Model strengths
Particular strengths of the design characteristics are the guidance provided in designing and implement-ing problem solving and fidelity. The model focuses designers on creating problem solving situations as the
basis for clinical simulation; this direction was impor-tant in developing the clinical scenario narrative that would trigger the decision points called for in the ob-jectives. The model is also explicit in describing the factors that alter the level of complexity, such as ad-justing the amount of information available, how infor-mation is made available, and how much conflicting information is included. The designer may use this to guide decisions regarding the types of information to provide to adjust the complexity of the clinical sce-nario.
Achieving the highest level of fidelity possible within a clinical scenario is also advocated by the model; a recommendation that contributed to student success in the current study. The perception that there was a possibility of encountering similar patient situa-tions in actual nursing practice was motivating to stu-dents. Conversely, areas where fidelity was lacking presented a barrier to students when participating in the clinical scenarios.
Model weaknesses
Finding from the current study suggest that the model provided minimal guidance in designing in-struction to prepare students for using simulation-based instruction and for structuring guided reflection. Although the model recommends writing objectives that provide sufficient detail for students to be able to participate in a simulation, this was shown to be insuf-ficient preparation in this context. Similarly, other than recommending reflecting on the scenario in terms of the objectives and application to practice, little guid-ance for structuring debriefing is provided by the model. This is a particularly important concern given that students in this study indicated that guided reflec-tion was the activity that most supported their learning. For both preparation and guided reflection, the de-signer referred to resources beyond the current model.
Within the design characteristic of student support, the model suggests pre-determining the content and timing of cues to be provided to students during a clinical scenario. Based on the findings of this study, this guideline may not be the best approach in every situation. Overall, the balance of providing student support in the form of cues during the clinical scenario was an area of uncertainty for both the designer and faculty. Additionally, the model indicates that student support also occurs within guided reflection but does not provide any further information regarding how to design or implement student support in that phase of the simulation.