Simulation Vocab

Actor

In healthcare simulation, professional and/or amateur people trained to reproduce the components of real clinical experience, especially involving communication between health professionals and patients or colleagues (ASSH).

Cueing

To provide information during the simulation that helps the participant progress through the activity to achieve stated objectives (modified from NLN-SIRC, 2013). • noun Information provided to help the learner reach the learning objectives (conceptual cues), or to help the learner interpret or clarify the simulated reality (reality cues); Conceptual cues help the learner reach instructional objectives through programmable equipment, the environment, or through responses from the simulated patient or role player; Reality cues to help the learner interpret or clarify simulated reality through information delivered

Debrief (Debriefing)

• (noun) A formal, collaborative, reflective process within the simulation learning activity. • An activity that follows a simulation experience and led by a facilitator. • (verb) To conduct a session after a simulation event where educators/instructors/facilitators and learners re-examine the simulation experience for the purpose of moving toward assimilation and accommodation of learning to future situations (Johnson-Russell & Bailey, 2010; NLN-SIRC, 2013); debriefing should foster the development of clinical judgment and critical thinking skills (Johnson-Russell & Bailey, 2010). • To encourage participants' reflective thinking and provide feedback about their performance while various aspects of the completed simulation are discussed. • To explore with participants their emotions and to question, reflect, and provide feedback to one another (i.e., guided reflection).

Live, virtual, and constructed (LVC) simulation

• A broadly used taxonomy describing a mixture of simulation modalities; a live simulation involves real people operating real systems; a virtual simulation is where a real person operates simulated systems; and a constructed simulation does not involve real people or real systems, but instead are computer programs that create an environment. (Sokolowski).

Avatar

• A computer generated graphic representation of a participant in avirtual reality simulation or game (ASSH). • A virtual object used to represent a physical object (e.g. a human)in a virtual world.

Fiction Contract

• A concept which implies that an engagement in simulation is a contract between the instructor and the learner: each has to do his or her part to make the simulation worthwhile (Rudolph, Dieckmann, et al.). • The degree of engagement that healthcare trainees are willing to give the simulated event; also known as the "suspension of disbelief," it is a literary and theatrical concept that encourages participants to put aside their disbelief and accept the simulated exercise as being real for the duration of the scenario.

Portable Simulator

• A simulator that has the capabilities of being moved, and may also be able to operate independently of tethers such as power cords or communication cables.

Healthcare Simulation

• A technique that creates a situation or environment to allow persons to experience a representation of a real healthcare event for the purpose of practice, learning, evaluation, testing, or to gain understanding of systems or human actions (SSH). • The application of a simulation activity to training, assessment, research, or systems integration toward patient safety (SSH).

Simulation

• A technique that creates a situation or environment to allowpersons to experience a representation of a real event for the purpose of practice, learning, evaluation testing, or to gain understanding of systems or human actions. • An educational technique that replaces or amplifies real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner (Gaba Future Vision Qual Saf Health Care 2004). • A pedagogy using one or more typologies to promote, improve, or validate a participant's progression from novice to expert (INACSL, 2013). • The application of a simulator to training and/or assessment (SSH). • A method for implementing a model over time.

Simulated-Based Learning Experience

• An array of structured activities that represent actual or potential situations in education and practice. These activities allow participants to develop or enhance their knowledge, skills, and attitudes, or to analyze and respond to realistic situations in a simulated environment. (Pilcher, Goodall, Jensen, Huwe, Jewell, Reynolds, and Karlson, 2012).

Deterministic

• Pertaining to a process, model, or variable whose outcome, result, or value does not depend on chance (M&S Glossary).

Mobile Simulation

• The ability to move a simulator from one teaching location to another or to teach a scenario on the move (F.C. Forrest, Bristol Med Sim Center).

Scribe / Scribing

• The act of making notes about a scenario and documenting the actions taken or not taken.

Coaching

• To direct or instruct a person or group of people in order to achieve goals, develop specific skills, or develop competencies.

Simulated/Synthetic Learning Methods

The principles, pedagogies, and educational strategies used in healthcare simulation. They include: • Case-based learning - written and oral presentations used to present and review clinical scenarios but do not involve hands-on learning. e.g., table-top simulation. • Computer simulation - see Computer Simulation. • Procedural or Partial Task Training - see Part-task Trainer or Task Trainer. • Hybrid Simulation- see Hybrid Simulation. • Integrated procedural training (psychomotor focus) - Combines a series of discrete tasks that are conducted simultaneously or in sequence to form a complex clinical task (e.g. endotracheal intubation and cervical spine immobilization in a trauma patient). • Integrated procedural training (whole procedure) - Integrates task training with role play (actors) to enable procedural and communication tasks to be practiced simultaneously. • Mixed simulation- see Mixed Simulation. • Simulation / Scenario-based learning - Learners interact with people, simulators, computers or task trainers to accomplish learning goals that are representative of the learner's real world responsibilities. The environment may resembles the workplace. Depending on the learning objectives, realism can be built into the equipment or the environment. • Standardized/Simulated Patient - see Standardized/Simulated Patient. Role play - see Role Play. • Debriefing - see Debriefing. • Multimodal formats - see Multiple Mod

Psychological Safety

• A feeling (explicit or implicit) within a simulation-based activity that participants are comfortable participating, speaking up, sharing thoughts, and asking for help as needed without concern for retribution or embarrassment. • The perception of members of the team that the team is safe for risk taking, and mistakes will be considered learning opportunities rather than there being embarrassment or punitive consequences (Edmondson, 1999; Higgins et al, 2012).

Safe Learning Environment

• A learning environment where it is clarified that learners feel physically and psychologically safe to make decisions, take actions and interact in the simulation. • A learning environment of mutual respect, support, and respectful communication among leaders and learners; open communication and mutual respect for thought and action encouraged and practiced.

Physical Fidelity

• A level of realism associated with a particular simulation activity. • The degree to which the simulation looks, sounds, and feels like the actual task (Alexander, Brunyé, Sidman, & Weil, 2005).

Psychological Fidelity

• A level of realism associated with a particular simulation activity. • The extent to which the simulated environment evokes the underlying psychological processes necessary in the real-world setting (Dieckmann et al., 2008). • The degree of perceived realism, including psychological factors such as emotions, beliefs, and self-awareness of participants in simulation scenarios (Dieckmann et al., 2008).

Manikin, Mannequin

• A life-sized human like simulator representing a patient for healthcare simulation and education (Palaganas, Maxworthy, Epps, & Mancini, 2015). • Full or partial body representation of a patient for practice. • Full or partial body simulators that can have varying levels of physiologic function and fidelity.

Shared Mental Model

• A means of describing that each participant in a simulation has a shared understanding of the purpose and process of the simulation activity and participant's roles. • The knowledge framework of the relationships between the task the team is engaged in and how the team members will interact, for example, facilitates team's ability to predict what team members will do when faced with a task, and what they will need to do it. • A framework whereby an individual team member develops a perception of the situation, it is shared, allowing the team to reflect on the information and revise their situational awareness and their own mental model based on new information; for example, sharing can be done by vocalizing observations, calling out information, using a structured time-out to communicate new information and thinking out loud to allow others to relate and appreciate the associations, assessments, and plans. Shared mental models facilitates collaboration, and is crucial when team communication in a situation is difficult (due to time pressure, etc.).

Serious Games

• A mental contest played with a computer in accordance with specific rules, that uses entertainment to further training, education, health, public policy, and strategic communication objectives (Zyda, 2005). • A game designed for a primary purpose other than pure entertainment. Serious games have an explicit and carefully thought out educational purpose, and are not intended to be played primarily for amusement (Michael and Chen, 2006). Serious games are simulations of real-world events, or processes designed for the purpose of solving a problem. • In the defense context, serious games are used to rehearse, train, or explore military options in a simulation of real-world events or processes (Australian Dept. of Defense); The "serious" adjective is generally appended to refer to products used by industries like defense, education, scientific exploration, healthcare, emergency management, city planning, engineering, religion, and politics.

Prepackaged / Preprogrammed Scenario

• A method of operation in which the simulator is programmed to be in one state and to respond to an input and transition to another state based on a script or algorithm. • A scenario where a script will assign initial values (such as heart rate, blood pressure, emotional state or concern) at the start of the scenario that will require specific actions by the participant or certain time frames, for the scenario to transition to the next state (Palaganas, Maxworthy, Epps, and Mancini, 2015).

Just in Time Simulation

• A method of training that is conducted directly prior to a potential intervention" (Palaganas, Maxworthy, Epps, & Mancini, 2015). The training that is utilized is "just in time" at the "place near the site of the potential intervention" (Palaganas, Maxworthy, Epps, and Mancini, 2015). • A learning approach that meets the learner's needs during or just before it is needed to maximize an educational outcome (Barnes, 1998). • A cost reduction method that is derived originally from the Japanese car manufacturing industry where it was a strategy that was utilized to reduce flow times in both production and response time costs (Ohno, 1978).

Simulated Patient (SP)

• A person who has been carefully coached to simulate an actual patient so accurately that the simulation cannot be detected by a skilled clinician. In performing the simulation, the SP presents the gestalt of the patient being simulated; not just the history, but the body language, the physical findings, and the emotional and personality characteristics as well (Barrows 1987). Often used interchangeably with standardized patients in the USA and Canada, but in other countries simulated patient is considered a broader term than standardized patient because the simulated patient scenario can be designed to vary the SP role in order to meet the needs of the learner. • An individual who is trained to portray a real patient in order to simulate a set of symptoms or problems used for healthcare education, evaluation, and research (SSH).

Assessor

• A person who performs assessment of individuals according to pre-established criteria. • Assessors must have specific and substantial training, expertise, and competency in assessment (Dictionary.com).

Incognito Standardized Patient

• A person who plays a role as a patient in real healthcare situations, while the healthcare workers in those situations are unaware of the fact that the person is not a real patient(Rethans et al. review Med Educ 2007).

Simulated Person

• A person who portrays a patient (simulated patient), family member, or healthcare provider in order to meet the objectives of the simulation; a simulated person may also be referred to as a standardized patient/family/healthcare provider if they have been formally trained to act as real patients in order to simulate a set of symptoms or problems used for healthcare education, evaluation, and research. Simulated persons often engage in assessment by providing feedback to the learner (Palaganas, J.C. (2012) Annex A).

Fixation Error

• A principle of crisis resource management wherein humans fail to revise a situation assessment in risky and dynamic systems or events (Decker 2011). • The persistent failure to revise a diagnosis or plan in the face of readily available evidence suggesting that a revision is necessary.

Model (as in Modeling and Simulation)

• A representation of an object, concept, event, or system; models can be physical models, computational models or theories of function (Sokolowski).

Monte Carlo Simulation

• A simulation in which random statistical sampling techniques are employed such that the result determines estimates for unknown values (M&S Glossary). • A mathematical model using probability distributions to calculate the possible outcomes for a given choice of action. Such a simulation involves many calculations and re-calculations to yield a range of possible outcomes.

Process-Oriented Simulation

• A simulation in which the process is considered more important than the outcome; for example, a model of a radar system in which the objective is to replicate exactly the radar's operation, and duplication of its results is a lesser concern (M&S Glossary). • In healthcare, the use of simulation to examine the process of care rather than the outcome of care. For example, using simulation to re-create an emergency in a patient area to see what latent safety threats exist, such as poor availability of patient equipment, inadequate emergency call buttons or unsafe obstacles.

Screen - based Simulation / Screen - based Simulator

• A simulation presented on a computer screen using graphical images and text, similar to popular gaming format, where the operator interacts with the interface using keyboard, mouse, joystick or other input device. The programs can provide feedback to, and track actions of learners for assessment, eliminating the need for an instructor (Ventre & Schwid, in Levine Chapter 14). • A computer generated video-game simulator which can create scenarios that require real-time decision-making (Bonnetain; Biese, et al, 2009).

Discrete Simulation (Discrete-Event Simulation)

• A simulation that relies on variables changed only at a countable number of points in time; discrete event simulation (DES) is the process of codifying the behavior of a complex system as an ordered sequence of well-defined events. • The operation of a system as a discrete sequence of events in time. Each event occurs at a particular instant in time and marks a change of state in the system. Between consecutive events, no change in the system is assumed to occur; thus the simulation can directly jump in time from one event to the next (Robinson, 2004). • One or more variables that completely describe a system at any given moment in time (Sokolowski and Banks).

High-Fidelity Simulator

• A term often used to refer to the broad range of full-body manikins that have the ability to mimic, at a very high level, human body functions. • Also known as a high complexity simulator. Other types of simulators can also be considered high-fidelity, and that fidelity (realism) has other characteristics beyond a particular type of simulator.

Modality

• A term used to refer to the type(s) of simulation being used as part of the simulation activity, for example, task trainers, manikin based, standardized/simulated patients, computer-based, virtual reality, and hybrid (SSH).

Deliberate Practice

• A theory of general psychology that states the differences between expert performers and normal adults reflect a life-long period of deliberate effort to improve performance in a specific domain. (Ericsson, K. A). • A systematically designed activity that has been created specifically to improve an individual's performance in a given domain (Ericsson,

Augmented Reality

• A type of virtual reality in which synthetic stimuli are superimposed on real world objects usually to make information that is otherwise imperceptible to human senses perceptible (M&S Glossary). • A technology that overlays digital computer generated information on objects or places in the real world for the purpose of enhancing the user experience. • The combination of reality and overlay of digital information designed to enhance the learning process. • A spectrum of mixed reality simulation that is part way between the real world and the virtual world. • A form of virtual reality that includes head mounted displays, overlays of computer screens, wearable computers or displays projected onto humans and manikins (D.R. Berryman et al; M. Bajura et al; H. Fuchs et al).

Brief (Briefing)

• An activity immediately preceding the start of a simulation activity where the participants receive essential information about the simulation scenario such as background information, vital signs, instructions, or guidelines. For example: before beginning a session, faculty conduct a briefing about the scenario to review the information being provided to the participants. • The information and guidelines given to faculty or simulated patients participating in a scenario to allow them to fully prepare for interactions with the participants. Briefing materials could include a handover, physician referral letter, or an ambulance call transcript. For example, at the start of the simulation scenario, participants receive a notification from ambulance personnel regarding a patient being transported to their facility with a gunshot wound. (Alinier, 2011; Husebø et al, 2012).

Objective Structured Clinical Examination (OSCE)

• An approach to the assessment of clinical or professional competence in which the components of competence are assessed in a planned or structured way with attention being paid to the objectivity of the examination (Harden 1988). • A station or series of stations designed to assess performance competency in individual clinical or other professional skills. Learners are evaluated via direct observation, checklists, learner presentation, or written follow-up exercises. The examinations may be formative and offer feedback or summative and be used for making high stakes educational decisions (ASPE). • A method of assessment where learners perform specific skills and behaviors in a simulated work environment.

Interprofessional Education /Training/Learning

• An educational environment where students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes (Interprofessional Education and Collaborative Expert Panel, WHO 2011). • An initiative to secure learning, and promote gains through Interprofessional collaboration in professional practice (Freeth et al.).

Facilitator (Simulation Facilitator)

• An individual who is involved in the implementation and/or delivery of simulation activities. For example, faculty, educators, etc. • An individual that helps to bring about an outcome (such as learning, productivity, or communication) by providing indirect or unobtrusive assistance, guidance, or supervision; for example: The debriefing facilitator kept the discussion flowing smoothly.

Feedback

• An individual who is involved in the implementation and/or delivery of simulation activities. For example, faculty, educators, etc. • An individual that helps to bring about an outcome (such as learning, productivity, or communication) by providing indirect or unobtrusive assistance, guidance, or supervision; for example: The debriefing facilitator kept the discussion flowing smoothly.

Embedded Participant

• An individual who is trained or scripted to play a role in a simulation encounter in order to guide the scenario, and may be known or unknown to the participants; guidance may be positive or negative, or a distractor based on the objectives, level of the participants, and the needs of the scenario. • A role assigned in a simulation encounter to help guide the scenario; the embedded participant's role is part of the situation, however the underlying purpose of the role may not be revealed to the participants in the scenario or simulation (INACSL, 2013).

operations Specialist

• An individual whose primary role is the implementation and delivery of a simulation activity through the application of simulation technologies such as, computers, audio-visual, or networking technologies. • An inclusive "umbrella" term that embodies many different roles within healthcare simulation operations, including simulation technician, simulation technology specialist, simulation specialist, simulation coordinator, and simulation AV specialist. While many of these individuals also design simulation activities, this term refers to the functional role related to the implementation of the simulation activities (SSH).

Confederate

• An individual(s) who, during the course of the clinical scenario, provides assistance locating and/or troubleshooting equipment. This individual(s) may provide support for participants in the form of 'help available', e.g. 'nurse in charge', and/or to provide information about the manikin that is not available in other ways, e.g., temperature, color change, and/or to provide additional realism by playing the role of a relative or a staff member (ASSH). • An individual other than the patient who is scripted in a simulation to provide realism, additional challenges or additional information for the learner e.g., paramedic, receptionist, family member, laboratory technician (Victorian Simulated Patient Network).

Prebrief (Prebriefing)

• An information or orientation session held prior to the start of a simulation activity in which instructions or preparatory information is given to the participants. The purpose of the prebriefing is to set the stage for a scenario, and assist participants in achieving scenario objectives. • The time used by educators, researchers, facilitators, or staff to plan their roles prior to the simulation; suggested activities in a prebriefing include an orientation to the equipment, environment, manikin, roles, time allotment, objectives, and patient situation. For example: Before starting the simulation session, there is a prebriefing where the equipment and its capabilities are reviewed and they are reminded of the equipment available to them in the room (INACSL, 2013). • The collaboration and planning of co-facilitators/co-debriefers prior to the simulation activity.

Mastery Learning

• An instructional philosophy originally proposed by Benjamin Bloom that stated a student must first practice and study to meet the predetermined level criteria (>90%) through the formative assessment of a prerequisite domain prior to advancing in subject matter. If the learner does not achieve the level of mastery, information from the test is used to diagnose areas of deficiency necessary for additional prescriptive support. The student is later tested again. This cycle of feedback and corrective procedures is repeated until mastery is achieved, at which point the student will move on to the next level (Guskey, 2010). • An instructional philosophy that highlights individualized feedback and adequate time, allowing the learner to progress through the subject in a customized manner, generally in smaller units to master the subject matter. This concept states that nearly all learners can achieve subject or skill mastery utilizing this method (Palaganas, Maxworthy, Epps, & Mancini, 2015).

Interprofessional

• Collaborating as a team with a shared purpose, goal, and mutual respect to deliver safe, quality health care (Freeth, Hammick, Reeves, Koppel, & Barr, 2005; World Health Organization (WHO), 2010).

Immersion

• Describes the level to which the learner becomes involved in the simulation; a high degree of immersion indicates that the learner is treating the simulation as if it was a real-life (or very close to real-life) event (SSH). • A state (or situation) in which trainees dedicate most of their time doing something related to or thinking about a simulation, and becomes involved in it; the level of immersion might vary, where a high degree indicates that the trainee is fully involved; for example: realistic environments facilitate a participant´s full immersion in the simulation.

Scenario

• In healthcare simulation, a description of a simulation that includes the goals, objectives, debriefing points, narrative description of the clinical simulation, staff requirements, simulation room set up, simulators, props, simulator operation, and instructions for SPs (Alinier, 2011). • The scripts, stories, or algorithms created for instructing the participants, including the simulators (human or robotic), on how to interact with the students. • The description of an exercise (including initial conditions), of events for a simulation that includes details for everyone taking part. • An initial set of conditions and timeline of significant events imposed on trainees or systems to achieve exercise objectives (M&S Glossary).

Participant

• In healthcare simulation, a person who engages in a simulation activity for the purpose of gaining or demonstrating mastery of knowledge, skills, and/or attitudes of professional practice (INACSL, 2013). • A person engaged in a simulation activity or event and for those involved in simulation research.

Conceptual Fidelity

• In healthcare simulation, ensures that all elements of the scenario relate to each other in a realistic way so that the case makes sense as a whole to the learner(s) (For example: Vital signs are consistent with the diagnosis). To maximize conceptual fidelity, cases or scenarios should be reviewed by subject matter expert(s) and pilot-tested prior to use with learners (Rudolph et al. (2007) and Dieckmann et al. 2007).

High-Fidelity Simulation

• In healthcare simulation, high-fidelity refers to simulation experiences that are extremely realistic and provide a high level of interactivity and realism for the learner (INACSL, 2013); Can apply to any mode or method of simulation; for example: human, manikin, task trainer, or virtual reality.

Haptic (Haptics)

• In healthcare simulation, refers to devices that providing tactile feedback to the user. Haptics can be used to simulate touching, palpating an organ, or body part, and the cutting, tearing or traction on a tissue. • Devices that capture and record a trainee's 'touch' in terms of location and depth of pressure at specific anatomical sites (McGaghie et al, 2010; Jackson et al).

Prop

• In simulation, an element or accessory used in a given scenario to enhance realism, or to provide a cue to learners. • A physical object used as an interface to a virtual world; a prop may be embodied by a virtual object and might have physical controllers mounted on it (Australian Dept. of Defense).

Non-technical Skills

• In the healthcare field, the skills of communication, (patient provider, team) leadership, teamwork, situational awareness, decision-making, resource management, safe practice, adverse event minimization/mitigation, and professionalism; also known as behavioral skills or teamwork skills (ASSH).

Interdisciplinary

• Involving two or more academic, scientific, or artistic disciplines (Merriam-Webster.com). • The combining of two or more academic disciplines, fields of study, professions, technologies or departments (dictionary. reference.com). • Of or relating to more than one branch of knowledge (oxforddictionaries.com).

Low-Fidelity

• Not needing to be controlled or programmed externally for the learner to participate (Palaganas, Maxworthy, Epps, & Mancini, 2015); examples include case studies, role playing, or task trainers used to support students or professionals in learning a clinical situation or practice (Adapted from NLN-SIRC, 2013).

Role Player

• One who assumes the attitudes, actions, and discourse of (another), especially in a make-believe situation, in an effort to understand a differing point of view or social interaction. For example: Nursing students were given a chance to role play a patient or a surgeon. This term is sometimes used interchangeably with the terms 'simulated' and 'standardized patient' and may include medical, nursing or other health professionals. (Victorian Simulated Patient Network).

In Silico

• Performed on computer or via computer simulation; the phrase was coined in 1989 as an analogy to the Latin phrases in vivo, in vitro, and in situ (Sieburg, 1990).

Interactive Model or Simulation

• Simulating a situation in which the outcome varies depending on human participation (Thomas). This allows humans to practice different sets of actions in order to learn the correct response to an event. • Modeling which requires human participation (Australian Dept. of Defense 2011).

In Situ/In Situ Simulation

• Taking place in the actual patient care setting/environment in an effort to achieve a high level of fidelity and realism; this training is particularly suitable for difficult work environments, due to space constraints or noise. For example, an ambulance, a small aircraft, a dentist's chair, a catheterization lab (Kyle & Murray, 2008). This training is valuable to assess, troubleshoot, or develop new system processes.

Realism

• The ability to impart the suspension of disbelief to the learner by creating an environment that mimics that of the learner's work environment; realism includes the environment, simulated patient, and activities of the educators, assessors, and/or facilitators (SSH). • A statement about the similarity of something (a 'copy') to something else (the 'original') (Dieckmann, Gabe, et al, 2007). • The quality or fact of representing a person, thing, or situation accurately in a way true to life; this enables participants to act "as if" the situation or problem was real. • Refers to the physical characteristics of the activity, semantical aspects of the activity (theories and conceptual relations - if A happens then B occurs), and/or the phenomenal aspects of the activity (emotions, beliefs and thoughts experienced).

Multidisciplinary

• The combining of professionals with different perspectives to provide a wider understanding of a particular problem (Bray & Hawkins, 2008).

Distributed Simulation

• The concept of simulation on-demand, made widely available wherever and whenever it is required; DS provides an easily transportable, self-contained 'set' for creating simulated environments, at a fraction of the cost of dedicated, static simulation facilities (Kneebone et al, 2010). • A set of simulations operating in a common environment and distributed to learners; a distributed simulation may be composed of any of the three modes of simulation: live, virtual, and constructive, and are seamlessly integrated within a single exercise (M&S Glossary).

Functional Fidelity

• The degree in which the equipment used in the simulation responds to the participant's actions; e.g. a static ventilator would offer low functional fidelity compared to a working ventilator in a simulation requiring a ventilator alarm.

Environmental Fidelity

• The degree to which the simulated environment (manikin, room, tools, equipment, moulage, and sensory props) replicates reality and appearance of the real environment.

Fidelity

• The degree to which the simulation replicates the real event and/or workplace; this includes physical, psychological, and environmental elements. • The ability of the simulation to reproduce the reactions, interactions, and responses of the real world counterpart. It is not constrained to a certain type of simulation modality, and higher levels of fidelity are not required for a simulation to be successful. • The level of realism associated with a particular simulation activity; fidelity can involve a variety of dimensions, including (a) physical factors such as environment, equipment, and related tools; (b) psychological factors such as emotions, beliefs, and selfawareness of participants; (c) social factors such as participant and instructor motivation and goals; (d) culture of the group; and (e) degree of openness and trust, as well as participants' modes of thinking (INACSL, 2013).

Human Factors

• The discipline or science of studying the interaction between humans and systems and technology; it includes, but is not limited to, principles and applications in the areas of human engineering, personnel selection, training, life support, job performance aids, and human performance evaluation (M&S Glossary). • The psychological, cultural, behavioral, and other human attributes that influence decision-making, the flow of information, and the interpretation of information by individuals or groups (M&S Glossary).

Simulation-Enhanced Interprofessional Education / (Sim-IPE)

• The education of health care professionals with different but complementary knowledge and skills in a simulation environment that promotes a collaborative team approach. Simulationenhanced interprofessional education (Sim-IPE)occurs when participants and facilitators from two or more professions are engaged in a simulated health care experience to achieve shared or linked objectives and outcomes (Decker, S. et al., 2015); It is designed for the individuals involved to...."learn about, from and with each other to enable effective collaboration and improve health outcomes" (WHO, 2010, p.13). • A collaborative educational approach that brings together health care professionals of varying specialties in a simulation environment engaging learners in an interprofessional teamwork model (Decker et. al). • A simulation environment of equal and mutual respect and recognition of each team member's knowledge and skills.

Interprofessionalism

• The effective integration of professionals through mutual respect, trust, and support, from various professions who share a common purpose to mold their separate skills and knowledge into collective responsibility and awareness that can be achieved through learned processes for communication, problem solving, conflict resolution, and conduct.

Reflective Thinking

• The engagement of self-monitoring that occurs during or after a simulation experience; this self-monitoring is performed by participants during or after a simulation experience. • A process to assist learners in identifying their knowledge gaps and demonstrating the areas in which they may need further improvement; it requires active involvement in the simulation and facilitator guidance to aid in this process (Rodgers, 2002; Decker et al., 2013 Kuiper and Pesut, 2004). • The conscious consideration of the meanings and implications of the events of the simulation; this process allows participants to make meaning out of the experience, to identify questions generated by the experience, and ultimately, to assimilate the knowledge, skills, and attitudes uncovered through the experience with pre-existing knowledge. • A process to assist learners in identifying their knowledge gaps and demonstrating the areas in which they may need further improvement; this reflection requires conscious self-evaluation to deal with unique patient situations (INACSL, 2013).

Simulation Activity

• The entire set of actions and events from initiation to termination of an individual simulation event; in the learning setting, this is often considered to begin with the briefing (prebriefing) and end with the debriefing. • All the elements in a simulation session including the design and setup required.

Debriefer

• The individual who facilitates a debriefing session and is knowledgeable and skilled in performing appropriate, structured, and psychologically safe debriefing sessions (Fanning & Gaba, 2007). • The person who leads participants through the debriefing; Debriefing by competent instructors and subject matter experts is considered important to maximize the

Moulage

• The makeup and molds applied to humans or manikins used to portray lesions, skin findings, bleeding, and traumatized areas (Levine et al). • The application of makeup and molds to a human or simulator's limbs, chest, head, etc. to provide elements of realism (such as blood, vomitus, open fractures, etc.) to the training simulation. • Techniques used to simulate injury, disease, aging, and other physical characteristics specific to a scenario; moulage supports the sensory perceptions of participants and supports the fidelity of the simulation scenario through the use of makeup, attachable artifacts (e.g. penetrating objects), and smells (INACSL, 2013).

Physiologic Modeling

• The mathematical computer models governing complex human physiology in a simulated patient case so that reasonable responses occur automatically to events inputted into the program; for example, a pharmacodynamic model could predict effects of drugs on heart rate, cardiac output, or blood pressure and display them on a simulated clinical monitor. (Howard Schwid, Rosen, K. (2013); in Levine et al. Chapter 2 and 14). • A computer model that allows for a method of operation in which an operator inputs a value to a given parameter, and it automatically adjusts the other variables in a physiologically realistic manner (Palaganas, Maxworthy, Epps, and Mancini, 2015).

"Running on the Fly"

• The method of operation for running a simulation whereby the operator changes the parameters of the scene, the SP, or the simulator as the scenario unfolds; the changes are dependent on the observations and knowledge of the instructor or the operator, which is based on the actions of the participant. • Running a simulation with minimal planning and preparation; amore impromptu type of simulation experience.

Manual Input

• The method of operation in which an operator inputs a value to a given parameter regardless of how it would affect any other parameter. The input of the parameter does not adjust the variables in any physiological manner (Palaganas, Maxworthy, Epps, & Mancini, 2015).

Computer-Based Simulation

• The modeling of real life processes with inputs and outputs exclusively confined to a computer, usually associated with a monitor and a keyboard or other simple assistive device (Textbook of Simulation). Subsets of computer-based simulation include virtual patients, virtual reality task trainers, and immersive virtual reality simulation (ibid).

Event

• The occurrences that cause variation or changes in the state of a system (Sokolowski and Banks, 2009); in healthcare simulation, this term is common when programming manikins and often refers to learner actions. • An event is described by the time it occurs and event lists can be created to drive changes in a simulation.

Frame(s)

• The perspectives through which individuals interpret new information and experiences for the purpose of decision-making; frames are formed through previous experiences and can be based on knowledge, attitudes, feelings, goals, rules, and/or perceptions. • The mindset of the internal participant or facilitator; their knowledge, thoughts, feelings, actions (speech/body language), attitudes (verbal/non-verbal), and perceptions (adapted from Rudolph, J.W. et al.).

Simulation Environment / Simulation Learning Environment / Synthetic Learning Environment (SLE)

• The physical setting where simulation activities may take place, inclusive of the people and equipment that forms part of the simulation experience. • A location where a simulation-based learning experience takes place, and where a safe atmosphere is created by the facilitator to foster sharing and discussion of participant experiences without negative consequences. • A context for learning that consists of a controlled and shielded representation of real world situations, and a set of educational methods and procedures in which trainees feel simultaneously challenged and psychologically safe to practice and reflect on their performance (Rudolph et al). • An atmosphere that is created by the facilitator to allow for sharing and discussion of participant experiences without fear of humiliation or punitive action. • A setting, surrounding, or conditions that reproduce components or aspects of the real world environment, for the purpose of learning and related activities, and/or research (ASSH).

Clinical Scenario

• The plan of an expected and potential course of events for a simulated clinical experience. A scenario usually includes the context for the simulation (hospital ward, emergency room, operating room, clinic, out of hospital, etc.). Scenarios can vary in length and complexity depending on the learning objectives. • A detailed outline of a clinical encounter that includes: the participants in the event, briefing notes, goals and learning objectives, participant instructions, patient information, environmental conditions, manikin, or standardized patient preparation, related equipment, props, and tools or resources for assessing and managing the simulated experience. • A progressive outline of a clinical encounter including a beginning, an ending, a debriefing, and evaluation criteria (INACSL, 2013).

Guided Reflection

• The process encouraged by the instructor during debriefing that reinforces the critical aspects of the experience and encourages insightful learning allowing the participant to link theory with practice and research (INACSL, 2013). • The facilitated intellectual and affective activities that allow individuals to explore their experience in order to lead to new understanding and appreciations (adapted from Boud et al, 1985). • A mentor facilitated process that allows the learner to "integrate the understanding gained into one's experience in order to enable better choices or actions in the future, as well as enhance one's overall effectiveness" (Rogers, 2001).

Orientation

• The process of giving participants information prior to a simulation event to familiarize them to a simulation activity or environment, such as center rules, timing, and how the simulation modalities work, with the intent of preparing the participants. • An activity that occurs prior to a simulation activity in order to prepare the faculty/instructors or learners; for example, a PowerPoint presentation that all participants must review to understand how the center operates, or how the activity is being conducted.

Modeling and Simulation (M&S) (also Modeling and Simulation)

• The terms modeling and simulation are often used interchangeably. • An academic discipline focused on the study, development and use of live, virtual, and constructive models, including simulators, emulators, and prototypes to investigate, understand, or provide data. • The use of models, including emulators, prototypes, simulators, and stimulators, to develop data as a basis for making managerial or technical decisions.

Hybrid Simulation

• The union of two or more modalities of simulation with the aim of providing a more realistic experience. • In healthcare simulation, hybrid simulation is most commonly applied to the situation where a part task trainer (e.g., a urinary catheter model) is realistically affixed to a standardized/simulated patient, allowing for the teaching and assessment of technical and communication skills in an integrated fashion (Kneebone, Kidd et al, 2002). • The use of two or more simulation modalities in the same simulation activity (Zulkepli et al).

Procedural Simulation

• The use of a simulation modality (for example, task trainer, manikin, computer) to assist in the process of learning to complete a technical skill(s), or a procedure, which is a series of steps taken to accomplish an end (INACSL). • A simulation that incorporates cognitive knowledge and technical skill into a precise sequence of actions that are safe and efficient, targeting any level of learner (Palaganas, Maxworthy, Epps, & Mancini, 2015).

Mixed Reality Human

• The use of a technology such as video, augmented reality, orvirtual reality in conjunction with a physical manikin to simulate a human. (Costanza, E., Kunz, A., and Fjeld, M. 2009); for example, in team-based training, using TV monitors in portrait mode with interactive videos as a stand-in for a real team member (Palaganas, Maxworthy, Epps, & Mancini, 2015).

Mixed Simulation (Mixed Methods Simulation)

• The use of a variety of different simulation modalities; this is differentiated from hybrid simulation in that it is not characterized by the combining of one type of simulation to enhance another,but rather the use of multiple types of simulation in the same scenario or place. For example, a SP and a mannequin are used in a scenario or a task trainer paired with an SP for venipuncture, etc. (SSH).

Manikin-based Simulation

• The use of manikins to represent a patient using heart and lung sounds, palpable pulses, voice interaction, movement (e.g., seizures, eye blinking), bleeding, and other human capabilities that may be controlled by a simulationist using computers and software. • The life-like aspects of people and situations generated by a manikin.

Multiple modality (Multi-modal) simulation

• The use of multiple modalities of simulation in the same simulation activity; differentiated from hybrid simulation in that it is not characterized by the combining of one type of simulation to enhance another, but rather the use of multiple types of simulation in the same scenario or place, e.g., SP and manikin used in a scenario or a task trainer paired with an SP for venipunture, etc. (SSH). • A mixture of textual, audio, and visual modes in combination with media and materiality with the aim of enhancing the realism of the simulation encounter (Lutkewitte).

Script

• The written plan for a simulation event that includes various sets of topics, subtopics, skills, and triggers that will create the situation to induce the desired observable behaviors by the participant(s). • A preordained series of actions based on the time and sequence of specific events. • A written set of instructions providing a detailed plan of action for a simulation case; similar to a theatrical play. • The lines to be spoken by operators, embedded actors or simulated patients during a simulation event.

Immersive Simulation

• adj: A real-life situation that deeply involves the participants' senses, emotions, thinking, and behavior; creating an immersive simulation depends on the alignment with learning objectives, the fidelity of the simulation (physical, conceptual and emotional), and participant´s perception of realism. • noun: A simulation session influenced by participants' characteristics, experiences, level of training, and preparation for the case or task,. The perceived physical, conceptual and emotional fidelity, the appropriate level of challenge, and the simulators and actors can all effect the simulation experience (Hamstra et al, 2014; Rudolph et al, 2007).

Gynecological Teaching Associate (GTA)

• is a female specifically trained to teach, assess, and provide feedback to learners about accurate pelvic, rectal and/or breast examination techniques. They also address the communication skills needed to provide a comfortable exam in a standardized manner, while using their bodies as teaching tools in a supportive, non-threatening environment (ASPE).

Male Urogenital Teaching Associates (MUTA)

• is a male specifically trained to teach, assess, and provide feedback to learners about accurate urogenital and rectal examination techniques. They also address the communication skills needed to provide a comfortable exam in a standardized manner, while using their bodies as teaching tools in a supportive, non-threatening environment

Genitourinary Teaching Associate (GUTA)

• is an individual trained to teach the techniques and protocol for performing the gender-specific physical examination to learners, using himself or herself as a demonstration and practice model. (ASPE).

Interdisciplinary / Interdisciplinary Learning

• noun: The academic disciplines, such as psychology, or to subspecialties within professions. For example, within the profession of medicine, anesthesia or cardiology (Barr, Koppel, Reeves, Hammick and Freeth, 2005). • adj: Working jointly, but address issues from their individual discipline's perspective (Gray and Connolly, 2008). • Integrating the perspective of professionals from two or more professions by organizing the education around a specific discipline, where each discipline examines the basis of their knowledge" (Bray & Howkins, 2008).

Advocacy and Inquiry

•A method of debriefing in which an observer states what was observed or performed in a simulation activity (advocacy) or shares critical or appreciative insights about it explicitly (advocacy) and then asks the learners for an explanation of their thoughts or actions (inquiry)(Rudolph et al, 2007). • Inquiry seeks to learn what others think, know, want, or feel; whereas advocacy includes statements that communicate what an individual thinks, knows, wants or feels (Bolman and Deal).