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Learning Social Work Skills From Simulations

By Laurel Iverson Hitchcock, PhD, MPH, LICSW, PIP

Today’s social work educators have a difficult task: how to best educate and train students and current practitioners to face increasingly complex client situations and systems of care in the United States. This is especially true for health care settings, which have seen dramatic changes in the last decade with the implementation of the Affordable Care Act and shifts in the roles and responsibilities of health care providers. Additionally, consider the 2016 findings from researchers at the Johns Hopkins University School of Medicine that medical errors are the third leading cause of death in United States, and do not forget about the complicated dynamics of communication between health care professionals who have diverse roles, responsibilities, and even cultural backgrounds. “All of these challenges combine to make health care a team sport,” says Marjorie Lee White, MD, an associate professor of pediatrics, emergency medicine, and medical education at the University of Alabama at Birmingham (UAB). “Social workers are key members of highly functioning teams and integral to providing care that will improve population health.”

What Are Simulations?
To help prepare students for membership on health care teams, social work educators are starting to use simulated learning experiences with students. Simulation in a pedagogical technique that substitutes a real experience for a mock situation based on the learner’s needs, the required curriculum, and/or other training needs. White, who is also director of the office of interprofessional simulation at UAB, says, “Health care simulation allows learners of all levels—students and practitioners—to demonstrate knowledge in action. By practicing as individuals and teams in the simulated setting, clinical teams can improve in a manner that keeps patients safe and puts patients first.”

Simulation also helps to address limitations in the social work profession’s signature pedagogy—field education, which provides real-life experiences for social workers in training. Social work educational programs in rural communities often have limited choices for students, and not all agencies can provide the necessary opportunities for students to experience interactions with multiple client systems such as group or community-based work.

In addition, Dawn Taylor Peterson, PhD, director of faculty development at the office of interprofessional simulation at UAB, notes that some problems experienced by clients are so rare that students may not be familiar with best practices or lack opportunities to develop competency. “Students in clinical rotations are not always exposed to uncommon yet critical situations wherein effective communication is key,” Peterson says. “Simulation allows students to practice these important discussions with the expert feedback of an experienced practitioner before they graduate.” By including simulation as a routine part of field education, social work can benefit [from] what the fields of medicine and nursing, and even pilot flight training programs have been doing for years—an evidence-based teaching practice that increases students’ and practitioners’ skill levels while improving client outcomes.

How Do Simulations Work?
While social work education has used role playing and case studies for many years, simulation moves beyond these traditional educational techniques in several ways. First, simulations do not take place in the classroom, but in settings that represent real life, such as a clinic or emergency department. Participants in simulations are asked to act in the same capacity as they would in their professional practice. In a simulation, a social worker is a social worker, not a client or other professional. Students assume their future professional role and treat the simulated experience as a real-world situation.

Finally, simulation includes a comprehensive debriefing between the participants (students or practitioners) and qualified trainers who have expertise related to the simulation’s content. For example, a simulation might include a volunteer acting out symptoms of depression and suicide while a social work student conducts an initial assessment interview and intervention. Then, following the simulation, the student would meet with the instructor to discuss how the interview went, covering both areas of competency and improvement. Key to this debriefing session is creating a space of psychological safety for the student; simulated experiences may be the first time a social work student or even a practitioner has encountered a particular client situation. Providing time and space to process the simulation also models supervision and consultation activities.

Types of Simulations
There are many types of simulation used in professional education, from mannequin-based scenarios to virtual reality simulators. The use of mannequins has been a longstanding practice in medical education and even by American Red Cross for CPR training (e.g., “Resuci Annie”). Mannequins range from low to high fidelity; some are static and do not respond to the student, while high-fidelity versions can blink, mimic symptoms such as a rapid pulse or heart palpitations, and even speak via remote control with a live person. These are less common in social work education, but may be included in simulations where multiple professional trainees interact with each other, e.g., medicine, nursing, and social work.

Standardized patients (SPs) are probably the most common simulation employed in social work educational and other types of training programs. As in classic role playing, a trained actor or volunteer portrays a specific client situation in consistent, standardized way. The goal is for each student or groups of students interviewing the SP encounter the exact same information and experience, with the only difference being how the student responds to the SP.

A good example of how to use SPs in social work education comes from the University of Toronto’s school of social work. There, educators created an SP of an “African Canadian young woman coming out to the social worker as someone struggling with her feelings of same-sex attraction.” SP simulations can also be employed as an assessment of competence for graduation or licensure, often referred to an objective structured clinical examination (OSCE). Frequently used in medical education, OSCEs are gaining traction in social work education as well.

Another type of simulation is a large-scale multiparticipant situation that mimics how complex social problems affect the daily lives of individuals and families. Examples include the Missouri Action Community Network’s Poverty Simulation or the Project HOPE’s (Helping Offenders Pursue Excellence) Re-Entry Simulation from the Southern District of the US Attorney’s Office. Both simulations employ a community-based experience, placing participants in the role of a person living in poverty or a person recently released from prison. Each participant is placed in situations where they must make difficult choices about their daily activities, and the goal is to raise awareness about the hardships of vulnerable populations.

Finally, simulations can also occur in the virtual world, through simulators or computer programs. Brendan Beal, PhD, MSW, an assistant professor at the University of Montevallo in Alabama, is developing a virtual reality experience for students using head-mounted display goggles, allowing students to be immersed in a group work experience to learn the management of group dynamics. Another example is the computer-based simulation trainings for health care settings produced by Kognito, a private company, in partnership with NORC at the University of Chicago, to help train students and practitioners in evidence-based practices such as Screening, Brief Intervention and Referral for Treatment (SBIRT). Students log onto the company’s website and assume the role of a social worker or nurse to interact with a virtual client, similar to playing a video game.

Not Just for Students
Social Worker Claire Lenker, LICSW, CCM, PIP, and Nutritionist Valerie Tarn, MS, RD, LD, both faculty members at the UAB Pediatric Pulmonary Center, use simulations to improve skills of practicing clinicians. “We have been using the Simulation Center at Children’s of Alabama for several years to train our Pediatric Pulmonary Center trainees how to implement motivational interviewing techniques for smoking cessation counseling,” Lenker says. “Our trainees are from the disciplines of social work, nursing, respiratory care, and nutrition.”

Tarn notes that smoking cessation can sometimes be an awkward topic. “So it’s very helpful to have the simulation center available so students can receive feedback in a nonjudgmental manner with a certified debriefer,” she says. “The students really enjoy seeing how each discipline approaches the topic from a different, yet equally effective, perspective and style. The simulations have been so well received, we also began doing them with our pediatric medical residents on their pulmonary rotation.”

How to Get Involved
“Social work practitioners can collaborate with educators to design simulation experiences that allow students to practice difficult discussions with clients before they actually occur,” Peterson says. Social work practitioners can also collaborate with educators to design simulation experiences for peers as well. The best simulation experiences are often based on real-life cases that recently occurred and may not have resulted in the best solution. These real-life cases can be turned into a simulation learning opportunity that will result in better patient/client outcomes for all.

— Laurel Iverson Hitchcock, PhD, MPH, LICSW, PIP, is an assistant professor of social work in the department of social work at the University of Alabama at Birmingham.