skills/generate-clinical-scenario/references/scenario-structure.md

# FILE: references/scenario-structure.md

# Clinical Scenario Structure

Use this reference when producing a complete clinical simulation scenario or when the user requests one or more of these components.

Include only sections relevant to the request.

# Scenario Overview

Provide:

- Scenario title
- Clinical setting
- Target learner group
- Suggested number of learners where relevant
- Approximate duration
- Level of difficulty
- Brief scenario summary
- 3-6 specific learning objectives

Learning objectives should be observable, achievable within the scenario and appropriate to the learner level.

# Patient Profile

For each simulated patient, include relevant:

- Fictional name
- Age
- Sex where clinically relevant
- Gender identity where educationally relevant
- Relevant ethnic, cultural or faith background
- Disability, communication or accessibility needs
- Occupation
- Social circumstances

Only include demographic characteristics that contribute meaningfully to clinical reasoning, communication, realism or the educational objectives.

All patient information must comply with the synthetic-data requirements in `SKILL.md`.

# Clinical Background

Include relevant:

- Presenting complaint
- History of presenting complaint
- Previous medical history
- Surgical history
- Current medications
- Allergies
- Family history
- Social history
- Smoking history
- Alcohol use
- Substance use
- Mobility
- Activities of daily living
- Baseline cognitive or functional status
- Relevant psychosocial circumstances

Include only information that contributes to the scenario.

# Initial Presentation

Describe the patient's presentation when learners first encounter them.

Include relevant:

- Position and environment
- General appearance
- Behaviour
- Level of distress
- Communication
- Symptoms
- Physical signs

Where useful, provide opening dialogue for the patient or simulated participant.

# Initial Observations

Provide clinically plausible observations appropriate to the presentation.

These may include:

- Respiratory rate
- SpO₂
- Oxygen therapy
- Heart rate
- Blood pressure
- Temperature
- Blood glucose
- Glasgow Coma Scale
- AVPU
- Pain score
- ECG findings
- Capillary refill time
- NEWS2 or another appropriate scoring system
- Relevant examination findings

Do not include observations simply to populate a template.

Ensure all values are internally consistent with the intended condition and severity.

# Investigations

Where relevant, provide results such as:

- 12-lead ECG
- Blood tests
- Blood gas analysis
- Urinalysis
- Imaging
- Point-of-care testing
- Pregnancy testing
- Microbiology
- Specialty-specific investigations

For simulation delivery, indicate when results become available:

- immediately
- when requested
- after an appropriate learner action
- at a defined stage of the scenario

# Scenario Progression

Use phases or states where useful.

For each phase, define relevant:

- Trigger
- Patient presentation
- Observations
- Information available to learners
- Expected learner actions
- Response to appropriate management
- Response to delayed or inappropriate management
- Criteria for progressing to the next phase

The patient's response must remain clinically plausible.

Do not force deterioration purely to increase scenario difficulty.

# Expected Learner Actions

Describe the important actions learners would reasonably be expected to undertake.

These may include:

- Initial assessment
- Recognition of clinical priorities
- Escalation
- Communication
- Investigations
- Treatment
- Medication administration
- Reassessment
- Team leadership
- Human factors
- Safeguarding
- Capacity or consent considerations
- Referral
- Disposition

Actions must remain appropriate to the profession and learner level.

Focus on key behaviours and decisions rather than prescribing one rigid sequence.

# Medications

Where medications form part of the scenario, include relevant:

- Generic medication name
- Indication
- Route
- Dose where educationally appropriate
- Relevant cautions or contraindications
- Expected response

Follow the medication and evidence requirements in `clinical-evidence.md`.

# Faculty Guidance

Provide relevant operational information for facilitators:

- Faculty roles
- Simulated participant instructions
- Prompts that may be given
- Information supplied only if learners request it
- Expected sequence of events
- Key decision points
- Scenario progression triggers
- When to pause or terminate the scenario
- Expected responses to important learner actions
- Optional escalation or simplification strategies

Avoid over-scripting faculty where flexible facilitation would better support the learning objectives.

# Simulation Requirements

## Equipment

Include only equipment needed for delivery.

Examples may include:

- Patient monitor
- Defibrillator
- Airway equipment
- Oxygen
- IV or IO equipment
- Medication props
- Documentation
- PPE
- Specialty-specific equipment

## Moulage

Where relevant, describe required:

- Wounds
- Skin changes
- Bleeding
- Swelling
- Burns
- Rashes
- Medical devices
- Other visible findings

Describe what educators need to reproduce rather than adding unnecessary graphic detail.

## Environment

Specify environmental requirements where relevant, such as:

- Hospital ward
- Emergency department
- Ambulance
- Patient home
- GP surgery
- Mental health setting
- Community location
- Theatre
- Maternity setting
- Major-incident scene

Include environmental details only where they influence scenario delivery, clinical reasoning or human factors.

# Debrief

Provide 3-6 open facilitation questions linked to the learning objectives.

Questions should promote reflection rather than simple factual recall.

Useful themes include:

- Initial priorities
- Clinical reasoning
- Recognition of deterioration
- Reassessment
- Communication
- Leadership
- Teamwork
- Human factors
- Alternative approaches
- Translation to clinical practice

Example prompts:

- What were your initial priorities and why?
- Which findings most influenced your clinical reasoning?
- How did the team recognise and respond to changes in the patient's condition?
- What communication strategies helped or hindered the team?
- Were there points where an alternative approach could have been taken?
- What would you take from this scenario into future practice?

Separate clinical and human-factor themes where useful.

# Diversity and Accessibility

Across scenarios, vary patient characteristics naturally.

Relevant characteristics may include:

- Age
- Sex
- Gender identity
- Ethnicity
- Language
- Religion or faith
- Disability
- Neurodivergence
- Learning disability
- Mental health
- Socio-economic circumstances
- Housing
- Family and caring responsibilities
- Sexual orientation where clinically or educationally relevant

Do not use demographic characteristics as shorthand for diagnoses, behaviours or social circumstances.

Include reasonable adjustments, communication needs and accessibility considerations where relevant.

# Output Variants

Adapt the structure to the requested deliverable.

## Brief Scenario Outline

Provide:

- Purpose
- Learner group
- Setting
- Patient summary
- Learning objectives
- Core scenario progression

## Full Simulation Package

Use the complete relevant structure in this reference.

## Faculty Guide

Prioritise:

- scenario progression
- simulated participant behaviour
- information release
- prompts
- decision points
- operational instructions

## Learner Handout

Include only information learners should legitimately receive before or during the scenario.

Do not expose faculty-only information, diagnosis or expected actions unless explicitly intended.

## Debrief Guide

Prioritise:

- learning objectives
- reflective questions
- clinical themes
- teamwork and human factors
- evidence or guidance relevant to discussion

## Scenario Progression

Present the scenario as clear phases or states with:

- trigger
- patient state
- observations
- learner actions
- resulting change