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Ideas / Research & Design / 8.16.2023

Design Excellence for Medical Simulation and Competency-based Curriculums in Nursing

University of Arizona Health Sciences Education Building Simulation Lab

As leaders in nursing school design, Ayers Saint Gross has closely followed the evolution of nursing education in recent years. Schools are adapting to overcome challenges related to the nursing shortage, COVID-19, remote learning, and more. Ayers Saint Gross works alongside many institutions as trusted advisors to plan and design best-in-class spaces to support the future leaders in nursing.

Simulation-based education has increased over the past few decades and continues its widespread implementation throughout all levels of nursing education; it is the gold standard for educating modern nurses and healthcare professionals.

How Nurses Learn: A Changing Pedagogy

Traditionally, the nursing curriculum has required students to earn contact hours in both lecture and clinical environments. By partnering with local hospitals, nursing schools provide students with opportunities to receive education and training in a healthcare setting through hours spent in rotations led by clinical faculty. However, coordinating clinical placements is not easy; scheduling is dictated by the hospital schedule, and with shortages and burn out in the workforce, it is challenging to educate high volumes of nursing students.

Simulation-based education bridges the gap for learners to participate in scenarios that replicate clinical practice and develop critical thinking skills in a classroom setting. Common methods for simulation include computer based or virtual simulation, role-playing scenarios, skills stations, and the use of standardized patients or high fidelity manikins- some now outfitted with AI to communicate on their own. Nursing research has also grown around simulation, both in best practices and to track its effectiveness. Dr. Pamela Jeffries authored the original framework, Simulation in Nursing Education: From Conceptualization to Evaluation, which later became a published theory (NLN Jeffries Simulation Theory, 2015). These resources have altered the teaching and learning environment of nursing and have standardized pedagogy nationally leading to significant implementation of simulation activities.

Auburn nursing students participate in a simulation exercise.
At the Auburn University College of Nursing, student perform a training scenario to care for a simulated patient. Each bay is uniformly fit out to simulate a hospital environment, complete with audio-video recording capabilities, enabling students to develop muscle memory for routine care.

It has been proven that simulation is effective at preparing nurses for clinical environments. A 2014 study from the National Council of State Boards of Nursing polled three different student groups and found evidence that up to 50% simulation can be effectively substituted for traditional clinical experience in all prelicensure core nursing courses. These results have led to a wave of new state regulations guiding how much simulation can and should be used in nursing programs to supplement traditional clinical learning.

The need for simulation was made clearer during the COVID-19 pandemic when many institutions were forced to quickly adapt from traditional in-person clinicals to virtual simulation, and many state boards of nursing took steps to address the needs of the profession through relaxed clinical and simulation standards. To maximize the rate of new nurses graduating into the workforce, these decisions validated virtual simulation as an effective clinical training tool.

Rendered image of nursing students working in a virtual simulation lab.
Ayers Saint Gross programmed and designed simulation labs for a new nursing building at Catholic University. An immersive VR space will immerse students in a virtual setting projected on walls; alternately students can utilize head mounted displays in augmented or virtual reality settings.
Quantifying Simulation-based Education and Space Needs

At Ayers Saint Gross, we embed metrics and data into our design process. To validate space needs for nursing clinical labs and simulation space, we conduct a robust analysis of each school’s curriculum to define which courses are taught in simulation and overlay their goals for how many hours each course will teach in simulation. It is important to plan for enrollment growth and discuss the logistics for how a simulation facility can best support a growing student population.


Duke nursing student observes a simulation exercise.
The concept Ayers Saint Gross developed for Duke’s Standardized Patient Suite maximizes adaptability and space utility. An “ante room” functions for charting, observation, post-exam evaluation, debriefing, and as the separate entrance for the student or patient actor.

From a space perspective, there is a direct correlation between an increase in simulation utilization and the need for more academic space, especially, for example, in comparing a program that only supplements 10% of clinical time in simulation to one that supplements 50%.

Duke nursing students discuss a simulation exercise.
At Duke University, the exam room side is fit out for a patient actor connected to a dedicated lounge and entry zone. Exam rooms are integrated with A/V capabilities and can also function for high-fidelity simulation utilizing a manikin.

When planning for simulation spaces, schools and institutions must carefully consider how they want to run simulation; we usually discuss the variables around enrollment, frequency, student group size, active vs observing participants and number of clinical cases that need to be performed. We have worked with institutions to plan various kinds, including high-fidelity, interprofessional and large format, and VR and AR.  Simulation involves the use of specially designed simulation labs, control rooms, and debriefing areas. Often, students are observed by faculty members using technology or one-way glazing.

Going forward, simulation will continue to evolve and be implemented for nursing and health sciences programs. Not only do these programs and spaces help schools remain competitive, they also provide valuable training for the next generation of nursing leaders. Even beyond the classroom, many health systems are implementing simulation for training across various levels and disciplines. If you are interested in learning more about simulation spaces and how they can be incorporated into your nursing spaces, please reach out.  We would be happy to work with you.

Ayers Saint Gross works with nursing programs all around the country to reimagine their simulation centers and has comprehensively programmed and designed several facilities for nursing programs.

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