When students entered the classroom, backpacks and suitcase, patient belongings bins (14x16 inch plastic crates), policies, patient profile, and instructions were on their desks. Before they began, students were randomly assigned to a partner using playing cards. This pairing was not an essential part of the exercise, but having students work with individuals they do not choose themselves helps them avoid falling into predictable roles. Faculty were in the room and found the simulation was more effective if they kept busy (e.g., reading and article, checking e-mail ), rather than standing at the front or walking around the classroom. Students were more likely to work on their own if faculty signaled that they should.
After approximately 30 minutes, students were ready to debrief. The debriefing is the most important part of the simulation, and students participated enthusiastically; debriefing was completed in approximately 30 minutes. Faculty asked students questions about specific items and hoe they decided what to do with them. Two students were asked to read the patient profiles; then they were asked if the patient profiles influenced their decision making, as students usually decided that certain items, such as eyeglasses, should be allowed for the librarian but taken from the patient who cut himself, until his risk for self-harm was reassessed. Clinical faculty shared their experiences (e.g., the time family member brought firecrackers and matches to the state hospital layered in a Thanksgiving dinner), and this sharing enriched the experience. At the conclusion of the simulation, the students were asked to keep the experience confidential so that other students could have a similar experience.