Making (Simulated) Mistakes Safely: Preparing Future Health Care Professionals with the Interactive Scenario Builder

By Cristina Lopez

Conversations between health care providers and their patients are complex and the stakes can be high. Health care providers must elicit information for determining the best course of treatment, build trust, and explain in clear terms complex and often highly technical information. In short, effective communication between health care providers and patients requires both experience and highly developed communication skills. And effective communication requires practice.

In the interest of improving provider/patient communication, a team from the University of Minnesota Center for Spirituality and Healing (CSH) developed the Interactive Scenario Builder (ISB), a simple but powerful Web-based tool with which instructors can create simulated interpersonal interactions. With the support of a five-year grant from the National Center for Complementary and Alternative Medicine, Mary Jo Kreitzer, principal investigator and the director of the CSH, Louise Delagran, a co-investigator and an education specialist in the CSH, Sheila Hoover, a co-investigator and currently an instructional designer in the School of Public Health, and team members Andy Rakotz, "flash programmer extraordinaire," and Beth Somerville initially set out to develop online learning modules. When they realized that the modules would be even more effective coupled with experiential learning activities, they began developing the ISB.

According to Delagran, the ISB enables students to "practice and safely make mistakes in preparation for high-stakes interactions." Instructors combine text and still photos to create the scenarios. A scenario grounded in effective teaching strategies might begin with an introduction to the patient and an overview of the instructors' learning objectives. The student then makes a series of choices to move through stages of a typical interview: determining what questions to ask, reflecting on the patient's responses (both verbal and non-verbal), and developing a plan of care. At every stage the student gets feedback from both the instructor and the patient. Feedback from the instructor might take the form of advice on the order and appropriateness of questions and choices made in developing a plan of care. The simulated patient, who is depicted with combined texts and photos, can express agreement, concern, and even annoyance. "In that way," Delagran explains, "the scenario mirrors real life."

In developing the ISB the team kept instructors' as well as students' needs in mind. Using the tool requires only basic skills such as the ability to enter text and upload photos. The scenarios are completely customizable, so instructors don't have to settle for "off-the-shelf" videos that are not specifically adapted to the goals of the course or of specific learning activities. Instructors can also develop scenarios to cover significant situations that students might not typically encounter in clinical work. These scenarios create a standardized experience for students and helps departments meet accreditation standards.

While the tool is easy to use, constructing a simulated interaction requires considerable expertise. Delagran advises instructors to use cases with which they are familiar to begin building their scenarios. "Think about the most effective way to conduct an interview: what are the really good questions? You can then formulate distractors by thinking about common mistakes and adding those." In other words, rather than building a scenario chronologically, the instructor builds architectonically, from the ground floor up.

Currently around 50 new scenarios are being developed by School of Nursing, the Medical School, Program in Occupational Therapy, Division of Dental Hygiene, and the College of Veterinary Medicine. But use of the tool is not restricted to health care professionals. It is available at no cost to anyone with a University of Minnesota Internet ID (x.500 username) and password and can easily be used to create simulations of all types of interpersonal interactions (such as job interviews), or even more broadly, interactive processes that lead to decision making. There are many possibilities, and this simple tool frees up instructors to focus on the creative process instead of on mastering a new and complex technology.

Related Resources

For more information about the ISB, see the Interactive Scenario Builder (ISB) page on the CSH site.
Delagran, Hoover, and Kreitzer were awarded 2002-03 and 2005 TEL grants in support of the ISB. For more information, see our Tools for Creating Virtual Integrated Care Scenarios page and their 2005 TEL grant application, The Interactive Scenario Builder (ISB): A Tool to Simulate Interpersonal Interactions (PDF).