Sim Passion

So why am I passionate about simulation and why is it important?  As a young bloke I used to work in the field of resuscitation – running around a massive UK hospital attending resuscitation attempts and teaching the life support courses.  Over the years I probably attended around 1,600 emergencies – which was great for my skill development.    The problem of course is that most of us don’t get that level of experience as emergencies are rare and often confusing and worrying events.  Now-a-days we also have a much bigger focus on the management of deteriorating patients which makes a lot of sense, as the earlier we catch people the less likely they are to arrest – with subsequent poor survival rates.  Where though are mandatory and essential updates on patient deterioration – not just resuscitation?

How also do we develop clinical skills in a safe and secure environment – the days of see one, do one, teach one should be gone – but are they?  Of course, centres around the world teach skills in labs with fantastic and often very realistic kit – but do they really simulate the real world or is it just – here’s is a head – have a practice intubating.  Interestingly, there is also evidence that teachers don’t know how to use the advanced manikins, so they get left in the cupboard.

We also know that failures of patient safety are frequently due to communication and teamwork problems, but how often and how well do we actually practice these non-technical skills?  Not a lot in my opinion and probably not helped by the fact that we call them ‘non-technical’ – not technical – not important!

The solution to these issues are of course high quality simulation – that matches the real world and is believable.  We call this high fidelity.  Note though that high fidelity does not need to be high technology and high cost.  Patient actors, for example are able to mimic the real world, provide fantastic feedback and when recruited locally enhance community engagement. Interactive screen based e-simulations are also available that are low cost and enable repetitive practice.

So my advice for educators is to plan enjoyable and holistic scenarios that encompass the relevant aspects of the real world.  Teach a skill first – say IV cannulation – but then encompass this into a medical emergency team call – lots of people, time limited, noisy and stressful.  Ideally video it as well – use your phone or an iPad then use this record for review and feedback.  Don’t get bogged down with all the educational theory on how to run a simulation – it’s just another teaching method and if you’re a good clinician you will know how the real work works and how to mimic it.  Try also to run things ‘in-situ’, in your ward or department, and don’t drag people away from their work for hours on end – just do a quick update during a shift overlap or a lunch break.  The important thing is to repeat frequently and have a good chat about performances.

In summary get siming and make healthcare safer.