaboration between UMSON and the University of Maryland School of Medicine. The program is housed in the UMSON building in Baltimore and features 14 examination rooms equipped with full audiovisual capabilities. The center is designed with separate student and standardized participant (SP) entrances to maintain simulation fidelity as well as dedicated space for faculty viewing and debriefing.
The program employs 120 SPs, many of whom are professional actors. SPs are trained to portray a patient to simulate a set of symptoms or problems used for education, evaluation, and research. The SPs serve as unscripted models for students to practice taking a history and conducting physical exam skills. Or they may be trained to present meticulous patient case scenarios in the same way during every student encounter to ensure a standardized experience for learning and assessment.
“It’s the highest fidelity because you have a person, which obviously is the most real,” says Nancy Culpepper, MBA, director of the SPP. “It’s a psychologically safe environment where mistakes can be made without repercussion. Additionally, with an SP, you get verbal feedback from a human point of view.”
Nursing students are always seeking more opportunities to practice communicating with patients. The SPP provides that, with a real person who’s trained to give students feedback about their communication style, including how students asked physical examination questions and how those questions made the SP feel.
Together, the various simulation modalities that UMSON offers ensure that students receive the full spectrum of practice scenarios. “Simulation is a really strong teaching approach because it supports all the domains of learning and includes elements for different types of learners,” Daniels says.
Simulation Experiences for All Ages
Attracting exceptional prospective nurses is a mission that begins before students finish their K-12 education. UMSON regularly hosts high schoolers, and even some middle schoolers, at the Baltimore and USG locations. These young students participate in a variety of hands-on activities, including simulation experiences.
This past summer, Vanessa Fahie, PhD ’94, MS ’83, BSN ’76, RN, assistant professor, coordinated the Vivien T. Thomas Medical Arts Academy summer camp for high schoolers, and the campers visited the simulation labs in Baltimore. They completed three skills: donning sterile gloves (which is harder than it looks, one observer noted); conducting CPR on a high-fidelity manikin; and interacting with a student auscultation manikin, where they used a stethoscope to listen for heart, lung, and bowel sounds.
Simulation technologists meet with students and discuss their own careers and how they ended up working at UMSON. “Simulation is booming: This is an industry that has a lot of potential jobs for students,” Schaefer says. “Perhaps a student may not want to be a nurse, but we need to grow future technologists.”
THIS ARTICLE FIRST APPEARED IN THE FALL 2024 ISSUE OF NURSING FOR/UM MAGAZINE.