This document discusses different models for integrating simulation-based learning experiences across nursing school curricula. It describes the champion, full-faculty, and concierge models and compares their pros and cons. The concierge model, where dedicated faculty deliver simulations, allows for a more comprehensive curriculum while limiting training costs compared to the full-faculty model. The document also provides examples of how a rotational design can be used to schedule students for simulations without increasing faculty needs. This design increases clinical group sizes so that small numbers of students from each group attend simulations each week.

1. Rotational Design:
Simulation Across the
Curriculum
Sara Fruechting, RN, MNSc, CCRN,CHSE
Jeffrey K. Carmack, DNP, MSN, RN,
CHSE
INACSL, 2015, Atlanta

2. ANCC Required Disclosures
Conflict of interest
• Jeffrey Carmack reports no conflict of interest
• Sara Fruechting reports no conflict of interest
Successful completion
• Attend 90% of session
• Complete online evaluation

3. Objectives
• The participants will
– identify appropriate situations for integration of
simulation based learning experiences across the
curriculum
– Understand limitation of the champion model
– explore the concierge model of simulation based
learning experiences
– examine the financial benefits of using a rotational
design for scheduling of students for simulation
based learning experiences.

4. Terminology… A common ground
• High-fidelity simulation: Irrespective of the
type of simulator
• Champion program: One or two faculty lead a
single content area
• Full-Faculty program: Every faculty member is
required to use the simulation space
• Concierge: Dedicated faculty delivering high-
fidelity simulation

5. High-fidelity Simulation
• Faculty has extensive training
• Most faculty have immersion training
• INACSL Standards of Best Practice:
SimulationSM is the guiding framework
• Faculty utilizes a reflective debriefing tool

6. Models of Staffing
• Champion
– Begin with champion's area of expertise
– Build up to further courses
• Pros
– Limited support needed
– Only one facilitator needs training
• Cons
– Limited support given
– Workload is often underestimated
– May not have training
– Simulation lacks “program” status

7. Models of Staffing
• Full-Faculty program
– Creates a more inclusive curriculum
• Pros
– Limited support needed
– Simulations occur during regular clinical hours
– May meet the definition of “program”
• Cons
– Workload is often underestimated
– Training costs are substantial
– Oversight is intensive if you meet a standard
– Equipment training for all faculty
» Manikin
» A/V system
» Debriefing system

8. Models of Staffing
• Concierge Model
– Creates a comprehensive and cohesive curriculum
• Pros
– Faculty are dedicated (Workload is known)
– Limited faculty training needed
» Manikin (in-house PM program)
» A/V system
» Debriefing system
– Simulation program
» Budget
– Training costs are limited to faculty facilitating simulations
• Cons
– Needs at least 1 FTE without a teaching load
– University policies
– Evaluation method may not exist for tenure track

9. High-fidelity Simulation
• Faculty has extensive training
• Most faculty have immersion training
• INACSL Standards of Best Practice:
SimulationSM is the guiding framework
• Faculty utilizes a reflective debriefing tool

10. Silo or Program?
AZ ADVISORY OPINION:
EDUCATION USE OF SIMULATION
• Simulation should be part of
SPE
• Calls for facilitators to be
immersion trained and for
ongoing evaluation
• Simulation cases based on
curriculum
NCSBN Simulation Guidelines
• Must have a supported
program
• Budget must include
ongoing training of
facilitators
• Calls for evaluation of
components including
learners and programs
methods

11. Program costs related to faculty
• Initial immersion training?
$1,000 - $5,000
• Biennial conference or other training?
$550
• Certification?
$350
• Travel? Hotel? Transportation?
$$$$

12. Budget Questions
• How many faculty will you train?
• What is your turnover rate for clinical faculty?
• Are your faculty tenured?
• Do you also need skills lab faculty?

13. Training and Certification for 1
3 year cost=
$6,900
Annual cost=
$2,300

14. Rotational Design at Work
• Increase size of all clinical groups to allow one
faculty member to teach simulation
• Send a small number of students from each
group to simulation each clinical week
• This gets all students through simulation over
the semester without hiring additional faculty

15. Simulation N=8
Clinical 1
Hospital =8
Simulation =2
Clinical 2
Hospital =8
Simulation =2
Clinical 3
LTC =8
Simulation =2
Clinical 4
LTC=8
Simulation =2
Clinical 5
Hospital =0
Simulation =0

16. N1505, Fundamentals
• Two faculty cover all simulation experiences
• Two hundred students enrolled
• Course divided into three rotations
– Simulation
– Long term care
– Acute care
• Simulation faculty have 70 students per week,
in groups of seven (five sessions per week)

17. N1505, Fundamentals
• One group of seven is in scenario with a
faculty running two mid-fidelity simulators
• Each simulator has an SP as a family member
• Twenty minutes in scenario and forty to
debrief
• The other seven students are working on skills
with the other faculty
• Both groups will be present for three hours,
once a week for four weeks.

18. 2420 Peds 3 FTEs
• Current enrollment n=61
• Without simulation
– 8 clinical groups needed (8:1) ratio is state mandated.
– 6 Adjuncts needed for the Spring 2016 Term $20,500
($4,100 each, for the half term)
• With simulation program
– 5 clinical groups needed (12:1) but State ratio max still
applies
– 3 Adjuncts needed $12,300
– 4 learners rotate out to simulation per week from
each group (1FTE and 1 Simulation director)

19. Facilitator Workload (typical)

20. Student Workload (6.5 hours)
• Student prepares for one of three simulation
cases for a clinical day
– Reading about an 1 – 1.5 hour(s)
• Student must complete 3 flat simulations before
the full scale simulation day, and earn a score of
at least 85%
– Online system, takes about 2.5 to 3 hours
• Full scale simulation-based cases
– 2 hours on campus
• Post-test and reflection after the day event
– 10 to 15 minutes per case

21. Contact Information
• University of Arkansas at Little Rock
Department of Nursing
• Jeff Carmack 501.682.8620
jkcarmack@ualr.edu
• Sara Fruechting 501.371.7627
skfruechting@ualr.edu