Transforming healthcare education: The history of Idaho’s first accredited Simulation Center

The history of simulation in healthcare education dates back to before the Greeks, but the most significant developments occurred only within the last century. For Boise State's School of Nursing, those advancements started nearly 25 years ago.

Getting a simulation program started

In 2010, the School of Nursing moved into the newly-built Norco Building, which includes a state-of-the-art Simulation Center. There are debrief rooms, a mock hospital hall and a control room for instructor observation. But simulations started before any of those facilities existed.

In the early 2000s, several Boise State faculty attended a healthcare simulation education conference. As one of the attendees, Rosemary Macy, recalls, the group was energized by the experience and came back to campus saying, "We can do this."

Macy taught from 1999-2020 and helped pioneer Boise State's simulation experiences alongside professor of nursing Kelley Connor, associate professor of respiratory care Lutana Hann and associate professor of medical imaging and radiologic sciences Leslie Kendrick.

They wrote the College of Health Sciences' first ten simulation scenarios and, in 2006, incorporated them into the entry-level skills lab courses that are required for students in clinical programs.

Rosemary Macy taught in the School of Nursing from 1999-2020 and was an early adopter of simulation education at Boise State.

The idea of simulation can seem complex - creating a controlled environment for immersive clinical scenarios that are bookended with briefs and debriefs - but Macy described the school's earliest set-up in 2006 as incredibly simple. It included:

• "a little tripod" (for recording sessions and reviewing them with students during debriefs)
• "a curtain with students behind it" (for instructor observation)
• a simple manikin that had heart and lung sounds

"And that was it," Macy said.

Dr. Kelley Connor, right, teaching a student with a low-fidelity manikin in 2010. Now the divisional dean of the School of Nursing, Connor has been researching simulation in nursing education since the early 2000s.

As Boise State's simulation technology developed, so did its manikin capabilities. At first they were simple stationary, low-fidelity manikins and those that might be able to breathe. Now the Sim Center's manikins go well beyond breathing, with complex high-fidelity abilities.

In the early days before the school developed a robust standardized patient program, faculty were sometimes asked to stand in as patients for students. Diana Mixon taught from 1996-2015 and fondly recalls a scenario designed to teach students about situations when it's necessary to sit bedside with patients: "I was "falling" out of bed all the time," she said, laughing at the memory.

Leading the field in simulation education

The school became a hub for simulation scholarship over the next decade.

In 2012, the school began hosting a biennial simulation conference in conjunction with the National League for Nursing. It featured leading sim educators from around the nation, but was canceled in its fifth year due to the global pandemic.

Suzan Kardong-Edgren served as the JoAnna "Jody" DeMeyer endowed chair in nursing at the time. She is a simulation expert and "really helped us create our simulation world," said Rosemary Macy. Similar to today, the Simulation Center's activities were organized "with a lot of help."

"It's not a one-person job," Macy said. "We had a great simulation team."

Nursing faculty attended many more simulation conferences themselves over the years, and several became certified healthcare simulation educators.

Part of Macy's role also included training Boise State's nursing faculty in simulation education. Simulation faculty mentoring is still part of the school's practices today, helping newer faculty through the expertise of their peers.

While the earliest simulations used simple manikins, like the one pictured here from 2006, the Simulation Center now has 15 manikins of various technological capabilities.

The school also launched a graduate certificate for healthcare simulation educators in 2015. It sunset a few years later, but Macy recalls it being successful while it ran.

"We had a great program, and we had students from all over," Macy said. "I loved it, and it's still fun to think about everything that we created."

In the center today, faculty, staff and students continue to conduct simulation-based research, advancing nursing excellence through simulation scholarship.

Raising the bar…

Now simulation education at Boise State stands out from the crowd:

• Earning accreditation in 2013, Boise State was the first to house an accredited simulation center in Idaho
• It was the first accredited simulation center west of St. Louis, Missouri, that was not affiliated with a major medical institution
• In 2019, it became dual-accredited as a teaching/education and research facility

What's the big deal with accreditation? The process is rigorous. In addition to thorough documentation, it also includes interviews with simulation center staff and faculty. After receiving re-accreditation in 2024, reviewers spoke highly of Boise State's dedication to collaboration and focus on student success.

"The most impactful thing for me is the unique relationship we have in simulation with our faculty," said Casey Blizzard, the Simulation Center operations coordinator. "We do work as a team, and the faculty support us as staff and as learners and contributors."

The current team of highly-trained staff and faculty instructors pose for a photo with two of the Simulation Center's high-fidelity manikins.

…and overcoming challenges

Since simulations usually require in-person interaction, the COVID-19 pandemic proved a new challenge. To ensure students still received adequate training, sims went virtual. The team pre-recorded all their scenarios (with staff stepping in to portray the patients, their family members and the student nurse) and then conducted the briefs and debriefs with students via Zoom.

"It was a huge lift for the Sim Center, but we still use those videos if we have a snow day or if the new faculty wants to see how a simulation is run before they teach it," Blizzard said.

Advancements for educational impact

The Simulation Center has come a long way since that inaugural year. It now houses 15 manikins of various technological capabilities. They're used in more than a dozen dedicated simulation rooms, each equipped with audio-visual technology for immersive education.

Thanks to a team of highly-trained staff and faculty instructors, the center runs more than 350 simulations each semester. As technology advances, faculty continue to develop scenarios focusing on real people's stories and experiences. Students now have learning experiences with telehealth, translator services and patients with obesity and Down Syndrome.

Students participating in the poverty simulation in 2023.

Particularly unique simulations include the multipatient behavioral health scenario - when the third floor of the Norco building transforms for a day - and the poverty simulation, which gives students a glimpse into the everyday struggles of individuals living in poverty. "It always seems to impact the students," Blizzard said.

Blizzard reflected on some of the major changes she's seen since joining the team in 2021:

• the standardized patient program grew from a handful of people to two dozen;
• students learn to use industry-standard electronic health record software and a medication administration software;
• and the addition of several 100% silicone, high visual fidelity manikins give students unparalleled training in empathy and communication.

"The cohort bonding that takes place during sims is also something we don't talk about very often," Blizzard added. "They learn to rely on and trust each other with simulation. At first most students are nervous, but they all report that it's a great way to learn."

The Simulation Center also gives community members the opportunity to learn, too. Groups from across the Treasure Valley are welcome to tour the facility and discover simulation education at Boise State. This academic year has included groups from Boise High and Sage International schools, the Idaho legislature and Nampa Composite Squadron Civil Air Patrol.

Dr. Kelley Connor talked to guests touring the Simulation Center in 2023 about different high-fidelity manikins.

As the School of Nursing proudly celebrates two dozen years offering simulation learning, it also looks forward to what the future might hold.

"The technology we use in simulation will keep changing," said Kelley Connor, divisional dean of the School of Nursing. "We may be training students with AI at the bedside, virtual reality, or even holograms, but the heart of simulation will remain the same. Simulation is a safe place for students to practice skills, be present with patients and families, and to communicate and connect before they do it in real life."

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