Describing How Sequencing Simulation Scenario Topic and Situation Urgency Impacts Observers’ Clinical Judgement: Lessons for Scaffolding Simulation Observations

Abstract :

Background: Clinical judgment (CJ) is an essential competency. The original study found observing simulations leads to significant CJ gains, but gains were not consistent over time. There is a gap for understanding how sequencing simulation scenario topics and situation urgency impacts observer CJ.

Methods: Guided by NLN Jeffries Simulation Theory, a secondary analysis was performed to describe how simulation designs impact observers’ CJ. Sixty-one junior-level learners responded to 11 CJ prompts scored using Lasater CJ Rubric (LCJR) after observing eight expert-modeled simulations sequenced with increasingly complex medical-surgical or mental health scenario topics and urgent or routine situations. Learners were assigned to low, medium, or high-ability groups based on cumulative LCJR rankings. Statistical analysis consisted of serial two-way mixed ANOVAs, Gwet’s AC and descriptive statistics.

Results: There was a statistically significant interaction between scenario topic and sequence on CJ F(2.606, 312.706)=3.846, p=.014. ηp2=.031, ε=.869. Sequencing significantly impacted observers’ CJ in medical surgical and mental health scenarios. Medium ability observers’ CJ was impacted by scenario topic and sequencing, whereas high and low ability observers were not. There was a statistically significant interaction between scenario urgency and sequence on CJ F(3, 360)=19.141, p<.001, ηp2=.138. Sequencing routine and urgent scenarios significantly impacted observers’ CJ. The situation urgency and sequencing significantly impacted high, medium, and low ability observers’ CJ. Cumulative Gwet’s AC= 0.74.

Conclusion: Educators should use caution when scaffolding complexity for mental health and urgent situation observations. Observers' CJ is overwhelmed in urgent situations, despite learner ability. Using routine situations improves observer CJ.