Scenario design in simulation-based education is often time-consuming and inconsistent. This article explores how a simulation center in Italy transformed its approach to scenario design by adopting a cloud-based platform tailored for simulation education, iRIS. This case study highlights how structured tools aligned with best practices can improve efficiency, boost faculty engagement, and raise the overall quality of simulation-based learning. The experience offers a model for other centers seeking scalable, sustainable improvements in educational design.
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The Missing ECG
It’s 8:25 a.m., five minutes before a simulation starts. The equipment is ready, learners are on their way, and the instructor makes one final check, only to realize the ECG printout is missing. A frantic search begins: emails, USB drives, old folders. The file exists, somewhere, but which version? Was it updated last week? Did someone forget to attach it?
This kind of last-minute scramble is all too common in simulation-based education. Despite using detailed templates and best practices, many centers struggle with fragmented files, inconsistent formats, and poor version control. What should be a streamlined educational experience can quickly become a logistical headache: wasting time, increasing stress, and risking the quality of the learning.
The Problem with Our Scenario Design Process
Designing simulation scenarios is a time-intensive task, often requiring hours of work by skilled instructors. At SIMNOVA, the Simulation Center of the University of Eastern Piedmont in Novara, Italy, we followed a detailed template based on best practices in simulation education, covering learning objectives, patient details, vital signs, and debriefing points.
Despite this structure, the process was inconsistent and inefficient. Instructors interpreted the template differently, often leaving sections incomplete or poorly formatted. Scenarios were stored as individual Word or PowerPoint files, scattered across personal devices, with key materials, like lab results or imaging, frequently lost in emails or forgotten on USB drives.
Version control was a persistent challenge. Without a central repository, identifying the most up-to-date file was guesswork. Reusing past scenarios was rare; starting from scratch was often quicker than digging through old folders. As Dr. David Grant, former SESAM president, observed, we were stuck in the cycle of “reinventing the wheel.”
Attempts at standardization through templates and peer review fell short without effective enforcement tools. Busy schedules, differing tech skills, and human error continued to undermine consistency. Over time, our scenario library became fragmented, with varying quality and usability, making cross-instructor collaboration difficult and error-prone.
Searching for a Better Solution
By early 2024, we knew we needed a more effective method for designing scenarios. Our team was forward-thinking, and university administration supported exploring new approaches. We considered building a custom platform: a database or web application specifically for our needs. We envisioned a central location for all scenario information, attached media files, and revision tracking. However, developing a custom solution seemed daunting. It required significant IT expertise, funding, and time, with no guarantee of future compatibility with simulation technology or proper long-term maintenance.
We also examined tools already known by our team, who formerly used CAE LearningSpace. This works well for audiovisual recording and managing scheduling and debriefing needs, and we wondered if it could also manage scenario content. Unfortunately, LearningSpace wasn’t designed for collaborative authoring and structured content creation. It meant we would still be uploading Word files, and living with all the old issues of inconsistency and version confusion.
We experimented with simpler solutions like shared cloud folders and Google Docs. A shared drive provided a single storage location but didn’t enforce consistency or ease the writing process. Google Docs offered real-time collaboration, addressing a small part of the problem, but we were still using our difficult template in an online document. We still needed to manually format everything and remember every detail to include. Collaborating in a generic document also risked accidental content overwrites or formatting problems. We needed something specifically built for simulation scenario design.
As summer approached, the SESAM 2024 conference in Prague arrived, and one workshop caught our attention: “Standardizing scenario design with AI: Using the iRIS cloud-based design system” led by Dr Kim Leighton, Executive Director of ITQAN Simulation Centre, an iRIS user, and Alexandra Clark of the iRIS team. It sounded remarkably close to what we needed, so we added it to our conference plan.
Discovering iRIS at SESAM 2024
The iRIS session at SESAM 2024 provided valuable insights. Though listed as a promoted industry workshop, the room was filled with simulation educators who, like us, sought solutions to scenario design challenges. Within minutes, the presenters described our exact struggles and demonstrated how their platform could resolve them.
Their live demo showed a structured yet dynamic template, guiding users through each element of scenario design logically. We recognized many sections from our own template, but here the software directed the process, making it difficult to overlook sections. This offered the built-in structure we wanted to ensure complete, consistent scenarios.
What impressed us most was that this wasn’t just a better form—it was a fully integrated system for scenario development. iRIS aligned with established simulation best-practice frameworks like ASPiH and INACSL standards, incorporating them into the platform’s workflow. For educators who had worked hard to teach and enforce those standards manually, this was reassuring. The platform seemed to encourage best practices automatically, potentially reducing our faculty development burden.
We were surprised to learn that over 2,000 simulation authors globally were already using iRIS. How had we not heard of it before? (We later realized that iRIS had strong early adoption in the UK among networks we weren’t connected to). Its widespread use gave us confidence that this was a mature platform with a growing user base.
The “FairShare” library particularly interested us: a collection of user-contributed scenarios available to all iRIS users. The presenter showed how an existing scenario could be imported with A.I. and quickly modified for local use, customizing hospital names, vital signs, or translating content to Italian. This directly addressed our challenge of starting every design from scratch.
Conversations with other attendees who had implemented iRIS were encouraging. A UK educator mentioned iRIS’s ability to output scenario files compatible with their manikin software. This was something we hadn’t considered before.
By the conference’s end, we felt strongly about iRIS’s potential. We still needed to evaluate costs, data security, and team acceptance, but the advantages seemed substantial enough to move forward.
Implementing iRIS at SIMNOVA
After returning from Prague and completing administrative reviews and IT consultations, we obtained an iRIS license for SIMNOVA. Within weeks, our accounts were ready, and staff training sessions were scheduled.
Training proved straightforward. The platform’s step-by-step guidance meant even less tech-savvy colleagues quickly adapted. Many faculty members commented that using it felt like completing a well-designed survey with helpful prompts (except this “survey” produced a complete simulation scenario). This user-friendly design lowered barriers to participation in scenario creation. Previously hesitant clinicians found more confidence with iRIS, as the software ensured critical components weren’t overlooked, and they could reference library examples for structure guidance.
We began transferring existing scenarios into iRIS using the AI-import function. As we then added details into iRIS’s structured format, we discovered areas we hadn’t previously documented well, such as clearly defined performance metrics. The template prompted us to include this information, improving the scenario during transfer. We attached all supporting files directly within iRIS, ensuring everything was consolidated. After migrating other frequently used scenarios, we immediately saw the value of centralization. Now, when preparing sessions, we simply log into iRIS, where all necessary materials are organized clearly and up to date.
Expanding the Shared Scenario Library
In the months following implementation, the SIMNOVA scenario library grew significantly in number and variety, involving a multidisciplinary team. Creating new scenarios became more efficient and less tedious. Duplicating existing scenarios or using pre-defined templates made developing variations much easier. If we wanted a different chest pain scenario, we could start with our basic acute coronary syndrome case, duplicate it, and modify specific details. This saved considerable time. In the first six months, our scenario collection expanded much faster than before. Many ideas previously considered too time-consuming to develop were now implemented. The streamlined process encouraged creativity and a wider scenario range.
We also accessed the iRIS FairShare library for ideas and content. When needing scenarios in areas of limited expertise – like neonatal emergencies – we could search the global library and often find cases uploaded by other institutions to use as starting points. We would duplicate these into SIMNOVA’s workspace, review them, and adapt them to our specific setting, translating language, aligning with Italian clinical protocols, or adjusting details to match our equipment. Original authors were always credited, maintaining academic integrity, while we freely adjusted content for our educational requirements. We felt connected to a larger community of simulation educators through the platform.
Increased Consistency and Quality in Authoring
One of the most noticeable improvements was increased consistency in scenario design across our team. iRIS’s structured format became our new standard. Every scenario, whether created by an experienced professor or a first-time author, followed the same layout (mostly the Mini-Sim format) and included the same types of information. This had a significant effect: our entire team approached scenario design with a common framework. We all knew where to find learning objectives, event timelines, participant cues, debriefing guides, and evaluation criteria.
Standardizing Faculty Training Processes
Implementing iRIS also changed how we trained new instructors. We updated our faculty development program to include iRIS training as a requirement. Contrary to our concerns, new instructors found it easier to learn scenario design using iRIS compared to our old manual template. The software itself became a teacher; completing each section helped them understand its importance. For instance, new tutors learned the importance of specific, measurable learning objectives through iRIS’s dedicated fields with examples and pre-defined options. By using the platform, trainees implicitly learned simulation design standards built into the system.
This brought long-sought training standardization. All faculty development participants learn the same system for creating scenarios, creating a more level playing field. While creativity and clinical knowledge naturally vary, the fundamental structure and creation process remain consistent. New instructors became capable of designing scenarios independently more quickly. Previously, they might need several supervised attempts over many months before feeling confident. Now, after brief iRIS workshops, they often draft scenarios with minimal supervision, guided by the platform. When assistance is needed, mentors can easily access scenarios remotely to provide comments or suggest edits.
Looking Toward a Collaborative Future in Simulation Design
Our progression from struggling with separate, inconsistent documents to effectively using a specialized scenario design platform has transformed our approach to simulation-based education at SIMNOVA. What began as an effort to fix a time-consuming process ultimately revitalized and significantly stream-lined our practices.
Reflecting on this experience, we appreciate that successful simulation delivery depends as much on the underlying process as on clinical or educational content. We always had passionate, knowledgeable educators capable of creating valuable learning experiences, but our design and management method needed significant updating. By improving the process, content development and delivery naturally improved.
Sometimes investing in the right infrastructure enables your team to achieve potential in unexpected ways.
Our faculty are now more productive and focused on creativity, our simulations are delivered more consistently and effectively, and our learners benefit from more polished, well-organized educational experiences.
As we continue building our library we feel connected to a larger collaborative simulation design movement. Events like SESAM connect us with others sharing this vision, while tools like iRIS enable cross-border collaboration. We envision simulation networks where scenario development becomes a global shared effort, with improvements from one team quickly benefiting others.
If you want to find out more about this project please contact:
- Federico Lorenzo Barra – federico.barra@med.uniupo.it
- Giovanna Rodella – giovanna.rodella@uniupo.it
- Home – Nume Plus
- irissimulationauthoring.com
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