After the Sydney Forum – What’s Next?

On July 10th the ESS Collaborative hosted an invitation only forum in Sydney. Can simulation be used to replace clinical placement? Lessons learned from global and national perspectives to inform future research and practice.


38 participants attended the forum and the evaluation of the event was extremely positive.

A great day, well organised. Felt inspired hearing the speakers to continue moving forward in relation to my own research and curriculum design”.


Many participants requested that the ESS Collaborative hold annual events to bring together thought leaders in the intersection between education, simulation and safety.

So it seems that there is a real appetite to move this agenda forward and participants identified the following priorities for future activity.

The ESS Collaborative is currently working on, and seeking funding for, a number of projects which will inform these priorities. We are meeting in Wellington NZ in October to continue developing an undergraduate curriculum approach and principles which will guide future work. We are also looking for ways to widen participation in the ESS Collaborative – so watch this space!



Can simulation be used to replace clinical placement?

The Education, Simulation and Safety Collaborative is delighted to host an invitation only one day forum: Can simulation be used to replace clinical placement? Lessons from global and national perspectives to inform future research and practice.

Professor Pamela JeffriesThis forum and will be held at the Mercure George St Sydney on 10th July 930am – 430pm to coincide with the visit of Prof Pam Jeffries to Australia and New Zealand.

The primary purpose of the forum is to share best practice in research on simulation integration in health education from international and national perspectives. In addition to Professor Jeffries, a range of high profile, invited speakers will address current evidence and share experiences. Our thanks to Laerdal Australia for their generous sponsorship of this event.

History repeating itself….

In March the Nursing and Midwifery Council in the United Kingdom announced changes to standards for pre-registration nursing programmes, which were reported in the nursing press as ‘historic”. The term historic can have all manner of meanings ranging from important (momentous, remarkable, significant) to old (ancient, past, bygone) or simply full of history.

Amongst the raft of changes was the decision not to raise the cap on simulation hours from 300 hours from a total number of 2,300 clinical practice hours to the anticipated 1,150 hours i.e. a maximum of 50% of clinical practice hours being undertaken by simulation. Instead, the NMC decided to completely remove the cap on the hours that can be spent in simulation activities. Not surprisingly there has been some disquiet expressed about this decision and the NMC response is reportedly that they will monitor universities’ use of simulation. But if we look at the situation from an evidence based perspective, the decision by the NMC is difficult to challenge.

Historically simulation has been used for a long time in nursing programmes, with little evidence to support the type or amount of simulation learning and, it could be argued, with little or no control over the quality of simulation learning experiences. Early findings from a systematic review we are currently undertaking suggests that the evidence for an accreditation standard ratio, or proportion, of simulation hours to clinical placement hours is scant. While we are still synthesising international RCTs of the substitution of clinical placement hours with simulation hours across health disciplines, trial interventions favour replacement of 25-50% simulation to clinical placement, but determining the proportion for replacement seems arbitrary.

Application of these replacement proportions is made even more tenuous by the lack of evidence to support the mandated number of clinical placement hours in the first place, and that evidence gap is also the subject work by the ESS Collaborative. Perhaps our efforts will provide solid ground to inform standards for clinical placement hours and the use of simulation and, in doing so, we can stop history repeating itself.

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.