The art of simulation based learning

When we see footage of pilots learning or honing their skills in flight simulators, our natural reaction is that it just makes sense. Simulation Based Learning (SBL) is now widely used in the education and training of healthcare students and registered professionals. Advances in technology have developed human patient simulators and task trainers, while virtual reality sessions are also increasingly common. Students are provided with realistic scenarios that require them to think under pressure – as they will have to during their careers. After a conventional lecture in the anatomy and physiology of the lungs, for example, student nurses can assess and manage a simulated patient pre-programmed to display characteristic symptoms of specific respiratory problems.

Maximising the potential

Until relatively recently, however, the effectiveness of SBL varied – not least because many educators lacked confidence in using the equipment involved or did not prepare students adequately. Two senior lecturers in nursing at the University of Huddersfield have developed an international framework for the use of SBL in healthcare, which has provided guidelines for educators to use in educating student nurses and other health professionals using SBL strategies. This has provided educators with the knowledge and confidence to use SBL to its full potential. Drs Andrew Bland and Stephen Prescott, both senior lecturers in the University’s Department of Nursing and Midwifery, can trace the idea for the

Enabling learners to practice a challenging new skill utilising simulation has one obvious advantage: it’s safe for all involved.

framework back to a conference coffee break chat with European counterparts. Dr Bland says: “Those conversations underlined for us that, while SBL strategies and associated technology was being developed at a rapid pace, educators weren’t really being taught how to use it or how to apply it in ways most beneficial for students.” With colleagues from Denmark and Finland, the collaboration secured funding from an EU programme to research how best to teach and assess using simulation. They carried out a literature search and drew on their own research and teaching to identify the skills, competencies, and aptitudes that an educator using simulation needs. This led to the creation of the Nurse Educator Simulation-Based Learning Framework (NESTLED). This was piloted in Finland, Denmark and Estonia – in collaboration with colleagues from the conference where the idea was born.

Linking learning to practice

The framework helps educators prepare students for working with particular SBL strategies, for example working in small groups to develop teamworking and communication in the modern healthcare workplace. Dr Bland, whose PhD explored the role of simulation in undergraduate nurse education, explains: “Over the previous decade, SBL really started to accelerate in nursing and healthcare education and assessment. It is now used in undergraduate and post-registration nurse

education and in training courses for qualified clinicians. Universities invest in SBL resources but educators themselves were not necessarily confident in using some of this kit. If simulation is used inappropriately or without adequate preparation it can be quite detrimental. Imagine you’re a firstyear nursing student and you’ve never seen one of these human patient simulators: they talk, they blink, they’ve got pulses and even their skin is increasingly realistic. As an educator you need to understand the impact of seeing that for the first time.”

An evolving resource

NESTLED-based training is now being used in the United Kingdom and six other European countries. It has moved out of universities and into healthcare settings, including the NHS, where it has had an impact on patient safety and improving efficiency. Laerdal Medical®, a company that manufactures simulator technology has refined the framework content, ‘operationalising it’ by developing specific learning modules. Dr Prescott said: “The NESTLED framework is not just focused on student nurses: it has far wider applications. It can also be used to work with an entire clinical team – for example, how trauma unit clinicians react to an emergency call – and to help improve efficiency across patient services.”

Completing a virtuous circle, Drs Prescott and Bland have picked up the enhanced framework to shape their own teaching. A ‘high fidelity suite’ has been incorporated into the design of the University’s new health and research innovation campus, due for completion in 2024, to house the most advanced, incredibly lifelike, human patient-simulators.