Four Years of Reviewing for Clinical Simulation in Nursing

I started reviewing manuscripts for Clinical Simulation in Nursing in May of 2014. I just checked my records and the manuscript review I completed today is my 50th. That doesn't count the R1 & R2 reviews on the same manuscript, just the initial requests that I've accepted from the editors. That averages out to about one manuscript a month. Most of those manuscripts have gone on to be published, too. Yes, I do recommend rejecting a paper now and then, and a couple of the ones I thought were good were rejected by other reviewers and turned back to the authors for submission to other journals. In my small way, I have helped advance the science of simulation education.

Vaginal Examination Simulation Using Citrus Fruit to Simulate Cervical Dilation and Effacement

Back in 2015, Kathleen Shea and I published an article in Cureus, an on-line peer reviewed medical journal that is indexed in PubMed. The article can be found at In a nutshell, we created a way to use oranges and grapefruit to simulate cervical dilation and effacement. If you are looking for an inexpensive way to teach nursing and medical students what a dilated and effaced cervix feels like, give the article a look. To access the entire article, you will need to sign up with Cureus, but it is free and the information that’s showing up on Cureus is really very good.

Secretion-based Nasal Obstruction Trainer (SNOT)

This is an idea that’s been around since 2013, but I just recently started thinking it might be worth doing in our simulation center. We are currently creating standardized scenarios for our Pediatrics rotations and we are looking at the cueing that is currently being required. We want to be able to determine what explicit cues we are giving to learners with the hope of determining ways to reduce those cues. Paige and Morin (2013) did a very good review of the use of cues in simulation and found that the amount of cues is directly tied to the fidelity of the simulation. (Yes, I know there is a debate going on right now about the use of the word “fidelity” in healthcare simulation, but that’s a topic for another post.)  If we see that learners are consistently being cued about snotty noses, that’s going to drive my management to want to improve the fidelity around infants with URIs (Upper Respiratory Infections). This trick may well be one way to make our Respiratory Distress scenario better.

Ed Rovera

Paige, J. B., & Morin, K. H. (2013). Simulation Fidelity and Cueing: A Systematic Review of the Literature. Clinical Simulation in Nursing, 9(11), e481–e489.


LLEAP Multi-Column Event Window Display

While going through our testing of our new coded scenarios, we noticed that one Instructor Station (IS) computer displayed the events differently when we compared it to another of our LLEAP computers.  The IS in our Pediatrics control room showed only one category expanded; the others were minimized as in Figure 1. On the other hand, our Medical/Surgical IS presented the categories across the screen shown in Figure 2.

Figure 1. Single Column Event Display

Figure 2. Multi-Column Event Display

The single column presentation forces the operator to expand the specific menu to access the needed event. And expanding one menu minimized the other so we were constantly clicking on category headers to get to the event we wanted to invoke. We really wanted the expanded event display we had in Med/Surg.

We looked through the various menus and help files and could find nothing that indicated a way to change the Event category display. At that point, we reached out to Laerdal Tech Support. After a few emails back and forth, the technician assigned to the request, Edward Carter, took a long look at the issue and discovered that there WAS NO setting for this; the scenario code itself was determining how the events would be displayed. He dug into it further and discovered a flag inside the code that was determining how the display would look. While he couldn’t be certain, Edward though it might be an artifact of how the scenario came into being in the first place. He asked if either of the two sample scenarios we sent him were originally converted from the old Legacy format. The Med/Surg bay was the first one upgraded and that was probably the one where we converted all the scenarios to see how good the converter worked. And since we knew we had coded the Pediatrics scenarios from scratch to apply Hub programming, it made sense that we would see the single column presentation on that IS. Thus, Edward’s idea had some validity and we proceeded to test his theory.

Edward sent me a workaround that involved editing the XML file inside the scenario program and changing that flag value. Here are his instructions, almost word for word:

  1. Back up your scenario file(s)
  2. Rename the scenario file’s extension from .scx to .zip
  3. Unpack the zip file (simply opening it will usually not allow changes to the file)
  4. Find the Scenario.xml file and open it with Notepad. (We use NotePad++ here at SF State)
  5. Find the string containing “UsingStrictLegacyConversion” and change the value from false to true
  6. Save the file and close it
  7. Re-zip the scenario files/folders (make sure not to include the parent folder in the zip)
  8. Rename the new zip file to an .scx extension
  9. Test the new version

Step 7 can be explained as zipping the files IN the parent folder, not zipping the entire folder. To do this, open the folder, select all the files in the folder and zip them to a new location. If you do zip the entire folder, when you open the scenario in LLEAP your result looks like a newly defined, empty scenario with everything set at the default.

Changing that flag inside the XML did the trick. Thanks to Edward Carter’s research on the problem, now all our production scenario programs present the Events window with all event categories expanded. We no longer have to click to open event categories while running the scenario.