Simulation Training Is Key to Patient Safety

To meet this goal, one would need to create a scenario in which providers need to make multiple requests of multiple people (for example, for labs, blood, and medication) in a short time succession.

A hemorrhage and a code are examples of clinical situations in which there is a need for many closed-loop communications in a short time. The specific medical condition, however, becomes somewhat secondary in this case because the training and the debriefing will focus on closed-loop communication.

It is possible to meet multiple training goals during one training session, but it is important to not overwhelm the trainees (or the trainers). As trainees and trainers become more experienced, it becomes easier to incorporate more objectives into a single training session, but it is still crucial to focus the training on the objectives and to limit the number of such objectives.

▸ Keep it simple. A long complicated scenario is not necessarily what is needed to achieve training goals. It is worth considering that for certain teaching/training goals, multiple short scenarios may be a better way to get multiple training points across or to reinforce concepts that have already been taught.

Although there are some training goals that may require longer, more complex scenarios, it is worth remembering that when the scenario is longer and more complicated for the learner, it is also longer and more complicated for the trainer.

One should “save” such scenarios for specific training points for which they are needed.

We like to try to create scenarios that run in 10 minutes or less. We also like running a scenario, debriefing the trainees, and then immediately running it again to reinforce the learning points reviewed during the debriefing.

▸ Do not reinvent the wheel. One scenario can often be modified in simple ways to meet different teaching objectives. We added high blood pressure and headache to our simulated patient with precipitous delivery in triage, for instance.

In doing so, we easily added teaching points on the management of severe preeclampsia to our teaching points on managing a precipitous delivery.

Through this process, we also incorporated a teaching point that we try to reinforce through multiple scenarios—the idea that being focused on the task at hand is not the same as putting on blinders because the most obvious or pressing problem is not necessarily your only or biggest problem.

▸ No simulation is better than bad simulation. Do not reinforce bad habits or bad medicine. It is important that teaching points be evidence based, and that during training we reinforce management that is within the standard of care.

Similarly, one should not allow inappropriate behavior to be reinforced during debriefings. It defeats the purpose of simulation training to allow, during debriefings, the very behaviors we are trying to eliminate.

The belligerent, bullying nurse or physician cannot be allowed to dominate or commandeer the debriefing session.

The ability of the trainers to avoid this situation or to manage it in a manner that is going to be productive to the goals of teamwork and communication will be much greater if they have had an opportunity to train and practice their debriefing skills.

▸ Debriefing is key. A debriefing is the time after a scenario when participants are led in a discussion of what happened during the scenario.

The participants identify ways in which things went well and why, and ways in which things did not go well and why.

It is sometimes said that simulation is an excuse for a debriefing; this is because much of the teaching that happens during simulation training occurs during the debriefing.

A debriefing may be very straightforward such as when a scenario is designed to meet very technical or process-oriented goals.

For example, if the goal of the scenario is to practice the steps of the neonatal resuscitation program, then the debriefing may be as simple as identifying those moments when any of the team members did not follow the steps.

Debriefings have the potential, however, to become emotionally charged. This is most likely during debriefings that are meant to train providers on team interactions and communication.

We recommend that if a group is going to institute any team training using simulation, they invest in having their trainers participate in some sort of train-the-trainer programs that will teach them and let them practice their debriefing techniques.

▸ “What happens in 'sim' stays in 'sim.'” For learning to occur, it is important to keep simulation training friendly and safe for the participants.