Scenario Editing Guidelines

Introduction

Welcome to scenario creation for Pharmacy Simulator. We’re glad to see you taking an interest in creating scenarios and sharing them with our learning community. This document is intended to give you guidance on how to write scenarios that are easy to play, achieve their intended learning outcomes, and maintain high standards for quality. If you are not yet familiar with the basics of how to use the Scenario Editing tools in Pharmacy Simulator, you may want to first read the relevant user manual.

Before you begin, it’s probably best to calibrate your expectations. If you have never written a Pharmacy Simulator scenario before there is a learning curve to overcome. Although we have made every effort to make this process accessible and easy to understand, there are still areas that we need to improve, and there is a base level of difficulty that simply cannot be avoided. For first time scenario authors we recommend you choose a relatively simple scenario to write. Even then, from experience we have observed that for a first time scenario author you can expect to spend at least half a day and probably more like a full working day or even more, depending to some extent on the level of complexity of the scenario and how much dialog and depth you decide to consider. This is due mainly to two factors:

  1. You are still learning the tools
  2. You are still learning how to think about the structure of a Pharmacy Simulator scenario

You can expect that your second and third scenarios will be developed much more quickly, but even the most proficient scenario author will not be able to write a complex scenario from scratch in less than half a working day. However, it is important to remember that you do not always need to write scenarios from scratch – explore the list of scenarios before you begin: does the scenario you’re trying to write already exist? Has someone already written a similar scenario that you can modify to suit your needs? It is always possible to clone this scenario, and modify it.

But for the purpose of this document, let’s assume you want to write a new scenario from scratch. Before you load up the scenario editor in Pharmacy Simulator, you should have a plan of the type of scenario you want to create. Although there is no fixed way of going about designing your scenario, there are a few key factors that it is often wise to consider:

What is the learning objective of the scenario?

Ask yourself what you’re trying to teach the user. In the general sense, are you wanting your students to be more familiar with a particular health condition, a particular type of patient, a particular class of medicines, or perhaps with the details of a prescription?

Once you have decided the general topic, you should try to narrow it down to a particular patient encounter that demonstrates some key factor. For example, if you want students to be familiar with heart disease, what aspect of this disease are you going to focus on in your new scenario? Perhaps a patient who has been recently diagnosed? Perhaps a patient who has been recently discharged following an event? Perhaps a patient who has just started a new medicine?

What is the skill level of your intended learner?

The way you write the scenario needs should generally be adapted based on the level of your intended learner. This should always be varied based on the needs of your particular target group of students, but some general guidelines and tips based on a four year tertiary level Pharmacy program are below, but you will need to accelerate this for shorter programs with higher entry level requirements.

  • First year students & pharmacy technicians
    • Generally focus on a more formulaic method of patient counselling, encouraging students to be thorough in their lines of questioning and their advice given
    • Generally focus on relatively straightforward over the counter requests. If covering prescription requests, keep it very basic.
  • Second year students & experienced pharmacy technicians
    • Stick to formulaic patient counselling and advice, but try to include more points of interest. For example, you might complicate the scenario with comorbidities and other confounding factors.
  • Third year students
    • Start to introduce more complex scenarios such as over the counter requests from complex patients, and prescription requests where errors that should be detected may be present.
    • Less emphasis on formulaic patient questioning and counselling. For example, these students should already be very familiar with concepts like asking who the medication is for, so it becomes less important to continue to always challenge them on this point.
  • Fourth year students
    • Ensure the scenarios are complex and have significant points of interest that really challenge their clinical decision making and make them feel knowledgeable.
    • Much less focus on the formula of patient counselling. These students should have done this to death and will typically no longer be challenged by or interested in fine tuning their choice of language.
  • Postgraduate/Continuing Professional Development
    • Focus on identified professional shortcomings
    • Keep things interesting – sufficiently complex to challenge practicing pharmacists
    • Will often be less complex scenarios than fourth year students, but focusing on areas of significant interest – i.e. new reforms to best practice, recent changes to regulation, etc.
    • Remember that these are practicing pharmacists who may be less tolerant of needing to hit ALL the valid counselling points, and will want to be able to focus on the KEY messages.

What is the patient profile?

It is important to come up with a mental model for the type of patient in your scenario, that can be best employed to illustrate the key learning objectives you have in mind. Try to consider the following patient characteristics:

  • Age?
  • Enquiring for themselves or a loved one?
  • Pregnant?
  • Health status/medical history?
  • Socio-economic status?
  • Education?
  • Comprehension?
  • Native speaker?
  • Regular visitor to the pharmacy?

To inject personality into the patient and make their responses to student queries seem more organic it may also be useful to come up with something of a back-story for the patient. We tend to find this is more important for more experienced students who are looking for a more authentic patient experience, whereas less experienced students are often more focused on the technical details and may not engage with the patient back-story so much. At the very least you may find this helps make it easier for you when it comes time to write the dialog responses. Some example questions to stimulate your process are provided below, but really it’s up to you. Feel free to use your imagination.

  • Where did they grow up?
  • Where did they go to school?
  • Are they religious?
  • Who are their parents?
  • Do they have children?
  • What is their profession?

What is the RIGHT thing, that you want your students to do?

It is usually easiest to start by identifying the perfect and correct way to complete the scenario. Identify all the questions the student must ask the patient, identify all the advice they must provide, and the appropriate course of action i.e. to dispense a particular type of product, to refer the patient to another health service, to provide advice only.

At this point you may wish to open up the scenario editor, create the patient, and start adding all the dialog options/responses and rules that are necessary to achieve the perfect outcome. You may wish to preview the scenario at this point and see if it “feels” correct, like a real patient encounter. At this point you can also set the maximum score for the scenario.

What are the various WRONG things that students might choose to do?

It is important now to add opportunities to fail. It is of very limited value for students to load a scenario, click every option, and then get a perfect score. This would not prompt them to think, reflect, or research from reference materials.

Use your experience as a Pharmacy educator and/or Pharmacist to come up with several plausible ways in which a student or pharmacist could do the wrong thing. Some common areas to think about include:

  • Using insensitive wording or phrasing that may insult or offend the patient
  • Failing to ask key questions that would impact upon their decision of what action to undertake
  • Failing to provide key advice, which may result in a sub-optimal outcome for the patient
  • Inversely, asking too many questions, or providing too much advice – failing to identify which questions/advice are important and which ones are not

Having thought up several ways in which students can plausibly make mistakes, you must think about what the consequences of these mistakes would be. This requires a bit of imagination to think out what the likely outcomes would be. In simple terms – whenever you provide the student with an incorrect option to take, it will often to require the addition of extra incorrect options, or the modification of the responses the patient may give, further down the track.

  • Making the patient angry/annoyed – will cause them to shut down and be less forthcoming to future questions/advice, or perhaps even just walk out!
  • Failing to ask key questions – may mean key advice dialog options are not available, since the student will not have the information needed to prompt them.
  • Providing the wrong medication – should also give them the option to provide advice that is relevant to the wrong medication.

As a rough guideline, for each key element you should consider adding around 2 mistake options. One which you think students are quite likely to choose, and one which is perhaps more evidently incorrect but which is nevertheless plausible. If you’re feeling playful, you might also choose to add a "joke" option, which is clearly incorrect but which a student might try just to see what happens. It may help to imagine that you are writing a multiple choice questionnaire, where there is often one best option, two ok but inferior options, and a fourth bad option to choose from. The goal is to prompt the student to think.

Quality Assurance

It is important to replay the scenario several times and explore both the correct and the incorrect paths the student might take. By previewing the scenario in this way you’ll be able to identify sections that don’t feel right, or are logically inconsistent, and can typically fix the issues quite easily. This is a very important quality assurance step – if you don’t do this, students who play your scenario may become confused and frustrated when the scenario doesn’t make sense and isn’t behaving in the way they expect. Common things to look out for during this process:

  • Are any dialog options, or patient responses, too long and dense? Do they need to be split up into multiple lines or multiple options?
  • Do dialog options unlock and get locked at the right times?
  • Do dialog options have a consistent and coherent flow?
  • Are dialog options appropriately ordered so that they appear at the appropriate place in the list of options during playback?
  • Do the patient responses being provided still make sense when you play through the scenario in a different ordering?
  • Are the scores and feedback you’re providing appropriate? Do they put the focus on the right things?
  • Does the feedback for incorrect options steer the student in the right direction, without just giving them the answer directly?
  • Is the maximum score set correctly?

Your workflow for fixing these issues may vary. Some will prefer to play through the whole scenario noting down errors as they encounter them, then fixing them in a batch. Others will prefer to play until they identify an error, fix it immediately, then restart the process.

[Optional] What other things can you add to inject a bit of fun into the scenario?

We have observed that students typically go through the following learning process with their scenario:

  1. Attempt to complete the scenario correctly based on their existing level of understanding
  2. Reflect on the feedback provided
  3. Attempt to complete the scenario based on their enhanced level of understanding
  4. Reflect on the feedback provided and do additional reading
  5. Achieve mastery over the scenario
  6. [Optionally] Experiment with the scenario, doing incorrect and even strange things, just to see what happens

Because of this final behaviour, we have found it is interesting for the students if we add points of interest that allow the students to have a bit of fun. Consider the following examples of things that we have observed that students like to experiment with:

  • What happens if we press the silent alarm or the fire alarm?
  • What happens if we call the police?
  • What happens if we take the fire extinguisher?
  • What happens if we gossip about the patient with a co-worker?
  • What happens if we dispense completely inappropriate medications?
  • Are there any other easter eggs we can find?

In some cases there are default options that will occur if the student performs these actions, but as the scenario author you are always free to add custom responses to any of these options and more. Custom responses you add will override any default responses that are built into the engine.

Closing Words

Ultimately our goal when writing scenarios is to give students a learning experience. There are a lot of factors that can go into achieving this goal, and there's really no set method. Take everything in this document as well intentioned advice, use it as a framework if you find that helpful. But if you can come up with interesting and creative ways of achieving your goals, don't worry if you don't see them talked about in this document. You know your students and you know your objective. If you think it works, you're probably right.

Remember, if you're unsure of what you've created, or just need more help and guidance, feel free to reach out to us via email for some personalised support.