Healthcare Simulation Week 2020! Reflections of a simulationist.

When I discovered simulation, I was first intrigued by the technology, l’ll admit. And the overall coolness of it… but it led me on a path that transformed what teaching means to me… and to the learner.

I went into teaching at first… I thought… because I like to hear myself talk. OK, not exactly but, you know, I wanted to share all my knowledge. Translate information, facts and the skills of being a nurse through me and to students. I envisioned myself as the wise, honored teacher. The Sage on the Stage… those were the teachers I learned from in my life, those I respected and emulated.

But then, I discovered simulation.  I was first intrigued by the technology, l’ll admit. And the overall coolness of it… but it led me on a path that transformed what teaching means to me… and to the learner.

My first simulation experience was as an observer… I actually- literally stumbled onto it… I was at the training center for Madigan Army Medical Center (now known as the Charles A. Andersen Simulation Center) earning my ACLS instructor certification. I was working as a floor nurse at MAMC at the time, and just beginning to nurture the teacher within.

My first exposure to simulation- I stumbled into a room with this going on!

While I was in class, I was distracted by loud noises from another room… shouting, moaning,  explosions. I slipped out of my classroom and wandered the halls until I found the source of the commotion. A dimly lit room, camo nets hanging from the ceiling, darkness punctuated by strobe light flashes, the sound of mortar explosions and someone groaning in pain. I look down to see a man on the ground, covered in blood, the source of the groans. It took a minute for me to realize he wasn’t real… that I’d stumbled into a well crafted battle injury scenario training space.

I thought to myself, “wow! What a way to learn”… to be immersed in the reality of a situation (to learn later that’s fidelity) in a place where mistakes and  learning have no risk and cause no harm (to learn later that’s psychological safety) with the opportunity to reflect on actions taken and how to improve (to learn later that’s debriefing).  I was hooked!

I went back to my ACLS class and inadvertently created and ran my very first sim scenario. I had to teach the asystole algorithm.  So I created a scenario with a witnessed asystole patient, who the learners go on to discover was DNR after they initiated resuscitation… it was fun to see the progression of the scenario (I got to use a Sim Man too!). And have a meaningful discussion about the challenges of this algorithm and the ethics of resuscitation. 

Fast forward many years from that day. I’ve run hundreds of simulations, in a variety of fidelity levels, in all sorts of settings, with the complete gamut of technologies and I have taught hundreds of nurses and health care providers.

And I no longer want to be that Sage on the Stage. I will admit, I am finding myself doing a lot of webinars and other types of presentations still have me up there, speaking and sharing ideas. But still, my goal is to awaken knowledge in others, not pour my vast amount of wisdom unto their heads. As a simulationist, I guide learners through experiences that allow them to determine their own learning. There’s a whole host of learning theories and teaching methods this approach supports from constructivism to heutogogy. But what reinforces it to me is seeing the results. Seeing learners gain insight and awareness during a robust and learner-focused debriefing.  I have come to realize my skill as a sim facilitator and debriefer is critical to guiding them to creation of knowledge and hitting those crucial levels in learning taxonomy through experiential learning.

Bloom’s Taxonomy AND Vygotsky’s Zone of Proximal Development to explain the importance of preparation for simulation. How nerdy is that?!

I now am privileged to be in a leadership position and supporting a program that provides simulation experiences to learners. I am also training up the next generation of simulationists. Simulation is still fun to me, though. I love creating real life scenarios,  making the environment realistic, helping learners suspend disbelief and seeing them get caught up in the excitement of a challenging patient care situation, a communication challenge, a team based intervention or disaster scenario.  When I see the wheels turning in their heads, the self-reflection turned on and,  in that psychologically safe environment, the ability to learn from doing things right AND making mistakes, I am inspired by them!

Me, presenting a webinar about how we are bringing students back to the Simulation Center during the pandemic.

I became a nurse, like many have before me, to “help” others. That extended to my teaching, to “teach” others. I have learned, though, we help others the best by not doing for them or “to” them… but doing with them. The path to healing belongs to the patient and the path to learning, to the learner. As a nurse I have had the honor to walk alongside folks on their path to wellness,  and now, as a teacher,  I am privileged to guide learners through immersion experiences from which they emerge as safe, competent healthcare providers.