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SIMULATION BASED LEARNING EXPERIENCE

Title:

Course description: (summarise in 3-5 lines the educative activity)

Competencies / General objectives:

Specific learning objectives:

Synopsis (type of patient, environment/context, reason to attend health care centre)


CLINICAL SCENARIO

Scenario name

Clinical environment

□ Hospital pharmacy □ Recovery


□ Emergency department □ Theatres
□ Triage □ Primary care centre / Outpatients
□ Box □ Inpatient
□ Majors □ Home care

Patient profile
Gender: Height:
Age: Weight:
Type of patient

□ Low fidelity simulator □ Standardised patient


□ Medium fidelity simulator □ Hybrid model (please specify)
□ High fidelity simulator

Patient’s clinical history

Past medical history:

Past surgical history:

Known alergies:

Regular/current medication:
Storyboard (patient’s history)

Scenario start ( define how the scenario starts)

Distractors and/or stressors

Standardised patients and healthcare professional workers scripts

¨
Patient’s physiological progress:

State 1 Description
Airway (A) Breathing (B) Circulation (C) Dissability (D) Exposure (E)
Obstructed RR BP (mmHg) Pupils T (°C)
(in mm)
Free of Use of HR (x’) GCS / Wounds
obstructions axilary AVPU
muscle
s
Type Location
Skin colour Capilary Blood
refill sugar
(mg/dL)
Thorathic Central and Convulsions: Anatomical
expansion peripheral deformities:
pulses
Sat O2 Skin colour
ECG (cardiac
rythym)
Other
Notes:
Moulage:
Dressing:
Supplementary tests:

Physiological transitions

State 2 Description
Airway (A) Breathing (B) Circulation (C) Dissability (D) Exposure (E)
Obstructed RR BP (mmHg) Pupils T (°C)
(in mm)
Free of Use of HR (x’) GCS / Wounds
obstructions axilary AVPU
muscle
s
Type Location
Skin colour Capilary Blood
refill sugar
(mg/dL)
Thorathic Central and Convulsions: Anatomical
expansion peripheral deformities:
pulses
Sat O2 Skin colour
ECG (cardiac
rythym)
Other
Notes:
Moulage:
Dressing:
Supplementary tests:
Physiological transitions

State 3 Description
Airway (A) Breathing (B) Circulation (C) Dissability (D) Exposure (E)
Obstructed RR BP (mmHg) Pupils T (°C)
(in mm)
Free of Use of HR (x’) GCS / Wounds
obstructions axilary AVPU
muscle
s
Type Location
Skin colour Capilary Blood
refill sugar
(mg/dL)
Thorathic Central and Convulsions: Anatomical
expansion peripheral deformities:
pulses
Sat O2 Skin colour
ECG (cardiac
rythym)
Other
Notes:
Moulage:
Dressing:
Supplementary tests:

Physiological transitions

State 4 Description
Airway (A) Breathing (B) Circulation (C) Dissability (D) Exposure (E)
Obstructed RR BP (mmHg) Pupils T (°C)
(in mm)
Free of Use of HR (x’) GCS / Wounds
obstructions axilary AVPU
muscle
s
Type Location
Skin colour Capilary Blood
refill sugar
(mg/dL)
Thorathic Central and Convulsions: Anatomical
expansion peripheral deformities:
pulses
Sat O2 Skin colour
ECG (cardiac
rythym)
Other
Notes:
Moulage:
Dressing:
Supplementary tests:

Physiological transitions

Supplementary tests (ECG, radiology, blood tests, etc.)

Simulation documentation (please check the ones that apply)

□ Medical progress notes


□ Nursing progress notes
□ Drug chart
□ Observations chart
□ Assessment tools
□ Waterlow
□ Glasgow
□ Others:
□ Anaesthesia chart
□ Theatre’s check list
□ Radiology request form
□ Radiology images (CT, MRI, US, etc.)
□ RX
□ Ecography
□ CT
□ MRI
□ Gammagraphy
□ Others:
□ Sample requests
□ Blood
□ Urine
□ Sputum
□ Others:
□ Sample results
□ Blood
□ Urine
□ Sputum
□ Others:
□ Handover / Handoff
Description:
□ Health advise
Description:
□ Informed consent forms
Description:

Monitoring

□ Mannequin linked
□ Virtual independent monitor

Equipment

Simulation equipment (virtual reality, task trainer, etc.)

Medical equipment (mechanical ventilator, Desfibrilator, etc.)

Disposables

Airway

Breathing
Circulation

Disability

Exposure – Physical assessment

Preparation of the clinical environment

Moulage

Description:

Clinical environment (relevant aspects to consider)

Description:

Other necessary documentation:

□ Program /course agenda


□ Pre and post test knowledge test (MCQ, open ended questionnaire, etc...)
□ Participant’s list name
□ Timings / Agenda
□ Evaluation documents / tools
□ Bibliography

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