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Scenario Building

Building a patient scenario is considerably easier than most people think.  You already know the competencies you want your students to master.  They can be found in your syllabus, lab manuals, and clinical setting.  There is no need to start with a blank page.  Take what you already do and bring it home to your campus simulation set-up.

A patient scenario may be seen as a "series of events limited by time."  
   In other words we create a "start" and a "finish" to the interactions between the patient and our students.  The length of time determines the number of events that will be included and that also means, most likely, the number of competencies the student must demonstrate.  As an example, a cardiac arrest can be a short lived (no pun intended) experience and may be considered a single "event."  
   On the other hand, a more lengthy interaction with the patient for wound management (1 event) that includes a cardiac arrest (2 event) or drug reaction will involve more competencies and rises to the level of a patient scenario, not just a single event.  Two or more patient events forms a patient scenario.  The more events, the more competencies the student must learn or demonstrate. 

A cardiac scenario playing out in a typical acute care facilityPatient events are more than single task training. 
   Teaching a student how to inject a drug into say, an "arm trainer" is a task.  A patient event would be administering a drug: including patient communication, documentation, preparing the dose, selection and preparation of the site, getting patient permission, watching for reactions, etc.  Want this single event to be a "scenario?"  Try adding a distraught spouse or child who may give conflicting information about allergies.  Now the student has to decide what to do next.  A different set of competencies now come into play and you have a short patient scenario. 

There are several approaches to building a patient scenario. 
   Method 1 involves taking the competencies you expect students to master in the clinical setting, and bringing those competencies back to your campus simulation set up.   This method relies on your professional experiences in a clinical setting.  Perhaps you notice that your students did not handle very well a particular patient experience. Dose administration is a concern of all clinical settings, so let's use that as an example. 

   Outline what happened with this "dose miscalculation" patient.  Sometimes it helps to close your eyes and run through the images of what happened.  As you see those events, jot down some key points.  Think of all the things that are supposed to happen and what actually happened.  We will assume the patient was not harmed.  Take your notes and go see one of your simulation patients.  Walk through what happened in the clinical setting. Think about and jot down what it would take to duplicate what happened.  Include supplies and equipment.  It really helps to talk out loud to another person while you do this.  Maybe they can take notes for you.  Now, identify the competencies where things went wrong.  You have a patient this case, a re-enactment of a clinical experience.  Yes, you do need to clean up your notes, but all the "stuff" you need is there. This method is essentially a "debriefing" of the clinical experience put to paper, a process you do all the time with student evaluation and documentation. 

   Method 2: begins with the competencies you want a student to learn or demonstrate, but you can still draw upon your clinical experiences.  We will keep with the drug dose idea for comparison.  First decide if this is more a learning experience or a demonstration experience. If this is a learning experience, you will want to lengthen the time to account for "teaching moments."  Next decide if you want to keep this basic with no complications at all.  Happy patient, no relatives, perfect site, jovial doctor, all equipment at hand and no worries.  If you go this route, you are actually constructing a patient event.  Good.  List all the competencies that are contained within a single dose administration in order of appearance. Repeat competencies as need.  Next to each competency, list what it will take to provide the correct environment for the student to learn or perform that particular competency.  People, patient status, supplies, etc.
   By now you have had it dawn on you that this is precisely what you have been doing for years in your lab.  Take your list of competencies and head to the patient simulation set-up. As you walk through what the student is to do, you might discover that a few more competencies are required or not.  If you had decided to make this experience a bit more interesting, you can have the blood pressure cuff missing, the phone ring, the patient be really cranky, patient ID be missing or confusing, etc.  Anything that will make the student have to hold the current objective and handle other issues.  This is what critical thinking is all about. 

None of this is perfect, but it will get you started on creating a great patient event, then a series of events to form an enriching patient scenario.  

Got suggestions?  Let me hear from you.  See below. 

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