Essentials of Scenario Building for Simulation- Based Education

  • James L. Huffman
  • Gord McNeil
  • Zia Bismilla
  • Anita Lai
Part of the Comprehensive Healthcare Simulation book series (CHS)


Scenario building, also referred to as scenario design, is a fundamental component of simulation-based medical education. When done effectively, the scenario can reliably meet the needs of the curriculum and the learners. This chapter explores the rationale for utilizing a formal scenario-building process, outlines many of the theoretical underpinnings important to the endeavor, and describes a practical, six-step approach to designing scenarios. Some of the topics explored in depth include curriculum design, teamwork/interprofessional education, fidelity/realism, the use of distraction, and confederates. The six-step approach involves identifying the target audience, learning objectives and simulator modalities, building a case summary, procuring staging needs (such as moulage, confederates, and adjuncts), writing the script, preprogramming the scenario where appropriate, and finally practicing or pilot-testing the scenario. A sample template is provided and common pitfalls are discussed.


Scenario Design Case Process Curriculum Goals Objectives Fidelity Realism Confederates Moulage Adjuncts Script Planning Programming In situ Personnel 


  1. 1.
    Terrett L, Cardinal P, Landriault A, Cheng A, Clarke M. Simulation scenario development worksheet (Simulation Educator Training: course material). Ottawa: Royal College of Physicians and Surgeons of Canada; 2012.Google Scholar
  2. 2.
    McGaghie WC, Issenberg SB, Petrusa ER, Scalese RJ. A critical review of simulation-based medical education research: 2003–2009. Med Educ. 2010;44:50–63.CrossRefPubMedGoogle Scholar
  3. 3.
    Holmboe E, Rizzolo MA, Sachdeva AK, Rosenberg M, Ziv A. Simulation-based assessment and the regulation of healthcare professionals. Simul Healthcare. 2011;6:S58–S62.CrossRefGoogle Scholar
  4. 4.
    Khan K, Pattison T, Sherwood M. Simulation in medical education. Med Teach. 2011;33:1–3.CrossRefPubMedGoogle Scholar
  5. 5.
    McGaghie WC, Siddall VJ, Mazmanian PE, Myers J. Lessons for continuing medical education from simulation research in undergraduate and graduate medical education: effectiveness of continuing medical education: American College of Chest Physicians Evidence-Based Educational Guidelines. Chest. 2009;135:62S–8S.CrossRefPubMedGoogle Scholar
  6. 6.
    Cook DA, Brydges R, Zendejas B, Hamstra SJ, Hatala R. Technology-enhanced simulation to assess health professionals: a systematic review of validity evidence, research methods, and reporting quality. J Assoc Am Med Coll. 2013;88:872–83.CrossRefGoogle Scholar
  7. 7.
    McGaghie WC, Issenberg SB, Cohen ER, Barsuk JH, Wayne DB. Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence. J Assoc Am Med Coll. 2011;86:706–11.CrossRefGoogle Scholar
  8. 8.
    Issenberg SB, McGaghie WC, Petrusa ER, Lee Gordon D, Scalese RJ. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach. 2005;27:10–28.CrossRefPubMedGoogle Scholar
  9. 9.
    Norman G, Dore K, Grierson L. The minimal relationship between simulation fidelity and transfer of learning. Med Educ. 2012;46:636–47.CrossRefPubMedGoogle Scholar
  10. 10.
    Lisko SA, ODell V. Integration of theory and practice: experiential learning theory and nursing education. Nurs Educ Perspect. 2010;31(2):106–8.PubMedGoogle Scholar
  11. 11.
    Maran NJ, Glavin RJ. Low- to high-fidelity simulation—a continuum of medical education? Med Educ. 2003;37:22–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Dieckmann P, Gaba D, Rall M. Deepening the theoretical foundations of patient simulation as social practice. Simul Healthc. 2007;2:183–93.CrossRefPubMedGoogle Scholar
  13. 13.
    Rudolph JW, Simon R, Raemer DB. Which reality matters? Questions on the path to high engagement in healthcare simulation. Simul Healthc. 2007;2:161–3.CrossRefPubMedGoogle Scholar
  14. 14.
    Cheng A, Lang TR, Starr SR, Pusic M, Cook DA. Technology-enhanced simulation and pediatric education: a meta-analysis. Pediatrics. 2014;133:e1313–23.CrossRefPubMedGoogle Scholar
  15. 15.
    Hamstra SJ, Brydges R, Hatala R, Zendejas B, Cook DA. Reconsidering fidelity in simulation-based training. J Assoc Am Med Coll. 2014;89:387–92.CrossRefGoogle Scholar
  16. 16.
    Brydges R, Carnahan H, Rose D, Rose L, Dubrowski A. Coordinating progressive levels of simulation fidelity to maximize educational benefit. 2010. J Assoc Am Med Coll. 2010;85:806–12.CrossRefGoogle Scholar
  17. 17.
    Cooper SJ, Cant RP. Measuring non-technical skills of medical emergency teams: an update on the validity and reliability of the Team Emergency Assessment Measure (TEAM). Resuscitation. 2014;85:31–3.CrossRefPubMedGoogle Scholar
  18. 18.
    Glavin RJ, Maran NJ. Integrating human factors into the medical curriculum. Med Educ. 2003;37:59–64.CrossRefPubMedGoogle Scholar
  19. 19.
    Flin R. Identifying and training non-technical skills for teams in acute medicine. Qual Safe Health Care. 2004;13:i80–i4.CrossRefGoogle Scholar
  20. 20.
    Rudolph JW, Simon R, Raemer DB, Eppich WJ. Debriefing as formative assessment: closing performance gaps in medical education. Acad Emerg Med. 2008;15:1010–16.CrossRefPubMedGoogle Scholar
  21. 21.
    Hoffman DR. An overview of concurrent engineering. Reliability and maintainability symposium. 1998. doi:10.1109/RAMS.1998.653529.Google Scholar
  22. 22.
    Gilbert JHV, Yan J, Hoffman SJ. A WHO report: framework for action on interprofessional education and collaborative practice. J Allied Health. 2010;39(Suppl 1):196–7.PubMedGoogle Scholar
  23. 23.
    Cheng A, Donoghue A, Gilfoyle E, Eppich W. Simulation-based crisis resource management training for pediatric critical care medicine: a review for instructors. Pediatr Crit Care Med. 2012;13:197–203.CrossRefPubMedGoogle Scholar
  24. 24.
    van Merriënboer JJG, Sweller J. Cognitive load theory in health professional education: design principles and strategies. Med Educ. 2010;44:85–93.CrossRefPubMedGoogle Scholar
  25. 25.
    Paas F, Renkl A, Sweller J. Cognitive load theory and instructional design: recent developments. Educ Psychol. 2003;38:1–4.CrossRefGoogle Scholar
  26. 26.
    Fraser K, Ma I, Teteris E, Baxter H, Wright B, McLaughlin K. Emotion, cognitive load and learning outcomes during simulation training. Med Educ. 2012;46:1055–62.CrossRefPubMedGoogle Scholar
  27. 27.
    Cheng A, Auerbach M, Hunt EA, Chang TP, Pusic M, Nadkarni V, Kessler D. Designing and conducting simulation-based research. Pediatrics. 2014;133:1091–101.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • James L. Huffman
    • 1
  • Gord McNeil
    • 2
  • Zia Bismilla
    • 3
  • Anita Lai
    • 4
  1. 1.Department of Emergency MedicineUniversity of Calgary, Alberta Health ServicesCalgaryCanada
  2. 2.Department of Emergency MedicineUniversity of Calgary, Foothills Medical Centre and Alberta Children’s HospitalCalgaryCanada
  3. 3.Department of PaediatricsUniversity of TorontoTorontoCanada
  4. 4.Department of Emergency MedicineUniversity of CalgaryCalgaryCanada

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