Building Student Confidence Through Simulation at Tulsa Technology Center
Patient simulation can provide CTE health science students with hands-on, immersive experiences that bridge the gap between classroom instruction and real-world clinical practice.
Candace Shoopman, CHSE, M.Ed, RDH, Coordinator, HSC Simulation at Tulsa Technology Center in Tulsa, OK, has grown her school’s simulation program from an ambitious initiative into an essential component of training. Focusing on confidence-building, clinical judgment, and hands-on skill development, she is using simulation to prepare her students for the demands of patient care.
In this interview, Candace discusses the impact of simulation on student confidence, the importance of professional development, and lessons learned along the way.
Candace Shoopman, CHSE, M. Ed, RDH
Coordinator, HSC Simulation
Tulsa Technology Center
Tell us a about your program and what kind of simulation tools you’re using.
Candace: In July of 2020, the district had the initiative to start a simulation so we could replace a percentage for clinicals, for practical nursing. Our practical nursing program was our primary focus at the time.
Year one, we did 5 simulations. Each year, we continued to add a few additional simulations. We are currently servicing 6 adult cohorts for 96 students, will soon add a 7th cohort, and we have them for a total of 15 days of simulation.
Last year, we added what we call a nursing transition program that services high school students [during] their senior year. During that first semester, they’re getting their CNA. Then they start fundamentals and other entry level practical nursing courses. In the spring, if they’ve passed all of their courses, and they have good grades, and they got their CNA license, then they can apply to come into the adult cohort for practical nursing. We accepted 16 [students] this last year for our first year [of the program.] Fifteen of them graduated in December, and were able to sit for their NextGen NCLEX exam. So far, every student has passed – which is great, to be 6 months out from high school and a licensed nurse.
We have SimCapture, a SimMom®, two SimMan 3Gs, and two Nursing Annes. It’s just myself and a simulation specialist that run this program.
It’s kind of taken off with a boom. We started from nothing except for a few rooms and a couple of simulators. Four and a half years later, this is where we are. We’ve done a complete expansion. We’ve added 2 additional simulation rooms, extension of our control room, multiple simulators, A/V equipment, electronic medical records (EMR), and we’re waiting on the design plans right now to do another expansion [to] add an office, storage, and debriefing rooms.
How has simulation impacted your program?
Candace: Confidence is probably the biggest [impact]. They are usually very anxious to come to the simulation, even if we really try to establish a psychologically safe learning environment. But since we’re recording them through SimCapture, we’re giving them feedback. We’re giving them an opportunity where instructors can see their clinical judgment and their clinical reasoning, and they get to make the decisions as the nurse.
During the debrief, the content experts are able to dive into, “Why did you make that decision?” and correct any misunderstandings, or probe their thinking further to say, “What would this potentially lead to?”
Even though they hate being recorded, by the time they’re finished, they’re extremely thankful that they were able to practice on a simulator in a safe environment. If they did cause harm, which we see sometimes – medication errors, [doing] injections wrong, maybe they break sterile field … you know that they’re not putting a live patient at risk for a medical error.
When they’re at clinicals, [they say,] “Oh, yes, I just did that in the sim lab the other day. I understand why the nurse is doing that.” And they’re able to ask more higher order thinking questions. They’re able to dive in a little bit deeper and get that experience that those seasoned nurses have, or medical assistant or pharmacy tech.
It develops their clinical judgment, their clinical reasoning, because we’re stretching them. They’re not stretched in clinicals as much as they are during simulation. They have a preceptor, or they have their instructor that’s telling them to do X, Y, and Z – and they don’t make any decision on their own. In simulation, they are the nurse making the decisions.
"You see teamwork, you see both effective and ineffective communication. Those are all things that the instructors can use to work on with the students so that they can be better clinicians – whether it’s medical assisting, nursing, [or] pharmacy."
What has been the biggest benefit of incorporating simulation into your program?
Candace: It would be the confidence in the students and providing that realistic environment where they get to be the nurse; to make the decisions.
We also have a lot of simulations that they will be licensed to do, but they never get to do during their preceptorship or clinicals – because the hospitals, or long-term care facilities have policies that student nurses can’t do skills like indwelling Foley catheters or trach care.
We give them the opportunity to do it here... so the first time is not on a live patient. That helps with the anxiousness, that helps with the confidence level, and it gives them learning opportunities to get that crucial, immediate feedback from a content expert.
The students are usually so thankful for being able to do simulation, especially the skills-focused simulations, [because] LPN is a lot of skill focus. In our skills lab, when they’re doing these skills, they probably verbalize a large portion of the skill. And they’re working on a task trainer, which is just a section of a forearm. Or they’re working on only the genitalia area to do a Foley. They’re not getting that whole realistic environment and patient communication. It’s just a checklist that they’re going through, and they’re trying to demonstrate to the instructor that they know how to do this skill. But it’s not realistic at all. And what they’ve done is, they’ve memorized the steps.
The gap that we continually see is that some students struggle to transfer skills to a real scenario. So a lot of times [they say,] “I’m so glad that I got to come to sim, because in check-off all I did was verbalize the majority of the content.” They’re missing that critical thinking, and they can’t transfer it from the skills lab to the simulation lab to the clinical. So it helps bridge that gap for them. They’ll say, “I got to do that at clinicals yesterday, and I did so well because we just did that in simulation the other day, and you gave us that curve ball.”
We also see some things that they need remediation on, or help, because they have the wrong thought process about it. It helps them be a better clinician in the long run.
What kinds of professional development have you done?
Candace: I’ve done a ton of professional development. [The Certified Healthcare Simulation Educator® (CHSE) certification] helped me a lot. I dove into a lot of the pedagogy with Dr. Jeffries – she’s a simulation guru.
I am a part of a simulation advisory for the state of Oklahoma, and I am the simulation lead right now. We plan boot camps and conferences and have guest speakers come in and then also network with our other schools here. We’re able to get that professional development twice a year, whether it’s at boot camp or at the conference that we’ve hosted, and we’ve had Dr. Jeffries speak. This year I think we’re pulling in someone more from the AV side.
It really made me focus on INACSL’s Healthcare Standards of Best Practice. How are we meeting the mark with my program, or is there a gap there? And if there was an identified gap, then how do we fill it?
I’ve done a ton of conferences. I’ve done a ton of studying on my own, and then I sat for the [CHSE] exam. I would highly recommend getting it just because it makes you focus on those INACSL Standards, and then you can do a cross analysis of your program of where you’re meeting it and where you’re not.
We’re going to apply to get an endorsement from INACSL. That’s been another opportunity for me to go through the Standards. It’s helped us identify gaps in where we need to improve.
What advice would you give to another organization that is starting or growing a simulation program?
Candace: Be a sponge to the theory and technical side of simulation. The international standard isn’t for a simulation specialist to be of the same discipline the sim program is offering training for. I’m a dental hygienist by trade. You have to understand the technology and the maintenance part. But you [also] have to understand the pedagogy of simulation, how to develop it, and effective debriefing and prebriefing. [You have to know] how to establish psychological safety. That’s what I’m focused on as the simulation coordinator, not teaching clinical content. That is their instructor’s role.
Be a sponge and be flexible. Spend a lot of time developing yourself professionally in the pedagogy of simulation. And then you have the whole technical realm of AV equipment and the simulators. You’re learning two really big components. You’re focusing on the theory part, but then you’ve got the application part. You just have to be flexible. We’ve had to course correct many times. We realize [something] didn’t work, and we adjust and then come from a different direction.
