Exam of 7 pages for the course CHSOS – Certified Healthcare Simulation Operations Specialist at CHSOS – Certified Healthcare Simulation Operations Specialist (CHSOS EXAM 2023)

ABC
airway, breathing, circulation

AC
before meals

Advocacy and inquiry
A communication method within debriefing that pairs a statement of observation and point of view with a question directed at understanding an action through a participant’s cognitive construct or frame.

AMA
against medical advice

APAP
Automatic Positive Airway Pressure

Assessment
The process of documenting, usually in measurable terms, a subject’s knowledge, skills, attitudes, and beliefs.

Avatar
Graphical representation of the user or user’s alter ego or character. It may take either a 3-dimensiona form, as in games or virtual worlds, or a 2-D form as an icon in Internet forums and other online communities.

Behavioral Skills
the decision-making and team interaction processes used during team’s management of a situation

best practices
An idea that asserts that there is a technique, method, process, activity, incentive, or reward that is more effective at delivering particular outcomes than any other technique, method, process, and so on. the most efficient (least amount of effort) and effective (best results)way of accomplishing a task based on repeatable procedures that have proven themselves over time for large numbers of people

Briefing
This refers to any activity that occurs prior to a simulation event such as an educational activity. This can include giving instructions, guidelines, or directives. This can be for the instructional staff as well as for the learners.

CABG
coronary artery bypass grafting

CHF
congestive heart failure

CHSE
Certified Healthcare Simulation Educator

CHSE-A
Certified Healthcare Simulation Educator-Advanced

CHSOS
Certified Healthcare Simulation Operations Specialist

CHSOS program
A term used throughout various documents and resources of the CHSOS certification. It is a general term used to encompass any and all activities related to the application, verification, certification granting, administrative, and other functions performed in the certification program.

Clinical scenario (simulated scenario)
A plan of an expected and potential course of events for a simulated clinical experience.

Computer-based simulation
Simulation activities that are performed via a computer program. These are similar to virtual reality simulations, but do not include additional interfaces between the learner and the computer.

Confederate
An individual other than the patient who is scripted in a simulation to provide realism, additional challenges, or additional information for the learner.

Construct validity
the degree to which a test measures what it claims, or purports, to be measuring

Content validity
The extent to which a measure represents all facets of a given social construct. It requires the use of recognized subject matter experts to evaluate whether test items assess defined content and more rigorous statistical tests than does the assessment of face validity.

COPD
chronic obstructive pulmonary disease

Core standards
The fundamental simulation education standards that have been developed by the Society for Simulation in Healthcare Certification Committee as a cooperative effort with input from other simulation societies and groups.

Critical thinking
A disciplined process that requires validation of data, including any assumptions that may influence thoughts and actions, and then careful reflection on the entire process while evaluating the effectiveness of what has been determined as the necessary actions to take. The process entails purposeful, goal-directed thinking and is based on scientific principles and methods (evidence) rather than assumptions and conjecture.

Cueing
Information provided by instructors or designated participants in the simulation that helps the student progress through the simulation activity by providing information about the step the student is on or is approaching.

Cut Suit
The human worn partial task surgical simulator. In realistic scenarios it simulates the treatment of the 3 most common causes of preventable death on the battlefield, including hemorrhage from extremity wounds, tension pneumothorax and airway compromise.

debriefing
Activity that follows a simulation experience led by a facilitator wherein feedback is provided on the simulation participants’ performance while positive aspects of the completed simulation are discussed and reflective thinking encouraged.

DM
diabetes mellitus

DOB
date of birth

ECHO
echocardiography, echocardiogram

EEG
electroencephalography, electroencephalogram

Embedded participant
scenario guide, scenario role player, or confederate; assigned to help guide the scenario; The guidance may be influential as positive, negative, or neutral or as a distractor.

ETOH
ethyl alcohol

Evidence-based
Educational materials or methods that have been proven through rigorous evaluation and research.

Experiential learning
The process of making meaning from direct experience.

Face validity
the extent to which a test is subjectively viewed as covering the concept that it purports to measure

Facilitation
Any activity which makes tasks for others easy, or tasks that are assisted.

Feedback
Information given or dialogue between participants, facilitator, simulator, peer with the intention of improving the understanding of concepts or aspects of performance.

FHM
fetal heart monitor

FHR
fetal heart rate

Fidelity
Describes the level of realism associated with a particular simulation activity.

Formative evaluation
Evaluation wherein the evaluator’s focus is on the learner’s progress toward goal achievement. A process for determining the competence of a person engaged in a healthcare activity for the purpose of providing constructive feedback for the person to improve.

FSBS
finger stick blood sugar

Full body patient simulator
A realistic, full-body, wireless manikin which offers comprehensive clinical functionality to teach the core skills of airway, breathing, cardiac, and circulation management.

Full scale simulation
A device or scenario that allows simulation of tasks related to applicable learners for a given operational requirement. It is capable of simulating the operational environment (e.g. audio, visual, and tactile) to achieve maximum realism and training effectiveness.

guided reflection
The process used by the facilitator during debriefing that reinforces the critical aspects of the experience and encourages insightful learning, allowing the participant to assimilate theory, practice, and research in order to influence future actions.

haptic
Tactile feedback technology which takes advantage of the sense of touch by applying forces, vibrations, or motions to the user.

High fidelity simulator
a broad range of full-body manikins that have the ability to mimic, at a very high level, human body functions

High-stakes assessment
assessment having important consequences for the test taker; serves as a basis for a major decision; Has the following; a single, defined assessment, has clear distinction between those who pass or fail, and has direct consequences for passing or failing.

HoTN
hypotension

H&P
history and physical

HTN
hypertension (high blood pressure)

Human factors
The discipline or science of studying interactions between humans and systems and technology. Covers all biomedical and psychological considerations.

Hx
history, history of

Hybrid Simulation
Integrating different types of simulation across different dimensions of applications, purposes, and target populations and assessing the impact or benefit of simulation-based training across the various dimensions.

In situ
educational activity that takes place in the actual patient care area/ setting in which the healthcare providers would normally function.

Interprofessional education
When students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes

IV
intravenous

Laparoscopy
minimally invasive surgery within the abdomen

LP
lumbar puncture

manikin (mannequin)
Part or full body simulators that can have varying levels of function and fidelity.

Microsimulation
Synonym for laptop or web-based simulation.

Mixed simulation
The use of a variety of different types of simulations simultaneously. Not characterized by the use of one type of simulation to enhance another, but rather the use of multiple types of simulation as part of the overall educational activity.

Modality
the type of simulation being used as part of the educational activity (e.g. task trainers, manikin-based, standardized patient, computer-based, virtual reality, and hybrid)

Modeling and simulation
The use of models (e.g. emulators, prototypes, simulators, and stimulators) either statically or over time to develop data as a basis for making managerial or technical decisions.

moulage
Makeup and molds applied to actors or manikins used to portray lesions, skin findings, and bleeding and traumatized areas.

MRSA
methicillin-resistant staphylococcus aureus

MVC
motor vehicle collision

NG
nasogastric (usually tube)

NKA
no known allergies

Nontechnical skills
Behavioral skills which can be categorized as either (1) skills of dynamic decision-making (e.g. anticipation and planning, use of cognitive aids, avoiding fixation errors) or (2) skills of teamwork and team management (e.g. workload distribution, communication, and/or role clarity).

Objective
Statement of specific measurable results that participant(s) is expected to achieve during a simulation-based learning experience.

On the fly approach
activities that develop or occur dynamically rather than as the result of something that is statically predefined.

Operator-driven approach
Relying on direct control by the operator of all the clinical data and features, sometimes augmented by software “scripts” to automate certain stereotyped responses in well-defined clinical situations.

OSCE
Objective Structured Clinical Examination: A station or series of stations designed to assess performance competency in individual clinical or other professional skills.

prebriefing/briefing
An information or orientation session held prior to the start of a simulation-based learning experience in which instructions or preparatory information is given to participants. Purpose is to set the stage of the scenario and assist participants in achieving scenario objectives. Activities include an orientation to the equipment, environment, manikin, roles, time allotment, objectives, and patient situation.

Pre-programmed scenario
Scenarios that include a combination of automated physiological and/or pathophysiological model(s) of the medical condition and a complex decision-making tree that reflects the patient’s response(s)to various clinical/medical interventions that lead to any number of possible clinical outcomes.

PRN
as needed

Problem-based learning
Small group learning with a facilitator where the students access and engage as a group with the virtual patient case.

prompt
A cue given to a participant in a scenario.

QSEN
stands for Quality and Safety Education for Nurses, a project for preparing future nurses with the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of the health care systems within which they work

Readback
An order is given; it is written down and read back. It is then acknowledged by giver as correct.

reliability
The extent to which a measure is consistent across repeated tests and includes test-retest reliability correlation of tests applied more than once to same subjects, internal consistency correlation of subsets of scores measuring same construct, and inter-rater reliability degree of agreement between multiple raters of same test subjects.

remote feedback
Uses all the distant interconnection technology to bring together participants, observers, and instructors for a shared experience, without each and every one of them actually bringing themselves to a common observation/debriefing room.

RR
respiratory rate

SBAR
consistent, clear, structured, and easy-to-use method of communication between health care personnel; it organizes communication by the categories of: Situation, Background, Assessment, and Recommendations. It allows a clinical team member to easily and quickly describe the clinical presentation of a patient and make a recommendation for future action.

simulated patient/ standardized patient
In healthcare, ia an individual who is trained to act as a real patient in order to simulate a set of symptoms or problems.

simulated patient/ standardized patient
In healthcare, an individual who is trained to act as a real patient in order to simulate a set of symptoms or problems.

simulation fidelity
refers to the simulation- how the simulator is used in context to represent a patient care situation- rather than to the simulator device itself.

simulation fidelity
refers to the simulation- how the simulator is used in context to represent a patient care situation- rather than to the simulator device itself.

SOB
shortness of breath

Summative assessment
A process for determining the competence of a person engaged in a healthcare activity for the purpose of certifying with reasonable certainty that they are able to perform that activity in practice.

summative evaluation
Evaluation at the end of a time period, in which participants are provided with feedback about their achievement of outcome criteria; a process for determining the competence of a participant engaged in an activity.

summative feedback
Information provided by a facilitator regarding aspects of performance that are associated with the assignment of a grade, demonstration of competency, merit pay, promotion, or certification.

task fixation
In medicine, this results from a physician, in a crisis situation, getting fixated on a single procedure, when instead, he should team lead and delegate tasks to those who are qualified to perform the tasks at hand. Should call for assistance

Technical skills
The actual performance of patient treatment.

TPR
temperature, pulse, respiration

UTI
urinary tract infection

Validity
Translational outcomes. Educational effects measured at increasingly distal levels beginning in the classroom or sim lab and moving downstream to improved and safer patient care practices, better patient outcomes, and collateral educational effects, such as cost savings, skills retention, and systematic educational and patient care improvements.

virtual reality simulations
The simulated environment can be suimilar to the real world in order to create lifelike experience or it can differ significantly from reality

Common Video Connectors
VGA, RGBHV, DVI-A, SDI, HDMI, BNC, RCA, S-video, Display port

VGA connector
This is a connector for analog video. (No Audio). It has 3 rows and 15 pins. It is also sometimes referred to as the DE-15 or HD-15 connector.

DVI connector
(digital video interface connector) A digital interface that
is used to connect a video source (for example, a display controller to a display device) such as a computer monitor

DVI-A (Analog)
Provides an analog video signal (No Audio). Used by older HDTVs. Cables typically have a DVI-A connector on one end and a VGA connector on the other. Maximum supported resolution of 1920 × 1200 @ 60 Hz

DVI-D
A DVI mode that supports digital video signals (No Audio) and is partially compatible with HDMI. See also digital video interface and High-Definition Multimedia Interface. (3)

Actor
In health care simulation, professional and/or amateur people trained to reproduce the components of real clinical experience, especially involving communication between health professionals and patients or colleagues (Australian Society for Simulation in Healthcare).

Advocacy and Inquiry

• A method of debriefing in which an observer states what was observed or performed in a simulation activity (advocacy) or shares critical or appreciative insights about it explicitly (advocacy) and then asks the learners for an explanation of their thoughts or actions (inquiry)(Rudolph et al, 2007).
• Inquiry seeks to learn what others think, know, want, or feel; whereas advocacy includes statements that communicate what an individual thinks, knows, wants or feels (Bolman & Deal, 2013).

Advocacy and Inquiry
A method of debriefing in which an observer states what was observed or performed in a simulation activity (advocacy) or shares critical or appreciative insights about it explicitly (advocacy) and then asks the learners for an explanation of their thoughts or actions (inquiry)(Rudolph et al, 2007).

• Inquiry seeks to learn what others think, know, want, or feel; whereas advocacy includes statements that communicate what an individual thinks, knows, wants or feels (Bolman & Deal, 2013).

Alpha and Beta Testing

• Alpha- early testing of a product by the developers or programmers, but not by potential users. The purpose of alpha-testing is to find and resolve as many ‘bugs’ or problems in the software that were unanticipated during the design and development. (Lee-Jayaram et al, 2019)
• Beta – early testing of a software, program, simulation, or game, by potential users. The purpose of beta-testing is identical to alpha-testing. (Lee-Jayaram et al, 2019)

Artificial Intelligence (AI)
A system of computerized data-gathering and prediction that models human behavior and decision-making with minimal human intervention. In healthcare simulation, AI often refers to underlying programming that provides physiological or systembased algorithm changes based on inputs from users and learners. Often paired with machine learning, in which the software is programmed to alter algorithms and predictions based on observed data and results without human intervention. Virtual patients use artificial intelligence to react appropriately to the user or learner. (Bennett and Hauser, 2013)

Assessment
Refers to processes that provide information about or feedback about individual participants, groups, or programs. Specifically, assessment refers to observations of progress related to knowledge, skills, and attitudes (KSA). Findings of assessment are used to improve future outcomes (Scheckel, 2016; INACSL Standards Committee, 2016c, pp. S39-S40). • Involves measurement of the KSAs which can be recorded (Levine, DeMaria, Schwartz, & Sim, 2014).
Formative – a type of assessment (sometimes called an evaluation) “wherein the facilitator’s focus is on the participant’s progress toward goal attainment through preset criteria; a process for an individual or group engaged in a simulation activity for the purpose of providing constructive feedback for that individual or group to improve (National League for Nursing Simulation Innovation Resource Center [NLN-SIRC], 2013; Scheckel, 2016)” (INACSL Standards Committee, 2016c, p.S41).
Often completed at the same time as the instruction (Hamdorf & Davies, 2016), development of the individual is the focus for the simulation objectives/outcomes to be reached (INACSL Standards Committee, 2016c). • Summative – a type of assessment (sometimes called an evaluation) “at the end of a learning period or at a discrete point in time in which participants are provided with feedback about their achievement of outcome through preset criteria; a process for determining the competence of a participant engaged in healthcare activity. The assessment of achievement of outcome criteria may be associated with an assigned grade (NLN-SIRC, 2013; Scheckel, 2016)” (INACSL Standards Committee, 2016c, p. S41).
Performance of the individual is compared to a specific standard (Hamdorf & Davies, 2016). • High-stakes – a type of assessment (sometimes called an evaluation) “associated with a simulation activity that has a major academic, educational, or employment consequence (such as a grading decision, including pass or fail implications; a decision regarding competency, merit pay, promotion, or certification) at a discrete point in time (Hidden curriculum, 2014)” (INACSL Standards Committee, 2016c, p. S41).

Assessor

• A person who performs assessment of individuals according to pre-established criteria.
• Assessors must have specific and substantial training, expertise, and competency in assessment (Dictionary.com).

Augmented Reality
A type of virtual reality in which synthetic stimuli are superimposed on real-world objects, usually to make information that is otherwise imperceptible to human senses perceptible (M&S Glossary). • A technology that overlays digital computer-generated information on objects or places in the real world for the purpose of enhancing the user experience. • The combination of reality and overlay of digital information designed to enhance the learning process. • A spectrum of mixed-reality simulation that is part way between the real world and the virtual world. • A form of virtual reality that includes head-mounted displays, overlays of computer screens, wearable computers, or displays projected onto humans and manikins (D.R. Berryman et al; M. Bajura et al; H. Fuchs et al).

Avatar

• A virtual object used to represent a physical object (e.g., a human) in a virtual world. • A graphical representation, typically three-dimensional, of a person capable of relatively complex actions, including facial expressions and physical responses, while participating in a virtual simulation-based experience. The user controls the avatar through the use of a mouse, keyboard, or a type of joystick to move through the virtual simulation-based experience (Riley, 2008). • Controlled avatars may be either 1st-person perspective or 3rd-person perspective in virtual simulations. A 3rd-person perspective places the view and camera so the user and learner can see the controlled avatar (e.g., the player). A 1st-person perspective places the camera such that the user and learner views the world through the eyes of the avatar (i.e., the controlled avatar is never visible on the screen). These perspectives only apply to screen-based simulations using a mouse, keyboard, or joystick. Virtual Reality simulations are almost always 1st-person. (Schuurink and Toet, 2010)

Back Story or Backstory or Back-story
“A narrative, which provides a history and/or background and is created for a fictional character(s) and/or about a situation for a SBE (Backstory, n.d.)” (INACSL Standards Committee, 2016c, p.S40). (Ed note: this can include the back story provided to participants, standardized patients, and staff as required to support the simulation activity)

• A method, particularly in some game-based simulations, “for creating design prompts, dialogs, and interactions that contain realistic verbal behaviors and variability for multiple avatars or non-player characters (NPCs) . . .” (Zachary, Zachary, CannonBowers, & Santarelli, 2016, p. 207). • Something that is developed by an author in games for characters that gives them their characteristics and memories (Fairclough & Cunningham, 2004).

Behavioral Skills
The range of activities encompassed within the category of interpersonal interaction, including bedside manner, interpersonal, teamwork, leadership and communications. (Murphy, Nestel, & Gormley, 2019)

• The decision-making and team interaction processes used during the team’s management of a situation. (Gaba et al, 1998)

Brief (Briefing)

• An activity immediately preceding the start of a simulation activity where the participants receive essential information about the simulation scenario, such as background information, vital signs, instructions, or guidelines. For example, before beginning a session, faculty conduct a briefing about the scenario to review the information being provided to the participants.
• The information and guidelines given to faculty or simulated patients participating in a scenario to allow them to fully prepare for interactions with the participants. Briefing materials could include a handover, physician referral letter, or an ambulance call transcript. For example, at the start of the simulation scenario, participants receive a notification from ambulance personnel regarding a patient being transported to their facility with a gunshot wound. (Alinier, 2011; Husebø et al., 2012)

Cave Automated Virtual Environment (CAVE)
Large cube wall structure inside which a participant stands; the walls have projected images to simulate an immersive, virtual environment, including shadows cast by the participant. CAVE participants use specialized goggles for the illusion of stereoscopic depth when inside the CAVE. (Cruz-Neira et al, 1993).

Clinical Scenario

• The plan of an expected and potential course of events for a simulated clinical experience. A scenario usually includes the context for the simulation (hospital ward, emergency room, operating room, clinic, out of hospital, etc.). Scenarios can vary in length and complexity, depending on the learning objectives.
• A detailed outline of a clinical encounter that includes: the participants in the event, briefing notes, goals and learning objectives, participant instructions, patient information, environmental conditions, manikin or standardized patient preparation, related equipment, props, and tools or resources for assessing and managing the simulated experience.
• A progressive outline of a clinical encounter, including a beginning, an ending, a debriefing, and evaluation criteria (Meakim et al., 2013).

Coaching

• To direct or instruct a person or group of people in order to achieve goals, develop specific skills, or develop competencies.

Cognitive Load

• The amount of information the working memory of the participant and/or facilitator can manage at any given point. The definition is based on the Cognitive Load Theory (CLT) proposed by Sweller et al. (1998) based on the working memory model introduced by Baddeley (1992).

Computer-Based Simulation

• The modeling of real-life processes with inputs and outputs exclusively confined to a computer, usually associated with a monitor and a keyboard or other simple assistive device (Textbook of Simulation). Subsets of computer-based simulation include virtual patients, virtual reality task trainers, and immersive virtual reality simulation (ibid)..

Conceptual Fidelity
In health care simulation, ensures that all elements of the scenario relate to each other in a realistic way so that the case makes sense as a whole to the learner(s) (For example: Vital signs are consistent with the diagnosis). To maximize conceptual fidelity, cases or scenarios should be reviewed by subject matter expert(s) and pilot-tested prior to use with learners (Rudolph et al., 2007; Dieckmann et al., 2007).

CONSORT (Consolidated Standards of Reporting Trials)

• CONSORT is a guideline that standardizes the reporting for any randomized control trials. First developed for clinical trials, the guideline has been adopted by the simulation research community. (Cheng et al, 2016)

Cue/Cueing
To provide information during the simulation that helps the participant progress through the activity to achieve stated objectives (modified from National League for Nursing – Simulation Innovation Resource Center, 2013). • Information provided to help the learner reach the learning objectives (conceptual cues), or to help the learner interpret or clarify the simulated reality (reality cues). Conceptual cues help the learner reach instructional objectives through programmable equipment, the environment, or through responses from the simulated patient or role player, Reality cues to help the learner interpret or clarify simulated reality through information delivered during the simulation (modified from Paige & Morin, 2013). See also: PROMPT

Debrief (Debriefing)
(noun) A formal, collaborative, reflective process within the simulation learning activity. • An activity that follows a simulation experience and led by a facilitator. • (verb) To conduct a session after a simulation event where educators/instructors/facilitators and learners re-examine the simulation experience for the purpose of moving toward assimilation and accommodation of learning to future situations (Johnson-Russell & Bailey, 2010; National League for Nursing – Simulation Innovation Resource Center, 2013); debriefing should foster the development of clinical judgment and critical thinking skills (Johnson-Russell & Bailey, 2010). • To encourage participants’ reflective thinking and provide feedback about their performance, while various aspects of the completed simulation are discussed. • To explore with participants their emotions and to question, reflect, and provide feedback to one another (i.e., guided reflection).

Debriefer
The individual who facilitates a debriefing session and is knowledgeable and skilled in performing appropriate, structured, and psychologically safe debriefing sessions (Fanning & Gaba, 2007). • The person who leads participants through the debriefing. Debriefing by competent instructors and subject matter experts is considered important to maximize the opportunities arising from simulation (Raemer et al, 2011).

Deliberate Practice
A theory of general psychology that states the differences between expert performers and normal adults reflect a life-long period of deliberate effort to improve performance in a specific domain. (Ericsson, K. A). • A systematically designed activity that has been created specifically to improve an individual’s performance in a given domain (Ericsson, Krampe, & Tesch-Römer, 1993)

Deterministic
Pertaining to a process, model, or variable whose outcome, result, or value does not depend on chance (Department of Defense Modeling and Simulation Glossary).

Discrete Simulation (Discrete-Event Simulation)

• A simulation that relies on variables changed only at a countable number of points in time; discrete event simulation (DES) is the process of codifying the behavior of a complex system as an ordered sequence of well-defined events. • The operation of a system as a discrete sequence of events in time. Each event occurs at a particular instant in time and marks a change of state in the system. Between consecutive events, no change in the system is assumed to occur; thus the simulation can directly jump in time from one event to the next (Robinson, 2004). • One or more variables that completely describe a system at any given moment in time (Sokolowski & Banks, 2011).

Distance Simulation
Implementing a simulation or training at a physical distance from the participant(s) (LeFlore et al., 2014; von Lubitz et al., 2003). This may include operating a simulator via some type of remote access where the operator remotes into a simulator stationed where the participants are located; otherwise known as remote-controlled (LeFlore et al., 2014). Or, it could be where the participants remote into something like the cameras during a simulation where the simulator is stationed at a different site, which may be called “distance-based high-fidelity human patient simulation training” (von Lubitz et al., 2003, p. 379). Advantages of this method are being able to use experts to run the simulator (LeFlore et al., 2014) or to instruct (von Lubitz et al., 2003) if not currently available at the site where the participants are located.

Distributed Simulation
The concept of simulation on-demand, made widely available wherever and whenever it is required; DS provides an easily transportable, self-contained ‘set’ for creating simulated environments, at a fraction of the cost of dedicated, static simulation facilities (Kneebone et al, 2010). • A set of simulations operating in a common environment and distributed to learners; a distributed simulation may be composed of any of the three modes of simulation: live, virtual, and constructive, and are seamlessly integrated within a single exercise (Department of Defense Modeling and Simulation Glossary).

Durational Simulation

• Multiple simulations that build off of one another. This can include a simulation that focuses on an initial assessment of a simulated or standardized patient portraying a patient role and the subsequent simulations are the follow-up visit (e.g., initial visit, one-month visit and six-month visit, etc.). • A Durational Simulation is the opposite of a Discrete Simulation in that changes occur in the system between simulations.

Dryrun
A “planning meeting with standardized learners” is used to reveal un-intentional problems within the scenario. A designated time to explore the possibility of errors. (Boilat et al, 2012) • A verification period prior to live encounters to ensure a “safe and therapeutic” environment. (Greswell et al, 2018)

Educator (Simulation Educator)
Person who uses the modality of simulation to educate learners, utilizing evidence -based strategies. • Person who supports healthcare professionals who are learning to manage clinical situations and provide care that is safe, effective, efficient, timely, patient-centered, and equitable. May teach an individual learner or a group of learners practicing to work as a team (Lindell, Poindexter, & Hagler, 2016).

Embedded Participant
Definition • An individual who is trained or scripted to play a role in a simulation encounter in order to guide the scenario, and may be known or unknown to the participants; guidance may be positive or negative, or a distractor based on the objectives, level of the participants, and the needs of the scenario. • A role assigned in a simulation encounter to help guide the scenario. • The embedded participant’s role is part of the situation. However, the underlying purpose of the role may not be revealed to the participants in the scenario or simulation (INACSL, 2013).

Environmental Fidelity

• The degree to which the simulated environment (manikin, room, tools, equipment, moulage, and sensory props) replicates reality and appearance of the real environment.

Evaluation

• Determination of the value, nature, character, or quality of something or someone (Merriam Webster) • A broad term for appraising data or placing a value on data gathered through one or more measurements. It involves rendering a judgment, including strengths and weaknesses. Evaluation measures quality and productivity against a standard of performance. Evaluation may be formative, summative, high stakes, or related to the simulation program or process. (INACSL Standards Committee, Glossary, 2016c)

Event

• The occurrences that cause variation or changes in the state of a system (Sokolowski and Banks, 2009); in health care simulation, this term is common when programming manikins and often refers to learner actions. • An event is described by the time it occurs and event lists can be created to drive changes in a simulation

Facilitator (Simulation Facilitator)

• An individual who is involved in the implementation and/or delivery of simulation activities. For example, faculty, educators, etc. • An individual that helps to bring about an outcome (such as learning, productivity, or communication) by providing indirect or unobtrusive assistance, guidance, or supervision. For example: The debriefing facilitator kept the discussion flowing smoothly

Feedback•

• An activity where information is relayed back to a learner; feedback should be constructive, address specific aspects of the learner’s performance, and be focused on the learning objectives (Society for Simulation in Healthcare). • Information transferred between participants, facilitator, simulator, or peer with the intention of improving the understanding of concepts or aspects of performance (INACSL 2013). Feedback can be delivered by an instructor, a machine, a computer, a patient (or a simulated person), or by other learners as long as it is part of the learning process.

Fiction Contract
A concept which implies that an engagement in simulation is a contract between the instructor and the learner: each has to do his or her part to make the simulation worthwhile (Rudolph, Dieckmann, et al.). • The degree of engagement that healthcare trainees are willing to give the simulated event. Also known as the “suspension of disbelief”, it is a literary and theatrical concept that encourages participants to put aside their disbelief and accept the simulated exercise as being real for the duration of the scenario.

Fidelity
The degree to which the simulation replicates the real event and/or workplace; this includes physical, psychological, and environmental elements. • The ability of the simulation to reproduce the reactions, interactions, and responses of the real-world counterpart. It is not constrained to a certain type of simulation modality, and higher levels of fidelity are not required for a simulation to be successful. • The level of realism associated with a particular simulation activity; fidelity can involve a variety of dimensions, including (a) physical factors such as environment, equipment, and related tools; (b) psychological factors such as emotions, beliefs, and self-awareness of participants; (c) social factors such as participant and instructor motivation and goals; (d) culture of the group; and (e) degree of openness and trust, as well as participants’ modes of thinking (INACSL, 2013);

Fixation Error
A principle of crisis resource management wherein humans fail to revise a situation assessment in risky and dynamic systems or events (Decker, 2011). • The persistent failure to revise a diagnosis or plan in the face of readily available evidence suggesting that a revision is necessary

Frame(s)

• The perspectives through which individuals interpret new information and experiences for the purpose of decision-making. • Frames are formed through previous experiences and can be based on knowledge, attitudes, feelings, goals, rules, and/or perceptions. • The mindset of the internal participant or facilitator; their knowledge, thoughts, feelings, actions (speech/body language), attitudes (verbal/non-verbal), and perceptions (adapted from Rudolph, J.W. et al, 2007, 2008).

Functional Fidelity

• The degree in which the equipment used in the simulation responds to the participant’s actions; e.g., a static ventilator would offer low functional fidelity compared to a working ventilator in a simulation requiring a ventilator alarm.

Gamification

• The application of game design elements (conceptual building blocks integral to building successful games) to traditionally nongame contexts (Rutledge et al, 2018). • The application of the characteristics and benefits of games to real-world processes or problems. “Gamification differs from serious games in terms of the design intention, with gamification interventions involving the application of game elements with a utilitarian purpose…” (Gentry et al, 2019).

Guided Reflection
The process encouraged by the instructor during debriefing that reinforces the critical aspects of the experience and encourages insightful learning, allowing the participant to link theory with practice and research (INACSL, 2013). • The facilitated intellectual and affective activities that allow individuals to explore their experience in order to lead to new understanding and appreciations (adapted from Boud et al, 1985).

• A mentor-facilitated process that allows the learner to “integrate the understanding gained into one’s experience in order to enable better choices or actions in the future, as well as enhance one’s overall effectiveness” (Rogers, 2001).

Gynecological / Genitourinary Teaching Associate (GTA, GUTA, MUTA)

• A Genitourinary Teaching Associate (GUTA) is an individual trained to teach the techniques and protocol for performing the gender-specific physical examination to learners, using himself or herself as a demonstration and practice model. • A Gynecological Teaching Associate (GTA) is a female specifically trained to teach, assess, and provide feedback to learners about accurate pelvic, rectal and/or breast examination techniques. They also address the communication skills needed to provide a comfortable exam in a standardized manner, while using their bodies as teaching tools in a supportive, nonthreatening environment (ASPE). • A Male Urogenital Teaching Associates (MUTA) is a male specifically trained to teach, assess, and provide feedback to learners about accurate urogenital and rectal examination techniques. They also address the communication skills needed to provide a comfortable exam in a standardized manner, while using their bodies as teaching tools in a supportive, nonthreatening environment (ASPE).

Haptic (Haptics)

• In health care simulation, refers to devices that providing tactile feedback to the user. Haptics can be used to simulate touching, palpating an organ, or body part, and the cutting, tearing, or traction on a tissue. • Devices that capture and record a trainee’s ‘touch’ in terms of location and depth of pressure at specific anatomical sites (McGaghie et al, 2010; Jackson et al).

Health Care Simulation

• A technique that creates a situation or environment to allow persons to experience a representation of a real health care event for the purpose of practice, learning, evaluation, testing, or to gain understanding of systems or human actions (Society for Simulation in Healthcare). • The application of a simulation activity to training, assessment, research, or systems integration toward patient safety (Society for Simulation in Healthcare).

High-Fidelity Simulator

• A term often used to refer to the broad range of full-body manikins that have the ability to mimic, at a very high level, human body functions. • Also known as a high-complexity simulator. Other types of simulators can also be considered high-fidelity, and that fidelity (realism) has other characteristics beyond a particular type of simulator.

High-Fidelity Simulation

• In health care simulation, high-fidelity refers to simulation experiences that are extremely realistic and provide a high level of interactivity and realism for the learner (International Nursing Association for Clinical Simulation and Learning, 2013). It can apply to any mode or method of simulation; for example: human, manikin, task trainer, or virtual reality.

Human Factors

• The discipline or science of studying the interaction between humans and systems and technology; it includes, but is not limited to, principles and applications in the areas of human engineering, personnel selection, training, life support, job performance aids, and human performance evaluation (M&S Glossary). • The psychological, cultural, behavioral, and other human attributes that influence decisionmaking, the flow of information, and the interpretation of information by individuals or groups (Department of Defense Modeling and Simulation Glossary).

Hybrid Simulation

• The union of two or more modalities of simulation with the aim of providing a more realistic experience. • In health care simulation, hybrid simulation is most commonly applied to the situation where a part task trainer (e.g., a urinary catheter model) is realistically affixed to a standardized/simulated patient, allowing for the teaching and assessment of technical and communication skills in an integrated fashion (Kneebone, Kidd et al, 2002). • The use of two or more simulation modalities in the same simulation activity (Zulkepli et al, 2012).

Immersion
Describes the level to which the learner becomes involved in the simulation; a high degree of immersion indicates that the learner is treating the simulation as if it was a real-life (or very close to real-life) event (Society for Simulation in Healthcare). • A state (or situation) in which trainees dedicate most of their time doing something related to or thinking about a simulation, and becomes involved in it; the level of immersion might vary, where a high degree indicates that the trainee is fully involved; for example: realistic environments facilitate a participant´s full immersion in the simulation. • The placing of a human in a synthetic environment through physical and/or emotional means. (M&S Glossary)

Immersive Simulation

• adj: A real-life situation that deeply involves the participants’ senses, emotions, thinking, and behavior; creating an immersive simulation depends on the alignment with learning objectives, the fidelity of the simulation (physical, conceptual, and emotional), and participant´s perception of realism.
  noun: A simulation session influenced by participants’ characteristics, experiences, level of training, and preparation for the case or task,. The perceived physical, conceptual and emotional fidelity, the appropriate level of challenge, and the simulators and actors can all affect the simulation experience (Hamstra et al, 2014; Rudolph et al, 2007).

Incognito Standardized Patient
A person who plays a role as a patient in real health care situations, while the health care workers in those situations are unaware of the fact that the person is not a real patient (Rethans et al., 2007).

In Silico
Performed on computer or via computer simulation; the phrase was coined in 1989 as an analogy to the Latin phrases in vivo, in vitro, and in situ (Sieburg, 1990).

In Situ/In Situ Simulation

• Taking place in the actual patient care setting/environment in an effort to achieve a high level of fidelity and realism; this training is particularly suitable for difficult work environments, due to space constraints or noise. For example, an ambulance, a small aircraft, a dentist’s chair, a catheterization lab (Kyle & Murray, 2008). This training is valuable to assess, troubleshoot, or develop new system processes.

Interactive Model or Simulation
Simulating a situation in which the outcome varies depending on human participation (Thomas). This allows humans to practice different sets of actions in order to learn the correct response to an event. • Modeling that requires human participation (Australian Department of Defense, 2011).

Interdisciplinary•

• Involving two or more academic, scientific, or artistic disciplines (Merriam-Webster.com). • The combining of two or more academic disciplines, fields of study, professions, technologies or departments (dictionary. reference.com). • Of or relating to more than one branch of knowledge (oxforddictionaries.com).

Interdisciplinary / Interdisciplinary Learning
noun: The academic disciplines, such as psychology, or subspecialties within professions. For example, within the profession of medicine, anesthesia or cardiology (Barr, Koppel, Reeves, et al., 2005). • adj: Working jointly, but address issues from their individual discipline’s perspective (Gray & Connolly, 2008). • Integrating the perspective of professionals from two or more professions by organizing the education around a specific discipline, where each discipline examines the basis of their knowledge” (Bray & Howkins, 2008)

Interprofessional
Collaborating as a team with a shared purpose, goal, and mutual respect to deliver safe, quality healthcare (Freeth, Hammick, Reeves, Koppel, & Barr, 2005; World Health Organization [WHO], 2010). • Interprofessional is a more contemporary term describing a team effort in healthcare from two or more professions whose members learn about, from, and with each other to improve health outcomes (Nester, 2016)

Interprofessional Education /Training/Learning
An educational environment where students from two or more professions learn about, from, and with each other to enable effective collaboration and improve health outcomes (World Health Organization Interprofessional Education and Collaborative Expert Panel, 2011). • An initiative to secure learning, and promote gains through interprofessional collaboration in professional practice (Freeth, Hammick, Reeves, et al., 2008).

Interprofessionalism
The effective integration of professionals through mutual respect, trust, and support, from various professions, who share a common purpose to mold their separate skills and knowledge into collective responsibility and awareness that can be achieved through learned processes for communication, problem solving, conflict resolution, and conduct.

Just-in-Time Simulation

• A method of training that is conducted directly prior to a potential intervention (Palaganas, Maxworthy, Epps, & Mancini, 2015). The training that is utilized is “just in time” at the “place near the site of the potential intervention” (Palaganas, Maxworthy, Epps, and Mancini, 2014). • A learning approach that meets the learner’s needs during or just before it is needed to maximize an educational outcome (Barnes, 1998). • A cost-reduction method that is derived originally from the Japanese car manufacturing industry where it was a strategy that was utilized to reduce flow t

Learning Goal
Higher order ambitions for the learners. • Broad, general statements of what is desired for students to learn, and provide direction, focus, and cohesion.

Learning Objective

• Expected goal of a curriculum, course, lesson or activity in terms of demonstrable skills or knowledge that will be acquired by a student as a result of instruction. • Measurable results which can be knowledge, skills, or attitudes (KSAs). (INACSL Standards Committee, 2016c, December). • A learning objective guides the debrief activity by supporting what content should be covered or avoided (Szyld & Rudolph, 2014).

Learning Outcome
A result of an activity the learners demonstrate by the end of an educational activity in terms of knowledge, skills, and attributes (KSAs) acquired. • “Measurable results of the participants’ progress toward meeting a set of objectives.” (INACSL Standards Committee, 2016c, December). • “Outcomes include: knowledge, skill performance, learner satisfaction, critical thinking and self-confidence” (Ironside, Jeffries, & Martin, 2009, p.333) • Outcomes are a measurable judgement (Cooke, Stroup, & Harrington, 2019). • Learning outcomes “measure the effect on learning: psychomotor, affective and cognitive skills” (Cant & Cooper, 2017, p.69).

Live, virtual, and constructed (LVC) simulation

• A broadly used taxonomy describing a mixture of simulation modalities; a live simulation involves real people operating real systems; a virtual simulation is where a real person operates simulated systems; and a constructed simulation does not involve real people or real systems, but instead consists of computer programs that create an environment. (Sokolowski & Banks, 2011).

Logistics
Details of an entire process. (Merriam Webster) • Ensuring the details, in simulation-based education, such as scheduling of learners, facilitators, moulage, props, scenario preparation and design are all complete.

Low-Fidelity

• Not needing to be controlled or programmed externally for the learner to participate (Palaganas, Maxworthy, Epps, & Mancini, 2015); examples include case studies, role playing, or task trainers used to support students or professionals in learning a clinical situation or practice (Adapted from National League for Nursing – Simulation Innovation Resource Center, 2013).

Manikin
A life-sized human like simulator representing a patient for health care simulation and education (Palaganas, Maxworthy, Epps, & Mancini, 2015). • Full or partial body representation of a patient for practice. • Full or partial body simulators that can have varying levels of physiologic function and fidelity.

Manikin-based Simulation
The use of manikins to represent a patient using heart and lung sounds, palpable pulses, voice interaction, movement (e.g., seizures, eye blinking), bleeding, and other human capabilities that may be controlled by a simulationist using computers and software. • The life-like aspects of people and situations generated by a manikin.

Mannequin
A life-sized human like simulator representing a patient for health care simulation and education (Palaganas, Maxworthy, Epps, & Mancini, 2015). • Full or partial body representation of a patient for practice. • Full or partial body simulators that can have varying levels of physiologic function and fidelity

Manual Input
The method of operation in which an operator inputs a value to a given parameter regardless of how it would affect any other parameter. The input of the parameter does not adjust the variables in any physiological manner (Palaganas, Maxworthy, Epps, & Mancini, 2015). Compare:

Mastery Learning

• An instructional philosophy originally proposed by Benjamin Bloom that stated a student must first practice and study to meet the predetermined level criteria (>90%) through the formative assessment of a prerequisite domain prior to advancing in subject matter. If the learner does not achieve the level of mastery, information from the test is used to diagnose areas of deficiency necessary for additional prescriptive support. The student is later tested again. This cycle of feedback and corrective procedures is repeated until mastery is achieved, at which point the student will move on to the next level (Guskey, 2010). • An instructional philosophy that highlights individualized feedback and adequate time, allowing the learner to progress through the subject in a customized manner, generally in smaller units, to master the subject matter. This concept states that nearly all learners can achieve subject or skill mastery utilizing this method (Palaganas, Maxworthy, Epps, & Mancini, 2015).

Mental Simulation

• Mentally rehearsing an action to enhance performance. (Van Meer P., 2009). • Cognitive rehearsal of a task in the absence of overt physical movement that can be used to learn cognitive, kinesthetic, psychomotor, or technical skills. (Driskell, 1994 and Rao, 2015). • Activities that take place in the brain such as “mental imagery, imagination, thought flow, narrative transportation, fantasizing, and counterfactual thinking.” These are “specific processes that occur in the brain when an individual is mentally simulating an action or forming a mental image,” or are “focused on the consequences of mental simulation processes for affect, cognition, motivation, and behavior” (Markman, Klein, & Suhr, 2009).

Mixed Reality (XR
A category that encompasses the hybrid combination of virtual reality environments and reality (e.g., real environment, standardized patient, normal manikin simulator). Often encompasses the definition of Augmented Reality (AR), but has more virtual features than typical AR. The blend of what is physically present to what is 100% computer-generated is expressed in this continuum: Reality——— Augmented Reality——— Mixed Reality——— Virtual Reality (Hsieh and Lee, 2017). • A simulator that combines virtual and physical components (Robinson et al, 2014).

Mixed Reality Human
The use of a technology such as video, augmented reality, or virtual reality in conjunction with a physical manikin to simulate a human. (Costanza, Kunz, and Fjeld, 2009); for example, in team-based training, using TV monitors in portrait mode with interactive videos as a stand-in for a real team member (Palaganas, Maxworthy, Epps, & Mancini, 2015).

Mixed Simulation (Mixed Methods Simulation)

• The use of a variety of different simulation modalities; this is differentiated from hybrid simulation in that it is not characterized by the combining of one type of simulation to enhance another, but rather the use of multiple types of simulation in the same scenario or place. For example, a standardized patient (SP) and a mannequin are used in a scenario or a task trainer paired with an SP for venipuncture, etc. (SSH).

Mobile Simulation/Mobile Simulator
A simulator that can be transported relatively easily. Often refers to digital simulations with minimal equipment, without manikins (Mladenovic et al, 2019).

Modality

• A term used to refer to the type(s) of simulation being used as part of the simulation activity, for example, task trainers, manikinbased, standardized/simulated patients, computer-based, virtual reality, and hybrid (SSH). • A selected type or types of simulation equipment, concept, or technique that constitutes a method of simulation use (Rutherford-Hemming et all, 2019). • Broad description of the simulation experience, consisting of one or more of the following: Computer- or Digital-based simulation; Simulated Patient (SP); Simulated clinical immersion; Procedural simulation (Chiniara et al, 2013). See also: SIMULATED/SYNTHETIC LEARN

Model (as in Modeling and Simulation)

• A representation of an object, concept, event, or system; models can be physical models, computational models, or theories of function (Sokolowski, 2011).

Modeling and Simulation (M&S) (also Modeling and Simulation)
The terms modeling and simulation are often used interchangeably. • An academic discipline focused on the study, development, and use of live, virtual, and constructive models, including simulators, emulators, and prototypes to investigate, understand, or provide data. • The use of models, including emulators, prototypes, simulators, and stimulators, to develop data as a basis for making managerial or technical decisions.

Monte Carlo Simulation
A simulation in which random statistical sampling techniques are employed such that the result determines estimates for unknown values (Department of Defense Modeling and Simulation Glossary). • A mathematical model using probability distributions to calculate the possible outcomes for a given choice of action. Such a simulation involves many calculations and re-calculations to yield a range of possible outcomes.

Moulage
The makeup and molds applied to humans or manikins used to portray lesions, skin findings, bleeding, and traumatized areas (Levine et al). • The application of makeup and molds to a human or simulator’s limbs, chest, head, etc. to provide elements of realism (such as blood, vomitus, open fractures, etc.) to the training simulation. • Techniques used to simulate injury, disease, aging, and other physical characteristics specific to a scenario; moulage supports the sensory perceptions of participants and supports the fidelity of the simulation scenario through the use of makeup, attachable artifacts (e.g. penetrating objects), and smells (INACSL, 2013).

Multidisciplinary

• The combining of professionals with different perspectives to provide a wider understanding of a particular problem (Bray & Hawkins, 2008).

Multiple Modality (Multi-modal) Simulation
The use of multiple modalities of simulation in the same simulation activity; differentiated from hybrid simulation in that it is not characterized by the combining of one type of simulation to enhance another, but rather the use of multiple types of simulation in the same scenario or place, e.g., SP and manikin used in a scenario or a task trainer paired with an SP for venipunture, etc. (SSH).• A mixture of textual, audio, and visual modes in combination with media and materiality with the aim of enhancing the realism of the simulation encounter (Lutkewitte).

Negative Learning
“When stress among students occurs, and when knowledge and abilities are not properly developed” (Dormann, Demerouti, & Bakker, 2017). • “The acquisition of erroneous conceptual and procedural knowledge and understanding from unwarranted information, which leads to faulty mental models an

Never Event
A serious and costly” error “in the provision of healthcare services that should never happen” (Centers for Medicare & Medicaid Services [CMS], 2006); an example is when the wrong body part is operated on (Agency for Healthcare Research and Quality [AHRQ], 2019; CMS, 2006). • The term has expanded to mean other serious and most often, preventable errors (AHRQ, 2019). • In relation to simulation-based education, avoidance of such errors is the basis for training and/or assessment.

Non-technical Skills

• In the healthcare field, the skills of communication, (patientprovider, team) leadership, teamwork, situational awareness, decision-making, resource management, safe practice, adverse event minimization/mitigation, and professionalism; also known as behavioral skills or teamwork skills (ASSH). • Interpersonal skills that include: communication skills; leadership skills; teamwork skills; decision-making skills; and situationawareness skills (Australian Radiation Protection and Nuclear Safety Agency, n.d.) • Social, cognitive and personal skills that can enhance the way you or your staff carry out technical skills, tasks, and procedures. By developing these skills, people in safety-critical roles can learn how to deal with a range of different situations (Rail Safety and Standards Board, 2019). • Non-technical skills are the cognitive (decision-making, situation awareness) and interpersonal (communication, teamwork, leadership) skills that underpin technical proficiency, and are considered particularly important for preventing errors. Non-technical skills include communication, leadership and followership, decision-making, situation awareness, and taskmanagement (Pires et al., 2017).

Objective Structured Clinical Examination (OSCE)
An approach to the assessment of clinical or professional competence in which the components of competence are assessed in a planned or structured way with attention being paid to the objectivity of the examination (Harden, 1988). • A station or series of stations designed to assess performance competency in individual clinical or other professional skills. Learners are evaluated via direct observation, checklists, learner presentation, or written follow-up exercises. The examinations may be formative and offer feedback or summative and be used for making high stakes educational decisions (Lewis et al, 2017). • A method of assessment where learners perform specific skills and behaviors in a simulated work environment.

Online Simulation
Interactive simulation experience offered through an online platform that connects participants with other learners in a virtual world to complete assessment, diagnosis, and treatment tasks for virtual patients (Dikshit et al., 2005; Duff et al., 2016). • Online, often multiplayer, simulation exercises involving care for a single patient or multiple patients. Often utilizes gamification concepts to engage and incentivize learners (Evans et al., 2015; Kusumoto et al., 2007).

Operations Specialist
An individual whose primary role is the implementation and delivery of a simulation activity through the application of simulation technologies such as, computers, audio-visual (AV), or networking technologies. • An inclusive “umbrella” term that embodies many different roles within health care simulation operations, including simulation technician, simulation technology specialist, simulation specialist, simulation coordinator, and simulation AV specialist. While many of these individuals also design simulation activities, this term refers to the functional role related to the implementation of the simulation activities (SSH).

Orientation

• The process of giving participants information prior to a simulation event to familiarize them with a simulation activity or environment, such as center rules, timing, and how the simulation modalities work, with the intent of preparing the participants. • An activity that occurs prior to a simulation activity in order to prepare the faculty/instructors or learners; for example, a PowerPoint presentation that all participants must review to understand how the center operates, or how the activity is being conducted.

Participant
In health care simulation, a person who engages in a simulation activity for the purpose of gaining or demonstrating mastery of knowledge, skills, and/or attitudes of professional practice (INACSL, 2013). • A person engaged in a simulation activity or event and for those involved in simulation research.

Patient Simulator

• Life-like, anatomically correct, computer-driven manikin with physiologic responses that mimic real patients (Ober, 2009). • High- or low-fidelity full-body manikins controlled by instructors to create a structured learning environment in a clinically realistic setting where learning can take precedence over patient care (Good, 2003). • Ed note: while these definitions are manikin-oriented, the reader should consider other simulators as meeting the concepts of these definitions.

Physical Examination Teaching Associates (PETAs or PTAs)

• Standardized patients who are specifically trained to teach, assess, and provide feedback to learners about physical examination techniques. They also address the communication skills needed to provide a comfortable exam in a standardized manner, while using their bodies to instruct in a supportive, non-threatening environment (Lewis et al, 2017). • An individual who is trained to teach and provide feedback on basic physical exam techniques and process; serves as coach and as a model (is the instructor and patient) (The John Hopkins University, 2019). • The person may also serve in the role as evaluator and is considered under the larger category of simulated participants (Lewis et al., 2017). • Also referred to at some institutions as PTA (Physical Training Assistants) or PI (Patient Instructors) (East Carolina University, 2019).

Physical Fidelity

• A level of realism associated with a particular simulation activity. • The degree to which the simulation looks, sounds, and feels like the actual task (Alexander, Brunyé, Sidman, & Weil, 2005).

Physiologic Modeling
The mathematical computer models governing complex human physiology in a simulated patient case so that reasonable responses occur automatically to events inputted into the program. For example: a pharmacodynamic model could predict effects of drugs on heart rate, cardiac output, or blood pressure and display them on a simulated clinical monitor. (Howard Schwid, Rosen, 2013). • A computer model that allows for a method of operation in which an operator inputs a value to a given parameter, and it automatically adjusts the other variables in a physiologically realistic manner (Palaganas, Maxworthy, Epps, and Mancini, 2015).

Pilot Test

• A small-scale, short-term effort designed to provide data about the feasibility of a simulation prior to large-scale implementation. • Trial of simulation operations, scenarios, procedures, and teaching methods on a smaller scale to determine acceptability, identify feasibility concerns, and refine processes prior to full implementation. • A phase that includes review of the scenario to gain “clarification from experts and participants” (Rizzolo, 2014, p .114). • Explores the feasibility of the proposed application pertaining to such things as: recruitment, methods, and procedures (Leon, Davis, & Kraemer, 2010). • An assessment of the feasibility and acceptability of the proposed design and procedure (Feeley et al, 2009)

Portable Simulator
A simulator that has the capabilities of being moved, and may also be able to operate independently of tethers such as power cords or communication cables.

Prebrief (Prebriefing)

• An information or orientation session held prior to the start of a simulation activity in which instructions or preparatory information is given to the participants. The purpose of the prebriefing is to set the stage for a scenario, and assist participants in achieving scenario objectives. • The time used by educators, researchers, facilitators, or staff to plan their roles prior to the simulation. Suggested activities in a prebriefing include an orientation to the equipment, environment, manikin, roles, time allotment, objectives, and patient situation. For example: Before starting the simulation session, there is a prebriefing where the equipment and its capabilities are reviewed and they are reminded of the equipment available to them in the room (INACSL, 2013). • The collaboration and planning of co-facilitators/co-debriefers prior to the simulation activity.

Prepackaged / Preprogrammed Scenario
A method of operation in which the simulator is programmed to be in one state and to respond to an input and transition to another state based on a script or algorithm. • A scenario where a script will assign initial values (such as heart rate, blood pressure, emotional state, or concern) at the start of the scenario that will require specific actions by the participant or certain time frames, for the scenario to transition to the next state (Palaganas, Maxworthy, Epps, and Mancini, 2015).

Procedural Simulation

• The use of a simulation modality (for example, task trainer, manikin, computer) to assist in the process of learning to complete a technical skill(s), or a procedure, which is a series of steps taken to accomplish an end (INACSL).
  A simulation that incorporates cognitive knowledge and technical skill into a precise sequence of actions that are safe and efficient, targeting any level of learner (Palaganas, Maxworthy, Epps, & Mancini, 2015). Compare: PROCESS-O

Process-Oriented Simulation
A simulation in which the process is considered more important than the outcome. For example, a model of a radar system in which the objective is to replicate exactly the radar’s operation, and duplication of its results is a lesser concern (M&S Glossary). • In health care, the use of simulation to examine the process of care rather than the outcome of care. For example: using simulation to re-create an emergency in a patient area to see what latent safety threats exist, such as poor availability of patient equipment, inadequate emergency call buttons, or unsafe obstacles.

Prompt
(noun) A cue given to a participant in a scenario (Meakim et al 2013). • (noun) A word or phrase spoken as a reminder to an actor of a forgotten word or line (Dictionary.com). • (verb) (of an event or fact) cause or bring about (an action or feeling) (Dictionary.com). • (verb) Assist or enc

Prop

• In simulation, an element or accessory used in a given scenario to enhance realism, or to provide a cue to learners. • A physical object used as an interface to a virtual world; a prop may be embodied by a virtual object and might have physical controllers mounted on it (Australian Department of Defense).

Psychological Fidelity
A level of realism associated with a particular simulation activity. • The extent to which the simulated environment evokes the underlying psychological processes necessary in the real-world setting (Dieckmann et al., 2008). • The degree of perceived realism, including psychological factors such as emotions, beliefs, and self-awareness of participants in simulation scenarios (Dieckmann et al., 2008).

Psychological Risk

• A perceived or actual feeling of mental threat as a result of participation in a simulation which can mean feeling unsafe. Examples include feelings of shame or humiliation (Rudolph et al., 2014).

Psychological Safety

• A feeling (explicit or implicit) within a simulation-based activity that participants are comfortable participating, speaking up, sharing thoughts, and asking for help as needed without concern for retribution or embarrassment. • The perception of members of the team that the team is safe for risk taking, and mistakes will be considered learning opportunities rather than there being embarrassment or punitive consequences (Edmondson, 1999; Higgins et al, 2012).

Realism

• The ability to impart the suspension of disbelief to the learner by creating an environment that mimics that of the learner’s work environment; realism includes the environment, simulated patient, and activities of the educators, assessors, and/or facilitators (SSH). • A statement about the similarity of something (a ‘copy’) to something else (the ‘original’) (Dieckmann, Gaba, & Rall, 2007). • The quality or fact of representing a person, thing, or situation accurately in a way true to life; this enables participants to act “as if” the situation or problem was real. • Refers to the physical characteristics of the activity, semantical aspects of the activity (theories and conceptual relations – if A happens then B occurs), and/or the phenomenal aspects of the activity (emotions, beliefs, and thoughts experienced).

Reflective Thinking
The engagement of self-monitoring that occurs during or after a simulation experience; this self-monitoring is performed by participants during or after a simulation experience. • A process to assist learners in identifying their knowledge gaps and demonstrating the areas in which they may need further improvement; it requires active involvement in the simulation and facilitator guidance to aid in this process (Rodgers, 2002; Decker et al., 2008; Kuiper & Pesut, 2004).

• The conscious consideration of the meanings and implications of the events of the simulation; this process allows participants to make meaning out of the experience, to identify questions generated by the experience, and ultimately, to assimilate the knowledge, skills, and attitudes uncovered through the experience with pre-existing knowledge. • A process to assist learners in identifying their knowledge gaps and demonstrating the areas in which they may need further improvement; this reflection requires conscious self-evaluation to deal with unique patient situations (INACSL, 2013).

Remote Simulation
Simulation performed with either the facilitator, learners, or both in an offsite location separate from other members to complete educational or assessment activities (Laurent et al., 2014; Shao et al., 2018). Facilitation and assessment can be performed either synchronously or asynchronously using video or web conferencing tools.

Remote-controlled Simulation

• Simulation sessions conducted by an instructor who is in a location separate from the learners for a given session. The remote facilitator introduces the simulation environment and session, runs scenarios and debriefs with (Ohta et al., 2017) or without an onsite facilitator (Ikeyama et al., 2012; Shao et al., 2018). • A simulation-based session where mannequins are operated by remote control and instructors facilitate in real time via Web or videoconferencing, as an alternative method to face-to-face simulation-based training (Christensen et al., 2015).

Risk Management
“Proactive management of risk” that increases the rate of successful implementation. (Zakari et al, 2017). • Managing factors that can result in success or loss within a project. (Sonchan & Ramingwong, 2015).

Role Player
One who assumes the attitudes, actions, and discourse of (another), especially in a make-believe situation, in an effort to understand a differing point of view or social interaction. For example: Nursing students were given a chance to role play a patient or a surgeon. This term is sometimes used interchangeably with the terms ‘simulated’ and ‘standardized patient’ and may include medical, nursing, or other health professionals. (Victorian Simulated Patient Network).

“Running on the Fly”

• The method of operation for running a simulation whereby the operator changes the parameters of the scene, the standardized patient, or the simulator as the scenario unfolds; the changes are dependent on the observations and knowledge of the instructor or the operator, which is based on the actions of the participant. • Running a simulation with minimal planning and preparation; a more impromptu type of simulation experience.

Safe Learning Environment

• A learning environment where it is clarified that learners feel physically and psychologically safe to make decisions, take actions, and interact in the simulation. • A learning environment of mutual respect, support, and respectful communication among leaders and learners; open communication and mutual respect for thought and action encouraged and practiced.

Scenario

• In healthcare simulation, a description of a simulation that includes the goals, objectives, debriefing points, narrative description of the clinical simulation, staff requirements, simulation room set up, simulators, props, simulator operation, and instructions for standardized patients (Alinier, 2011). • The scripts, stories, or algorithms created for instructing the participants, including the simulators (human or robotic), on how to interact with the students. • The description of an exercise (including initial conditions) of events for a simulation that includes details for everyone taking part. • An initial set of conditions and timeline of significant events imposed on trainees or systems to achieve exercise objectives (M&S Glossary).

Screen – based Simulation / Screen – based Simulator
A simulation presented on a computer screen using graphical images and text, similar to popular gaming format, where the operator interacts with the interface using keyboard, mouse, joystick, or other input device. • The programs can provide feedback to, and track actions of learners for assessment, eliminating the need for an instructor (Ventre & Schwid, in Levine Chapter 14). • A computer-generated video game simulator that can create scenarios that require re

Scribe / Scribing
The act of making notes about a scenario and documenting the actions taken or not taken.

Script

• The written plan for a simulation event that includes various sets of topics, subtopics, skills, and triggers that will create the situation to induce the desired observable behaviors by the participant(s). • A preordained series of actions based on the time and sequence of specific events. • A written set of instructions providing a detailed plan of action for a simulation case; similar to a theatrical play. • The lines to be spoken by operators, embedded actors, or simulated patients during a simulation event. • A computer script is a list of commands that are executed by a certain program or scripting engine. Scripts may be used to automate processes on a local computer or to generate web pages on the Web. (https://techterms.com/definition/script)

Sequential Simulation
A concept defined as “physically simulated trajectories of care” (Weldon, Kneebone, & Bello, 2016, p. 78); in this type of simulation, “elements of a patient’s care pathway” are incorporated “into a scenario-based simulation using real clinicians and simulated patients in order to create a simulated experience from a patient’s perspective” (Weldon, Kneebone, & Bello, 2016, p. 78-79). • Where the different components of care are re-created; may include transitions of time and different scenes (Weil et al, 2018). The focus is on the patient’s journey and the effect of the care on the patient (Weil et al, 2018).

Serious Games

• A mental contest played with a computer in accordance with specific rules, which uses entertainment to further training, education, health, public policy, and strategic communication objectives (Zyda, 2005). • A game designed for a primary purpose other than pure entertainment. Serious games have an explicit and carefully thought out educational purpose, and are not intended to be played primarily for amusement (Michael and Chen, 2006). Serious games are simulations of real-world events, or processes designed for the purpose of solving a problem. • In the defense context, serious games are used to rehearse, train, or explore military options in a simulation of real-world events or processes (Australian Dept. of Defense). • The “serious” adjective is generally appended to refer to products used by industries like defense, education, scientific exploration, healthcare, emergency management, city planning, engineering, religion, and politics.

Shared Mental Model

• A means of describing that each participant in a simulation has a shared understanding of the purpose and process of the simulation activity and participants’ roles. • The knowledge framework of the relationships between the task the team is engaged in and how the team members will interact. For example: this framework facilitates a team’s ability to predict what team members will do when faced with a task, and what they will need to do it.
• A framework whereby an individual team member develops a perception of the situation, it is shared, allowing the team to reflect on the information and revise their situational awareness and their own mental model based on new information. For example: Sharing can be done by vocalizing observations, calling out information, using a structured time-out to communicate new information, and thinking out loud to allow others to relate and appreciate the associations, assessments, and plans. Shared mental models facilitate collaboration, and are crucial when team communication in a situation is difficult (due to time pressure, etc.).

Simulated-Based Learning Experience

• An array of structured activities that represent actual or potential situations in education and practice. These activities allow participants to develop or enhance their knowledge, skills, and attitudes, or to analyze and respond to realistic situations in a simulated environment. (Pilcher, Goodall, Jensen, et al., 2012).

Simulated Patient (SP)
nition • A person who has been carefully coached to simulate an actual patient so accurately that the simulation cannot be detected by a skilled clinician. In performing the simulation, the SP presents the gestalt of the patient being simulated; not just the history, but the body language, the physical findings, and the emotional and personality characteristics as well (Barrows, 1987). Often used interchangeably with standardized patients in the USA and Canada, but in other countries simulated patient is considered a broader term than standardized patient, because the simulated patient scenario can be designed to vary the SP role in order to meet the needs of the learner. • An individual who is trained to portray a real patient in order to simulate a set of symptoms or problems used for health care education, evaluation, and research (Society for Simulaton in Healthcare). • SPs can be used for teaching and assessment of learners, including but not limited to history/consultation, physical examination, and other clinical skills in simulated clinical environments. SPs can also be used to give feedback and evaluate learner performance (Lewis et al, 2017).

Simulated Person

• A person who portrays a patient (simulated patient), family member, or health care provider in order to meet the objectives of the simulation; a simulated person may also be referred to as a standardized patient/family/health care provider if they have been formally trained to act as real patients in order to simulate a set of symptoms or problems used for health care education, evaluation, and research. Simulated persons often engage in assessment by providing feedback to the learner (Palaganas, et al., 2012).

Simulated/Synthetic Learning Methods
The principles, pedagogies, and educational strategies used in health care simulation. They include: • Case-based learning – written and oral presentations used to present and review clinical scenarios but do not involve hands-on learning, e.g., table-top simulation. • Computer simulation – see Computer Simulation. • Procedural or Partial Task Training – see Part-task Trainer or Task Trainer. • Hybrid Simulation- see Hybrid Simulation. • Integrated procedural training (psychomotor focus) – Combines a series of discrete tasks that are conducted simultaneously or in sequence to form a complex clinical task (e.g., endotracheal intubation and cervical spine immobilization in a trauma patient). • Integrated procedural training (whole procedure) – Integrates task training with role play (actors) to enable procedural and communication tasks to be practiced simultaneously. • Mixed simulation- see Mixed Simulation. • Simulation / Scenario-based learning – Learners interact with people, simulators, computers, or task trainers to accomplish learning goals that are representative of the learner’s real-world responsibilities. The environment may resemble the workplace. Depending on the learning objectives, realism can be built into the equipment or the environment. • Standardized/Simulated Patient – see Standardized/Simulated Patient. Role play – see Role Play. • Debriefing – see Debriefing. • Multimodal formats – see Multiple Modality.

Simulation
A technique that creates a situation or environment to allow persons to experience a representation of a real event for the purpose of practice, learning, evaluation, testing, or to gain understanding of systems or human actions. • An educational technique that replaces or amplifies real experiences with guided experiences that evoke or replicate substantial aspects of the real world in a fully interactive manner (Gaba, 2004). • A pedagogy using one or more typologies to promote, improve, or validate a participant’s progression from novice to expert (INACSL, 2013). • The application of a simulator to training and/or assessment (SSH). • A method for implementing a model over time.

Simulation Activity
The entire set of actions and events from initiation to termination of an individual simulation event; in the learning setting, this is often considered to begin with the briefing (prebriefing) and end with the debriefing. • All the elements in a simulation session, including the design and setup required.

Simulation-Enhanced Interprofessional Education / (Sim-IPE)
The education of health care professionals with different but complementary knowledge and skills in a simulation environment that promotes a collaborative team approach. Simulationenhanced interprofessional education (Sim-IPE)occurs when participants and facilitators from two or more professions are engaged in a simulated health care experience to achieve shared or linked objectives and outcomes (Decker, et al., 2015). It is designed for the individuals involved to “learn about, from and with each other to enable effective collaboration and improve health outcomes” (WHO, 2010, p.13). • A collaborative educational approach that brings together health care professionals of varying specialties in a simulation environment engaging learners in an interprofessional teamwork model (Decker et. al., 2008). • A simulation environment of equal and mutual respect and recognition of each team member’s knowledge and skills.

Simulation Environment / Simulation Learning Environment / Synthetic Learning Environment (SLE)
The physical setting where simulation activities may take place, inclusive of the people and equipment that form part of the simulation experience. • A location where a simulation-based learning experience takes place, and where a safe atmosphere is created by the facilitator to foster sharing and discussion of participant experiences without negative consequences. • A context for learning that consists of a controlled and shielded representation of real-world situations, and a set of educational methods and procedures in which trainees feel simultaneously challenged and psychologically safe to practice and reflect on their performance (Rudolph et al., 2007). • An atmosphere that is created by the facilitator to allow for sharing and discussion of participant experiences without fear of humiliation or punitive action. • A setting, surrounding, or conditions that reproduce components or aspects of the real-world environment, for the purpose of learning and related activities, and/or research (ASSH).

Simulation Ethics

• A self-imposed formalized code for all simulationists that includes the following values: “Integrity, Transparency, Mutual Respect, Professionalism, Accountability, and Results Orientation” (Park, Murphy, & Code of Ethics Working Group, 2018). • Is applicable for both simulation facilitators and the participants (learners); based on frameworks and values; includes one’s behaviors and conduct during a simulation-based experience (Lioce, Graham, & Young, 2018). • A basis for simulations which is to promote patient safety and engage learners/participants (Pinar & Peksoy, 2016).

Simulation Fidelity

• The level of realism associated with a particular simulation activity. • The physical, semantic, emotional, and experiential accuracy that allows persons to experience a simulation as if they were operating in an actual activity (SSH). • The believability, or the degree to which a simulated experience approaches reality. Fidelity can involve a variety of dimensions, including (a) physical factors such as environment, equipment, and related tools; (b) psychological factors such as emotions, beliefs, and self-awareness of participants; (c) social factors such as participant and instructor motivation and goals; (d) culture of the group; and (e) degree of openness and trust, as well as participants’ modes of thinking (Rudolph et al., 2007).

Simulation Guideline

• A recommendation of the qualities for simulation fidelity, simulation validity, simulation program, or for formative or summative evaluation (SSH). • A set of procedures or principles that are recommended to assist in meeting standards. Guidelines are not necessarily comprehensive. They provide a framework for developing policies and procedures based on best practice. • A set of recommendations, incorporating currently known best practice, based on research and/or expert opinion.

Simulationist

• A modeling and simulation professional (Tucker, 2010). • A person “who is involved, full-time or part-time, in modeling or simulation activities,” for example, develops models to be used for simulation purposes; performs simulation studies; develops simulation software; manages simulation projects; advertises and/or markets simulation products and/or services; maintains simulation products and/or services; promotes simulation-based solutions to important problems; advances simulation technology; and advances simulation methodology and/or theory (Ören, 2000). • A term used to describe “professionals involved in providing simulation activities, products, and services” (Kardong-Edgren, 2013, p. e561). This can include simulated patient educators, trainers, and standardized or simulated patients (SPs). • A term for “professionals involved in modelling and simulation activities and/or with providing modelling and simulation products and/or services” (Ören, Elzas, Smit, & Birta, 2002).

Simulation Operations

• “The infrastructure, people, and processes necessary for implementation of an effective and efficient simulation-based education (SBE) program” (The INACSL Standards Committee, 2017, p. 681). • A term that encompasses “the job duties related to the overall management, delivery, and function of simulation-based education” (Crawford, Bailey, & Steer, 2019, p. 148).

Simulation Reliability
The consistency of a simulation activity, or the degree to which a simulation activity measures in the same way each time it is used under the same conditions with the same participants. • “Consistency of performance” under the same conditions with similar participants. (Scalese & Hatala, 2014). • The consistency is “tested by interrater, test-retest, and intrainstrument”(Adamson, 2014,p.155).

Simulation Standard
A statement of the minimum requirements for simulation fidelity, validity, formative or summative evaluation, or any other element related to a simulation activity or program (SSH)

Simulation Technology Specialist
A person, defined as someone “with a diverse set of skills and expertise both technical and administrative related to the operation, support, and delivery of healthcare simulation” (Crawford, Bailey, & Steer, 2019, p. 148). • A person, also known as a “Sim Tech” or Simulation Technician who functions as a technician for healthcare simulation technology (Baily, 2014; Crawford, Bailey, & Steer, 2019). In addition to technical support, job duties may vary and include such duties as preparing for simulations (mannequin programming, set-up), running of equipment during simulations (simulator, audiovisual), equipment maintenance/repair, and education of others concerning simulation technologies (UW Health, 2017). • An individual who provides technological expertise, instructional support, and advocacy in healthcare simulation.

Simulation Testing Environment
A context for formative or summative evaluation of an individual´s or team´s performance. The goals of the simulation testing environment are to create an equivalent activity for all participants in order to test their knowledge, skills, and abilities in a simulated setting (INACSL, 2013).

Simulation Time
A simulation’s internal representation of time; simulation time may accumulate faster, slower, or at the same pace as real time. • A time established by the simulation educator before the start of the simulation exercise, irrespective of the actual real time (Hancock et al, 2008).

Simulation Tool
A model or mock-up for purposes of experiment or training. • A device, including lower and higher simulation technologies, that can be used to promote participant learning (Yale University, n.d.). Examples include task trainers, mannequins (manikins) and immersive environments (i.e., virtual reality). The specific simulation tool should be chosen based on the predetermined objectives and outcomes (INACSL Standards Committee, 2016b; Yale University, n.d.). • The modality or “the platform for the experience” (INACSL Standards Committee, 2016b, S7). • A description of what healthcare simulation is; known as “an effective tool, technique, or method” (Barjis, 2011, p. 2). • An instrument used to assess/evaluate in a simulation

Simulation Validity

• The degree to which a model or simulation accurately represents or measures what it intends to measure. (Scalese and Hatala, 2014). • In health care simulation, the quality of a simulation or simulation program that demonstrates that the relationship between the process and its intended purpose is specific, sensitive, reliable, and reproducible (Dieckmann, 2009; SSH). • “The degree to which a test or evaluation tool accurately measures the intended concept of interest” (INACSL Standards Committee, 2016). • “How well the data measures the construct it is intended to measure” (Adamson, 2014,p.155).

Simulator
A setting, device, computer program or system that performs simulation (Hancock et al, 2008). • Any object or representation used during training or assessment that behaves or operates like a given system and responds to the user’s actions (SSH). • A device that duplicates the essential features of a task situation. A simulator generally has three elements – a modelled process which represents, emulates, or otherwise simulates a real-world system; a control system; and a human-machine interface which is representative of the inputs found in the real-world system (Australian Department of Defense). Examples include manikins and part-task trainers.

Situated Learning
A theory that posits that learning occurs within authentic activity, context, and culture. Social interaction and collaboration are considered essential components (Lave and Wenger, 2008). This is opposed to a classroom learning activity that is abstract and out of context.

Situational Awareness
Situation awareness (SA) is the perception of environmental elements within time and space, and a perception of their meaning; it involves being aware of what is happening around you to understand how information, events, and your own actions impact the outcomes and objectives. • A field of study concerned with understanding of the environment critical to decisionmakers in complex, dynamic areas; situational awareness refers to the degree to which one’s perception of a situation matches reality. • The awareness of fatigue and stress among team members (including oneself), environmental threats to safety, immediate goals, information sharing, and the deteriorating status of the crisis or patient. Most commonly used in the context of crisis resource management training (Hancock et al, 2008).

Standardized Patient (SP)
A person who has been carefully coached to simulate an actual patient so accurately that the simulation cannot be detected by a skilled clinician. In performing the simulation, the SP presents the gestalt of the patient being simulated; not just the history, but the body language, the physical findings, and the emotional and personality characteristics as well (Barrows, 1993). • An individual trained to portray a patient with a specific condition in a realistic, standardized, and repeatable way and where portrayal/presentation varies based only on learner performance; this strict standardization of performance in a simulated session is what can distinguish standardized patients from simulated patients. • SPs can be used for teaching and assessment of learners, including but not limited to history/consultation, physical examination, and other clinical skills in simulated clinical environments Association of Standardized Patient Educators (ASPE). SPs can also be used to give feedback and evaluate learner performance (ASPE). • An individual who is trained to portray a real patient in order to simulate a set of symptoms or problems used for healthcare education, evaluation, and research (SSH). • •More commonly used in the USA and Canada in large part because SPs participate in high stakes assessments in which SP responses to the learner were standardized. In recent years as SPs have been included in more formative teaching scenarios, its meaning

Standardized Patient Simulation
A simulation using a person or persons trained to portray a patient scenario or actual patient(s) for health care education (SSH). • A modality used for the purpose of practice, learning, assessment, or to gain an understanding of systems or human actions in which standardized (or simulated) patients play a central role.

State/States

• A term used when programming manikins; state variables may include vital signs, monitor readings, body sounds, and verbalizations made by the simulator. • [pleural] A sequence of events that change over time. (Sokolowski & Banks, 2011). This may include psychosocial behaviors in the simulation activities.

Stochastic
Pertaining to a process, model, or variable whose outcome, result, or value depends on chance (M&S Glossary).

Synthetic Learning Technologies

• The technologies used in synthetic or simulated learning environments, including manikin; computer-based virtual reality; haptics; actors; simulated patients; part-task / task trainers; hybrid; and video (ASSH).

Systems Integration
An engineering term meaning to bring together the component subsystems into one system that functions together. In health care, the ability to improve the quality of care and patient outcomes through re-engineering of care delivery processes. • A category of simulation program accreditation that recognizes programs that demonstrate consistent, planned, collaborative, integrated, and iterative application of simulation-based assessment, research, and teaching activities with systems engineering and risk management principles to achieve excellent bedside clinical care, enhanced patient safety, and improved outcome metrics across the health care system(s) (SSH).

Tabletop Simulation (TTX)
An educational tool intended to provide students/learners an opportunity to apply knowledge through formal discussion of a described scenario (Lehtola, 2007). • In the context of tabletop exercise, involves key personnel discussing simulated scenarios in an informal setting. Can be used to assess plans, policies, and procedures (California Hospital Association, 2017).

Take-home Simulation
A combination of devices (e.g., laparoscopic box trainer), software, tasks, instructional videos, target performance levels, log sheets, and program overview materials that are provided to participants for use at in-home or other similar locations for completing simulation activities (Wilson et al., 2019).

Take-home Simulators

• Simulators that can be taken home or used in other locations (e.g., call room). (Bokhari et al., 2010).

Task Trainer / Part-Task Trainer / Partial Task Trainer
A device designed to train in just the key elements of the procedure or skill being learned, such as lumbar puncture, chest tube insertion, central line insertion or part of a total system, for example, ECG simulator (Center for Immersive and Simulation Based Learning [CISL] & Levine et al). • A model that represents a part or region of the human body such as an arm, or an abdomen. Such devices may use mechanical or electronic interfaces to teach and give feedback on manual skills such as IV insertion, ultrasound scanning, suturing, etc. Generally used to support procedural skills training; however they can be used in conjunction with other learning technologies to create integrated clinical situations (Australian Society for Simulation in Healthcare).

Team-based Learning
A learning method that makes use of small group discussion and collaborative, self-directed study to foster new learning as opposed to imparting information. After a period of preliminary individual accountability, teams of learners compete with each other to learn information and solve problems, This is in distinction to traditional learning in which information is imparted from teacher to learner. • A learning method with many similarities to Problem Based Learning (PBL). Unlike PBL, where a complex, open-ended, case is given without the information to solve it, team-based learning capitalizes on the use of carefully chosen learning activities based on reading assignments (Michaelson, Parmelee, & McMahon, 2008).

Technical skills

• A skill that is required for the accomplishment of a specific task. • In health care, the knowledge, skill, and ability to accomplish a specific medical task; for example, inserting a chest tube or performing a physical examination.

Technology-Enhanced Health care Simulation (encompasses high-and low-technology health care simulation)
A group of materials and devices created or adapted to train health care professionals in a simulated environment. Examples include such diverse products as computer-based virtual reality simulators, high-fidelity and static mannequins, plastic models, live animals, inert animal products, and human cadavers (Cook et al., 2011). • An educational tool or device with which the learner physically interacts to mimic an aspect of clinical care for the purpose of teaching or assessment.

Telepresence
Telepresence is the bridging of geographical separation using technology that enables interaction and communication approximate to being actually present. Work-from-home meeting software, like Cisco WebEx, Zoom, etc., is telepresence. The environment you see through the webcam of your colleague is a real, non-computer generated environment (e.g., their office or home). Manikin-based simulations with a debriefer who is geographically separated but uses a telepresence robot would be telepresence, but not virtual presence (Shaw et al., 2018).

Telesimulation
“A telesimulation platform utilizes communications technology to provide mannequin-based simulation education between learners and instructors located remotely from one another. Specifically, the instructor controls the mannequin and moderates the debriefing remotely. During these sessions, the instructor observes the learners in real time and provides immediate feedback during the debriefing. This platform obviates the need to have instructors, learners, and mannequins in the same place at the same time, potentially allowing simulationbased educational sessions to occur with greater frequency for institutions not located proximate to formal simulation centers. Additionally, the telesimulation platform enables an experienced simulation instructor to observe and directly help new simulation instructors at remote simulation locations. Readily available Webconferencing, screen-sharing software, microphones, and webcams makes telesimulation possible. Mannequin-based telesimulation is relatively new and not well represented in the literature, but could facilitate systems changes, providing educational experiences to healthcare professionals in locations not currently benefiting from mannequin-based simulation opportunities. Several research questions need to be addressed in future studies to better develop this educational approach, including technical feasibility, logistic issues, a comparison of telesimulation to other simulation approaches, and assessing limitations of the telesimulation platform” (Hayden et al., 2018, p. 144). • “Telesimulation (TS) is a novel concept that uses the internet to link simulators between an instructor and a trainee in different locations” (Okrainec et al., 2010, p. 417). “Telesimulation uses the Internet to link simulators between an instructor and trainee in different locations” (Okrainec et al., 2010, p. 417). “Using two simulators, multiple computers, a series of webcams, and basic video conferencing software, the instructor and trainee can see within each other’s simulators as well as see and speak to each other” (Okrainec et al., 2010, p. 418). Telesimulation differs from “telementoring or teleconferencing because it actually connects two simulators in different physical locations,” allowing teacher and student to see, but not control, what the other is doing in real time (Okrainec et al., 2010, p. 418). “Telesimulation is a novel, practical, inexpensive, effective, and well-received method for teaching appropriate procedural skills” (Mikrogianakis et al., 2011, p. 427).

Training Scars
A bad habit, practice, or procedure that is taught, can result from errors of commission or errors of omission in teaching. • The unintentional bad habits acquired during the course of training. • The creation of obvious or latent errors in behaviors that typically appear under certain conditions, especially when under stress or in stressful situations. • Methods in which learners have been trained that do not directly apply to practice or operations and are not based in reality (Ellefritz, 2019; Grossman, 2008).

Trigger(s)

• An event or events that move the simulation from one state to another. • Anything, as an act or event, that serves as a stimulus and initiates or precipitates a reaction (dictionary.com).

Typology

• The classification of different educational methods or equipment; for example, 3-dimensional models, computer software, standardized patients, partial-task trainers, or high-fidelity patient simulators (INACSL, 2013).

Virtual Environment

• A simulated environment rendered by a computer, mobile device, or virtual reality / augmented reality / mixed reality device (Schwebel, Severson, & He, 2017).

Virtual Patient
A representation of an actual patient. Virtual patients can take many forms such as software-based physiological simulators, simulated patients, physical manikins, and simulators, (Ellaway, Poulton, Fors et al., 2008). • A computer program that simulates real-life clinical scenarios in which the learner acts as a health care provider obtaining a history and physical exam, and making diagnostic and therapeutic decisions (ASSH).

Virtual Presence
The “sense of being physically present with visual, auditory, or force displays generated by a computer” and is similar but distinct from Telepresence, the “sense of being physically present with virtual object(s) at the remote teleoperator site” (Sheridan, 1992). • Virtual presence refers to the degree to which individuals experience a computer-generated environment rather than the physical locale (Samosorn et al., 2019).

Virtual Reality
The use of computer technology to create an interactive threedimensional world in which the objects have a sense of spatial presence; virtual environment and virtual world are synonyms for virtual reality (M&S Glossary). • A computer-generated three-dimensional environment that gives an immersion effect. Often refers to the three-dimensional (3D) Head-mounted Display VR (HMD VR) in which the Virtual World is projected using a head-mounted display (e.g. Oculus Rift, HTC Vive Pro). (Chang and Weiner, 2016) • A shorthand of the HMD VR hardware, which always uses a Virtual World. In that way, it is not necessarily synonymous with Virtual Environment and Virtual World, but a synecdoche / metonymy

Virtual Reality Environment
A wide variety of computer-based applications commonly associated with immersive, highly visual, 3D characteristics, that allow the participant to look about and navigate within a seemingly real or physical world. It is generally defined based on the type of technology being used, such as head-mounted displays, stereoscopic capability, input devices, and the number of sensory systems stimulated (ASSH).

Virtual Reality Simulation
Simulations that use a variety of immersive, highly visual, 3D characteristics to replicate real-life situations and/or health care procedures; virtual reality simulation is distinguished from computer-based simulation in that it generally incorporates physical or other interfaces such as a computer keyboard, a mouse, speech and voice recognition, motion sensors, or haptic devices (ASSH).

Virtual Simulation
The recreation of reality depicted on a computer screen (McGovern, 1994). • A simulation involving real people operating simulated systems. Virtual simulations may include surgical simulators that are used for on-screen procedural training and are usually integrated with haptic device(s) (McGovern, 1994; Robles-De La Torre, 2011). • A type of simulation that injects humans in a central role by exercising motor control skills (for example, flying an airplane), decision skills ( committing fire control resources to action), or communication skills (as members of an air traffic control team) (Hancock et al, 2008).

Virtual World
Similar to Virtual Environment, though implies multiple characters, learners, or participants and potentially, a larger scale than a virtual environment. (Chang and Weiner, 2016). • A virtual world or massively multiplayer online world (MMOW) in a computer-based simulated environment (Change et al, 2016).

Wide-Area Virtual Environment (WAVE)

• First used in the military, the Wide Area Virtual Environment is a non-proprietary term similar to a CAVE, in which participant(s) undergo a simulation within an area enclosed by walls with projected images. Specialized goggles are not required for WAVEs. • WAVES can be very large, almost 8,000 square feet (745 square meters) with multiple chambers, corridors, and sections. The walls act as large movie screens with continued projected images, and sound systems enable participants to echolocate ambient noises.