Eugene Tseytlin, MS John R. Boulet, MD Laurence Torsher, MD Matthew B. Weinger, MD Tanja Bekhuis, PhD, MS, MLIS, AHIP William R. McIvor, MD A taxonomy that categorizes scenario delivery and documentation deviations during high-fidelity simulations Medical Simulation Scenario Deviations A taxonomy that categorizes scenario delivery and documentation deviations during high-fidelity simulations Medical Simulation Scenario Deviations Examples of a Contributor include a person, an organisation, or a service. Typically, the name of a Contributor should be used to indicate the entity. An entity responsible for making contributions to the content of the resource. Contributor Coverage will typically include spatial location (a place name or geographic coordinates), temporal period (a period label, date, or date range) or jurisdiction (such as a named administrative entity). Recommended best practice is to select a value from a controlled vocabulary (for example, the Thesaurus of Geographic Names [TGN]) and that, where appropriate, named places or time periods be used in preference to numeric identifiers such as sets of coordinates or date ranges. The extent or scope of the content of the resource. Coverage Examples of a Creator include a person, an organisation, or a service. Typically, the name of a Creator should be used to indicate the entity. An entity primarily responsible for making the content of the resource. Creator Typically, Date will be associated with the creation or availability of the resource. Recommended best practice for encoding the date value is defined in a profile of ISO 8601 [W3CDTF] and follows the YYYY-MM-DD format. A date associated with an event in the life cycle of the resource. Date Description may include but is not limited to: an abstract, table of contents, reference to a graphical representation of content or a free-text account of the content. An account of the content of the resource. Description Typically, Format may include the media-type or dimensions of the resource. Format may be used to determine the software, hardware or other equipment needed to display or operate the resource. Examples of dimensions include size and duration. Recommended best practice is to select a value from a controlled vocabulary (for example, the list of Internet Media Types [MIME] defining computer media formats). The physical or digital manifestation of the resource. Format Recommended best practice is to identify the resource by means of a string or number conforming to a formal identification system. Example formal identification systems include the Uniform Resource Identifier (URI) (including the Uniform Resource Locator (URL)), the Digital Object Identifier (DOI) and the International Standard Book Number (ISBN). An unambiguous reference to the resource within a given context. Resource Identifier Recommended best practice is to use RFC 3066 [RFC3066], which, in conjunction with ISO 639 [ISO639], defines two- and three-letter primary language tags with optional subtags. Examples include "en" or "eng" for English, "akk" for Akkadian, and "en-GB" for English used in the United Kingdom. A language of the intellectual content of the resource. Language Examples of a Publisher include a person, an organisation, or a service. Typically, the name of a Publisher should be used to indicate the entity. An entity responsible for making the resource available Publisher Recommended best practice is to reference the resource by means of a string or number conforming to a formal identification system. A reference to a related resource. Relation Typically, a Rights element will contain a rights management statement for the resource, or reference a service providing such information. Rights information often encompasses Intellectual Property Rights (IPR), Copyright, and various Property Rights. If the Rights element is absent, no assumptions can be made about the status of these and other rights with respect to the resource. Information about rights held in and over the resource. Rights Management The present resource may be derived from the Source resource in whole or in part. Recommended best practice is to reference the resource by means of a string or number conforming to a formal identification system. A reference to a resource from which the present resource is derived. Source Typically, a Subject will be expressed as keywords, key phrases or classification codes that describe a topic of the resource. Recommended best practice is to select a value from a controlled vocabulary or formal classification scheme. The topic of the content of the resource. Subject and Keywords Typically, a Title will be a name by which the resource is formally known. A name given to the resource. Title Type includes terms describing general categories, functions, genres, or aggregation levels for content. Recommended best practice is to select a value from a controlled vocabulary (for example, the DCMI Type Vocabulary [DCMITYPE]). To describe the physical or digital manifestation of the resource, use the Format element. The nature or genre of the content of the resource. Resource Type Thing documentation was missed that could have been captured on audio or video recording. E.g., cannot see or hear if an action was performed or who was speaking Audio or visual recording deviation audio recording not adequate to assess some element of participant performance Audio recording deviation equipment provided participants with more information or capability than scripted, e.g., when AED present that announced 'shock indicated,' or when equipment failed and did not provide participants with enough of a resource, as when an anesthesia machine failed during the scenario Clinical equipment deviation-during scenario Confederate cue deviation-during scenario Confederate deviation-during scenario Displayed vital signs deviation-during scenario there was a problem creating evidence needed to assess performance Documentation deviation things or people participants could interact or work with after the start of the simulation During scenario deviation Early departure of unscripted participant-during scenario Early entry of unscripted participant-during scenario E.g., participant giggles or performs nonchalantly during a crisis, mocks the situation, etc. Engagement failure Equipment deviation-during scenario case not sufficiently conducted to feel like a real clinical experience. E.g., participants or confederates not dressed as they would be in the real world, 'Voice of God' is used, etc. Fidelity environment deviation E.g., participant insists that they have given a drug when they have not drawn the medication up into a syringe and injected it into an intravenous line Ground rule violation Image deviation-during scenario E.g., if a 12-lead ECG is scripted to be available 2 minutes after being ordered and it becomes available outside that timing window Image presented at incorrect time-during scenario confederate did something outside the scripted clinician's scope of practice, e.g., when a nurse draws an arterial blood gas, a respiratory therapist identifies a dysrhythmia, etc. Inaccurate portrayal of confederate role-during scenario as when a confederate to be a nurse is portrayed as a surgeon Incorrect confederate role-start of scenario became available to participants before or after scripted times Incorrect timing of lab values-during scenario Lab results deviation-during scenario E.g., if script states that certain medicines are not to be present until specific times in scenario, or if a rule states that unanticipated medication requests must be available after a 2-minute delay Medication deviation-during scenario Missing confederate cue-during scenario says something correct, but at wrong time per the script Mistimed confederate cue-during scenario Mistimed entry or departure of confederates-during scenario notes or observations made during the scenario are inaccurate or attributed to participants incorrectly; an observation that was supposed to be documented in some form other than audio or visual was not made Other artifact deviation event occurs because participant disrupts simulation delivery Participant deviation scenario not conducted according to its script, rules for its conduction were not followed, or equipment failed Scenario conduction deviation scenario not performed according to script or rules Scenario execution deviation E.g., stethoscopes, anesthesia machines, defibrillators, etc. that were scripted to be available or not at the beginning of the scenario. Cognitive aids or checklists are included in this category Set-up clinical equipment deviation scripted scenario participants Set-up confederate deviation things that were or were not to be present at the start of the scenario are incorrect Set-up deviation E.g., radiologic images Set-up images deviation Set-up lab values deviation E.g., simulated patient is to be unconscious, yet eyes are open; is to be a woman, yet appears to be a man; is to have a wound, yet wound not present, etc. Set-up mannequin or patient physical signs or findings deviation drugs that were or were not to be present at the beginning of the scenario per the script or study rules Set-up medications deviation information on the patient monitor that should be displayed is not; information on the patient monitor that should not be displayed is; or the wrong values or information is displayed Set-up patient monitor information deviation something the participant or confederates could use or receive information from during the scenario Set-up resources deviation records, e.g., intra-operative anesthesia records, pre-operative history and physical records, etc., that are or are not to be present at beginning of scenario per the script or study rules Set-up written records deviation Simulated patient deviation-during scenario see previous definition of physical findings; simulated patient's response to queries, verbal cues they were scripted to give, or examination findings are also included. Simulated patient physical signs or findings deviation-during scenario E.g., patient's vital signs did not respond to a medication according to script Simulated patient responds to intervention incorrectly-during scenario E.g., script indicates patient could not to be cardioverted before 12 minutes, yet was allowed to occur at 9 minutes Simulated patient response to intervention at incorrect time-during scenario interventions are medications, oxygen, CPR, airway procedures, cardioversion, etc. Simulated patient response to intervention deviation-during scenario simulation room/theater does not sufficiently emulate intended clinical environment. E.g., simulation environment does not look like an operating room, post-anesthesia care unit, etc. Simulated physical environment deviation Simulation center deviation milieu in which scenario occurred was not as intended or scripted Simulation environment deviation mannequin or its monitor did not work as intended Simulator deviation-during scenario Too few confederates-start of scenario Too many confederates-start of scenario other course or study participants not part of the simulation delivery team, i.e., not confederates, allowed to deviate from rules or script Unscripted participant deviation-during scenario performance event not adequately captured on video Video recording deviation says something not scripted Wrong confederate cue-during scenario Wrong image-during scenario Wrong lab values given-during scenario Wrong number of confederates-during scenario Wrong number of unscripted participants-during scenario Eugene Tseytlin, MS John R. Boulet, MD Laurence Torsher, MD Matthew B. Weinger, MD Tanja Bekhuis, PhD, MS, MLIS, AHIP William R. McIvor, MD A taxonomy that categorizes scenario delivery and documentation deviations during high-fidelity simulations Medical Simulation Scenario Deviations A taxonomy that categorizes scenario delivery and documentation deviations during high-fidelity simulations Medical Simulation Scenario Deviations