As supervisors, managers and leaders, we have a responsibility to participate in preparing our practitioners for practice. Likewise, we have a responsibility to participate in succession planning. We should be preparing practitioners who want to grow professionally to fill supervisory, management and leadership roles.

There are various classes available and although they’re a valuable component of professional development, most have high costs associated. In-house programs have costs as well, not the least of which is the time and expertise needed to design and develop them.


But there’s another resource we often overlook. We frequently use simulation to develop and assess only two domains: the psychomotor domain (i.e., skill) and the cognitive domain (i.e., knowledge). A third domain, the affective domain, is defined by behaviors that reflect and demonstrate attitudes and values. I suggest that, with careful consideration and well-designed scenarios, we can use simulation to develop and assess values and attitudes in addition to knowledge and skill. There’s still a cost, but the returns are worth the investment.

Role-Play & Scenario Design

Thinking of simulation probably brings to mind a sophisticated manikin that presents lung sounds and cardiac rhythms, with a blood pressure arm and an IV arm. Although an excellent tool for teaching, practicing, developing and evaluating clinical knowledge and skill, I’d like you to think of another aspect of simulation: the live actor. Patient actors have been used in medicine for some time, but how about using other sorts of role players to help us with developing supervisory, management and leadership skills?


It takes some thought and consideration when crafting the scenario, but using this methodology is a very productive tool. The National Fire Academy uses role-play to great effect during several of the classroom exercises in its Management of EMS course. The challenging and fun exercises allow people to experience the stress, uncertainty and immediacy of dealing with difficult employees in a “safe to fail” environment.


The first step in the scenario design process is completing a gap analysis. What does a supervisor need to know that’s different than an EMT or medic’s roles and responsibilities? What are the expected supervisory behaviors defined in your organization’s rules, regulations, policies and procedures? Are all the supervisors meeting organizational expectations? If not, why not? Once you’ve diagnosed the reasons, you can use education and training to address some of the gaps.


Enlist the assistance of training and education experts, both inside and outside your organization, to help with writing the performance objectives for the scenario that address identified performance gaps. Next, design the overall concept for the scenario and then develop the rest of the details, the scripts and various responses for your role players. Finally, beta test the activity, make any adjustments and implement your program. You should also be able to get the activity approved for continuing education.

Example Scenarios

Scenario for evaluating affective domain competency: A BLS ambulance crew responds to a report of a “sick person.” On arrival they find an elderly woman in a hospital bed in the living room of a small home. She’s clearly very sick. As they begin to examine the patient, a family member comes into the room and says, “You don’t need to do all that stuff, you just need to get my grandma out of here. You need to take her to the hospital right now!” The EMTs have to demonstrate compassion, empathy, caring and diplomacy—all areas of affective domain competency—in order to interact effectively with the family member.


In this scenario, the clinical component is important but it’s not only taking care of the elderly woman that matters. It’s equally, perhaps more importantly, about how the EMTs deal with the family member.


Scenario for evaluating clinical and supervisory, management and leadership skills: An ambulance staffed with a paramedic and an EMT responds to a report of a cardiac arrest in a supermarket with bystander CPR in progress. The ambulance arrives on scene and within a minute the ambulance calls for a second ambulance and a supervisor to respond immediately. When the supervisor arrives he finds the ambulance parked in front of the supermarket with the paramedic sitting in the front seat. The second ambulance arrives on scene.



In this scenario, the paramedic in the first ambulance is a role player and part of the scenario. The EMT and the second crew are being evaluated on their ability to run the cardiac arrest. The supervisor is being evaluated on his supervisory, management and leadership skills in dealing with the EMT, the responding crew, and the paramedic who is just sitting in the ambulance.


In these two scenarios, your design and your role players are the keys to an effective learning experience and performance evaluation. With well-thought-out and carefully designed scenarios and some willing role players, you’ll be able to demonstrate that simulation isn’t only about skills and knowledge. You can contribute to creating three-dimensional practitioners and prepare new supervisors, managers and leaders for success.