Table 1 Applying with good judgment across the SimZones
Simulation zone | ||||
|---|---|---|---|---|
Zone 1: procedure and skills workshops | Zone 2: acute situational instruction | Zone 3: team and system development | ||
Learning leader’s stance | Goal of experience | Learn basic domain-specific skills | Practice skills in context | Continuous development of individuals and teams |
What learning happens | Acquiring and demonstrating skills such as the following: • Clinical • Conversational • Teaming Patient assessment | How to recognize and manage situations using zone 1 skills in context such as the following: • Anesthesia induction in an obese patient • Escalating care using “SBAR” | Clarifying the underlying barriers to and corrective actions for high performance using the unique perspectives of participants such as the following: • Managing a failed airway • Team-based management of massive hemorrhage | |
Learning domain | Skill acquisition: e.g., psychomotor, conversational, teaming, patient assessment | Skills are refined. Performance of a skill with contextual demands and higher cognitive load | Co-creation of learning and change by identifying personal and team strategies | |
How to create and sustain the trusting learning environment? | I create trust by sharing expertise but also model that I am also still learning and refining my own practice. I have many but not all the answers. I signal openness humility to remain approachable despite my expertise | I create trust by being dependable and honest and holding a high standard and sharing it with compassion. I use predictable direct feedback techniques. I avoid shaming or showing up the learner | I create trust by giving up control and authority and position myself as an external helper, observer and supporter of the team, and offer insights if and when invited | |
Zone 1: procedure and skills workshops | Zone 2: acute situational instruction | Zone 3: team and system development | ||
In-zone activity | Learning conversation strategies | Teaching with good judgment: preview, advocacy, teach Modeling and demonstration and asking guiding questions and sharing direct feedback Identify developmental next step and make prescriptions for future practice | Coaching with good judgment: preview, advocacy, coach Providing expert feedback, encouraging successes, and motivating high-performance standards Propose discussion agenda and then inquire, listen, and coach to needs | Debriefing with good judgment: preview, advocacy, inquire Coordinating reflective conversations and fostering dialogue among team members Use inquiry to explore mental models, assumptions, and biases that drove participant’s actions |
Role of the learning leader | The expert — holder of knowledge and a master of the standard. Controls the experience to a great extent | A colleague with valuable expertise. Guides many elements of experience and may negotiate some such as topic selection or time allocation during reflection | A facilitator of reflection. Helps team recording findings and synthetizing next steps. Coordinates the conversation and shares their expertise sparingly | |
Role of the learner | Seeker of knowledge & skill | Beginning practitioner | Competent practitioner(s) striving for continuous improvement | |