Teaching with Virtual Simulations


Virtual simulations are an exceptional way for online students to get experience applying what they have learned to real-life situations. My colleagues and I created 20-minute virtual simulations that had our online students treat patients for cancer and end-stage liver failure, perform a liver transplant, administer postpartum care, and more. The materials needed to create the simulations were readily available at our institution, though during the pandemic we turned my basement into a hospital set and filmed there because the labs were closed. While these are healthcare scenarios, the processes can be applied to building scenarios in nearly any subject.


While the simulations are online, they can be done as a class, individually in a face-to-face session, and synchronously or asynchronously. They end with an instructor debrief with reflection questions for the student, which can be done via video conference or discussion board.

After logging in, students receive directions on what to do, information about the scenarios, and an evaluation rubric. The scenarios themselves are organized as a series of videos shot in simulated patient rooms in which the student assumes the role of a nurse making treatment decisions about the patient.

The opening scene has a nurse providing the viewer with a two-minute overview of the patient’s situation as if the patient had just been admitted to the hospital and put into the viewer’s care. Then there is a sequence of scenes with the patient. After each scene, the viewer must answer a question to move on. For instance, they might be asked which of a variety of options are the appropriate next steps.

Nurse in mask and visor in a simulated patient room standing next to a dummy on a hospital bed

The viewer’s answers lead to two different types of responses. One tells the viewer whether they answered correctly; if they did not, the response includes a hint about the right answer and asks the viewer to try again. If they fail three times, they receive the correct answer and an explanation as to why it is correct. The other type of response shows the viewer a video in which a nurse acts out a scene that would result from the choice. If it is the wrong choice, the scene leads to a bad outcome, and at the end, the viewer is asked to try another choice. This choice again leads to a video based on it. The different videos continue until the viewer makes the right choice, which moves them to the next scene. We thought it important to not only tell students that a choice was incorrect but also show them why by acting out the results of that choice. Doing so makes the ramifications of their decisions more real, and thus memorable.

Creating virtual simulations for your class

Virtual simulations are time-consuming to plan and create, but the results are well worth the effort. Our development team would start with a topic and then create the learning outcomes, instructions, scripts, and debriefing questions. They would then act out the scripts and record the performance, with an instructional designer putting the simulations together afterward.

While you can shoot a video can with a phone, it is better to use real video equipment—such as a tripod, camera, lights, and microphones—to get high-quality sound and visuals. This means that you will need someone who knows how to shoot video and record audio and some equipment. Your institution should have both.

You will also need an instructional designer who will combine the videos and other material into the simulation. We used Articulate Storyline to create the interactive elements of the simulation—the videos and questions—and embedded the interactions into the Articulate Rise web platform to host the simulations. Rise makes it easy to build online simulations that scroll vertically from top to bottom, and most instructional designers know how to use the software.

It is a good idea to take a course on how to build a simulation. In Canada, for instance we are most fortunate to have both CAN-Sim and Simulation Canada as nonprofit organizations offering workshops and courses for educators on how to build a simulation. In particular, healthcare educators can take the two-and-a-half-day CAN-Sim workshop, which guides them through the simulation development process and even creates a simulation during the workshop. There are also many books to purchase on this topic and articles available to read to expand your knowledge base.

Brenda Orazietti, MScN, is an assistant professor of nursing at York University School of Nursing.

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