When Simulation Has to Travel: Count the Repetitions
By Evan Fallon, Regional Director of Business Development, VRpatients
A simulation outreach day starts long before the first crew walks in.
As a Simulation Specialist at OhioHealth, I supported EMS outreach programs across rural Ohio. Many of those days ended in a fire department an hour or more from the nearest simulation center. Manikins, patient monitors, and moulage supplies had to be loaded, driven, unloaded, assembled, and tested before the first scenario could begin.
The training was valuable. Then there was the arithmetic.
Each paramedic typically got one pass through a scenario before the next crew rotated in. Crews were still on duty, so a dispatch could pull someone out mid-scenario and end the exercise for them. When the last scenario wrapped, we packed up and drove home. The next chance to run that scenario with that crew might be months away.
I still think about that arithmetic, because it points to a question most simulation programs never put on the calendar:
Attendance Is Easy to Count. Repetitions Aren’t.
Simulation programs track what’s simple to track: events held, learners present, hours logged. Those numbers describe activity. Repetitions describe practice, and practice is what a clinician takes to the next low-frequency, high-acuity call.
The research points the same way. A 2011 meta-analysis in Academic Medicine (McGaghie and colleagues) found that simulation-based education with deliberate practice produced better results than traditional clinical education. Deliberate practice means repetition with feedback, aimed at a specific skill.
An outreach day delivers the feedback well. A debrief with a skilled instructor is hard to beat. The repetition is the part that’s hard to schedule, and it gets harder with every mile between the learner and the equipment.
A Four-Question Repetition Audit
You can run this on your own program in an afternoon, or on any program you’re evaluating.
- How many repetitions does each learner get? Count the passes each learner gets through each scenario in a year. If the honest answer is one, you’ve found your starting point.
- What happens to the learner who misses the day? Dispatches, shift changes, and snow days will remove learners from a scheduled event. Check whether a make-up path exists or whether the learner simply misses it.
- Does every site run the same scenario to the same standard? Different sites, shifts, and instructors can drift into different versions of the same scenario. Standardization takes a deliberate decision.
- What does one repetition cost? Add up staff time, travel, equipment transport, and learner backfill for one event, then divide by the repetitions it delivered. The result is a number you can compare against any alternative.
A Division of Labor for In-Person and Virtual Simulation
Once repetitions are on the table, the useful question is which kind of simulation should deliver which kind of practice.
In-person simulation does what only a room full of people can do. Psychomotor skills, team communication, physical assessment, and a face-to-face debrief belong there, and they should get the best of your instructors’ time.
Virtual simulation can carry the repetitions of assessment and decision-making. A learner can re-run a scenario after instructor feedback, work through a rare high-acuity call before ever seeing one, or make up the session a dispatch interrupted.
Sequence matters too. When learners arrive at the in-person day having already worked the scenario, the day can start at the second pass. The truck still goes out. It carries a different agenda.
Questions to Ask Any Virtual Simulation Platform
If virtual simulation is going to carry repetitions, hold it to the same audit.
- Can your own instructors write and revise scenarios to match your local protocols?
- Does it run on the equipment your learners already have?
- Can you see who practiced which scenario, and how often?
- Who helps your faculty after onboarding ends?
VRpatients lets instructors build their own scenarios from scratch and run them in a web browser, a VR headset, or mixed reality, all included, with ready-to-run scenarios to start from.
Funding Starts Programs. Repetition Sustains Them.
Rural Health Transformation Program funding is putting new attention on rural training. In case you missed it, we covered the workforce numbers and how the money moves in The Rural Healthcare Workforce Gap Is Growing.
Whatever pays for a program, the question that outlasts the grant is whether clinicians are still practicing. A program that can show repetitions per learner, by scenario, has a clear answer. Click here to speak to a simulation specialist and learn more how VRpatients helps simulation programs add repetitions between in-person events.