Leave the Sim Lab Behind

This is a guest post by Jesse Spurr (@inject_orange)

On the afternoon of the 23rd June the inaugural SMACC Leave the Sim Lab Behind workshop was held.

A dream team (Editor’s note: team of dreamers?) was assembled to help participants take simulation into their workplace:

We were very ably assisted by volunteers Ali Gould (@intransition2) and Laura Raiti (@lauraraiti). Dr Clare Desmond (@domerdr and Simulation Fellow at NorthShore University HealthSystem) provided equipment and logistical support. We would also like to thank iSimulate and Laerdal USA for loaning the simulators for the workshop.


Following an overarching pre-brief, the format of the workshop was established. The concept of Phases of In Situ Sim was used as a linear structure through which we danced the dance of simulation.

The workshop started with each of the facilitators giving an example of an input that had fuelled their own sim experiences.

  • Dr Jon Gatward – Addressing M&M: The Chest Re-open in Cardiothoracic ICU
  • Dr Chris Nickson – Team Roles and Functions in ECPR
  • Dr Andrew Petrosoniak – Procedural Skills Competence: Cricothyroidotomy
  • Dr Ernie Wang – Precipitous Birth and Obstetric Emergency in the ED
  • Jesse Spurr – Finding Latent Risk in Hospital Wide Medical Emergency Program

The Sheraton Towers Hotel, host to the smaccUS pre-conference workshops had set the remit of the SMACC simulation service (our workshop participants) to design four scenarios to test the contracted private emergency medical response team hired to protect the hotel from litigation (Plausible? It is America!).

  1. Drowning +/- inebriation
  2. Traumatic fall down stairs/escalator
  3. Choking in restaurant
  4. Psychotic episode triggered by a delegate realising he had missed Cliff Reid speaking because he had stayed to listen to Roger Harris.

Participants were split into four teams, each with a coach, and given a scenario template (download here) to develop and present back to the whole group.

After a quick break Jon Gatward gave some lessons learned in establishing an In Situ Simulation program, while the sim ninjas went to set up for the Drowning Sim.

Potential arrest, prosecution, and rough nights in the slammer were avoided by expert prior planning and hazard identification. We were soon able to state that SMACC US was proudly supported by the Chicago PD (thumbs up and wave – not formal endorsement).

Then it was show time. The team that had designed the Drowning scenario ran a highly immersive (pardon the pun) simulation for the team that had won the best scenario design to participate as the SMACC medical team.

Then it was show time. The team that had designed the Drowning scenario ran a highly immersive (pardon the pun) simulation for the team that had won the best scenario design to participate as the SMACC medical team.

Following some relaxing time in the sun, we ventured back into the debrief space for the sim team to practice the deft arts of venting emotions, unpacking frames, and making the most of teachable moments.

Following the debrief, we got all ‘meta’ and debriefed the debriefers, leading to some great discussion and referring to some excellent debriefing aides and resources (see Debrief on Mobilesim)

Like all good workshops, Leave the Sim Lab Behind came to an end. Unfortunately we had to truncate the session on evaluation and metrics. In summary, the key priority is to link the sim program to organisational goals. If adverse clinical events, clinical audit, complaints, or new services are highlighted as risks, develop scenarios to address these and then report the outcomes – loud and proud. Articulate scenario outcomes to department leads, hospital administrators, safety and quality groups, the world. Get traction to keep running great simulation. If you are not seeing wins, maybe rethink your ‘Inputs’ and go back to the start of the program development.

Also don’t underestimate the often maligned participant feedback surveys. While not of huge educational rigour, Jon Gatward emphasized that strong participant satisfaction and enjoyment of the training (graphically displayed for ‘management’) was enough to allow his program to get a foothold and a small budget to enhance the training capacity.

So on that note, thank you for an awesome workshop, we really enjoyed it!

Thanks finally to the most important people, the participants. You all suspended disbelief, placed trust and opened up to an amazing learning experience.

Recommended resources

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also a Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of three amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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