“Hand-it-on”: an innovative simulation on the relation of non-technical skills to healthcare

Rationale for using Hand-it-on

Conceptually speaking combines Hand-it-on elements of simulations and games. It enables generation of learning opportunities in a simulated situation (participants, simulate working in an “organization” and engage in simulated tasks), without endangering any patients. Its game-like character draws on several learning principles and makes use of certain learning mechanisms [31]. We first discuss the principles: Hand-it-on generates intrinsic motivation as most people perceive it as fun to play it. While the tasks participants perform are artificial, participants can (in our experience) easily see them as a representation of tasks they do in clinical care, especially during the discussion in the debriefing. Hand-it-on provides ample opportunity for learners to try out different behaviors and supports such an approach by its playfulness. Finally it is a highly experiential learning situation, which is combined with reflection in the following debriefing. Those principles are implemented in practice via a range of mechanisms [31]. There are rules for the actions of participants and (vaguely) defined goals. Hand-it-on is constructed as a fictional setting (an organization is simulated) that provides some background information for the tasks to be done. It is possible to implement increasing levels of difficulties (see the discussion of possible variations below). There is a high degree of participant interaction as well as some elements of surprise and uncertainty. There is feedback while the game is running—from the other players, from the processes themselves, and from the game leader. There is also feedback and reflection during the debriefing. Finally, Hand-it-on is a highly social group learning activity. Research shows that those principles and mechanisms are related to high engagement of learners [31], while the evidence that this results in changed behaviors or even improved outcomes are still sparse [30, 31].

By removing medical content and basing Hand-it-on on the straightforward task of handing on everyday objects from one person to another, participants can concentrate on the essence of what is occurring during the organization of the processes. Many other simulation modalities, such as manikin-based simulations, challenge participants on three different dimensions of complexity [32]: the actions taken during diagnosis and treatment of the depicted patient; the issues from using the simulator as a complex technical device; and the issues of NTS and how they relate to patient care. The combination of all three aspects can burden participants’ learning [32, 33]. Hand-it-on removes the medical challenges and uses simple tasks, reducing complexity from the task itself and from using the simulator as device and setting the focus on the third, namely, NTS in their relation to healthcare. These connections can be discussed in the debriefing.

Working with such out-of-context exercises can remove threats to participants’ self-image as a clinician. For most, there is little at stake as a healthcare professional when handing on objects to another person. Typically, none of the participants is an expert at the tasks involved, thus the existing order in hierarchy and/or expertise of the participants is less relevant during the game’s conduct.

Hand-it-on caters to different learning styles [34]. The highly active and physical nature of Hand-it-on renders the game particularly suitable for learners who prefer active engagement during learning. The physical aspects also support the learning on a more bodily plane, which, for example, was shown to support the acquisition of concepts in different educational contexts [35]. An in-depth discussion of the activity during the debriefing caters to participants with a more theoretical-learning orientation [34].

Apart from the cost regarding the time and remuneration of those involved and of that of securing a venue, Hand-it-on is virtually cost free. Most of the equipment is inexpensive and can be re-used.