Title : Navigating change: Integrating virtual simulation into the 3:1 clinician educator model
Abstract:
Purpose: To describe how an academic–practice partnership used a structured change approach to integrate virtual simulation into an undergraduate acute-care clinical experience, and to share an implementation and evaluation toolkit that programs can adapt to expand capacity while protecting learning quality.
Intended Audience Novice, competent, and expert nurse educators in academic and clinical settings; clinical instructors and preceptors; and healthcare leaders interested in sustainable academic–practice partnerships and innovative clinical teaching models.
Methods/Innovation/Strategy: Starting in Summer 2025 on OHSU’s 11K Intermediate Cardiovascular Care Unit, RN clinician-educators supported three students during weekly 12-hour shifts plus a 4-hour post- conference. Post-conference was redesigned as a hybrid learning block: (1) brief debrief of bedside learning needs, (2) a targeted virtual simulation case using a prebrief-scenario-debrief format, and (3) structured reflection mapped to Tanner’s Clinical Judgment Model and Oregon Consortium for Nursing Education (OCNE) competencies
Background: Virtual simulation expanded rapidly during and after the COVID-19 pandemic, creating an urgent need for evidence and implementation strategies. A randomized controlled trial found virtual simulation more effective than traditional teaching for improving nursing students’ self-efficacy and learning/self-confidence when delivered with pre-briefing, simulation, and debriefing (Tamilselvi et al., 2024). Other work suggests virtual simulation-based education can be cost-efficient and associated with high student satisfaction and confidence, while also surfacing predictable barriers such as technical difficulties and limited realism that require programmatic mitigation (Asiri et al., 2025).
Implications
Evaluation Outcomes (Key Findings): Early implementation feedback suggests that integrating virtual simulation into post-conference activities provides consistent exposure to high-stakes decision points, allows for repetition and scaffolding of clinical judgment, and helps standardize learning across sites. Learners and RN clinician-educators also highlighted the conditions needed for successful change: reliable technology, clear expectations for facilitation time, role clarity across partners, and escalation pathways that protect psychological safety.
Practical Recommendations: We propose a change-ready implementation approach: (1) co-design/select virtual simulation cases with unit and school partners to align with course outcomes; (2) use a consistent prebrief-sim-debrief template and faculty coaching to improve fidelity and reflection; (3) scaffold scenario complexity over the term to build diagnostic reasoning; (4) invest in platform stability, orientation, and just-in-time troubleshooting to reduce cognitive load; and (5) use a hybrid model that intentionally links virtual decisions to bedside practice and competency assessment. Attendees will leave with a replicable implementation checklist, sample prebrief/debrief prompts, survey item examples, and a roadmap for sustaining hybrid clinical education that integrates virtual simulation while supporting student readiness and educator well-being. As ONEPIR expands to additional and rural/community sites, we hope to use virtual simulation to (a) extend access to consistent clinical judgment experiences when placements are limited, (b) standardize post-conference learning across varied units, (c) provide safe practice and repetition for rare or high-risk scenarios, and (d) generate shared data on learner progression to inform coaching and continuous quality improvement.
