Last week I wrote about the important components in writing a simulation case. It is an exhausting list, but the thoroughness pays off.

The next big task is writing the actual case storyboard, which can be done in many ways. All revolve around the concept of action and reaction. The key to a well written simulation case is understanding the actions that the learners will take, the actions that they should take, the actions they shouldn’t take.

1. Table Format

TimeStatus of PatientCritical Action / Triggers to move to next stateDebriefing Learning Points
Time state 1
Time state 2
Time state 3


  • The important actions are clearly laid out.
  • Time is easy to identify.
  • Facilitates debriefing.


  • >More of a linear format.
  • Could be difficult to match to learner actions which may not be as linear.
2. Diagram Format


  • Actions can be anticipated.
  • Simulation case easily be adjusted for learners and different levels.
  • Can be confusing to see all the arrows.
  • May not be understandable by others without significant explanation.


3. Longhand Format

Exactly as it sounds, this format is a longhand, written, step-by-step account of each event, what the learners should do, etc. Think of writing out mini essays.  Here is a short example of such formatting for a case that Dr. Jacqueline Nemer and I wrote for ACEP 2012 SimWars:

Time 2-4 minutes

  • Patient status: Vitals unchanged (still 200/100 if no labetalol given); GCS 10-13 
  • Head CT results come back – display images sequentially until team asks for a radiology reading 

PMD Operator (assuming team asks to call primary MD):

  • 1st attempt: S/he interrupts immediately “please hold” plays awful music, hangs up. 
  • 2nd attempt: Puts the phone down so team can hear operator say “this guys keeps calling for Dr X”… finally connects the team to the PMD 
  • PMD contacted: 
    • Somewhat arrogant, slow to answer. “Let’s see here… Blood work done 1 week ago that showed platelets of 130, normal Cr.” PMH: repeatedly mentions the prostate cancer 10 years ago. Questions whether tPA should be given at all. Asks if the members of your team are neurologists. Questions whether the team knows the contraindications of tPA or not. Asks the team if they even bothered to talk to the wife about tPA risks stating that communication with families are the best way to avoid getting sued. Talks down to the team. 
    • Asks to speak with wife, “Are you sure you want him to get this tPA? He’s better off as he is rather than bleeding into his brain or dead. Well, I suppose there’s good benefit of tPA if you believe the news reports. Maybe you should call your kids first? Good luck with your decision. Got to go.” 


  • Formatting issues doesn’t get in the way of getting your ideas down on paper.
  • Understandable to other facilitators, assuming they read all of it.


  • Long and detailed oriented.
  • May not be well organized.
Nikita Joshi, MD

Nikita Joshi, MD

ALiEM Chief People Officer and Associate Editor
Clinical Instructor
Department of Emergency Medicine
Stanford University
Nikita Joshi, MD


Emergency Medicine Doctor Associate Editor of ALiEM Gun Sense Advocate #FOAMed #Docs4GunSense #MomsDemandAction Tweets represent my own views and opinions