Simulation Use in Entry-Into-Practice Respiratory Care Programs

Discussion

Compared to colleagues in nursing and medicine, the respiratory care profession lags behind in the adoption and utilization of simulation-based education. These findings are expected as the respiratory care profession is much newer in comparison, and the authors are encouraged by the current widespread use of simulation in entry-into-practice programs. Themes that emerged from this study that warrant further discussion are faculty development, debriefing, and standards of best practice.

Results of this survey indicate that faculty development in simulation for respiratory care educators is fragmented and sparse. Fewer than half of all respondents indicated receiving any faculty development in simulation design, debriefing, or technology-based instruction. Lack of faculty development may be related to limited financial resources, insufficient time or space, or a general scarcity of simulation research in respiratory care education demonstrating the need for such training. Without facilitators who are trained in simulation pedagogy and able to deliver consistent experiences that are formally evaluated, the outcomes of simulation-based learning are difficult to measure.¹⁰ Variable learner experiences and the inability to articulate return on investment to administrators may create a snowball effect leading to lack of buy-in and inadequate resource allocation, making it even more difficult to launch or maintain a simulation program. Simulation is an instructional technique informed by learning theories, intended to enhance and supplement real experiences with guided experiences.¹⁵ To get distracted by the bells and whistles of cutting-edge technology without investing time and effort to learn simulation pedagogy is a common pitfall but is short-sighted and may have lasting negative effects.

Faculty development in simulation spans all phases of the process from design and facilitation to debriefing and operations. Through membership in professional societies, attendance at international conferences, and participation in stand-alone workshops, aspiring simulationists can gain the knowledge and skill needed to deliver high-quality simulation experiences. Debriefing is an important aspect of faculty development in simulation that has its own dedicated courses and standards of best practice. The simulation facilitator’s role is to ensure an environment where lessons learned in the didactic and simulation environments can be translated and applied to clinical practice. In debriefing, learners will recount their experiences, celebrate successes, and debate shortcomings, but the facilitator is needed to guide the discussion from description to analysis to application.¹⁰

Whereas most survey respondents indicated that they engage in debriefing as part of their simulation practice, nearly two-thirds indicated that they do not use a structured approach. Among those who engage in structured debriefing, PEARLS,¹⁰ advocacy/inquiry,¹¹ and Plus/Delta¹² were most used. PEARLS is a conceptual debriefing framework focused on learner’s self-assessment, facilitating focused discussion, and providing information in the form of direct feedback.¹⁰ Advocacy/inquiry is a conversational tool embedded within the Debriefing with Good Judgment model that involves pairing one’s stated perspective with an open-ended inquiry to learn more about others’ perspectives.¹¹ Plus/Delta is a debriefing technique where learner’s actions are placed into columns labeled plus (+) and delta (Δ), indicating which actions should be continued or changed, respectively.¹² Structured debriefing methods exist beyond those described here and are largely selected by facilitator preference.¹⁵ Novice simulation educators may use scripted and structured debriefing to improve learner’s knowledge acquisition while standardizing the debriefing process.¹⁶ Expert simulation educators often do not ascribe to any specific debriefing method but rather use the method most relevant to the learning objectives, scenario, location, and overall situation.¹⁷ With only 40% of survey respondents indicating that faculty receive professional development in simulation debriefing, it is not surprising that 60% do not use any structured debriefing method. Without training or mentorship, faculty may be unaware of structured debriefing methods, their proper use, or lack confidence in their debriefing facilitation skills. Professional development opportunities and funding are needed to better prepare respiratory care educators for simulation practice.

Respondents’ unfamiliarity with INACSL Standards of Best Practice: Simulation offers an excellent opportunity to learn from our colleagues in other disciplines regarding best practices in simulation. Instead of starting from scratch, respiratory care educators and simulationists should seek guidance from those who have done this work for decades. Our colleagues have put energy into developing and vetting standards of best practice that can inform our simulation practice and its integration into our academic programs and accreditation standards. Other professional organizations, such as the Association of Standardized Patient Educators and The Gathering of Healthcare Simulation Technology Specialists, have created standards of best practice specific to standardized patients and simulation operations.^18,19 Examples of these standards are outlined in Table 5. Beyond the knowledge gained through learning and integrating these standards into our practice, they provide a foundation for those interested in seeking simulation accreditation. Adapting the various standards of best practice may better prepare respiratory care educators to articulate return on investment, secure funding for equipment or professional development, engage in scholarship to advance the profession, or obtain simulation leadership roles.