Simulation Training Is Key to Patient Safety

The internal validity of such training has always been the aviation industry's impetus to conduct extensive team and simulation training.

The citation on the award given to the crew following this event read: “The reactions of all members of the crew, the split-second decision making, and the handling of this emergency and evacuation was 'textbook' and an example to us all.”

Captain Sullenberger, who himself runs a safety consulting business on the side, has publicly credited the training that he and his crew have received for years for allowing them to successfully land and evacuate the plane without any casualties.

Getting Started

The following tips are based on our experience and that of others:

▸ Simulation is a technique—not a technology. Purchasing a simulator does not mean you have a ready simulation program. The simulators and mannequins are technologies used for simulation. We have heard many stories of people with expensive simulators still sitting unused.

Similarly, owning a particular simulator is not a prerequisite to initiating simulation training.

Before undertaking what can be a significant monetary investment in an expensive simulator, first outline the type of training that will be conducted and then determine what type of simulator and other equipment will be necessary for the type of training that is planned.

There are some relatively affordable low-tech mannequins that can be used in combination with a standardized patient/actor to create a hybrid simulator and very realistic scenarios. For certain scenarios it is possible to use an actor or standardized patient instead of a mannequin.

Some sites have started conducting training using very low-tech solutions and have incorporated both higher-tech simulators and more complex scenarios as both their expertise and their programs have grown.

▸ Plan big but start small. It is critical to identify your target audience(s) and program goals early. It is also important, however, to not try to meet all goals and serve all audiences from the start.

Some sites have very specific training goals that will involve relatively few participants. For example, a site may decide to use simulation to train their nurses and hospitalist ob.gyns. on a couple of basic obstetric emergencies in a “drill” sort of format.

Even a site with a small audience and well-defined objectives will benefit from starting slowly. In this case, for example, it would be best to start by picking one of the “simpler” emergencies such as shoulder dystocia and run that scenario repeatedly until the people responsible for running the simulations feel comfortable and confident in the process of running simulations and debriefing trainees.

Waiting until there is a basic comfort before moving onto more complex scenarios (such as a maternal code) will prevent much frustration among both the trainers and the trainees.

▸ A program does not run itself. Probably one of the most important steps when beginning a simulation initiative is to identify the individual(s) who will organize and run the simulation program and who will take care of such things as scheduling, securing equipment and supplies, setting up and cleaning up, testing scenarios, and managing video recordings.

Although some sites choose to have providers serve in this role, the individuals who run the program do not have to be the medical experts on the topics that will be trained. It is crucial, however, that these individuals be allotted enough time to run the simulation training.

If these individuals are not already well versed in simulation, it may be worth allowing them some time to become familiar with the subject and possibly allowing them to attend some training on running a simulation program.

▸ Simulation takes time. Conducting simulation training is like running a theater where each training session is a play. Writing and rehearsing a scenario take time, as does mounting the stage and conducting the performance.

Although the time it takes to develop a training session will decrease with experience, it is nonetheless a time-consuming effort and not something that is easily added to someone's already full schedule.

▸ Decide up front what you want to accomplish. You have to know what you want to do before you set out to accomplish it. Define a goal before writing a scenario, and then write the scenario to achieve that goal.

“To train teams to have better team communication during obstetric emergencies” is a good goal for a simulation program, but is not a good, clearly defined goal for a scenario, for instance.

“The learner will practice using callbacks or closed-loop communications during obstetric emergencies” is an example of a clearly defined goal appropriate for a scenario.