DESIGNING & BUILDING EFFEC TIVE SCENARIOS
Using simulation to teach effective healthcare communication
By Jennifer McCarthy, MAS, NRP, MICP, CHSE; Amar P. Patel, DHSc, MS, NRP;
Andrew E. Spain, MA, NCEE, EMT-P & Timothy Whitaker, BS, CHSE, CHSOS, EMT-P
EMS educators often think of simula- tion as a tool used for enhancing patient assessment techniques, teaching skills
before performing them on actual patients (e.g.,
IVs or airways), or performing patient care simulation experiences (i.e., full scenarios). These
are easy ways to enhance what’s taught in the
classroom and are great examples of education
that can be bridged into practice.
How often are communication concepts
considered and deliberately integrated into a
patient assessment or skills activity? And how
often do they become the sole focus of the simulation activity?
There’s little doubt that communication
is an important skill for healthcare providers,
either between the caregiver and the patient or
caregiver to caregiver, yet it’s often minimal or
performed poorly. 1
Poor communication and patient handoff
has been identified as a contributing cause of
medical errors. 2 How healthcare providers communicate with each other and to their patients
is as important as what they’re communicating.
Consideration must be given when designing and delivering simulation activities for
including, evaluating and enhancing communication. The considerations for inclusion can
be construed in two frameworks: meta objectives and specific objectives.
Meta objectives are objectives that always exist
no matter what the simulation activity is. They
aren’t specifically written down, but are generally
understood principles that exist within a profession or professional setting. For instance, one
meta objective is that individuals should communicate effectively and professionally during
all simulation activities. Meta objectives.
Meta objectives can be continuously embed-
ded behaviors and expectations that serve to
build the appropriate culture of care and ethical
behavior. For communication, there are some
common examples to draw from.
Advanced Cardiac Life Support (ACLS)
communication techniques: Readers should be
familiar with the effective team communication techniques that are highlighted for use in
ACLS courses conducted through the American Heart Association. Clear messages, closed-loop communication, knowledge sharing, and
mutual respect are just some of the concepts
addressed in the course. 3
CUS methodology in TeamSTEPPS: These
communication techniques are designed as the
consistent terminology used to alert the team to
an issue that the individual believes exists, and
to escalate as needed until a satisfactory resolution is obtained. CUS is an acronym from
the assertive statements used in the technique:
I am Concerned; I am Uncomfortable; this is
a Safety issue. 4
These two examples demonstrate common
communication techniques or principles that
should be embedded in normal appropriate
communications in the healthcare setting.
There are certainly other courses, options and
techniques that are routinely used. Your agency
should have guidelines that can be included in
any activity as a background objective to support development and maintenance of effective communication.
Specific objectives are defined as objectives
that are explicitly stated as a part of the simulation activity. Specific objectives typically start
with verbiage such as, “On completion of this
activity, the learner shall be able to …” They’re
supposed to be specific, measurable, achievable,
relevant and time-oriented. 5
Specific objectives support the idea that
communication is a deliberate and desired
outcome of the simulation activity. Here are
some examples of simulation activities for
which specific objectives can be written.
Introduction of crews: Patients have a right to
know who is treating them. This introduction
serves to calm patients and reduce tension at
the EMS scene. Introduction of the crew allows
the EMS crew to connect with the patient
and families which improves communication. 6
Explanation of procedures throughout treat-
ment: Patients have a right to know what’s being
done to them and why. In EMS, we often glaze
over this step out of fear of being told not to
proceed. There’s a way to inform and empower
patients to understand the importance of our
treatments and interventions.
Breaking the bad news: There’s nothing worse
than having to tell a family or friends that a
patient has died. Many healthcare providers
avoid this important step of family interaction.
The moment treatment is no longer being ren-
dered to the patient; the family/friends become
our patients. The only way to become better
at saying a patient has died is to practice it.
Preparing the family for a negative outcome:
In EMS we know that the patient has a tough
road ahead. Encouraging the family through
effective communication techniques can allow
them to mentally prepare for complicated news
that will be delivered either in the field or at
Interprofessional activities: Integration of two
or more professions, where handoff of care can
be measured and assessed to offer improvement in technique.
Public health education: The back to sleep
campaign for infants, fall risk assessment for
the elderly and medication compliance for all
patients are three examples of how EMS can
greatly reduce healthcare expenditures by identifying public health risk in the homes of our
patients. Non-judgmental communication can
mean the difference between an infant surviving, avoiding a broken hip or preventing hospital readmission.