Designing a Simulation Scenario

Function

Scenario Design

Simulation design can be viewed as similar to a professional stage production. A well-designed scenario typically includes:

• A script with an instructor guide or document
• A simulation technician document
• A list of required equipment, technology, and supplies

The director and writers are represented by faculty, while the production staff includes educational specialists, simulation technicians, and visual effects personnel responsible for moulage. Learners function as the audience within the scenario. The use of standardized simulation scenario templates and structured storyboarding is strongly recommended to support systematic and coherent scenario design. In addition, AI-driven design tools may serve as valuable adjuncts, assisting educators in organizing content, clarifying objectives, and improving design efficiency.[5]

Assessment scenarios should be crafted at a level where learners are expected to perform well, whereas educational simulation scenarios should be intentionally designed with greater complexity to promote learner growth and development.

Moreover, scenario design should incorporate strategies to anticipate and manage deviations from planned objectives and unexpected reactions from learners, ensuring continuity and the achievement of educational goals despite unforeseen challenges.[6]

Writing a Simulation Scenario

The development of a simulation scenario should follow a systematic approach that clearly defines the intended outcomes, context, goals, and objectives. Key steps include:

• Identifying the target learners to ensure alignment with their level of expertise.
• Defining the desired outcomes, which encompass relevant teaching points. Goals represent what learners should understand, while objectives specify the skills and behaviors they are expected to demonstrate upon completion of the activity.
• Establishing clear objectives that outline the knowledge and competencies learners are expected to acquire through participation.
• Determining the context, including the case type, patient characteristics, fidelity requirements, the necessary equipment, technologies, and supplies to support the objectives.
• Planning strategies to anticipate and manage unexpected situations during the scenario.

SMART Template

The SMART template is used to construct specific goals and objectives, as mentioned below.

• S: Specific            
• M: Measurable
• A: Achievable
• R: Relevant
• T: Timely

Specific

• What do you need to achieve?
• Who needs to be involved to accomplish the goal?
• When do you want to have your goal finished?
• Why exactly should you achieve this goal?

Measurable

• How can you measure progress and know if you have met your goal?

Achievable

• Are you capable of achieving the goal?
• Do you have the necessary skills?
• Can the learners meet the goals through simulation?

Relevant

• Why should you achieve this goal?
• What is the impact?

Timely

• What is the due date of your goal?
• Can the goal be achieved by this date?
• Can the learning objectives be met in the time allotted for the scenario?

Scenario Development

Multiple steps need to be addressed to construct a successful simulation.[7] Preparation includes the case, case stem, flow, role and scripts, resources, pre-briefing, debriefing, and dry run.

Simulation

A simulation is a live-action production involving instructors, learners, simulation technicians, specific roles and scripts, debriefing, and evaluations.

Design

Scenario development typically begins by organizing ideas using 1 of 2 traditional approaches: storyboarding or a scenario design template. Storyboarding provides a graphical method of organization that visually represents the scenario through illustrations, allowing educators to visualize the progression of events across the entire scenario. In contrast, a scenario design template offers a structured written format that outlines the case and its flow.

Multiple scenario templates have been published or are available online, including the California Simulation Alliance Simulation Scenario Template (CASST), the Human Patient Simulation Scenario Development Patient Care Template (HPSSDPCT), the Simulation Design Template (SDT), the Special Interest Group Simulation Scenario Template (SIGSST), the Template for Simulation Patient Design (TSPD), and Teach Sim.[3] These templates typically include elements such as the chief complaint, past medical history, medications, allergies, data summary, laboratory results, imaging, and physical examination findings, along with several additional structured sections.

The scenario design must also include branch points for a planned response. Written components of a well-designed scenario include the following:

1. Prebrief summary: A brief introduction to the simulation is essential for ensuring a meaningful learning experience. The prebrief also introduces learners to the simulation concept and orients them to the simulation environment, equipment, and embedded participants. This approach also establishes expectations regarding performance, professionalism, and confidentiality, making it a critical component of an effective simulation experience. The instructor should clearly state the purpose of the simulation scenario upfront, whether it is intended for education or assessment. Simulation scenarios developed for educational purposes are often designed with a level of difficulty that challenges learners beyond their current level of mastery to promote growth. In contrast, simulation scenarios designed for assessment should reflect the expected level of performance for the individual being evaluated.
2. Instructor document: This document typically includes the primary goals and objectives, a case summary, instructor notes, the ideal scenario flow, anticipated learner errors, branch points, strategies for maintaining scenario progression, and designated hard stops. A critical action checklist and a list of critical errors may also be included to assess and document learner performance during the scenario.
3. Simulation technician document: This document outlines the equipment, props, level of fidelity, standardized patients, moulage, and mannequins required for the scenario. The goals and objectives determine the appropriate level of fidelity. For example, if the objective is to teach learners how to place a central line, a low-fidelity task trainer may be sufficient. In contrast, if the objective is to manage a deteriorating patient as part of a team, a high-fidelity immersive scenario would be more appropriate to meet the learning objectives.[8]
4. Additional roles and scripts: These are developed for standardized patients, mannequins, or embedded participants and outline how each role should be performed. They typically include details on which words to say, what to avoid, which emotions to portray, and which behaviors to exhibit during the scenario. 
5. Debriefing plan: At the end of the scenario, a debriefing session is conducted to review the case, reinforce key learning points, and provide feedback related to the goals and objectives. This guided period of self-reflection typically lasts about twice as long as the simulation scenario itself.

In addition to these written materials, several additional steps can help ensure smooth simulation implementation.

1. Conducting a final planning meeting with all involved participants to review the scenario, goals and objectives, critical actions, expected outcomes, required resources, and production needs.
2. Scheduling a dry run or rehearsal to optimize the process, with attention to timing and scenario flow. This rehearsal may reveal unexpected outcomes or identify prompts (such as stimuli or wording) that could inadvertently lead learners away from the primary learning objectives.

Clinical Significance

The ultimate goal of experiential learning through simulation is to improve clinical practice and enhance patient safety. Numerous studies have evaluated the outcomes and benefits of simulation in healthcare, demonstrating improvements in teamwork, procedural skills, leadership, communication, and clinical outcomes.

Okuda et al reviewed the utility of simulation in medical education with a focus on the supporting evidence.[9] Barsuk et al showed that residents involved in simulation-based learning performed thoracentesis with low complication rates.[10] Schmidt-Huber et al demonstrated that leadership skills can be effectively developed through simulation-based training.[11]

Pearls and Other Issues

A successful simulation scenario requires a clear, concise, and well-organized approach, and typically includes the following elements:

• Education goals and objectives
• Intended outcome
• Critical actions checklist
• Simulation setup
• Case narrative
• Scenario flow diagram with branch points
• Instructor notes
• Prebriefing and debriefing plan

Additional Steps for Scenario Development

1. Scenario design may begin with a storyboard or a scenario builder template to organize the structure.
2. Simulation scenario design development is typically approached in a stepwise manner, with attention to the intended learners, educational goals and objectives, identified knowledge or skill gaps, level of fidelity, feedback strategies, and planned didactics.
3. An effective educational scenario should be sufficiently challenging to maintain learner engagement without becoming overly difficult or frustrating for participants.
4. Dry runs or rehearsals are essential for successful scenario implementation and help minimize unexpected deviations during the simulation.
5. The integration of AI and digital tools should be considered thoughtfully to enhance design efficiency while maintaining pedagogical integrity.
6. Adequate time for debriefing is critical, as debriefing represents one of the most important components of simulation-based learning. Simulation without debriefing may reinforce errors or misconceptions rather than correct them.
7. Scenarios should also be evaluated using measurable outcomes, and feedback from learners or participants should be used to refine them for future success.

Artificial Intelligence and Digital innovation in scenario Design

Advancements in AI and large language models are transforming simulation scenario design and have the potential to revolutionize this process.[12] These technologies can support several aspects of scenario development, including:

• Generating detailed scenario scripts
• Aligning outputs with established best-practice standards
• Reducing educator workload while preserving educational rigor

AI design tools represent a promising complementary resource, offering support in scenario construction, objective alignment, and iterative refinement of educational content. Nonetheless, concerns persist regarding the accuracy, contextual relevance, and structural coherence of AI-generated content, highlighting the need for rigorous evaluation and sustained human oversight throughout the design process.[13] 

E-simulation and Virtual Reality

Digital platforms expand the reach and fidelity of simulation, creating new and innovative opportunities to engage a new generation of learners and address spatial limitations, particularly in underserved regions or areas lacking dedicated simulation centers. Examples include:

• Scenario-based e-simulations that provide adaptable and interactive learning experiences delivered remotely.[4] 

• Virtual reality simulation models that support immersive clinical practice with positive educational outcomes.[14] 

Conclusion

The design of effective simulation scenarios is a structured, learner-centered process that supports the development of knowledge, clinical skills, critical thinking, and communication abilities. While recent advances in artificial intelligence have expanded the possibilities for scenario design, core principles such as clearly defined objectives, realistic context, and purposeful debriefing remain essential.

Enhancing Healthcare Team Outcomes

Simulation-based education spans all roles and disciplines in healthcare, including administrative staff, nurses, technicians, administrators, physicians, and institutional leaders such as the chief of staff. A systematic review by Zendejas et al found that simulation-based education is associated with small to moderate improvements in patient outcomes.[15][16]