Recommendations for the design and delivery of Visually Enhanced Mental Simulation: insights from participants and facilitators

Introduction Visually Enhanced Mental Simulation (VEMS) is a simulation technique that combines mental simulation and think-aloud with flat plastic representations of a patient(s) and relevant assessment and treatment adjuncts. It offers simple, effective and efficient education for healthcare professionals, but there is a paucity of guidance on effective VEMS design and delivery. We aimed to explore facilitator and participant perceptions of VEMS at our institution to inform guidance for facilitators and simulation program leaders. Methods Using a constructivist approach, we conducted an exploratory qualitative study of the experience of VEMS participants and facilitators. The VEMS simulations at our institution ranged across community nursing, medical and surgical wards, geriatrics, emergency department, maternity and intensive care. Interviews were used to collect data on the design, delivery, experience and impact of VEMS. We analysed the data thematically, from the stance of researchers and practitioners embedded in the institution and seeking to improve our simulation delivery. Results Thirteen interviews were conducted. Study participants’ experience with VEMS ranged from one or two sessions to more than 50 sessions. The context of VEMS experience was mostly interprofessional team-based simulation in diverse hospital or community settings. We identified five themes through our data analysis: 1) Flexibility and opportunity, 2) Unexpectedly engaging, 3) Sharper focus on teamwork, 4) Impact on simulation practice and programs and 5) Manikins are confusing. Conclusion VEMS is a feasible and flexible simulation modality in a health service where time and cost are at a premium. It was perceived as easier to deliver for facilitators with less technical simulation experience, and widely applicable to the diverse range of clinical situations faced by our healthcare teams. Participant engagement appeared to be easier to achieve than with manikin-based simulation and this has encouraged us to critically reconsider our modality choices for simulation within our health service.