Have you been wondering how to engross learners in your simulation? In our last post, Jennifer and I introduced several storytelling strategies you can use to encourage learners to “suspend their disbelief.” This week, I’d like to share how two of our clients have used branching techniques to increase the psychological fidelity of their simulations—or in other words, to create “engaging stories that feel real because they are based upon real occurrences” (Powell, 2014).

Both simulations use storytelling and branching to assess clinical decision-making in the Emergency Department (ED). One simulation creates an illusion of progressing time. For example, learners who spend a lot of time reviewing information prior to diagnosing their patient see their patient’s vital signs deteriorating. This is achieved through a Sources of Information hub where learners can access information about the patient. However, each time learners select a resource to review, one point is added to a counter. This counter remains hidden to the learners. As this counter increases, the patient’s vital signs worsen. If learners decide to continue reviewing information, they will see a deteriorating patient. This approach creates a sense of urgency in which learners don’t know how much their patient’s condition may deteriorate while they are reviewing information and formulating a diagnosis.

This simulation also “freezes” at various times to assess learners’ situational awareness. As that counter increases, learners are directed to an assessment branch of text response screens that measure how much learners remember about their patient’s condition, and what their differential diagnosis would be at that point in time.

The second simulation increases psychological fidelity by recreating the flow of one patient through the ED. Learners are invited to diagnose and treat their simulated patient much as they would a real patient. They can review triage notes and medical history, order labs and imaging studies, and consult with experts. Then, they make decisions by prescribing treatment, formulating a diagnosis and choosing to admit or discharge the patient. Throughout each of these steps, hidden counters are working in the background. After moving the patient through the ED, learners progress to a feedback section that reviews the efficacy of their decision-making. This includes scores on diagnostic accuracy, treatment, disposition decision (whether to admit or discharge the patient), imaging, and cost/resource utilization.

These simulations illustrate two branching sequences that are achieved through rules and counters. The exciting news is that DecisionSim now has a total of 12 counters including 8 custom counters. This opens the door to a wide variety of innovative approaches that you can use to engage and assess your learners and increase fidelity.

To learn more about psychological fidelity, read: Getting Real Using Low Fidelity Simulation