Bux summarized the findings of his study in the following cycle diagram (Figure 1):

Figure 1: Common themes indicating effects of SimMan^TM high-fidelity simulation class on nursing practice

The main reason that nursing students respond so favorably to high-fidelity simulations compared with more traditional training modalities lies in the perceived “safety” of the process. Not only are students free to learn and make mistakes without fear of harming a real patient, but at University of Phoenix, they are also free from tests and grades while immersed in these training scenarios.

“In this immersive experience, there is no grading,” Associate Dean of Nursing Angie Strawn explains. “This is a totally safe environment to practice and perfect nursing skills without fear of failure. The student approaches these scenarios with the attitude that ‘this is a place for me to learn.’”

Jane Kleinman and Kristy Chambers have put the skills they learned in nursing school to use developing high-fidelity nursing simulations for use by nursing schools. University of Phoenix recently contracted their company, Medical Simulation Design, to develop its centrally-developed simulation curriculum across all of its LPN-to-BSN program campuses.

Kleinman, an RN and University of Phoenix alumna obtained her master’s degree in Organizational Management, and joined forces with Chambers, who received her Master of Science in Nursing (MSN) from the University, to form Medical Simulation Design. Both nurses had prior experience as nurse educators and curriculum developers in their existing careers, but they believed they could bring their unique set of skills, education, and experience together to create a more dynamic methodology for 21st-century nursing education. With the formation of Medical Simulation Design, Chambers and Kleinman have brought the skills they developed at University of Phoenix back to a new generation of nursing students.

Kleinman and Chambers met five years ago while they were both working in the world of high-fidelity simulation development. “It became clear to both of us that simulation in healthcare was a powerful tool that was not well understood, and that many did not have a good concept of how to actually plan for and effectively implement, not to mention evaluate,” says Chambers. “The sheer need for something more drove the creation of the company.”

Kleinman and Chambers created a comprehensive, three-step approach to producing their high-fidelity simulation modules. Development of each module can take anywhere from three to twelve months from concept to completed module. A flowchart of the module development process follows in Figure 2:

Figure 2: Medical Simulation Design Process

Chambers stresses that, unlike lecture-based teaching, high-fidelity simulation dynamically informs and alters the behavior each nursing student will exhibit in future critical-care situations. The techniques developed in these simulations “directly impact [nurses’] critical behavioral skills, which affect how they apply their knowledge. In turn, patient care outcomes are improved,” says Chambers. Areas that Medical Simulation Design’s simulation modules focus on particularly include:

• Decision-making
• Prioritization
• Communication
• Coordination of Care 
• Accessing Resources
• Legal and Ethical Issues
• Situational Awareness

Both Kleinman and Chambers have published outcomes research derived from their high-fidelity simulations in the scholarly literature; their work has even been used in academic educational models applied in medicine. Institutions that have made use of Medical Simulation Design’s work in their own curricula include the National League of Nursing, the American Academy of Pediatrics, and the Loma Linda University Medical Simulation Center.

Despite these accolades, Chambers acknowledges that there is still a degree of skepticism about the effectiveness of high-fidelity simulations versus traditional lectures and “real world” clinical rotations.

“Faculty are usually skeptical that a learning experience that does not involve lecture, testing, grading, or skills competency check-offs could have any real value,” says Chambers. “But they are immediately converted once they experience the overwhelmingly positive response learners have, and can see that performance gaps can be identified and corrected in a peer-driven, proactive, objective manner.” Chambers goes on to say that the feedback Medical Simulation Design has received from students is overwhelmingly positive.

One recent University of Phoenix graduate who shares that enthusiasm is Zanza Kruer, RN, BSN, who graduated from University’s Phoenix’s LPN-to-BSN program in 2009.

“I was impressed with the simulation manikins' lifelike reactions, such as tears, tongue swelling, vital response, and speech,” says Kruer. “The simulation program allows the student and instructors to learn in a safe environment, since some real-life patients are considered too high-risk and off-limits to students.”

High-fidelity simulation technologies show great promise for the future of nursing education.

“What we do when we treat the simulated patients in the immersion scenarios is just as important as what we would do when we treat our next-door neighbor,” says Saylors. “We are doing this work to help create better nurses.”