Developing Simulation Scenarios from Japanese Clinical Pathways
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What Are Clinical Pathways in Japan?
What Are Clinical Pathways in Japan?
Japanese clinical pathways (クリニカルパス) are standardized, evidence-based care plans used in hospitals to guide multidisciplinary treatment. They outline:
Expected symptoms and recovery timeline
Nursing assessments and interventions
Medical procedures and tests
Patient education and discharge planning
Common pathways include:
急性心不全クリニカルパス（Acute Heart Failure Pathway）
虫垂炎クリニカルパス（Appendicitis Pathway）
正常分娩クリニカルパス（Normal Delivery Pathway）
脳卒中クリニカルパス（Stroke Pathway）
がん治療クリニカルパス（Cancer Treatment Pathways）
Clinical pathways are widely used by university hospitals, Red Cross hospitals, and community hospitals across Japan.
Why Use Clinical Pathways for Simulation Scenario Development?
Why Use Clinical Pathways for Simulation Scenario Development?
Clinical pathways are ideal foundations for creating Simulated Patient (SP) scenarios because they provide:
Realistic, chronological patient progression
Clear nursing responsibilities and red flags
Consistent, evidence-based practice
Multidisciplinary checkpoints
Opportunities for communication training
How to Create SP Scenarios From Clinical Pathways
How to Create SP Scenarios From Clinical Pathways
1. Choose a Specific Pathway
1. Choose a Specific Pathway
Select a real Japanese pathway appropriate for your lesson goals.
Examples:
心不全（Heart Failure）
虫垂炎（Appendicitis）
正常分娩（Normal Delivery）
大腿骨頸部骨折（Hip Fracture）
2. Break the Pathway Into Phases
2. Break the Pathway Into Phases
Most Japanese pathways are organized by day or event:
入院（Admission）
術前（Pre-operative）
術後 Day 1–7（Post-operative recovery）
リハビリ開始（Rehabilitation start）
退院指導（Discharge teaching）
For each phase, list:
Expected symptoms
Nursing assessments
Patient questions
Communication needs
Risk signs
3. Identify “Teachable Moments”
3. Identify “Teachable Moments”
Look for moments where students must make decisions or communicate clearly.
Examples:
New pain, nausea, or changes in vital signs
Anxiety about procedures
Misunderstanding of instructions
Cultural or language barriers
These become the key turning points in your SP scenario.
4. Build the SP Script
4. Build the SP Script
Create a script that includes:
Chief complaint
Current symptoms
Emotional tone
Cultural or language needs
Questions the patient will ask
Expected student actions
Scripts can have 2–5 stages that mirror the pathway’s timeline.
5. Add International Nursing Elements
5. Add International Nursing Elements
To support global readiness, add appropriate elements such as:
English or simplified-Japanese communication
Interpreter role-play
Health literacy issues
Medication misunderstanding
Cultural expectations about care
This integrates international nursing skills directly into pathway-based learning.
Example: Scenario From the Appendicitis Clinical Pathway
Example: Scenario From the Appendicitis Clinical Pathway
Phase 1: Admission (Day 0 – ER)
Phase 1: Admission (Day 0 – ER)
Lower-right abdominal pain
Mild fever
English-speaking patient with limited Japanese
Student tasks: assessment, triage, explaining tests
Phase 2: Post-Op Day 1
Phase 2: Post-Op Day 1
Pain increases to 7/10
Nausea, difficulty standing
Student tasks: prioritize symptoms, check wound, report concerns
Phase 3: Day 3 – Recovery
Phase 3: Day 3 – Recovery
Patient is anxious about returning to work
Student tasks: explain diet/activity restrictions in simple English
Phase 4: Discharge
Phase 4: Discharge
Patient unsure about wound care
Student tasks: teach-back education (to check the patient understands), safety instructions
How to Use These Scenarios in Class
How to Use These Scenarios in Class
Combine with a Simulated Patient (SP) actor
Use checklists for unscripted, natural responses
Add vital signs charts or “pathway cards” for realism
Debrief using the clinical pathway as an evaluation tool
Integrate English phrases into every stage
Resources You May Add Later
Resources You May Add Later
Sample bilingual pathway extracts (e.g., Day 1 assessment items)
Downloadable SP script templates
Evaluation checklists for educators
Glossaries of pathway terminology (JP/EN)
Japanese Clinical Pathway Examples for SP Scenario Development
Japanese Clinical Pathway Examples for SP Scenario Development
1. 虫垂炎（Appendicitis）クリニカルパス（京都第一赤十字病院）
1. 虫垂炎（Appendicitis）クリニカルパス（京都第一赤十字病院）
Type: Surgery, acute abdomen
Very common condition
Students can practice pain assessment, pre-op explanation, post-op care, early mobility, discharge teaching
Easy to simulate in English with simple vocabulary
Source: (Note: Kyoto JRC’s CP list page includes surgical paths; you may need to check their list for “虫垂炎”) — CP list page 京都第一赤十字病院
2. 気胸（Pneumothorax）クリニカルパス（日本医科大学付属病院）
2. 気胸（Pneumothorax）クリニカルパス（日本医科大学付属病院）
Type: Respiratory, chest tube management
Clear clinical phases (ER → drainage → recovery → discharge)
Students practice respiratory assessment, oxygen therapy, warning signs, pain management
SP can present with "shortness of breath" and anxiety
Source: Toho University Omori Hospital, Respiratory Surgery: CP for pneumothorax (PDF) lab.toho-u.ac.jp
3. 糖尿病教育入院パス（Diabetes Education Hospitalization Pathway）京都第一赤十字病院
3. 糖尿病教育入院パス（Diabetes Education Hospitalization Pathway）京都第一赤十字病院
Type: Chronic disease + patient education
Excellent for communication and health literacy
Students practice daily assessments + teaching about diet, exercise, medication, blood glucose
Ideal for English role-play because content is predictable and safe
Source: Kyoto First Red Cross Hospital – CP list (includes multiple diabetes-education pathways) 京都第一赤十字病院
4. 鼠径ヘルニア（Inguinal Hernia）手術クリニカルパス（東部地域病院）
4. 鼠径ヘルニア（Inguinal Hernia）手術クリニカルパス（東部地域病院）
Type: Simple elective surgery
Straightforward pre-/post-op progression
Good for practicing explaining NPO (Nil by mouth), anesthesia concerns, wound care
Low complexity → good for undergraduate students
Source: Tokyo Metropolitan Tobu Hospital: General Surgery CP page, includes 鼠径ヘルニアパス (PDF) 東京都立病院機構
5. 良性乳腺腫瘍（Benign Breast Tumor Surgery）クリニカルパス（日本医科大学付属病院）
5. 良性乳腺腫瘍（Benign Breast Tumor Surgery）クリニカルパス（日本医科大学付属病院）
Type: Breast surgery (benign)
Excellent for psychosocial and emotional support
Students can practice sensitive communication (body image, anxiety)
Includes post-op wound care + discharge teaching
Source: Japanese Medical University (Nippon Medical School) – “乳房部分切除＋腋窩リンパ節郭清” CP sheet (PDF) Nihon Medical School
6. 小児喘息（Pediatric Asthma）入院クリニカルパス（広尾病院）
6. 小児喘息（Pediatric Asthma）入院クリニカルパス（広尾病院）
Type: Pediatric respiratory
Good for family-centered communication
Students practice explaining inhaler use, triggers, emergency signs
SP can be the parent → easy and realistic
Source: Hiroo Hospital (東京都立広尾病院) – Clinical-Path page listing CPs including pediatric asthma (“ウイルス性気管支炎/喘息性気管支炎”) 東京都立病院機構
Advantages of using Clinical Pathway Scenarios for Nursing Education
Advantages of using Clinical Pathway Scenarios for Nursing Education
Each has a clear timeline (admission → treatment → recovery → discharge).
All involve nursing assessments + communication tasks suitable for role-play.
They cover a mix of acute, chronic, surgical, and pediatric conditions.
All can be adapted into simple English without heavy medical jargon.
They match typical 3rd-year Japanese Bachelor of Science in Nursing curricula.
Contact & Collaboration
Contact & Collaboration
If you are an educator interested in developing pathway-based simulation scenarios or contributing your own cases, please contact us.
We welcome collaboration with universities, hospitals, and researchers.
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