CPIA Module 17, Section 3: Train-the-Trainer and Simulation Techniques
MODULE 17: TRAINING & END-USER SUPPORT

Section 17.3: Train-the-Trainer and Simulation Techniques

Learn how to scale your educational efforts exponentially. We’ll cover the “Train-the-Trainer” model to build a force of peer educators and explore how to leverage a training environment to simulate real-world scenarios, building critical workflow muscle memory.

SECTION 17.3

Train-the-Trainer and Simulation Techniques

From Solo Practitioner to Clinical Preceptor: Scaling Your Expertise.

17.3.1 The “Why”: The Unscalable Expert and the Power of Force Multiplication

You have completed a brilliant Training Needs Analysis and designed a suite of world-class training materials. You are, without a doubt, the subject matter expert on the new system. And that is a profound liability. A project’s success cannot hinge on the knowledge locked inside the heads of a few informatics specialists. There are a finite number of you and a finite number of hours in the day. The simple, brutal math of a large-scale implementation dictates that the informatics team alone cannot possibly train hundreds, let alone thousands, of end-users effectively. Attempting to do so is a recipe for burnout, inconsistent messaging, and ultimately, project failure.

This presents a strategic dilemma: how do you get your expert knowledge into the hands of every single user in a way that is timely, credible, and sustainable? The answer does not lie in working harder; it lies in working smarter by adopting a strategy of force multiplication. In a military context, a force multiplier is a factor that dramatically increases the effectiveness of a combat force. For an informatics project, your force multiplier is a well-designed Train-the-Trainer (T3) program. This model transforms you from the sole source of knowledge into the leader of an educational platoon.

The core concept is simple: instead of training 300 end-users yourself, you will intensively train and mentor 30 carefully selected “super-users.” You will pour your expertise into them, equip them with the skills to teach their peers, and empower them to become champions for the new system. These 30 super-users will then go on to train the other 270 staff members. This approach has several profound advantages:

  • Scalability: It is the only feasible way to train an entire organization. It allows training to happen in parallel, dramatically compressing the time required to get everyone up to speed.
  • Credibility & Trust: A message delivered by a respected peer is often far more powerful than one delivered by an “IT person” from another department. When a veteran pharmacist says, “I was skeptical too, but this new workflow is actually safer,” it carries immense weight.
  • Customization & Relevance: Peer trainers understand the unique culture, challenges, and inside jokes of their specific unit. They can tailor the training content and answer questions with a level of real-world context that an informatics analyst, no matter how skilled, can never fully replicate.
  • Sustainability: The T3 model builds a lasting infrastructure of expertise within the departments. Long after the informatics team has moved on to the next project, these super-users remain as the first line of support, the go-to experts for new hires, and the champions for ongoing optimization.

Paired with this model is the essential tool of simulation. You cannot learn to swim by reading a book about swimming. You cannot learn a complex clinical workflow by watching a video. You must build “muscle memory” through deliberate, hands-on practice. A dedicated training environment, or “sandbox,” provides a safe space for users to practice, make mistakes, and build confidence without any risk to patient safety. When led by skilled peer trainers, these simulation sessions become high-fidelity dress rehearsals for Go-Live, transforming abstract knowledge into concrete, real-world competence.

Retail Pharmacist Analogy: From Preceptee to Preceptor

Think back to your own journey as a pharmacist. On your first APPE rotation, you were the end-user. You had a wealth of book knowledge but almost no practical skill in navigating the pharmacy’s specific computer system and workflow. Your preceptor was your trainer.

A great preceptor didn’t just tell you where to click. They invested in you. They explained the “why” behind the workflow. They let you practice on dummy profiles (your first “simulation environment”). They watched you, gave you immediate feedback, and gradually gave you more responsibility. They spent an intensive 4-6 weeks pouring their knowledge into you. This was your “super-user training.”

Now, fast forward five years. You are an experienced pharmacist, and you’ve decided to become a preceptor yourself. You are now part of a Train-the-Trainer model. The college of pharmacy (the “informatics team”) can’t possibly train every student in the country. Instead, they rely on a network of trusted, skilled preceptors like you to scale their educational mission. The college provides you with the curriculum, the objectives, and the evaluation tools (the “T3 materials”), but you are the one who delivers the training, tailored to the unique environment of your pharmacy.

When your new student arrives, you don’t throw them onto the bench on day one to verify real prescriptions. That would be unsafe and overwhelming. Instead, you start them in a simulation. You create fake prescriptions in the training environment. You give them a complex scenario: “This patient is on warfarin, has a new antibiotic, and their insurance is rejecting. What are the five things you need to do?” You let them work through the problem, make mistakes, and ask questions in a safe space. Only after they have demonstrated competence in this simulated environment do you allow them to perform the task under supervision with real patients.

This entire, time-honored model of pharmacy education—of intensively training preceptors who then use simulation to safely build the skills of new practitioners—is the exact blueprint for a successful Train-the-Trainer and simulation strategy in pharmacy informatics. You are moving from being the student to being the master preceptor for the entire department.

17.3.2 The Train-the-Trainer (T3) Model: Architecting Your Army of Champions

A Train-the-Trainer program is far more than just giving a few people early access to the system. It is a formal, structured initiative to build a sustainable, in-house network of experts. A successful T3 program requires a deliberate, multi-phase approach, starting with a rigorous selection process and culminating in the empowerment of a confident, competent training force.

Phase 1: Recruitment and Selection — Choosing Your Platoon Leaders

This is the single most important success factor for your T3 program. Selecting the wrong people—even if they are technologically brilliant—can actively sabotage your efforts. A super-user who is respected but a poor communicator is ineffective. A super-user who is a great communicator but not respected by their peers will be ignored. You are looking for a rare combination of technical aptitude, interpersonal skills, and cultural influence. This is not a role for everyone, and it should be a selective, application-based process where possible.

You must work closely with departmental leadership to identify candidates, but the final selection should be made by the informatics training team based on a clear, objective set of criteria.

Masterclass Table: The Super-User Selection Matrix
Attribute Category Specific Trait Why It Matters How to Assess It
Technical Aptitude Comfort with Technology They must be able to master the system themselves before they can teach it. They should not be afraid to click, explore, and troubleshoot. Manager feedback. Self-assessment on survey (“On a scale of 1-5, how comfortable are you learning new software?”).
Process-Oriented Thinking They should see workflows as a series of logical steps and be able to explain them sequentially. Interview question: “Walk me through the steps you take when you receive a verbal order. What do you do first, second, third?”
Problem-Solving Skills When faced with an error, do they give up, or do they try to figure it out? Manager feedback. Interview question: “Tell me about a time you encountered a problem with our current system. How did you resolve it?”
Interpersonal Skills Patience & Empathy They will be training anxious, sometimes resistant colleagues. They must be able to remain calm and supportive. Observation. Manager feedback. Interview question: “Imagine a colleague is very frustrated with the new system. How would you approach them?”
Clear Communication Can they explain a complex topic using simple, non-technical language? Observe them precepting a student or training a new hire. Ask them to explain a simple pharmacy workflow to you during the interview.
Active Listening Do they listen to understand, or just to respond? They need to be able to diagnose a learner’s true point of confusion. Role-play a brief training scenario during the interview. Note if they ask clarifying questions.
Cultural Influence Respected by Peers This is non-negotiable. If their colleagues don’t trust them, their message will be dismissed. They must have clinical and social credibility. Manager nomination. Ask staff on surveys: “Who is the person you go to when you have a question about a complex clinical or workflow issue?”
Positive & Pro-Change Attitude They don’t have to be cheerleaders, but they must be professionals who see the project as a necessary and positive step forward. Chronic complainers are toxic to a T3 program. Survey responses about the project. General attitude observed in the department. Manager feedback.
Phase 2: The T3 Curriculum — Training the Trainers

Training a super-user is fundamentally different from training an end-user. An end-user needs to know “what” to do and “how” to do it. A trainer needs to know that, plus the “why” behind it, and “how to teach it” to someone else. Your T3 curriculum must be a rigorous, multi-faceted program that builds both system mastery and pedagogical skill.

The Four Pillars of a World-Class T3 Curriculum
  • Pillar 1: Deep System Mastery. Super-users get more time and more depth. They should be trained on not just their core workflows, but also on less common “edge case” scenarios. They need to be pushed to the point of failure in the training environment so they learn how to recover and troubleshoot.
  • Pillar 2: The “Why” Behind the Build. This is crucial. You must spend time explaining why the system was configured a certain way. “The reason you have to select a ‘Reason for Override’ is because The Joint Commission requires us to audit every single ADC override. This field is what allows us to create that report and remain compliant.” When a trainer can explain the “why,” they can defuse frustration and turn a seemingly annoying click into a meaningful action.
  • Pillar 3: Adult Learning Principles 101. Do not assume your super-users know how to teach. You must equip them with the basics. Teach them about learning objectives, the importance of hands-on practice, and how to give constructive feedback. Provide them with the core principles from Section 17.2 of this course.
  • Pillar 4: Facilitation and Classroom Management. Give them the tools to manage a classroom. This includes how to start a class, how to handle difficult questions (and what to do when you don’t know the answer), how to manage a dominant talker, and how to encourage quiet learners to participate. Provide them with a fully scripted “Instructor’s Guide” for the classes they will be teaching.
Phase 3: Empowerment and Logistics

Once trained, your super-users need to be officially empowered and supported. This is a management responsibility that the informatics team must facilitate.

  • Official Recognition: Their role as a super-user should be formally recognized by leadership. This can be through a certificate, a mention in a departmental newsletter, or even a small pin for their badge. This signals the importance of the role.
  • Dedicated Time: This is the most critical element. Super-users cannot be expected to provide training and support “in their spare time.” Management must commit to scheduling them off the bench and protecting their time to prepare for and conduct training. This is a project cost and must be budgeted for.
  • A Direct Line of Communication: Super-users need a dedicated communication channel to the informatics team (e.g., a specific Microsoft Teams channel or email group) to ask questions and get rapid support themselves.
  • The Instructor’s Kit: Provide them with everything they need to teach: a polished slide deck, a detailed instructor’s guide with talking points and timings, class rosters, evaluation forms, and copies of all QRGs and job aids.

17.3.3 The Power of Simulation: Building Muscle Memory in the Sandbox

The single greatest training resource at your disposal is the training environment, often referred to as TST, PLY, BUILD, or most commonly, the “sandbox.” This is a dedicated, non-production copy of the live EHR system. It is a technological playground where users can click any button, enter any order, and explore any workflow without any fear of impacting real patients. The use of this environment transforms training from a passive lecture into an active, hands-on simulation. It is the key to building procedural skill and user confidence.

Principles of Effective Simulation Design

Simply giving users access to the training environment is not enough. “Go play in the sandbox” is not a strategy. Effective simulation is structured, deliberate, and guided. It is built upon a foundation of well-designed clinical scenarios that mirror the complexity of the real world.

  • Context is King: Scenarios must be clinically realistic and relevant to the learner’s role. A pharmacist should not be practicing with a fake patient named “Mickey Mouse.” They should be working on “John Smith,” a 68-year-old male with a history of CHF who is being admitted for pneumonia. This clinical context makes the practice more meaningful and aids in knowledge transfer.
  • Start Simple, Build Complexity (Scaffolding): The first simulation should be a simple, “perfect world” scenario. Once the learner masters the basic clicks, you introduce complications. What happens if the drug is non-formulary? What if you get a critical allergy alert? This progressive difficulty builds skill without overwhelming the learner.
  • Embrace Safe Failure: The goal of simulation is to uncover misunderstandings before they can harm a patient. You must create a learning environment where it is psychologically safe to make a mistake. The trainer’s response to an error should never be judgmental. It should be, “That’s a really common mistake. Let’s walk through why the system gave you that alert.”
  • Guided, Not Dictated: A good simulation provides a clear goal (e.g., “Verify all of this patient’s new admission orders”) but does not give a click-by-click instruction sheet. The learner should have to think, problem-solve, and navigate the system to achieve the goal. The trainer’s role is to be the “guide on the side,” offering hints and feedback, not the “sage on the stage” dictating every move.
Masterclass in Scenario Development

Developing a library of high-fidelity simulation scenarios is a core task for an informatics trainer. These are your lesson plans for your hands-on sessions. A great scenario includes a patient backstory, a clear task for the learner, a list of expected actions, and key discussion points for the trainer.

Simulation Scenario 1: The Complex Med Rec (Pharmacist)

  • Patient: “Brenda Walsh,” a 72-year-old female with a history of A-Fib, HTN, HLD, and Osteoporosis. She is being admitted from home for a Community-Acquired Pneumonia.
  • Learner’s Task: “Brenda’s daughter has provided her home medication list. Please perform a complete admission medication reconciliation and verify all appropriate home medications.”
  • The Setup (in the Training Environment):
    • Patient Brenda Walsh has allergies to Penicillin (causes hives) and Lisinopril (causes cough).
    • Her home medication list (provided on paper to the trainee) includes:
      • Eliquis 5mg twice daily
      • Metoprolol Succinate 50mg daily
      • Losartan 50mg daily
      • Atorvastatin 40mg at bedtime
      • Fosamax 70mg every Sunday
      • Lisinopril 10mg daily (“I stopped this a month ago, it made me cough”)
    • The admitting physician has ordered Ceftriaxone and Azithromycin for the pneumonia.
  • Expected Actions & Trainer Debrief Points:
    1. Learner correctly documents the Lisinopril allergy (cough). (Debrief: Importance of allergy vs. intolerance documentation).
    2. Learner correctly discontinues the home Lisinopril from the list. (Debrief: Action for a discontinued med).
    3. Learner correctly continues the Eliquis, Metoprolol Succinate, Losartan, and Atorvastatin. (Debrief: Standard continuation workflow).
    4. Learner places the Fosamax on hold. (Debrief: Discussing hospital policy on holding non-essential home meds).
    5. Learner recognizes the potential drug interaction alert between Azithromycin and Metoprolol (QTc prolongation, bradycardia). (Debrief: How to evaluate and act on clinical decision support alerts).

Simulation Scenario 2: The STAT IVIG (IV Room Technician)

  • Patient: “Dylan McKay,” a 35-year-old male in the ICU with Guillain-Barré Syndrome.
  • Learner’s Task: “The physician has placed a STAT order for IVIG. The pharmacist has verified it. Prepare the first dose.”
  • The Setup (in the Training Environment):
    • A verified, STAT order for IVIG 400mg/kg is active in the system for patient Dylan McKay. His weight is documented as 80kg.
    • The system’s IV compounding module is active.
    • The standard IVIG concentration available is 10%.
  • Expected Actions & Trainer Debrief Points:
    1. Learner navigates to the IV preparation queue and selects the correct STAT order. (Debrief: Prioritizing the queue).
    2. Learner reviews the order. The system has calculated the dose as 32 grams (400mg * 80kg). (Debrief: Importance of trusting, but verifying, system calculations).
    3. Learner generates the label. The label prints with the calculated volume of 320 mL and includes specific instructions for infusion rate titration. (Debrief: Reviewing all elements of a complex IV label for accuracy).
    4. Learner correctly documents the lot numbers of the IVIG vials used in the compounding module. (Debrief: Importance of lot number tracking for biologics).
    5. Learner completes the preparation documentation, changing the order status from “Verified” to “In Process” and then “Prepared.” (Debrief: How real-time status updates improve communication with nursing).

17.3.4 Integrating T3 and Simulation: The Go-Live Dress Rehearsal

The Train-the-Trainer model and simulation-based learning are not separate strategies; they are two halves of a powerful whole. The pinnacle of your pre-go-live training program should be simulation labs that are led by your newly-minted super-users. This is where you put it all together. The super-user gets to practice their new teaching skills, and the end-users get to learn from a trusted peer in a hands-on, realistic environment. These sessions are your final, full-scale dress rehearsal before opening night.

Playbook for Running a Super-User-Led Simulation Lab
  1. The Huddle (15 minutes): Before the learners arrive, huddle with your co-facilitators (the super-users). Review the scenarios for the day, clarify the learning objectives, and assign roles. Decide who will lead the main demonstration and who will float around the room to provide one-on-one support. This is your pre-game strategy session.
  2. The Briefing (15 minutes): When the learners arrive, the lead super-user sets the stage. They welcome the group, reiterate the learning objectives (Gagné’s 2nd Event), and most importantly, establish the principle of “safe failure.” They might say, “This is the place to make mistakes. We want you to click the wrong thing here, so you don’t do it with a real patient next week. Our job is to help you, not to grade you.”
  3. Demonstration (30 minutes): The lead super-user demonstrates the “perfect world” version of the workflow, explaining the key steps and the “why” behind them (Gagné’s 4th & 5th Events).
  4. Guided Simulation (60 minutes): This is the core of the session. Learners work in pairs or small groups in the training environment to complete the prepared clinical scenarios. The super-users circulate, providing guidance, answering questions, and giving real-time feedback (Gagné’s 6th & 7th Events). The informatics trainer should observe the super-users in action and provide them with feedback on their teaching, but should resist the urge to jump in and take over.
  5. The Debrief (30 minutes): This is the most important part of the entire lab. The lead super-user facilitates a group discussion. This is not a Q&A session; it is a guided reflection on the learning process. The value of simulation is not just in the doing, but in the thinking about the doing.
The Art of the Debrief: Facilitating Reflection

A good debrief moves beyond “Does anyone have any questions?” It uses a structured model to guide the conversation. A simple and powerful model is the “Plus/Delta”:

  • Plus (+): The facilitator asks the group, “Based on the simulation you just did, what did you like about the new workflow? What parts felt easier or safer than the old way?” This focuses on the positive aspects of the change and helps to build buy-in.
  • Delta (Δ): The facilitator then asks, “What parts of the workflow felt confusing or challenging? Where did you feel uncertain or worried you might make a mistake?” This surfaces the remaining knowledge gaps and anxieties in a non-confrontational way.
  • Takeaways: The facilitator concludes by summarizing the key points and reinforcing the most critical “must-remember” steps for Go-Live. They might also identify a common Delta that needs to be addressed with a new Tip Sheet or QRG.