SimWars: The Ultimate Test of Clinical Management, Communication, and Teamwork

Recognition and appropriate treatment of medical situations is an important patient care skill for nurse practitioners. Communication proficiency is an equally important skill. The purpose of our innovative project was to radically transform how didactic and clinical coursework was evaluated in our Adult-Gerontology Acute Care Nurse Practitioner (AG-ACNP) curricula. The AG-ACNP faculty implemented ‘Simulation Wars’ (‘SimWars’), a new innovative andragogical strategy that was designed to mirror real life intra-disciplinary teamwork in managing a patient with an acute clinical deterioration. Student teams were not only expected to integrate theories, principles and techniques in the management of critically ill adult patients, they were also expected to evaluate and communicate among each other the response to the plan of care and revise, as necessary, the treatment based on established goals and criteria.

For each AG-ACNP student team, the scenario began with a progressively confused standardized patient and transitioned to utilization of a high-fidelity mannequin (i.e., to allow opportunity for demonstration of advanced clinical skills). Student teams competed against each other in front of their faculty and an invited expert panel of providers. Each team was blinded to each other’s performance. The expert panel evaluated each team on numerous outcome criteria (e.g., adherence to national sepsis guidelines, collaboration, communication skills) and provided each team with feedback and an opportunity to debrief.

The AG-ACNP student teams demonstrated minor deficits in cognitive performance (e.g., adhering to sepsis guidelines), evaluation of treatment efficacy, and consistent communication. However, they demonstrated excellent critical thinking and summative evaluations of their performance during their debriefing session with the faculty and expert panel. Utilization of an expert panel highlighted the importance of prioritization and re-evaluation of treatment efficacy.  

SimWars not only promoted healthy competition, it allowed our students an opportunity to practice their new provider roles and communication skills as they intervened in a life-threatening situation. Faculty now have a framework for creation of future SimWars cases to include subtle, moderate and/or obvious physiological cues that parallel real-world levels of acuity and clinical trends; early identification of these cues in a safe environment is critical to prepare future AG-ACNP providers.