Nursing Research and Practice ECRM Leadership Team communication Work delegation Attention allocation Information utilization Resource utilization Early call for help Professional behavior Total score ∗ Indicates signiﬁcance P < .05. Table 2: Results comparing scenario 1 (time 1) to scenario 2 (time 2). Scenario 1 mean Scenario 2 mean 4.13 3.79 3.64 3.92 3.76 3.54 3.70 3.83 30.32 4.22 4.33 3.75 4.10 4.25 3.42 3.25 4.54 31.90 5 Signiﬁcance (P value) .643 .047∗ .698 .456 .085 .783 .359 .003∗ .424 1 was conducted in September 2009, and Scenario 2 was conducted in November 2009. The students were all given background information on the scenario (i.e., some students playing roles in the simulation were given cue cards if a certain response was required during the simulation), and then the scenario was started. The students who played the roles were volunteers from the larger group. The communication was done using the text chat function in SL so that all students could see the communication interaction. The text chat function in SL is similar to most online chat programs and allows the students to type in their communication and others to respond. The communication stream is visible on the computer to all avatars in the area. One of the facilitators ran the scenarios in SL by giving the students their instructions via text chat and passing note cards (written information that can be passed in- world between avatars) when appropriate. The simulations ran for approximately 10–15 minutes. At the conclusion of the scenario, all of the students (including those who played a role) met in the classroom and were thoroughly debriefed by a trained facilitator. Text chat logs from the simulation were saved for future analysis. Students who did not play a role in the scenario were asked for speciﬁc feedback during the debrieﬁng on how they might have handled the situation. All 61 students participated in both virtual simulations; however, the majority of those students participated as observers. Diﬀerent students played roles in each scenario allowing a larger portion of the 61 students to directly participate. After the completion of the virtual scenarios all students were asked to complete the satisfaction questionnaire. 3.3. Data Collection. During the scenario only the charge nurse role and the bedside nurse role were evaluated using the shortened EMCRM by the trained observers. The other roles played by students (tech and family member) and facilitators were part of the scenario ﬂow but not scored. The bedside role was scored in all the scenarios, but the charge role was only scored if the charge nurse was called upon by the bedside nurse to help out which accounts for the diﬀerent number of observed cases between scenario 1 and 2 (8 versus 7). In other words, there were 8 observations for scenario one and 7 observations for scenario 2 that were analyzed in the study. Multiple raters independently observed the subjects’ per- formance in key roles (day RN or bedside nurse, charge RN) on both scenarios. The raters were trained by the researchers prior to the virtual simulations in the use of the tool and the behaviors that would indicate the various scores. Each rater was given an overview of the EMCRM tool and the deﬁnitions for each item. Examples of what that behavior looked like were discussed. All raters observed the simulation at the same time and scored their sheets. After the initial scenario, raters were able to compare their results and any disagreements in ratings were discussed immediately after the simulation. Raters then continued to score each subsequent simulation independently. The raters used a 5- point Likert scale (1 = poor; 5 = excellent) to assign scores for each of the 8 items on the scale, for a total possible score of 40. These scores were then averaged for a single consensus score for each subscale for each group and role. Scenario 1 had a total of 8 roles (bedside nurse and charge nurse) for ﬁve groups, and scenario 2 had 7 roles (bedside nurse and charge nurse) for four groups that were scored. Data was entered into PASW for Windows, Version 17.0. Descriptive statistics for all continuous variables were computed, and independent t-tests were performed to compare student performance over time. 4. Results and Discussion As noted in Table 2, overall student performance (total EMCRM score) on the second virtual unit scenario (average score 31.90, SD 3.19) was slightly better than performance on the ﬁrst scenario (average score = 30.32, SD 4.09) showing some improvement with exposure to this type of computer- based simulation. Independent t-tests were performed to compare the av- erage value of each of the subscale variables between Scenario 1 and Scenario 2 to determine if there were significant dif- ferences in performance based on repeated exposure. Team communication (P = .047, 95% CI: −1.06, −.007) and pro- fessional behavior (P = .003, 95% CI: −1.12, −.303) showed a signiﬁcant diﬀerence between the two scenario expo- sures. Speciﬁcally, the student’s ability to communicate with the team and their professional behavior improved from scenario 1 to scenario 2.