Simulation For Remediation?

One definition of remediation is a process designed to close the gap between what students know and what they’re expected to know.? Remediation usually entails a certain amount of “reteaching”.? For the learner, remediation can mean a chance to learn for the first time, what they didn’t pay attention to in the classroom.? Learners who know that remediation is available may use it as an excuse to slack off.? They may postpone reading the text or viewing audio-visual materials until they have to.??

This isn’t the definition of remediation I use when I talk about simulation.? Clinical simulation for clinical review can help learners polish their practice skills as well as hone clinical reasoning. Clinical faculty may refer a learner who had difficulty with a skill or thought process in the practice setting to the Simulation Specialist. Clinical Simulation is an ideal method to challenge the learner by recreating a scenario they found difficult in the real world.

James (not his real name) was referred to the simulation lab because he had difficulty managing the care of two clinical patients. James’ problem was that he couldn’t prioritize care for a patient with Type II diabetes as well as one with a complex medication regimen.? His clinical faculty reported that James was able to aptly care for one or the other of his patients but could not complete care for both in a timely fashion.? The student was chronically late to finish his care and documentation.? He often left the nursing unit an hour or more after the rest of his classmates.??

Faculty along with the Simulation Expert developed a simple scenario similar to the actual situation which challenged James in his clinical rotation.

1. Two patients were assigned - a diabetic patient and one with co-morbidities and a complex medication regimen.
2. James was expected to perform a focused assessment on the diabetic patient, collect a bedside glucose reading and cover the results as ordered by the provider.
3. He was also expected to do a focused assessment on the other patient and administer morning medications as prescribed.
4. James had a total of 30 minutes in the scenario to complete both patient care assignments.

James was given an ISBAR report for each patient during prebrief.? The scenario began but James was unable to meet the objectives in the time allowed.

During the debrief, James expressed frustration. He admitted he did not know which patient to care for first.? This identified the problem of prioritizing care.? Next, James said he wasn’t sure how to do a bedside glucose reading.? Further practice in the use of a glucometer was recommended.? Finally, the facilitator observed that James skipped around in his documentation going from one patient’s chart to the other.??

The scenario revealed three important deficits in James skillset, two of which were easily remediated in the skills lab.? After learning he had trouble prioritizing care, a problem common to nursing students, James was referred to an online workshop to help him develop better clinical judgment and critical thinking.

Using Clinical Simulation for clinical remediation enables faculty to work one-on-one with a learner in the safe environment of the simulation lab.? After James completed the follow-up practice and review, he admitted greater confidence and his clinical faculty reported significant improvement in his patient care.

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