A method for designing symmetrical simulation scenarios for evaluation of behavioral skills

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The increasing use of simulation technology in medical education necessitates a method to formulate carefully planned scenarios to assess performance. Much of simulation in healthcare endeavors to teach technical skills such as the drugs and dosages needed during Advanced Cardiac Life Support (ACLS)1 or procedural skills such as those needed for laparoscopic surgery2–8 or bronchoscopy.9–11 In contrast, scenarios can be designed specifically to evaluate behavioral skills such as communication, leadership, and situation awareness. These are skills typically emphasized in crisis resource management (CRM) courses.12–15 This manuscript describes a systematic framework for developing interchangeable, “symmetrical” simulation scenarios that can be randomly ordered to repeatedly test crisis behavioral skills. The mechanism given in this methodologic description is reproducible and can generate a series of scenarios that are similar in flow, basic content, and difficulty. This standardizes the expertise necessary to solve each crisis and avoids the wide range of complexity commonly seen in simulation scenarios. Symmetrical scenarios provide a context for assessment using behavioral skills scoring systems by providing clear opportunities within each scenario for participants to demonstrate elements of each skill. To compare “before and after” performance and behavioral skills retention using such a rating system, it is essential to have comparable simulation scenarios.


Bush, M. C., Jankouskas, T. S., Sinz, E. H., Rudy, S., Henry, J., & Murray, W. B. (2007). A method for designing symmetrical simulation scenarios for evaluation of behavioral skills: Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 2(2), 102–109. https://doi.org/10.1097/01.SIH.0b013e31802d981c