Innovative Simulation Pedagogy: Fostering Cognitive Skills Through Interprofessional Mind-Mapping Scenarios

     

This presentation describes the integration of high fidelity simulation (HFS) in advanced practice nursing (APN) education to teach cognitive skills with psychomotor skills.  Typically, it is recommended that simulation scenarios progress uninterrupted by the facilitators. Alternately, in-simulation debriefing allows simulation to be suspended intermittently to instruct and allow reflection throughout. We propose a style of in-simulation debriefing which we call ‘mind-mapping debriefing’. HFS often uses skill set based scenarios, such as in cardiopulmonary resuscitation. Our scenarios focus on developing differential diagnosis and subsequent clinical management through interprofessional scenarios, which involve higher levels of cognitive thinking than learning a standardized skill set. We use scenarios ‘on-the-fly’ where patient parameters are changed in response to student actions and interactions, capturing real-life patient encounters, which have an inherent element of uncertainty.  The students are familiar with the technique of ‘mind-mapping’, which is used throughout the clinical seminars as a form of reflection and consideration of the ‘why’ and ‘how come’ involved in critical thinking. It was a logical step to incorporate a teaching pedagogy utilized in the classroom into the simulation scenario design.  We have introduced two new roles, an APN preceptor and student, played by students into the scenario design. This allows the technique of ‘mind-mapping debriefing’ to be accomplished in a realistic manner through the familiar preceptor-student relationship. In this way, it is natural to occasionally interrupt and debrief during the course of a scenario when patient safety is at risk, as a preceptor would in the actual clinical situation. The curricular innovations designed to foster competence in APN students using evidence-based guidelines and interventions are described. The process of developing and implementing evidence-based scenarios is detailed, as is the critical role of debriefing and guided reflection.  Successes and challenges of lessons learned are shared. Finally, implications for APN practice and education are discussed.