Fixing the Problem with
Melissa Powell, MS, RN-BC
Goals for presentation
• To provide an expert view of simulation design for fixing problems
• To share methods of discovery and design for fixing problems with
Simulation because you want to…
• Teaching methods used MUST directly relate to the learning
Simulation does not teach basic cognitive information easily
Simulation does not review information
Simulation is not the best way to teach math
Simulation is not the answer for everything
We don’t simulate because we heard it was a great idea
We don’t simulate because we bought the manikin
When is simulation best?
• Simulation is best when you need people to put it all together.
• Simulation is best when you want people to “think on their feet” or in
the real situation.
• Simulation is a great way to develop clinical reasoning.
• Simulation is a great way to teach communication skills.
• Simulation is a great way to teach something complex that you “want to
stick” with them
• Simulation is best when the stakes are high and practice is expensive.
• Simulation is perfect at fixing real world complex problems.
What is the problem?
• Answering the question: Why do errors occur?
• Where does the data come from?
Event analysis & Error reporting systems
Cognitive task analysis
In-situ simulation for error discovery? WHAT?
• Simulate the event that keeps creating the problem.
• VIDEO the in-situ simulation
• This discovery method is excellent at uncovering key thoughts
• Seeing the task or event from a different view
• Opening up perspective on situation from the sky
• Experts are your greatest asset here
How do I know how to connect the problem
to the learning objectives?
Defining the error that learners have is key.
Why do they commit the error?
Under what circumstances do they commit the error?
What drives them to commit the error?
Error is the objective. Why is the trigger.
• When designing the scenario, the “why” is the scenario and
• The “why” becomes the “raison d'etre” - this is why we are here.
• Without knowing why a learner commits an error, one designs
without understanding what the learner needs to learn.
• Quality data analysis
• Interview and survey to ask why events occur.
• Leader, teacher or supervisor
• Interview direct leaders
• Cognitive task analysis
• Question experts during task - What are you thinking? What are the errors
you are heading off right now? Why do you do that? How would you teach
someone else to do this?
• Learner interview and survey
Big idea: Simulate because it is the right
• Simulation is great but don’t abuse the technology.
• Don’t just simulate because it is fun.
• FIX PROBLEMS!