The Human Simulation Continuum: Integration and Application

Abstract

The demand to integrate human simulation (HS) into experiential activities within health professions and professional fields beyond healthcare has seen a significant growth over the past few decades. To best meet this demand, a comprehensive understanding of the intricacies of human-based simulation is required. In this chapter we will identify and explore the full spectrum within the human simulation modality and introduce the concept of The Human Simulation Continuum Model. We will demonstrate how to apply the HS Continuum Model in the decision-making process in the day-to-day routine of simulation educators and simulationists. We will provide tools on how to select the appropriate HS application, provide sample scenarios and their unique challenges and discuss how to select human role players to meet curricular learning objectives.

Appendix 5.1: Printable Guide for Human Simulation Applications

Suggestions when to Select a Human Simulation applications (see Fig. 5.1).

When to select the Role Player Application	–	When to Select the Structured Role Player Application
Learning Activities-no standardization	–	Some standardization needed
Demonstrations, presentations and workshops	–	Targeted coaching and remediation (different elements need to relate to each other – more structure; may build on role play
To facilitate enhancement of learner communication skills (see Chap. 9)	–	If a few specific questions, cues or behaviors are required for the SP to ask/portray during the activity
When SPs are contributing to calibrations of emotional portrayals during new case development	–	When training SPs to provide feedback (e.g. to practice responding to different learner skills and communication styles)
For SP training (e.g. rehearse/pilot a case)	–	Activity objectives requires specialized skills including knowledge of cultural humility principles (i.e. non-verbal communication, language and specific cultural norms)
During recruitment to select SP Applicants	–	Faculty development workshops where more nuanced portrayal is necessary to teach learners who will be actively working with your human simulation programs (e.g. preceptors/facilitators)
One-time activity needing one SP (e.g. additional coaching/remediation for individual learner)	–	Provide learners with a range of (SP) patient stories that are all individuals with the same chief complaint and thus not standardized.
Activities where cases are based on SP own unique history/perspectives (i.e. diversity cases)	–	Assessments in Clinical Settings: Unannounced Patients
When to select the Embedded Participant Application	–	When to select the Simulated Patient Application
When it is appropriate for an SP to provide guidance in the scenario	–	When you can provide details in multiple aspects of the case content (history, PMH, FH, SH etc)
When you have an SP with healthcare background and cultural knowledge about related professions (e.g. if training for a nursing role, the SP understands the professional duties of a nurse and cultural knowledge of the nursing profession)	–	When increased calibration of the role portrayal within a single SP is important to meet educational and learning objectives
As a family member in the scenario	–	If you need pre-set responses based on the learner’s questions
If you have SP/actors experienced in medical role-play [6]	–	Reproducibility and repeatability are required
–	–	Formative assessments, Clinical
When to select the Standardized Patient Application	–	When to select the Standardized Patient High Stakes Application
Any Assessments (formative or summative), including assessments with unnounced patients	–	Licensing or accreditation assessments
Sessions when standardization of multiple SP for the same case are required	–	Highest degree of standardization
Preset responses based on the learner’s questions are required	–	Standardization between SPs and sites as needed
Preset standardized questions and challenges are required	–	–
High degree of reproducibility required	–	–