Effective simulation-based training for health care professionals requires staff expertise not only in education and health care but also in simulation technology. A staff that lacks technical knowledge and skills will be unable to leverage the equipment and environment’s full potential. Moreover, the need for broadened technical knowledge and skills has increased in recent years, as improvements in existing technology encourage the incorporation of new equipment and software into simulation-based education.1
Institutions and programs are increasingly responding to this need for technical expertise by hiring “simulation technicians,” individuals who provide dedicated expertise related to the technological components of simulation-based education. This role’s growth is evidenced by the fact that attendance doubled from the first simulation technician-based conference hosted by SimGHOSTS in 2011 (attended by 86) to its third in 2013 (attended by 172). During the same time, a Simulation Operations and Technology Section within the Society for Simulation in Healthcare has grown out of a smaller interest group. In addition, the role of the simulation technician has become increasingly valued. In an international survey, simulation centers were asked to identify the main strengths of and barriers for their programs. The top 3 strengths identified were dedicated financial support for operational budget, having a dedicated simulation technician, and support from institutional leaders, whereas the top 3 barriers listed were the need for more financial support, the need for a dedicated simulation technician, and the need for collaboration with other leading centers.2 Despite the recent growth and recognized value of the simulation technician, there is much ambiguity surrounding this role wherein its various aspects or responsibilities may be performed by other personnel, often out of necessity.
In our experience and through discussions with other centers, the responsibilities (and the tasks that accompany them) of simulation technicians—much like those of nurses in different units—seem to vary widely based on center needs.3 Within nursing, this variation exists under a broad role description that is well established and clearly understood among its existing and aspiring practitioners. The role of simulation technician, by contrast, has no shared overarching description. To our knowledge, there are no published studies describing the role of simulation technician or the associated educational needs. This lack of role clarity not only hinders the recruitment and training of qualified applicants but also might contribute significantly to job dissatisfaction and the ability to retain that talent.4
We designed this investigation to identify the range and frequency of tasks performed by people who self-identify as simulation technicians, thus developing a baseline of responsibilities required within this role. Second, we sought to determine whether there was correspondence between what tasks simulation technicians perform and what they feel their responsibilities should be. Lastly, we assessed simulation technicians’ perceptions about their own knowledge and skill levels, how they best learn, and which knowledge and skills are in most need of development or improvement. We hypothesized that there is a core set of responsibilities and tasks for the simulation technician role regardless of background, experience, and type of simulation center.
We conducted a prospective, survey-based study of individuals currently functioning in a simulation technician role in a simulation center. This study was approved by our institutional review board before commencement.
Potential survey respondents were identified and contacted through the mailing list for the Simulation Operations and Technology Section of the Society for Simulation in Healthcare. This allowed inclusion of simulation technicians from a variety of institutions (i.e., pediatric and adult settings, academic and private centers). The survey was sent electronically to all section members on the list, and survey respondents were included if they self-identified their role as “simulation technician” in response to the first question on the survey. Those who responded “other” to this question were immediately routed out of the survey.
The survey was designed by the research team, which included a simulation technician and a survey methodologist (a social psychologist with expertise in survey development). Because all questions on the survey were in reference to the tasks that simulation technicians perform in their role, the research team collaborated with 3 other academic simulation centers (pilot centers) to come up with a comprehensive list of known simulation technician responsibilities and tasks. These responsibilities, along with any additional ones that respondents identified, served as the reference for all responsibility-related questions in the survey.
Study investigators then developed the survey questions through an iterative process to identify and address issues that might contribute to survey error including question clarity, ease of completion, and correspondence with the stated research objectives. The survey content was then pretested by the 3 pilot centers using the Question Appraisal System5 as a framework to identify and fix any remaining problems related to the wording of questions and response options.
The survey was administered using Qualtrics software (Qualtrics, Provo, UT), a Web-based survey application that allows for complete respondent anonymity and includes a number of advanced functions such as question routing and display logic that were incorporated into the survey to make the survey flow as smoothly as possible, thereby minimizing respondent fatigue and associated error from nonresponse.
Respondents received an invitation and survey link via e-mail that included a brief description of the purpose of the project along with assurance of anonymity. This e-mail contained a statement that participation is completely voluntary and included the link to the survey. The survey was composed primarily of closed-ended questions, but many questions included an “other” response option that allowed for free-text entry. See Appendix 1 (http://links.lww.com/SIH/A243) for a print copy of the full survey and corresponding survey objectives. The survey remained open for 15 days, with a reminder sent at the end of each week.
Univariate descriptive frequencies were calculated for all closed-ended questions. Bivariate descriptive cross-tabulations were calculated to show the frequency distributions of responses to one question across another. Open-ended responses were thematically coded. Two investigators independently coded and then discussed each response to develop consensus coding and identify missing thematic categories. Themes that included multiple responses were included in the descriptive frequency calculations and reported along with closed-ended responses.
A survey request was sent to 280 potential participants. One hundred thirty-six (49%) responded to the survey. Of these, 73 respondents identified their current role as a simulation technician and were included in the analyses; the other 63 respondents were excluded. Respondents who identified their current role as simulation technicians came from a variety of facilities. Most worked at teaching hospitals (53%), followed by colleges (22%) and free-standing simulation centers (15%), with a smaller number of respondents working at a private hospital (4%). Two respondents (3%) indicated that they work at a facility not included within these 5 facility options.
Table 1 describes the demographic characteristics of our study sample. The majority of respondents had an undergraduate degree or higher, had more than 3 years of experience in their role, and came from a health care background. Table 2 reports respondents’ views regarding how well their previous field prepared them for their role as a simulation technician.
Respondents were asked to quantify how often they performed any 1 of 13 known simulation technician tasks developed by our research team in collaboration with 3 other academic simulation centers (pilot centers). Results are demonstrated in Figure 1. A majority of respondents answered that they perform all 13 tasks “sometimes” or “frequently” in their current role. More than 83% of the 73 respondents answered that they frequently performed 3 of the tasks: equipment setup and breakdown (n = 66), operation of software during simulation (n = 62), and on-site simulator maintenance (n = 60). The next 2 most frequently performed tasks were inventory and audiovisual support for courses. Twenty-two respondents identified 1 or 2 “other” tasks that they performed “sometimes” or “frequently,” including 12 who reported administrative duties such as scheduling and 6 who identified internal teaching/training of staff.
Respondents were then asked, “Which 3–5 responsibilities, in your opinion, should constitute the core of a simulation technician’s role?” and answered by ranking their top 3, 4, or 5 (Table 3). The 5 responsibilities most frequently identified as core, independent of ranking, were equipment setup and breakdown, programming scenarios into software, operation of software during simulation, audiovisual support for courses, and on-site simulator maintenance. Inventory, which was listed as one of the most frequently performed tasks, was not generally considered to be a “core” responsibility by respondents.
For the self-reported level of skill/knowledge, 37 respondents (51%) rated themselves as “good” or “excellent” for all 13 responsibilities or tasks. Ratings of “fair” were most common for moulage (n = 15), involvement in research (n = 12), course design (n = 10), and audiovisual support for courses (n = 7). No respondents rated themselves as “poor” for any responsibility or task.
When respondents rated current levels of skill/knowledge as “good” or “excellent” for a responsibility/task, the majority attributed improvement to self-taught learning, especially “experience over time,” rather than formal instruction. Other improvement methods varied by responsibility/task, as shown in Figure 2. For responsibilities rated as “fair,” respondents answered that formal instruction such as courses, workshops, and supervision/mentoring would be more effective methods for them to improve than self-taught learning.
In this survey-based study of self-identified simulation technicians, we found that backgrounds of simulation technicians were primarily health care or technical. Regardless of general background, less than 50% of the respondents felt well prepared for the simulation technician role. The majority of respondents attributed any improvement in skills while in their roles to experience over time yet indicated that formal learning is needed for skills in need of improvement. In general, respondents felt that those tasks most essential in their role are those they perform most frequently and are similar across respondents.
In the health care field, most occupations have a clear set of core responsibilities and tasks that providers are expected to perform. Contrary to our expectations, respondents were generally consistent on the tasks that simulation technicians most frequently perform. These included equipment setup and breakdown, programming scenarios into software, operation of software during simulation, audiovisual support for courses, and on-site simulator maintenance. Moreover, these tasks closely corresponded to the responsibilities they identified as being central to their role. Centers can take these core responsibilities and build recruitment, orientation, training, and evaluation processes around them. Standardizing orientation and training would give incoming simulation technicians a better idea of what is expected in their role, what concepts and skills they need to learn, and how to grow that role to meet the demands of their facility. This could also help refine existing certification programs and develop continuing education specifically focused on these core tasks. A clearly defined role should also help in the ability to attract and retain the right candidates.
So, if a standardized training program were developed, what methods of training would be required? When asked to rate their knowledge and skill level for tasks they most frequently perform, simulation technicians rated themselves as “good” to “excellent.” Technicians responded that they wanted more formal training within their position, yet the few who rated themselves as “fair” in the beginning of the role attributed their improvements to self-taught methods (experience over time and informal learning) rather than formal instruction (supervision, mentoring, or formal courses). Because no respondents rated themselves as “poor” on any given task, there is likely a self-reporting bias within the cohort and/or a methods bias within the survey instrument. This bias limits our results and makes it difficult to assess which training methods are more effective at developing technician responsibilities. Our results, however, at least give us the sense that simulation technicians feel that “directive” or “guiding” (some might say “dependent”) learning methods are more effective for simulation technician development versus purely independent or self-taught learning methods. Future studies should focus on a formal needs assessment of learners at different stages of job experience and attempt to correlate their knowledge, skill, and behavioral growth to certain training methods.
There are other limitations to our study. First, the sampling frame (the mailing list) that was used for this survey-based instrument likely excluded individuals with the role or title of “simulation technician” and certainly included individuals such as educators or facilitators who were not part of the “simulation technician” population that was of interest for this. Consequently, there is a possibility of both undercoverage and overcoverage error that limits the generalizability of the results. We did include a “filter” question in our survey to ensure that we captured responses only from those within the population of interest to minimize overcoverage error. At the time of our study, we used “simulation technician” as the only self-identified role/title in the survey. This was based on local practice and feedback from individuals at 3 other academic simulation centers who helped us derive and pilot the study instrument. However, through recent discussions with others in the simulation field, we have become aware that the simulation technician role does have some varied nomenclature from institution to institution including simulationist, resource technician, resource associate, simulation specialist, simulation technology specialist, and possibly others. The generalizability of future studies on this population would be greatly enhanced with a more comprehensive and accurate sampling frame.
A second limitation is the fact that the results are based on self-reported data and are subject to a number of respondent-related errors including problems with accurate recall, satisficing, and the possibility that respondents deliberately modified responses for one reason or another. Our question regarding self-reported knowledge/skill levels, as noted earlier, should be interpreted with particular caution. Future work could attempt to compare and contrast self-reported data with job descriptions written and implemented by simulation centers accredited by the Society for Simulation in Healthcare as a means to better validate the findings. A third limitation is related to how the respondents defined their background. It would be useful for recruiting and hiring to identify what professional backgrounds provide the best match for the responsibilities and tasks required of simulation technicians. In our survey (Appendix 1, http://links.lww.com/SIH/A243), we asked, “In what field did you work (or train for) prior to becoming a Simulation Technician?” We then gave respondents the options of information systems, audiovisual, medical, and other. For medical, we gave examples [i.e., paramedic, emergency medical technician (EMT), patient care assistant] but did not allow them to enter specifics regarding their background. This limits our ability to conclude if one background is superior to another. Future studies should avoid broad catchment of “medical” or “information systems” and attempt to identify specific experiences, backgrounds, and/or trades that provide a solid foundation for successful hiring of simulation technicians. Finally, as some simulation centers have multiple employees within this role, there is the possibility that a single center (or centers) could have had multiple simulation technicians complete the survey. If their responsibilities and tasks within that center were the same, then their job function data would be repeated and their responsibilities and/or tasks may be overrepresented in our results.
In conclusion, simulation technicians come from a variety of educational and work backgrounds, there is good overlap between the tasks that simulation technicians do most frequently and the responsibilities they consider to be core, and technicians advance their skills through day-to-day experience rather than formal mentorship. We feel that our findings represent a first step in defining what the technician role within simulation-based health care means and support the need for the development of a formal job description to allow recruitment, development, and certification of simulation technicians.
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