Designing for Health: Contemporary Simulation Design Objectives

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The contemporary context for the expansion of simulation design in medical education is affected by two factors:  government policy and demographics.  The Patient Protection and Affordable Care Act has given an estimated 32 million new people access to the healthcare system, creating a greater demand for well-trained healthcare professionals.1 The generation that will fill this gap consists predominantly of millennials, a large emerging workforce shaped by social networking, video games, multi-tasking, and the need to always be connected. They have grown up with rapidly changing technology as a normal part of life and consequently a new breed of student has been created.  This distinctly new type of learner thrives on rapid access to information and a dynamic interactive learning environment. Thus the millennials are uniquely poised to benefit greatly from advanced technology in the medical learning environment. However, these advancements create new challenges for the instructors who are more familiar with traditional methods of teaching.

Because the primary role of an educator is to provide the best available instruction to the learner, it is crucial for traditional methods of education to morph with the rapid technological advancements. As our technological capability continues to expand according to Moore's Law, doubling the processing speed of computing hardware every two years; the way we educate and the way we design the space within which we educate must also continue to evolve at a similar pace.2 Continued rapid expansion of technology is a reality that educators must incorporate into how they plan their curriculum in order to assure this new technology is not a distractor but an enhancer of learning.3

Simulation is currently recognized as one of the best methods to expedite and facilitate the transition from student to healthcare professional by providing experiential learning which never puts the patient at risk. It allows for deliberate practice in a controlled environment where students learn through experience, reflective practice, and immediate feedback. This process accelerates the student's development of critical medical skills and improves their performance on both an individual level and as members of interdisciplinary teams.  As a result the student's proficiency is at a high level prior to engaging in professional healthcare practice and thereby meets the medical professions' overarching objective of increasing the quality of patient care and safety.

The use of educational simulation is not a new trend; it has been used in the military, aviation, chemical and nuclear industries for decades. It was first introduced into the medical field about 15 years ago and since then has been rapidly evolving to a point where highly realistic medical simulation is now possible and practical. As such the application of simulation in medical education is an important tool.

Aligning the design of the simulation facility with the school's curriculum is a key design objective. Thus, no two facilities are alike. However, below are common programmatic areas typically included in the design.

•    Patient Simulation Rooms.  These rooms simulate the existing rooms in hospitals.
•    Observation Rooms. Where educators view student activity into the simulation rooms through one way glass and can interact when needed with the student through audiovisual equipment.
•    Debriefing Rooms.  Where students receive feedback on their performance and reflect on their behavior after the simulation experience.
•    Skills Lab.   Where students can practice clinical knowledge on mannequins.
•    Standardized Patient Rooms. Clinical exam rooms where actors are used to simulate patients.

Note that the simulation design may provide additional opportunities for the instructors that were previously not possible, therefore the instructors may want to modify their curriculum to enhance their teaching options. It is also important for the design team to visit existing facilities to understand the capabilities of simulation in an educational setting.

The overall design of a simulation facility is driven by technology. Audiovisual equipment connects the rooms through video cameras, microphones, and speakers. The ability to view real-time footage of the scenario on site or remotely greatly facilitates the learning process. Current evolving technologies within simulation centers focus on the use of sophisticated computerized mannequins which are anatomically precise and reproduce accurate physiologic responses. Therefore the design must consider that this technology will continue to evolve (Moore's Law) and as such the facility should be designed to accommodate routine upgrades.

A very important consideration that must be emphasized to the training facility staff is that the lack of trained personnel to support simulation can pose a significant liability to the success and ultimate functionality of the simulation center. At a recent conference held for the Society of Simulation in Healthcare, Professor David Gaba, Associate Dean for Immersive and Simulation-based Learning at the Stanford School of Medicine, stated, "Flexibility is key when designing simulation facilities. There is zero installed casework at Stanford University. The AV system at Stanford is extremely powerful and flexible in design, however it is so complicated only a few know how to use it correctly".4 Flexibility in the audiovisual infrastructure, services, equipment, and partitions can create an environment where multiple simulation scenarios can be performed, and future enhancements can be easily implemented; but without well trained staff available the entire project could be perceived as a failure.

There are many emerging technologies in medical simulation, which include the use of serious games and virtual learning environments. Serious games is a method of game based learning where virtual environments have been specifically engineered to accurately replicate an existing medical space such as an operating room or an exam room. Within these environments exists a virtual patient, whom students are challenged to assess, diagnose, and treat. The concepts of this simulation must be well understood by the training staff to avoid, as noted previously, startup problems that could lead to poor results and client rejection.

The accessibility to an infinite expanse of knowledge through the mobile internet changes traditional models of education. Now students and teachers can connect from any geographic location through'virtual discussion space'. This has resolved distance issues amongst interdisciplinary teams, and provided students with contact to their instructors whom are not on site. As students progress and equal or exceed the capability of their local instructors, they can now expand their training to specialized expert instruction from anywhere in the world.  This not only changes the traditional methods of interaction amongst students, but also transforms the way architects design space; we are no longer restricted to the walls which we build.

As the millennial generation continues to enter the medical work force, and technological advancements in simulation and virtual environments rapidly evolve, the need for flexible educational modalities and facilities has never been greater. Simulation and its accompanying technologies truly transform the way medical students learn, and architects design; there is now a limitless expanse of space which buildings can inhabit, and students can learn. If the implementation is well managed and applied intelligently the possibilities are endless.

Nadia Kulczycky is an architectural designer with the Perkins+Will Atlanta office. She has most recently been designing simulation facilities for medical education.  She can be reached at


1.     "The Patient Protection and Affordable Care Act, Detailed Summary", February 22, 2014.
2.    "Moore's Law", February 24, 2014.
3.    Jeffries R., Pamela. Clinical Simulations in Nursing Education; Advanced Concepts, Trends, and Opportunities. 2014 National League of Nursing.
4.    The Society for Simulation in Healthcare. IMSH Conference 2014. San Francisco, CA.  January 26-29, 2014
5.    Gabba, David. "The Future Vision of Simulation in Health Care.", February 16, 2014.
6.    Kahler Slater. "Designing a Simulation Lab That's Right for You" Top Simulation Lab Trends and Considerations. Milwaukee WI.