Photo Credit: Angela Foster/University of Tennessee at Chattanooga

In healthcare education, simulation has emerged as an essential part of experiential learning, helping to bridge the gap between theoretical knowledge and real-world clinical practice. The University of Tennessee at Chattanooga (UTC) has embraced simulation to provide nursing students hands-on experience in complex, real-world scenarios. The UTC simulation center, supported by expert faculty and cutting-edge technology, ensures that nursing students are well-prepared for the challenges of modern healthcare while fostering critical clinical reasoning, cultural inclusivity, and interprofessional collaboration.

The Evolution of the UTC Simulation Center

Simulation was integrated into the undergraduate curriculum in 2007. These simulations were conducted in the Main Nursing Lab. Following the landmark 2014 NCSBN study, which validated the effectiveness of simulation in nursing education, a commitment was made to expand its use in UTC’s programs. The Committee for Simulation in the School began working toward accreditation from the Society for Simulation in Healthcare (SSH) in 2017 and became a dedicated space for simulation-based learning. Since then, there has been a commitment to achieving full SSH accreditation, earning INACSL endorsement in Spring 2024, a testament to their dedication and the high quality of educational experiences they provide students.

The simulation center’s mission is to support the School of Nursing in its broader academic objectives by providing a secure, interactive, and respectful environment where students can develop critical clinical reasoning, sound judgment, and integrity in their practice. Moreover, the simulation center focuses on culturally inclusive care, ensuring that simulations are evidence-based and reflect the diverse patient populations UTC’s students will serve in their careers.

Over the years, UTC’s approach to simulation has evolved significantly in response to the changing needs of students and the healthcare industry. Initially, simulations were primarily used to supplement didactic learning and address clinical deficiencies. Today, they are an integral part of the curriculum, offering students hands-on experience with complex scenarios that mirror real-life challenges. These changes have kept UTC at the forefront of preparing students for the demands of modern healthcare.

The expertise of the faculty and instructors also contributes to the success of the simulation center. The team consists of specialists in Obstetrics, Med-Surg, Pediatrics, and Advanced Practice, and they play a crucial role in shaping the work of the simulation center. They collaborate to create interdisciplinary and interprofessional simulations relevant to the students’ academic and clinical needs and reflect healthcare’s complex, team-based nature.

The 2014 NCSBN study affirmed the effectiveness of simulation in nursing education. High-quality simulation experiences can replace up to 50% of traditional clinical hours to help students practice and hone skills safely.

The Impact of Simulation on Student Learning

One of the primary reasons UTC integrates simulation into the curriculum is to enhance student learning and improve clinical competence. Simulation provides opportunities for students to apply theoretical knowledge in a safe, controlled environment where mistakes can be made without the risk of harming real patients. This is particularly important in healthcare, where errors can have serious negative consequences.

Simulation drives home key learning objectives by allowing students to practice procedures, decision-making, and patient care in immersive scenarios. For example, in the acute care nurse practitioner program, students participate in high-fidelity simulation scenarios that challenge them to apply what they have learned in class and from previous bedside practice.

According to Dr. Chris Doneski, an Adult-Gerontological Acute Care Nurse Practitioner (AGACNP) faculty member, “For me, I see the students really enjoy a well-developed, quality, high-fidelity simulation scenario. Taking what they’ve learned, along with their previous bedside practice, makes those connections – it is truly a magical thing.”

Moreover, UTC’s approach to simulation is responsive to student needs. After each semester, the simulation faculty gathers feedback from students and preceptors to identify areas of deficiency. This feedback helps them tailor future lectures and simulations to address these needs, ensuring students are well-prepared for clinical practice.

How the UTC Simulation Center Improves Nurse Training

Planning, designing, and implementing simulation scenarios at the center is rigorous and collaborative. A needs assessment is used to identify the key areas where students need additional practice and support. This assessment is informed by input from faculty, preceptors, and students, ensuring that the simulations are targeted and relevant.

For example, the core acute care program includes didactics and procedural training. To enhance the realism of the training, the faculty has incorporated more simulations into procedural training. One of the most successful scenarios is the intubation scenario utilizing HAL® S5301, a high-fidelity patient simulator. This scenario was designed to improve critical thinking and realism, allowing students to practice intubation in a controlled environment where they can focus on the procedure’s indications, risks, and timing.

In addition to its use in daily instruction, simulation is used in student examinations and coursework. Summative simulations are used for procedures class and are incorporated into midterms and finals. These simulations blend material from previous lectures, such as advanced assessment, pharmacology, and acute care, to create high-fidelity, evidence-based scenarios.

Simulation adds an element of stress to the exams, which mirrors real clinical situations. Procedures such as intubation, central line insertion, and chest tube placement are inherently stressful, so simulations are designed to replicate this stress while focusing on patient care. This approach enhances fidelity and helps students develop the confidence and composure needed to perform under pressure.

Simulation is also used to train students in advanced assessment. The faculty has developed static assessment scenarios incorporating moulage, where students must write up their findings and create differential diagnoses. This year, UTC plans to expand the simulation offerings to include scenarios for the acute care intensivist class to reinforce key learning objectives further and build student confidence.

Simulation Facilitates Realistic Ventilator Training

One of the most exciting developments at the simulation center has been the recent integration of high-fidelity simulators like HAL S5301, which has revolutionized the center’s approach to training, providing an unprecedented level of realism that enhances student learning. Dr. Doneski says, “It’s thrilling to see students engage with complex scenarios and emerge with a deeper, practical understanding of advanced procedures.”

Acute care students utilize HAL S5301 during their midterm for an intubation/ventilation management scenario. HAL’s advanced features include realistic lung physiology, programmable lung airway/lung function, and support for real monitoring equipment like mechanical ventilators. Therefore, the students can assess the patient’s condition and determine the best action.

The scenario begins with basic interventions, such as increased oxygen and proper positioning. It progresses to more complex decisions, such as choosing induction medications based on the patient’s medical history and clinical findings. The use of high-fidelity simulation in this scenario allows students to practice in a safe environment where they can refine their skills and build confidence.

HAL S5301 has also helped facilitate an iatrogenic pneumothorax scenario, which is part of the final exam. In this scenario, HAL simulates increased ventilatory pressures and altered lung compliance to help students identify and manage a pneumothorax caused by central line insertion. The realism provided by HAL makes this scenario incredibly effective in reinforcing theoretical knowledge and honing practical skills.

Dr. Chris Doneski uses HAL® S5301 at the UTC simulation center to train students in intubation/ventilation management.

Balancing Simulation and Clinical Hours  

Dr. Doneski says that the simulation faculty continually asks themselves how much training should be done in the simulation center versus during traditional clinical hours. While simulation cannot replace all hands-on hospital experience, he argues that it is crucial in reinforcing key concepts and building confidence.

The feedback and needs of faculty, preceptors, and students inform the decision-making process for the simulation center. The faculty actively engages in clinical practice and student mentorship, providing real-time insights into knowledge gaps addressed through targeted simulation interventions.

“We also reference the NCBSN study, which found that substituting up to 50% of undergraduate clinical time with simulation did not significantly affect clinical competence,” says Dr. Doneski. He continues, “While this finding has been studied less in graduate programs, our experience suggests that simulation has a positive impact on both students and preceptors.” It allows UTC to provide a level of hands-on experience that complements traditional clinical hours, ensuring that students are well-prepared for the demands of clinical practice.

The simulation faculty is excited about the potential of simulation to enhance educational programs further. Currently, they are developing a collaborative advanced practice program simulation, which will involve Family Nurse Practitioner (FNP), Certified Registered Nurse Anesthetist (CRNA), and Adult-Gerontological Acute Care Nurse Practitioner (AGACNP) students.

In this simulation, a single patient will progress through an entire scenario that begins with an initial urgent care assessment, proceeds through pre- and intra-operative care, and concludes with intensive care management following a surgical complication. This collaborative approach will provide students with a comprehensive, interdisciplinary experience.

Conclusion

In conclusion, the University of Tennessee at Chattanooga (UTC) has set a high standard in nursing education by integrating high-fidelity simulation into its curriculum. Through a commitment to continuous improvement, cutting-edge technology, and expert faculty, the simulation center at UTC not only equips students with essential clinical skills but also fosters a deep understanding of interdisciplinary collaboration and culturally inclusive care. As the healthcare landscape continues to evolve, UTC’s approach to simulation ensures that its nursing graduates are well-prepared to meet the challenges of modern healthcare with competence and confidence.