What is Simulation in Healthcare?
Simulation in healthcare involves recreating events or scenarios as a teaching tool. There are various types of simulation, ranging from low to high fidelity depending on the level of realism created, along with the equipment used. Task trainers, computer-based simulators, standardized patients, and full-body manikins are described in further detail in the table below.
| Simulation from Low to High Fidelity | Description |
| Task Trainers | Simulators or anatomical models used for skills practice (i.e. IV starts, NG tube insertion). An IV arm and an airway management trainer are examples of task trainers |
| Computer Simulation | Can be used for learning, competency, and development of critical thinking skills (i.e. computer-based neonatal resuscitation that provides scenarios and feedback on actions taken) |
| Virtual Reality | Provides a lifelike computer-simulated environment with visual, auditory and tactile components (i.e. surgical laparoscopic trainers) |
| Standardized Patients | People trained to act like real patients. Can be used in case studies or role-playing |
| Full body manikin | Use of a mankin that can be programmed to respond appropriately to student actions |
(Lewis et.al., 2012)
Simulation Training and Teams
Interdisciplinary teams work together frequently in high stress situations and are expected to perform well with good patient outcomes. Yet, medical training is often done in silos. Simulation is one way to bring everyone together to teach and reinforce teamwork, communication, skills, and processes. This can be done with standardised patients or full body mankins, in a simulation lab removed from the clinical environment or on-site in the clinical area. There are several benefits of simulation training. It provides a safe environment in which it’s ok to make mistakes and learners can practice skills and behaviors without the watchful eye of a patient or family member. It can also be used to teach staff how to manage situations that are rare and catastrophic for patients, such as amniotic fluid embolism. Simulation can also help uncover system issues (Argani et.al., 2012). As such, simulation is often incorporated into patient safety programs.
Setting: In-Situ vs. Simulation Lab
There are advantages and disadvantages to simulations conducted in a clinical environment versus in a lab environment. A lab can be more difficult to make realistic with equipment and surroundings. However, it may be easier to plan and coordinate for all members to attend, and learners can fully focus on the simulation instead of having to worry about the patients they are caring for. When simulations are conducted onsite, the busyness of the unit and the availability of staff may impact the simulation. However, onsite simulations allow for real-time testing of response times, processes, and the potential for uncovering system issues. For example, a paging system that does not work well or drugs and equipment that are not readily available.
Ideally, a comprehensive simulation program incorporates both lab and on-site locations. The lab environment ensures everyone is getting the information and opportunity, and on-site allows for practice, reinforcement, and identification of any systems issues.
Simulation Program
A comprehensive simulation program includes didactic, simulation, and debriefing. Education can either be assigned before or after the simulation. One advantage to having learners complete education prior to the simulation is that they will come prepared and have good baseline knowledge. The simulation portion allows learners to have hands-on experience and apply what they have learned if given a pre-work assignment.
The traditional format used in a scheduled simulation that may take place in a simulation lab includes:
- Introduction of all staff involved
- Review of ground rules to establish a safe learning environment with confidentiality
- Review of equipment and environment
- Assignment of roles
- Review of scenario
- Simulation
- Debriefing
Case Example: Shoulder Dystocia Simulation
Let’s use an example of simulation to reinforce teamwork and communication, and teach a new process related to the team management of shoulder dystocia. This process includes the activation of an emergency response team, designated roles, and clear communication among staff. Learners are given materials to review prior to the simulation so that they come prepared and have good baseline knowledge. Participating in the simulation gives them an opportunity to apply muscle memory to education and integrate changes to the bedside. Bringing the team together in this format reinforces the importance/understanding of everyone’s roles, respectful behavior, and key team skills like communication. Clear communication is practiced by the provider to activate the emergency response team, which is repeated back by the nurse, to which the provider replies “that’s correct”. This is one example of closed-loop communication incorporated into the simulation.
After the scenario is complete the team debriefs to discuss what happened and why in the scenario, what went well, and any areas for improvement in moving forward. The debriefing portion of the simulation is often cited as the most important part. It allows for open communication among the group without the stress of a bad patient outcome (Argani et.al., 2012). Debriefings offer learners an opportunity to reflect on their actions, discuss process or system opportunities and make recommendations for improvement. For example, during this same shoulder dystocia simulation, the team cancels the emergency activation response team immediately after the neonate is delivered and prior to the neonatal intensive care unit (NICU) team responding (part of the emergency response team). The infant needed resuscitation and evaluation by NICU. During debriefing, the team recognizes the need to allow all members to respond prior to canceling the event.
In summary, interdisciplinary simulation training incorporated into a patient safety program teaches and reinforces teamwork, communication, skills, and processes. It provides a hands-on way to apply muscle memory to education and integrate changes to the bedside.
References
Argani, C. H., Eichelberger, M., Deering, S., & Satin, A. J. (2012). The case for simulation as part of a comprehensive patient safety program. American Journal of Obstetrics and Gynecology, 206(6), 451-455. doi:10.1016/j.ajog.2011.09.012
Lewis, R., Strachan, A., & Smith, M. M. (2012). Is high-fidelity simulation the most effective method for the development of non-technical skills in nursing? A review of the current evidence. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3415625/
Copyright by Jeanette Zocco RNC-OB, C-EFM, C-ONQS