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The increased use of simulation as an innovative teaching-learning tool has prompted many healthcare professional organizations to develop scenarios, standards, and techniques for simulation use within their own professional realm. In an effort to promote collaboration with these different organizations, the Society for Simulation in Healthcare (SSH), an organization dedicated to facilitating excellence in multidisciplinary healthcare education, practice, and research through simulation modalities, convened its second annual Simulation Education Summit meeting in October 2007 in Chicago, IL.


The summit brought together leaders of a variety of public organizations, private organizations, government entities, associations, and other agencies involved in healthcare education for a focused discussion of standards for simulation-based applications. Thirty-six organizations sent representatives for a total of 68 participants. Throughout the day, participants discussed in small and large groups the criteria needed for various training and assessment applications using simulation. I represented NNSDO as 1 of the 36 organizations present.


In addition to NNSDO, some of the other participating organizations included the American Hospital Association, National League for Nursing, American Heart Association, National Council of State Boards of Nursing, American Association of Nurse Anesthetists, Association of American Medical Colleges, American College of Surgeons, American College of Cardiology, and The Joint Commission.


During the summit, a professional facilitator led a series of working sessions where different small groups addressed the following areas related to simulation:


* formative and summative assessment of trainees,


* formative and summative assessment of practitioners,


* continuing medical/healthcare education,


* formative and summative assessment of new procedures,


* substitute for clinical encounter,


* rehabilitation and remediation of healthcare practitioners,


* credentialing of practitioners, and


* patient safety.



For each topic, participants were asked to discuss acceptable standards regarding the following:


* Simulators-what mode is appropriate? It is important to realize that simulation is not just about using a human patient simulator but rather incorporating the most appropriate mode for the identified learning activity. For example, in addition to using a high-fidelity computerized human patient simulator, one can also use standardized patients (trained medical actors), task trainers such as IV arms or pelvises, low-fidelity manikins that are not computerized, virtual reality, or video gaming technology. More than one mode can be used to create a blended simulation if appropriate. In addition to what mode is the most appropriate, how much fidelity is needed in a specific simulation?


* Instructors-is there a need for special training and/or formal certification?


* Metrics-what are the basic competencies that simulation is expected to measure?


* Evaluation-what are valid and reliable subjective-objective assessment tools?


* Ratification-what is the approval process for standards and verification of compliance?


* Time-what are the requirements related to duration and frequency of simulation training?


* Other elements to consider include differences between standards for technical versus cognitive or critical-thinking skills, training versus assessment, and formative versus summative evaluation.



After a day of brainstorming and group discussion, there were general themes agreed to by the participants. First, there was overarching unity that all simulation activities should be driven by identified educational objectives. Hence, if an organization is using a simulation activity, it must specify learning objectives and identify simulation technology and activity to meet these objectives.


In addition, the group agreed that instructors must have "appropriate" simulation training and demonstrate basic competency with the technology used, although the extent and meaning of appropriate was not explored at this time. Regarding evaluation of a learner's skills and abilities, the group agreed that simulation should be used as only one of the many tools available for learner assessment. A taxonomy of basic simulation-related definitions was discussed, including such terms as simulation fidelity, simulation program, and simulation standard.


Since the day consisted of brainstorming and group discussion, many issues were raised that could not be adequately addressed at one meeting. To carry on the work of this group, the participants agreed that ongoing communication and collaboration are necessary. On the basis of this feedback from the participants, SSH agreed to undertake the following:


* Form a coalition of professional organizations interested in simulation to collaborate in resolving simulation-based issues.


* Convene a group to create the standard documents and guidelines for review and dissemination.


* Along with input from other organizations, act as a clearinghouse to survey practices within organizations and continue to lead these efforts in consolidating common simulation needs and issues.



In response to the mentioned points, SSH formed the Simulation Alliance Task Force in July 2008. As the NNSDO representative to the summit and now to this more focused Simulation Alliance Task Force, as well as a member of SSH, I have found this coalition to be very positive and energizing. Active participation in this collaborative effort is in alignment with the NNSDO Strategic Priorities 2008-2010 identified in the NNSDO Update in the Journal for Nurses in Staff Development July/August 2008 issue under the broad categories of technology, knowledge management, and practice/education partnerships.


The Simulation Alliance Task Force consists of a smaller group of organizational representatives. Using conference calls, electronic communication, and a face-to-face meeting in the fall, the task force will work to create educational guidelines and standards for simulation-based training that will be used by organizations worldwide. The task force will present its work at the annual SSH conference in January 2009.


It is important for NNSDO to be a part of these larger efforts as we can not only benefit from others' knowledge and experience but also share our own staff development expertise. As the uses of various simulation modes and techniques continue to expand into new areas, NNSDO will remain a part of this growth process and an integral player in its development.


Mary E. Holtschneider, MPA, RN, BC, BCN, NREMT-P Director of Practice and Education North Carolina Nurses Association Raleigh, NC.