Authentic activities are a critical component of effective and engaging simulations that assess and develop decision-making. That is, in order to accurately measure performance and to develop expertise, it’s important to create tasks within the simulation that closely match the targeted skill set. So, if we want to measure how well physicians diagnose and treat patients, and also enhance this competency, it’s important to create a simulation that immerses learners within an authentic context, and that engages learners in tasks that closely resemble how they would diagnose and treat patients in a clinical setting.

Recently, I was reminded of this while working with a client on a simulation that assesses and develops clinical decision-making in the Emergency Department. To create an authentic context and task, we asked physicians to imagine that this is a real world patient while performing typical everyday activities, including: reviewing a patient history, ordering labs and/or imaging studies, identifying physical exams to perform, ordering treatment, and formulating a diagnosis.

During pilot testing, a Subject Matter Expert (SME) had an interesting comment that ultimately led to the creation of a new branching tool, the Review Previous Screens Branching Tool. The SME said that in the real world physicians would review relevant information prior to making these decisions and that this was an important skill to include. For me, this was that “Ah-ha” moment, where I realized that we needed to mimic the authentic task of identifying what information is critical to review before making a decision, and then requiring learners to analyze that information effectively. To meet this need, we added a Review Patient History option to an inquiry screen. With this approach learners can revisit several screens before making their decision. Some screens may have helpful information others may not.

Providing both the essential information and unnecessary information is another critical component of creating an authentic learning activity. It is often called creating an “ill-defined problem.” That is, the problems we encounter in our daily lives are not generally neatly defined—like they often are in formal learning environments. In most cases, we need to identify what information is required to solve a problem and what information is not helpful. ED physicians have lots of information that they can gather and analyze; yet, within the fast-paced and often high-pressure environment, the important skill is to consult just the necessary information without wasting time reviewing unnecessary data.

With the Review Patient History Branching Tool, not only can you provide previous screens for learners to revisit, but you can also analyze what screens learners chose to review prior to making their decisions. By analyzing the data after learners complete your simulation, you can identify how many learners revisited earlier screens, and if they did, what information they reviewed. Using rules and counters, you can even send learners down a suboptimal path if they spend too much time gathering and analyzing data before making a decision.

To review the branching tool, search for this title within DecisionSim: Review Patient History Branching Tool.

To learn more about authentic learning, visit:  https://net.educause.edu/ir/library/pdf/ELI3009.pdf