Scenario versus Simulation: What, Where, Why, & When

This article was originally posted in our June 2017 Newsletter, by John Spencer, Customer Service Manager, Lead Medical Educator

The advent of the NREMT’s Paramedic Psychomotor Competency Portfolio Program (Portfolio) has brought about a renewed focus, and some confusion, surrounding the use of scenarios and simulations. The Portfolio program requires the use of testing “scenarios” that unlock specific clinical categories for the student (see page 27 of the 2015 Paramedic Psychomotor Competency Portfolio Program Manual for the flow chart of this process, NREMT, 2017). They also revamped the Psychomotor testing process to include the Integrated Out of Hospital Scenario testing station (NREMT, 2017). It is this author’s opinion, the NREMT’s decision to use the term “scenario” to describe what is actually a testing “simulation” has been the catalyst that has brought about this increase in confusion. The terms have been used interchangeably, but in reality, they are very different creatures with different purposes. Let’s take a look at the what, where, why, & when of scenario versus simulation.

A scenario is defined as “an imagined or projected sequence of events, especially any of several detailed plans or possibilities” (The definition of scenario, 2017). Scenarios are used to help develop a student’s critical thinking abilities during the formative phase of education and are useful tools in both the didactic and skill lab sections of any program. They can be as simple as a verbal discussion of what should be done when given a situation or they could be used to paint a picture of a scene during psychomotor skill acquisition. They can be increased in complexity and difficulty to help encourage the students’ progression through the Bloom levels in both the cognitive and psychomotor domains. Due to the formative nature of scenarios, it is important to recognize and correct mistakes as they are being made to prevent the mistakes from being committed to memory. Recognizing this, it is easy to see that scenarios are teaching tools that are meant to aid in the students’ learning process.

A simulation is defined as an “imitation or enactment, as of something anticipated or in testing” (The definition of simulation, 2017). A simulation works to achieve an element of suspended disbelief, actually drawing the candidate into the scene, by using elements to make the experience seem as real as possible. Moulage, sights, sounds, and smells are used in simulations to create realism to aid in achieving the element of suspended disbelief. Simulations are most often objective summative testing events created to test a student’s ability to exercise their knowledge, judgment, and skills in a controlled “real world” environment. Simulations provide an excellent opportunity to evaluate a student, not only on their ability to apply what they have learned, but also on their ability to be an effective team leader or team member. They also provide an amazing opportunity to evaluate the participants on the affective domain. Due to their summative nature, simulations are allowed to run the allotted time limit without faculty interaction, regardless of participant performance, and are only interrupted for true safety concerns.

This is the type of event that our students will experience with the Out of Hospital Scenario testing during their NREMT psychomotor skills test. It is also the type of event that the Portfolio program utilizes to unlock clinical categories for the students to complete. Even though the NREMT uses the term “scenario”, it is helpful to understand that the summative evaluation process described is actually intended to be a simulation. This understanding will help each of us as we prepare the next generation of EMS providers.

If you have any questions or would like more information on these topics, please contact a member of our Education Team.

the definition of scenario. (2017). Retrieved 23 May 2017, from

the definition of simulation. (2017). Retrieved 23 May 2017, from

National Registry of EMTs. (2017). National Registry of EMTs. Retrieved 23 May 2017, from