Johanna Rhodes – SIT, Te Pūkenga: A new technique for actively involving large numbers of learners in simulation sessions was inspired by ‘choose your own adventure’ or ‘pick-a-path’ books.

“A continuing challenge when teaching using simulation modalities is maintaining the interest and engagement of the students who are observing the simulation as the audience,” says Johanna Rhodes, Head of School (Nursing) and Acting Head of Faculty (Health and Humanities) at Southern Institute of Technology, Te Pūkenga (SIT).

Rhodes had successfully used the Tag Team simulation method (Levett-Jones et al., 2015) during simulations with large cohorts. Tag Team simulation aims to ensure that both participants and observers have active and integral roles in the simulation. It immerses students as actors and audience in an unfolding drama in a way that that allows them to take joint responsibility for the actions and outcomes.

“It's a brilliant method, but I wanted to take it a little bit further,” she says. “I was reading my granddaughter a ‘pick-a-path’ book one night when I came up with an idea for a new approach – Pause, Consider and Decide audience-led simulation.”

In Pause, Consider and Decide, the educator stops the simulation at key decision-making moments. Using a game-based learning platform, learners then cast an anonymous vote for one of up to five possible clinical interventions. The intervention with majority support becomes the chosen action.

The aim of Rhodes’ study was to develop, implement, review and evaluate this audience-led simulation method in groups of around 30 people – though it can be applied in larger groups, too.

“We tested three cycles of this system using a free online platform called Kahoot. One cycle was with educators, another was with first- and second-year nursing students, and the last was with an interprofessional group of health care students including nursing, medical, physiotherapy, and dietician students,” she says.

Rhodes’ observations, and data gathered from participant debrief sessions and questionnaires, resulted in continuing reflective processes and improvements to Pause, Consider, and Decide throughout the implementation and testing process.

The educators completed their cycle at a staff meeting, after which Rhodes received useful feedback from her peers.

“The approach was really well received overall, and the group helped me refine some of the wording of the interventions and instructions to improve clarity for students,” she notes.

The nursing and interprofessional student groups were also very positive about Pause, Consider and Decide after their implementation cycles, and described feeling more engaged and involved in the simulation process.

“They felt it promoted a sense of shared responsibility for the interventions and outcomes for simulated patients,” she says. “It also increased the number of participants doing their prereading ahead of the simulation – they realised it was worthwhile because they were all going to be making the decisions.”

Rhodes says none of the decision options in her study would have put anyone at risk, “but there were some decisions you could argue were better than others”.

“Another interesting aspect the students talked about was having to accept a decision that was made for them by group majority, even if they felt that was not the right course of action. This sparked useful discussions about how frequently this can happen in health care – it’s not always your choice that will prevail.”

Rhodes worked with SIT’s Information Technology team to video SIT educators running a dummy simulation where they took every decision option presented to the participants. They recorded and edited all the different outcomes and uploaded these for students to access after the live simulation had occurred.

“This allowed participants the chance to revisit each simulation and pick different paths,” she says. “It took quite a lot of time to put this together, but it’s a fantastic interactive learning resource for our students. Now, whenever we run simulations, we always try to record them in this way.”

Rhodes says there is potential for a national approach to Pause, Consider and Decide across Te Pūkenga, which could be applied to many different health disciplines and simulation modalities.

“I think there is an advantage to using a range of different simulation methods, and this is one that adds to the body of approaches internationally,” she says. “It is specifically designed for large cohorts of students, enabling educators to increase student engagement and foster active inclusion.”

Johanna Rhodes is the former Head of School of Nursing and Acting Head of Faculty at Southern Institute of Technology, Te Pūkenga (SIT). She has recently started a new role as Assessment Design and Development Advisor with the Nursing Council of New Zealand. She believes embracing teaching pedagogies that reflect the ‘real world’ is critical to developing ‘work ready’ graduates who are equipped to work in the electrifying, intricate, and fluctuating world of healthcare. Simulation offers a willingness to advance the aesthetic narrative of healthcare, while embracing the realism of working with people, which is why Johanna includes this in her teaching. 

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