The Highs and Lows of Integrating Simulation into an Educational

Program

Luke Wainwright – Simulation CoordinatorJesse Spurr – Simulation Educator

How we evolved

• Equipment training and support from CSDS• Support from Laerdal• Multidisciplinary-interdisciplinary• RMDP to RESCUE program• Advance Life Support• Twisted ALS

Brief History of Simulation in Healthcare

• Madame du Coudray – The King’s Midwife

• 1751 - observed high maternal and foetal death rates in rural France

• Peasant midwives• Developed detailed textbook

and simulators• Witnessed huge decline in

complications

Brief History of Simulation in Healthcare

Negative Experiences with Simulation

• “I hate role play”• “We’re too busy”• “That wasn’t realistic”• “It’s just a dummy”• “I wouldn’t normally do

that with a real patient”

More reasons not to…

• Lack of management buy in• Concerns for other patients witnessing

training

How we have started to overcome these issues

No Field of Dreams

If you build it….it doesn’t necessarily mean they will come.

I hate role play

• Safe environment• Confidentiality• Clinicians always play themselves• Train as you play

We’re too busy

• In situ scenarios done at handover time, cross over of staff and a traditional time for education

• Own time if they are enthusiastic• Using professional development leave

That wasn’t realistic

• Moulage• Different manikins• Comprehensive prebrief• Big brother• Scenario development• Supporting documentation

Its just a dummy

• Terminology sets expectations• Familiarisation• Advanced manikins: crying, talking, seizures• Simulated patients

I wouldn’t do that in real life

• Scenario development – vital• Know your evidence!• Discuss own experiences in debrief• Encourage reflection of participants and

faculty• Debrief

Lack of management buy in

• Develop a community of practice• Do it for free (the drug dealer business model)• Minimise impact to department• Link simulation to accreditation standards and

facility strategies• Establish clear governance

Patients witnessing scenario

• Pre brief patients• Involve patients in feedback• Change location of scenario if inappropriate

(sometimes you just have to cancel)• Have a contingency plan, i.e. another ward

• Flagship program• Incorporating IT into scenarios• WIL and SLE• Feedback to stakeholders• Reflective practice• Targeted learning packages developed

from scenario assessment

• Nurse managers interested in staff performance

• Fun way to learn• Efficient and transferable• Saleable• Revenue stream

RESCUERESCUE

Responding Early to SSigns of the Critically Unwell & Emergencies

The future

• “Simulation sans frontieres”

• Improved fidelity, moulage and scenarios

• Technology• Creativity• Education methodology• Research and evidence

based practice

1. Leave egos at the door and be prepared to fail, recognise failure and learn from it

2. Start with learning outcomes and build your scenarios around these

3. Create the highest fidelity possible4. Give participants positive experiences in

simulated learning5. The learning happens in the debrief

Top 5

Questions, comments, feedback(How did it feel? What went well? What would

you do different next time?)