#3: Writing palliative care simulation scenarios

"I don't know how to write a palliative care sim scenario - where should I start?"

Let us help you.

Disclaimer: we hope this blog post will provide you with a good place to start and important points to consider. It cannot be all-encompassing. We have assumed that those reading have some familiarity with simulation, how it is conducted and ideally have attended a simulation faculty development course with associated human factors and debriefing skills training. Prior to writing any scenarios, have a look at our blog post titled "How to set up a palliative care simulation course".

SENSE CHECK: Is sim the right modality for what you want to teach? If so, read on.

A good scenario should:

Be pitched at the right level for the intended learners e.g. not too complex.
Be written so the attendee can undertake the scenario within whatever their current role is e.g. if they are a HCA, it is unfair to ask them to do things outside their normal job role within the sim setting.
Have time within the scenario itself restricted to around 10-12 minutes in length – this protects your attendees from being over-stimulated and stressed for too long, especially in palliative care scenarios which are inherently more emotionally charged.
Have generous amounts of debriefing time (at least triple the time spent in the scenario) e.g. 30-45 minutes debriefing time built in per scenario.
Should have clear learning objectives but should also leave space for other learning – depending on what the group wish to take away e.g. the scenario might be about recognising dying (clinical learning point) but gives space for discussion around how emotionally challenging that can be sometimes (human factors learning point).

Preparation:

You have thought about who your learners are and what they want to learn.
They may have a curriculum with specific palliative care competencies which you wish to address with your sim course and to which you can blueprint your scenarios.
You have thought about the overall course/sim day structure (half day, full day, multiple days) and what resources you have access to (space, equipment, funding, faculty).
You have recruited suitable faculty to teach alongside you. You have considered that your faculty group should be sufficiently comfortable teaching the material, should ideally mirror the participant group in terms of roles and diversity e.g. if teaching a mixed group of junior doctors and ward nurses, your faculty group should consist of senior palliative care doctor(s) and palliative care specialist nurse(s), with diverse backgrounds and experience.
Often a scenario and associated debrief doesn't (and shouldn't) occur entirely in isolation. To get the most out of learners, they need to feel safe to make mistakes and ask questions, especially given the sensitive subject matter. Often that takes time over the course of a day for them to relax enough.
The course will need an appropriate introductory segment with an icebreaker to build group rapport, then a number of scenarios run with associated debriefs and then an outro. Breaks need to be built in.

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Let's get writing...

1. See how others have done it

You need not reinvent the wheel. PalliSim Network have a resources page full of palliative care sim scenarios for every occasion - tried and tested content which you can review, learn from and even adapt (as long as you credit the original authors). You will see that everyone has a slightly different style and some are more prescriptive than others. Join our team and see if we can help you. Avoid duplicating work and effort and save yourself time!

2. Scenario content planning

Example:

You are planning to run a half day course. Usually this fits 3 scenarios = you now have 3 opportunities to address specific palliative care learning objectives.
Your learners are Internal Medical Trainees, they have a curriculum with specific palliative care competencies. You can choose some of these as your clinical headlines and build scenarios around these headlines. Try not to pick too many: 1-2 clinical points per scenario is a good starter. (If your learners do not have a curriculum to adhere to then consider what the aim of your course is and create suitable learning objectives.)
Also consider what the human factors learning points might be (though on the day, the learners may bring up something entirely different and you should consider going with the flow of conversation if so).

Scenario 1

Clinical headline:"Recognising dying in a frail elderly patient with dementia"

Clinical learning points: 1) Recognising dying 2) Symptom control at the end of life (pain)

Human factors learning points: 1) The emotional impact of caring for dying patients 2) Team-working in a stressful environment

Scenario 2

Clinical headline: "Communicating with a patient's distressed relative about DNACPR"

Clinical learning points: 1) Recognising limited reversibility 2) DNACPR

Human factors learning points: 1) How to cope with strong emotions from other people 2) Communicating in challenging circumstances

etc.

3. Write the scenario(s)

Imagine you have been given this scenario to run it for some learners - what do you need to know?

Estimated run time: e.g. 10-12 minutes scenario, 45 minutes debrief
Intended participant(s): e.g. 1 IMT doctor
Faculty roles: 1 person to play patient's voice, 1 person to play patient's relative, 1 person to be embedded practitioner, 1 sim technician to control the manikin, 1 person to be control room lead
Room set-up: hospice inpatient ward setting
Manikin requirements
Clinical headline
Learning objectives (clinical and human factors)
Expected scenario progression
Candidate briefing blurb
Patient voice briefing/blurb
Embedded practitioner briefing
Actor/faculty member (playing relative or other role) briefing

4. Sense check your material

Sense check your material with a diverse group of people including:

Other palliative care specialists - they can check the palliative care specific content
Other simulation fellows/educationalists (who are NOT palliative care background) - they can check the scenarios make sense from a sim perspective
ESSENTIAL: Some intended learners - they can check whether the material is pitched at the right level? Is it fair to ask a learner to do this scenario? Will it fit within the time frame? Is it too complex? Do the learning objectives match the content?

Think about Equality, Diversity and Inclusion (not just in your scenario content but also consider this within the context of your course as a whole e.g. your fellow faculty members, your learners, the patients you are representing in the sim) - this is a sign of excellence in simulation.

5. Test it out and edit based on feedback

Run the scenario/course and always ask the learners for constructive feedback on the content as well as facilitation. You can then adjust based on what they say and what your fellow faculty members felt as well.

Good luck!

Written by T Tran, Sept 2024