Management in clinical simulation: a proposal for best practices and process optimization

Schuelter, Patrícia Ilha; Tourinho, Francis Solange Vieira; Radünz, Vera; Santos, Viviane Euzébia Pereira; Fermo, Vivian Costa; Barbosa, Sarah Soares

doi:10.1590/0034-7167-2020-0515

Patrícia Ilha Schuelter Corresponding author: Patrícia Ilha Schuelter E-mail: ilha.patricia@gmail.com

Universidade Federal de Santa Catarina. Florianópolis, Santa Catarina, Brazil.

http://orcid.org/0000-0002-8510-8920

Francis Solange Vieira Tourinho

Universidade Federal de Santa Catarina. Florianópolis, Santa Catarina, Brazil.

http://orcid.org/0000-0002-8537-9958

Vera Radünz

Universidade Federal de Santa Catarina. Florianópolis, Santa Catarina, Brazil.

http://orcid.org/0000-0002-9262-8457

Viviane Euzébia Pereira Santos

Universidade Federal do Rio Grande do Norte. Natal, Rio Grande do Norte, Brazil.

http://orcid.org/0000-0001-8140-8320

Vivian Costa Fermo

Universidade Federal de Santa Catarina. Florianópolis, Santa Catarina, Brazil.

http://orcid.org/0000-0001-5324-4701

Sarah Soares Barbosa

Escola de Saúde Pública de Florianópolis. Florianópolis, Santa Catarina, Brazil.

http://orcid.org/0000-0002-6847-3942

Corresponding author: Patrícia Ilha Schuelter E-mail: ilha.patricia@gmail.com

EDITOR IN CHIEF: Dulce Barbosa

ASSOCIATE EDITOR: Maria Elisabete Salvador

Management Unit	Type of activity	Limitations	Strategies and facilities
Educational Management	Pedagogical Action - educational activity	Contact of the participant with the content only at the time of the simulation session or the update of the references without the participant's knowledge	Face-to-face, collective training, and individual meetings for the creation of the simulation stages
		Content development only by the facilitator/professor without the collaboration of the participant	Specialized professionals to guide the process involving simulation
		Methodological lack of knowledge of the simulation stages by facilitators/professors and participants/students
	Planning and building documents for simulation - planning activity	Building and updating schedules and documents for simulation in alternative ways by generating multiple versions	Printed delivery of the latest version of the schedule and documents at the time of the simulation
Simulation Practice	Pre-briefing - direct simulation activity	Lack of data in the clinical setting to achieve the desired outcome	Media facilities that allow clear explanation of the clinical case (presentation of imaging examinations, and others)
	Pre-briefing - direct simulation activity	Case description only at the time of simulation
	Simulation - direct simulation activity	Need of previous presence of the facilitator in the simulation center for checking and inserting the data in the simulator	High-tech, high-fidelity simulators
			Hybrid simulation possibilities
		Use of forms to follow the script and evaluate the simulation	Technology that allows interaction between the simulation site and the pre-briefing environment
		A superficial review of the accompanying data from the script for debriefing
	Debriefing - direct simulation activity	Use of mixed methods not compatible with the intended purpose of the simulation	Technologies that enable metrics of the interaction between the participant and the simulator
		Objective-only data records and technical standards
		Participant does not have access to the performance data and video feature after the simulation.
Resources Management	Materials - routine activity	Manual count of the material	Adequate storage place for the specific materials
Resources Management	Materials - routine activity	Availability of the material by free demand, with flawed control	Adequate storage place for the specific materials
Resources Management	Human - planning activity	Centralization of the simulation conduction actions in the technical team	Constant communication about the planning processes via e-mail
	Technological - planning activity	Use of various instruments for building the processes (Word, e-mail, filming software, simulation software) generating multiple data in multiple locations	Compatible simulation networks, software, and hardware
	Maintenance - routine activity	Manually daily checking of activities (counting materials, equipment control, room reservation)	Financial self-sustainability with the development of activities for third parties
Handling of Data and Instruments	Simulation Evaluation - evaluation activity	Manual registration, some illegible and losses due to volume at delivery	Pre-defined instruments for simulation evaluation.
	Simulation Evaluation - evaluation activity	Abstention of answers due to non-practicality
	Collection of Evaluative Data - Evaluation Activity	Data collected by printed instruments
	Data Analysis - research activity	Data transcribed manually, time-consuming, and error-prone
	Instruments - planning activity	Lack of instruments that standardize the information for planning the simulation of the technical part and data for the simulator	Availability of methodologists for analysis
	Data Availability - research activity	Delay in making data available for improvement of the center and educational activities
	Data Availability - research activity	Search for data when there is a need to use it; there is no routine for analysis and disclosure.

Management Unit	Activity	Action orientation	Indicated resource
Educational Management	Pedagogical action - educational activity	Provide study guides or references prior to the session⁽⁷7 Nimbalkar A, Patel D, Kungwani A, Phatak A, Vasa R, Nimbalkar S. Randomized control trial of high fidelity vs low fidelity simulation for training undergraduate students in neonatal resuscitation. BMC Res Notes. 2015;8. https://doi.org/10.1186/s13104-015-1623-9 https://doi.org/10.1186/s13104-015-1623-... ⁾.	Virtual Teaching and Learning Environments. Use of Serious Games and Virtual Patient⁽¹⁶16 Liaw SY, Chan SW, Chen FG, Hooi SC, Siau C. Comparison of virtual patient simulation with mannequin-based simulation for improving clinical performances in assessing and managing clinical deterioration: randomized controlled trial. J Med Internet Res. 2014;16(9). https://doi.org/10.2196/jmir.3322 https://doi.org/10.2196/jmir.3322... ^,¹⁹19 Liaw SY, Wong LF, Chan SW, Ho JT, Mordiffi SZ, Ang SB, et al. Designing and evaluating an interactive multimedia Web-based simulation for developing nurses competencies in acute nursing care: randomized controlled trial. J Med Internet Res. 2015;17(1). https://doi.org/10.2196/jmir.3853 https://doi.org/10.2196/jmir.3853... ⁾.
Educational Management	Planning and building documents for simulation - planning activity	Create standard guides for each stage of the simulation and create training and orientation courses for the educators⁽⁴4 Fabri IRP, Mazzo A, Martins JCA, Fonseca ASF, Pedersoli CE, Miranda FBG, et al. Development of a theoretical-practical script for clinical simulation. Rev Esc Enferm USP. 2017;51. https://doi.org/10.1590/s1980-220x2016265103218 https://doi.org/10.1590/s1980-220x201626... ^,⁸8 Almeida RGS, Mazzo A, Martins JCA, Coutinho VRD, Jorge BM, Mendes IAT. Validation to Portuguese of the Debriefing Experience Scale. Rev Bras Enferm. 2016;69(4):705-11. https://doi.org/10.1590/0034-7167.2016690413i https://doi.org/10.1590/0034-7167.201669... ^,¹⁸18 Jaye P, Thomas L, Reedy G. "The Diamond": a structure for simulation debrief. Clin Teach. 2015;12(3):171-5. https://doi.org/10.1111/tct.12300 https://doi.org/10.1111/tct.12300... ⁾.	Cloud-like instant document sharing, editing, and updating location⁽⁴4 Fabri IRP, Mazzo A, Martins JCA, Fonseca ASF, Pedersoli CE, Miranda FBG, et al. Development of a theoretical-practical script for clinical simulation. Rev Esc Enferm USP. 2017;51. https://doi.org/10.1590/s1980-220x2016265103218 https://doi.org/10.1590/s1980-220x201626... ^,¹⁷17 Bullock A, Webb K. Technology in postgraduate medical education: a dynamic influence on learning?. Postgrad Med J. 2015;91(1081):646-50. https://doi.org/10.1136/postgradmedj-2014-132809 https://doi.org/10.1136/postgradmedj-201... ⁾.
Simulation Practice	Pre-briefing - direct simulation activity	Provide (prior to or during) data, guidance and/or case studies in a visual manner that can be consulted at any time during the simulation⁽⁴4 Fabri IRP, Mazzo A, Martins JCA, Fonseca ASF, Pedersoli CE, Miranda FBG, et al. Development of a theoretical-practical script for clinical simulation. Rev Esc Enferm USP. 2017;51. https://doi.org/10.1590/s1980-220x2016265103218 https://doi.org/10.1590/s1980-220x201626... ^,⁷7 Nimbalkar A, Patel D, Kungwani A, Phatak A, Vasa R, Nimbalkar S. Randomized control trial of high fidelity vs low fidelity simulation for training undergraduate students in neonatal resuscitation. BMC Res Notes. 2015;8. https://doi.org/10.1186/s13104-015-1623-9 https://doi.org/10.1186/s13104-015-1623-... ^,²⁶26 Herbstreit F, Merse S, Schnell R, Noack M, Dirkmann D, Besuch A, et al. Impact of standardized patients on the training of medical students to manage emergencies. Medicine (Baltimore). 2017;96(5). https://doi.org/10.1097/MD.0000000000005933 https://doi.org/10.1097/MD.0000000000005... ^,²⁸28 The INACSL Standards Committee. INACSL standards of best practice: SimulationSM: Simulation design. Clin Simulat Nurs. 2016;12(S):S5-S12. https://doi.org/10.1016/j.ecns.2016.09.005 https://doi.org/10.1016/j.ecns.2016.09.0... ⁾.	A place to share, edit, and update instant cloud-like documents. Use of printouts or display technology such as monitors⁽⁴4 Fabri IRP, Mazzo A, Martins JCA, Fonseca ASF, Pedersoli CE, Miranda FBG, et al. Development of a theoretical-practical script for clinical simulation. Rev Esc Enferm USP. 2017;51. https://doi.org/10.1590/s1980-220x2016265103218 https://doi.org/10.1590/s1980-220x201626... ^,⁶6 Landman AB, Redden L, Neri P, Poole S, Horsky J, Raja AS, et al. Using a medical simulation center as an electronic health record usability laboratory. J Am Med Inform Assoc. 2014;21(3). https://doi.org/10.1136/amiajnl-2013-002233 https://doi.org/10.1136/amiajnl-2013-002... ^,¹⁷17 Bullock A, Webb K. Technology in postgraduate medical education: a dynamic influence on learning?. Postgrad Med J. 2015;91(1081):646-50. https://doi.org/10.1136/postgradmedj-2014-132809 https://doi.org/10.1136/postgradmedj-201... ⁾.
	Simulation - direct simulation activity	Develop easy-to-fill and easy-to-follow procedure guides, considering order changes and intercurrences⁽⁴4 Fabri IRP, Mazzo A, Martins JCA, Fonseca ASF, Pedersoli CE, Miranda FBG, et al. Development of a theoretical-practical script for clinical simulation. Rev Esc Enferm USP. 2017;51. https://doi.org/10.1590/s1980-220x2016265103218 https://doi.org/10.1590/s1980-220x201626... ^,⁷7 Nimbalkar A, Patel D, Kungwani A, Phatak A, Vasa R, Nimbalkar S. Randomized control trial of high fidelity vs low fidelity simulation for training undergraduate students in neonatal resuscitation. BMC Res Notes. 2015;8. https://doi.org/10.1186/s13104-015-1623-9 https://doi.org/10.1186/s13104-015-1623-... ^,²⁶26 Herbstreit F, Merse S, Schnell R, Noack M, Dirkmann D, Besuch A, et al. Impact of standardized patients on the training of medical students to manage emergencies. Medicine (Baltimore). 2017;96(5). https://doi.org/10.1097/MD.0000000000005933 https://doi.org/10.1097/MD.0000000000005... ^,²⁸28 The INACSL Standards Committee. INACSL standards of best practice: SimulationSM: Simulation design. Clin Simulat Nurs. 2016;12(S):S5-S12. https://doi.org/10.1016/j.ecns.2016.09.005 https://doi.org/10.1016/j.ecns.2016.09.0... ⁾.	Use of printouts or technology with quick-fill potential⁽⁴4 Fabri IRP, Mazzo A, Martins JCA, Fonseca ASF, Pedersoli CE, Miranda FBG, et al. Development of a theoretical-practical script for clinical simulation. Rev Esc Enferm USP. 2017;51. https://doi.org/10.1590/s1980-220x2016265103218 https://doi.org/10.1590/s1980-220x201626... ^,¹⁷17 Bullock A, Webb K. Technology in postgraduate medical education: a dynamic influence on learning?. Postgrad Med J. 2015;91(1081):646-50. https://doi.org/10.1136/postgradmedj-2014-132809 https://doi.org/10.1136/postgradmedj-201... ^,²⁸28 The INACSL Standards Committee. INACSL standards of best practice: SimulationSM: Simulation design. Clin Simulat Nurs. 2016;12(S):S5-S12. https://doi.org/10.1016/j.ecns.2016.09.005 https://doi.org/10.1016/j.ecns.2016.09.0... ⁾.
	Debriefing - direct simulation activity	Use developmental metrics, explore feelings, apply self-assessment, and discuss practices based on the references and videos in the session. Training courses and educator orientation⁽⁵5 Cai L. Potential applications of latent variable modeling for the psychometrics of medical simulation. Mil Med. 2013;178(10suppl). https://doi.org/10.7205/MILMED-D-13-00214 https://doi.org/10.7205/MILMED-D-13-0021... ^,⁸8 Almeida RGS, Mazzo A, Martins JCA, Coutinho VRD, Jorge BM, Mendes IAT. Validation to Portuguese of the Debriefing Experience Scale. Rev Bras Enferm. 2016;69(4):705-11. https://doi.org/10.1590/0034-7167.2016690413i https://doi.org/10.1590/0034-7167.201669... ^,¹⁸18 Jaye P, Thomas L, Reedy G. "The Diamond": a structure for simulation debrief. Clin Teach. 2015;12(3):171-5. https://doi.org/10.1111/tct.12300 https://doi.org/10.1111/tct.12300... ^,²²22 House JB, Choe CH, Wourman HL, Berg KM, Fischer JP, Santen A. Efficient and effective use of peer teaching for medical student simulation. West J Emerg Med. 2017;18(1). https://doi.org/10.5811/westjem.2016.11.32753 https://doi.org/10.5811/westjem.2016.11.... 23 Nyström S, Dahlberg J, Edelbring S, Hult H, Dahlgren MA. Debriefing practices in interprofessional simulation with students: a sociomaterial perspective. BMC Med Educ. 2016;16. https://doi.org/10.1186/s12909-016-0666-5 https://doi.org/10.1186/s12909-016-0666-... -²⁴24 Oikawa S, Berg B, Turban J, Vincent D, Mandai Y, Birkmire-Peters D. Self-Debriefing vs Instructor Debriefing in a Pre-Internship Simulation Curriculum: Night on Call. Hawaii J Med Public Health [Internet]. 2016 [cited 2019 Oct 01];75(5):127-32. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4872264/ https://www.ncbi.nlm.nih.gov/pmc/article... ^,²⁹29 The INACSL Standards Committee. INACSL standards of best practice: SimulationSM Debriefing. Clin Simulat Nurs. 2016;12(S):S21-S25. https://doi.org/10.1016/j.ecns.2016.09.008 https://doi.org/10.1016/j.ecns.2016.09.0... ⁾.	Communication systems with manikins and metrics processors. Printed self-assessment questionnaire, peer assessment and video resource⁽⁵5 Cai L. Potential applications of latent variable modeling for the psychometrics of medical simulation. Mil Med. 2013;178(10suppl). https://doi.org/10.7205/MILMED-D-13-00214 https://doi.org/10.7205/MILMED-D-13-0021... ^,⁸8 Almeida RGS, Mazzo A, Martins JCA, Coutinho VRD, Jorge BM, Mendes IAT. Validation to Portuguese of the Debriefing Experience Scale. Rev Bras Enferm. 2016;69(4):705-11. https://doi.org/10.1590/0034-7167.2016690413i https://doi.org/10.1590/0034-7167.201669... ^,¹⁷17 Bullock A, Webb K. Technology in postgraduate medical education: a dynamic influence on learning?. Postgrad Med J. 2015;91(1081):646-50. https://doi.org/10.1136/postgradmedj-2014-132809 https://doi.org/10.1136/postgradmedj-201... ^-¹⁸18 Jaye P, Thomas L, Reedy G. "The Diamond": a structure for simulation debrief. Clin Teach. 2015;12(3):171-5. https://doi.org/10.1111/tct.12300 https://doi.org/10.1111/tct.12300... 19 Liaw SY, Wong LF, Chan SW, Ho JT, Mordiffi SZ, Ang SB, et al. Designing and evaluating an interactive multimedia Web-based simulation for developing nurses competencies in acute nursing care: randomized controlled trial. J Med Internet Res. 2015;17(1). https://doi.org/10.2196/jmir.3853 https://doi.org/10.2196/jmir.3853... 20 Nestel D, Bearman M, Brooks P, Campher D, Freeman K, Greenhill J, et al. A national training program for simulation educators and technicians: evaluation strategy and outcomes. BMC Med Educ. 2016;16(25). https://doi.org/10.1186/s12909-016-0548-x https://doi.org/10.1186/s12909-016-0548-... -²¹21 Gordon CJ, Jorm C, Shulruf B, Weller J, Currie J, Lim R, et al. Development of a self-assessment teamwork tool for use by medical and nursing students. BMC Med Educ. 2016;16(218). https://doi.org/10.1186/s12909-016-0548-x https://doi.org/10.1186/s12909-016-0548-... ^,²³23 Nyström S, Dahlberg J, Edelbring S, Hult H, Dahlgren MA. Debriefing practices in interprofessional simulation with students: a sociomaterial perspective. BMC Med Educ. 2016;16. https://doi.org/10.1186/s12909-016-0666-5 https://doi.org/10.1186/s12909-016-0666-... -²⁴24 Oikawa S, Berg B, Turban J, Vincent D, Mandai Y, Birkmire-Peters D. Self-Debriefing vs Instructor Debriefing in a Pre-Internship Simulation Curriculum: Night on Call. Hawaii J Med Public Health [Internet]. 2016 [cited 2019 Oct 01];75(5):127-32. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4872264/ https://www.ncbi.nlm.nih.gov/pmc/article... ⁾.
Resources Management	Materials - routine activity	Update daily by double-checking stocks⁽⁴4 Fabri IRP, Mazzo A, Martins JCA, Fonseca ASF, Pedersoli CE, Miranda FBG, et al. Development of a theoretical-practical script for clinical simulation. Rev Esc Enferm USP. 2017;51. https://doi.org/10.1590/s1980-220x2016265103218 https://doi.org/10.1590/s1980-220x201626... ^,¹⁴14 Livingston P, Bailey J, Ntakiyiruta G, Mukwesi C, Whynot S, Brindley P. Development of a simulation and skills centre in East Africa: a Rwandan-Canadian partnership. Pan Africa Med J. 2014;17. https://doi.org/10.11604/pamj.2014.17.315.4211 https://doi.org/10.11604/pamj.2014.17.31... ⁾.	Computerized material management programs⁽⁶6 Landman AB, Redden L, Neri P, Poole S, Horsky J, Raja AS, et al. Using a medical simulation center as an electronic health record usability laboratory. J Am Med Inform Assoc. 2014;21(3). https://doi.org/10.1136/amiajnl-2013-002233 https://doi.org/10.1136/amiajnl-2013-002... ⁾.
	Humans - planning activity	Train the educators in the development of all the center's activities. A reference professional for each area⁽⁴4 Fabri IRP, Mazzo A, Martins JCA, Fonseca ASF, Pedersoli CE, Miranda FBG, et al. Development of a theoretical-practical script for clinical simulation. Rev Esc Enferm USP. 2017;51. https://doi.org/10.1590/s1980-220x2016265103218 https://doi.org/10.1590/s1980-220x201626... ^,²⁰20 Nestel D, Bearman M, Brooks P, Campher D, Freeman K, Greenhill J, et al. A national training program for simulation educators and technicians: evaluation strategy and outcomes. BMC Med Educ. 2016;16(25). https://doi.org/10.1186/s12909-016-0548-x https://doi.org/10.1186/s12909-016-0548-... ^,²⁵25 LaFond CM, Blood A. Targeted simulation instructor course for nursing professional development specialists. J Nurses Prof Dev. 2016;32(6). https://doi.org/10.1097/NND.0000000000000306 https://doi.org/10.1097/NND.000000000000... ⁾.	To have professionals working exclusively in the research center, with educational and health backgrounds⁽¹⁰10 Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349-57. https://doi.org/10.1371/journal.pone.0228587.s001 https://doi.org/10.1371/journal.pone.022... ^,²⁵25 LaFond CM, Blood A. Targeted simulation instructor course for nursing professional development specialists. J Nurses Prof Dev. 2016;32(6). https://doi.org/10.1097/NND.0000000000000306 https://doi.org/10.1097/NND.000000000000... ⁾.
	Technological - planning activity	Use technologies that provide compatible adaptations and resources⁽⁴4 Fabri IRP, Mazzo A, Martins JCA, Fonseca ASF, Pedersoli CE, Miranda FBG, et al. Development of a theoretical-practical script for clinical simulation. Rev Esc Enferm USP. 2017;51. https://doi.org/10.1590/s1980-220x2016265103218 https://doi.org/10.1590/s1980-220x201626... ^,⁶6 Landman AB, Redden L, Neri P, Poole S, Horsky J, Raja AS, et al. Using a medical simulation center as an electronic health record usability laboratory. J Am Med Inform Assoc. 2014;21(3). https://doi.org/10.1136/amiajnl-2013-002233 https://doi.org/10.1136/amiajnl-2013-002... ^,¹⁷17 Bullock A, Webb K. Technology in postgraduate medical education: a dynamic influence on learning?. Postgrad Med J. 2015;91(1081):646-50. https://doi.org/10.1136/postgradmedj-2014-132809 https://doi.org/10.1136/postgradmedj-201... ⁾.	Network of computerized or mutually compatible programs⁽⁶6 Landman AB, Redden L, Neri P, Poole S, Horsky J, Raja AS, et al. Using a medical simulation center as an electronic health record usability laboratory. J Am Med Inform Assoc. 2014;21(3). https://doi.org/10.1136/amiajnl-2013-002233 https://doi.org/10.1136/amiajnl-2013-002... ^,¹⁷17 Bullock A, Webb K. Technology in postgraduate medical education: a dynamic influence on learning?. Postgrad Med J. 2015;91(1081):646-50. https://doi.org/10.1136/postgradmedj-2014-132809 https://doi.org/10.1136/postgradmedj-201... ⁾.
	Maintenance - routine activity	Create a routine maintenance spreadsheet for the equipment according to the manufacturer⁽¹⁴14 Livingston P, Bailey J, Ntakiyiruta G, Mukwesi C, Whynot S, Brindley P. Development of a simulation and skills centre in East Africa: a Rwandan-Canadian partnership. Pan Africa Med J. 2014;17. https://doi.org/10.11604/pamj.2014.17.315.4211 https://doi.org/10.11604/pamj.2014.17.31... ⁾.	Direct contact and maintenance network with suppliers⁽¹⁴14 Livingston P, Bailey J, Ntakiyiruta G, Mukwesi C, Whynot S, Brindley P. Development of a simulation and skills centre in East Africa: a Rwandan-Canadian partnership. Pan Africa Med J. 2014;17. https://doi.org/10.11604/pamj.2014.17.315.4211 https://doi.org/10.11604/pamj.2014.17.31... ⁾.
Handling of data and Instruments	Avaliação da Simulação - atividade de avaliação	Create standard instruments for scenario evaluation⁽⁶6 Landman AB, Redden L, Neri P, Poole S, Horsky J, Raja AS, et al. Using a medical simulation center as an electronic health record usability laboratory. J Am Med Inform Assoc. 2014;21(3). https://doi.org/10.1136/amiajnl-2013-002233 https://doi.org/10.1136/amiajnl-2013-002... ^,²⁰20 Nestel D, Bearman M, Brooks P, Campher D, Freeman K, Greenhill J, et al. A national training program for simulation educators and technicians: evaluation strategy and outcomes. BMC Med Educ. 2016;16(25). https://doi.org/10.1186/s12909-016-0548-x https://doi.org/10.1186/s12909-016-0548-... ^-²¹21 Gordon CJ, Jorm C, Shulruf B, Weller J, Currie J, Lim R, et al. Development of a self-assessment teamwork tool for use by medical and nursing students. BMC Med Educ. 2016;16(218). https://doi.org/10.1186/s12909-016-0548-x https://doi.org/10.1186/s12909-016-0548-... ⁾.	Use of printouts or technology with quick-fill potential⁽⁶6 Landman AB, Redden L, Neri P, Poole S, Horsky J, Raja AS, et al. Using a medical simulation center as an electronic health record usability laboratory. J Am Med Inform Assoc. 2014;21(3). https://doi.org/10.1136/amiajnl-2013-002233 https://doi.org/10.1136/amiajnl-2013-002... ^,¹⁷17 Bullock A, Webb K. Technology in postgraduate medical education: a dynamic influence on learning?. Postgrad Med J. 2015;91(1081):646-50. https://doi.org/10.1136/postgradmedj-2014-132809 https://doi.org/10.1136/postgradmedj-201... ⁾.
	Collection of Evaluative Data - Evaluation Activity
	Data Analysis - research activity	Create routine quantitative and qualitative data analysis and improvement of instruments. Professionals specialized in methods and analysis⁽¹⁵15 Maglio PP, Sepulveda MJ, Mabry PL. Mainstreaming modeling and simulation to accelerate public health innovation. Am J Public Health. 2014;104(7). https://doi.org/10.2105/AJPH.2014.301873 https://doi.org/10.2105/AJPH.2014.301873... ^,²¹21 Gordon CJ, Jorm C, Shulruf B, Weller J, Currie J, Lim R, et al. Development of a self-assessment teamwork tool for use by medical and nursing students. BMC Med Educ. 2016;16(218). https://doi.org/10.1186/s12909-016-0548-x https://doi.org/10.1186/s12909-016-0548-... ^,²⁵25 LaFond CM, Blood A. Targeted simulation instructor course for nursing professional development specialists. J Nurses Prof Dev. 2016;32(6). https://doi.org/10.1097/NND.0000000000000306 https://doi.org/10.1097/NND.000000000000... ⁾.	Construction of articles and publications, layout of printed or online reports. Discussion Meetings⁽¹⁴14 Livingston P, Bailey J, Ntakiyiruta G, Mukwesi C, Whynot S, Brindley P. Development of a simulation and skills centre in East Africa: a Rwandan-Canadian partnership. Pan Africa Med J. 2014;17. https://doi.org/10.11604/pamj.2014.17.315.4211 https://doi.org/10.11604/pamj.2014.17.31... ^-¹⁵15 Maglio PP, Sepulveda MJ, Mabry PL. Mainstreaming modeling and simulation to accelerate public health innovation. Am J Public Health. 2014;104(7). https://doi.org/10.2105/AJPH.2014.301873 https://doi.org/10.2105/AJPH.2014.301873... ^,²⁰20 Nestel D, Bearman M, Brooks P, Campher D, Freeman K, Greenhill J, et al. A national training program for simulation educators and technicians: evaluation strategy and outcomes. BMC Med Educ. 2016;16(25). https://doi.org/10.1186/s12909-016-0548-x https://doi.org/10.1186/s12909-016-0548-... ⁾.
	Instruments - planning activity
	Data Availability - research activity

[1] Corresponding author: Patrícia Ilha Schuelter E-mail: ilha.patricia@gmail.com

Brasil

Brasil

Management in clinical simulation: a proposal for best practices and process optimization

Gestión en simulación clínica: una propuesta de buenas prácticas y optimización de los procesos

ABSTRACT

Objectives:

Methods:

Results:

Final Considerations: