Mini-Sims for Critical Care

Book Review: Mini-Sims for Critical Care, by Charle Corke, Nick Simpson and Amutha Samuel (RRP AU$50 from www.eruditemedicalbooks.com)

Overview

The cover says it all really, Mini-Sims for Critical Care is a hardy spiral-bound book with A4-sized pages that contains “80 user-friendly, easy-to assemble scenarios for medical simulation”. Why does this matter? Well, recent years have seen a push towards an increasing role for simulation in medical education. There are many drivers for this, the most obvious being a moral imperative to avoid putting real patients at risk while trainees learn. More than that, there is increasing evidence that simulation quite simply “works”. However, a barrier to simulation is the perception that an expensive high fidelity manniquin in a purpose-built facility is needed to ‘make sim happen’. This perception could not be more wrong in my opinion, and I suspect the authors of this book agree. The authors are all specialists based in Geelong, near Melbourne. Intensivist Charlie Corke is well known in Australasia as both the Education Officer and Vice President of the College of Intensive Care Medicine, as well as the author of a number of useful, practical books for ICU trainees. Nick Simpson, an intensivist, and Amutha Samuel, an anaesthetist, are practicing clinicians as well as the Medical Directors of Simulation and Clinical Skills at ReVISE, the Regional Victorian Institute for Simulation Education. Needless to say, the authors know their stuff and this book proves it.

Book structure and design

Mini-Sims for Critical Care is designed to knock down the barriers to implementing simulation in the workplace. The scenarios are easy to follow, well designed and have a logical format. The structure for each scenario description includes learning objectives, mannequin requirements, information for participants, equipment to set up, a briefing for scenario confederates, additional information to provide if sought by participants and the key technical points to cover in a debrief. Within the pages of the book there are relevant patient data, clinical materials and screenshots of monitor screens (from the ‘SimMon’ iPad app, see KI Docs’ Simulation Apps Review for a comparative review of this app). These props are also easily accessible on the accompanying DVD. The book also contains basic advice on how to run simulation sessions safely and effectively. Simulations can even be run without any simulated monitoring devices if you are technologically deprived, by just showing the monitor images and props on a computer or as print outs.

Scenarios

The selection of scenarios included in the book is hard to fault from an intensivist’s perspective. They are comprehensive and cover numerous situations that are common but often misunderstood, as well as situations that are rare and potentially catastrophic if managed by the inexperienced. Examples run the gamut from VF arrest post cardiac surgery, the displaced tracheostomy tube, a pacemaker that fails to sense, a chest drain connected to suction in a post-pnemonectomy patient and even donation after cardiac death (DCD). ECMO emergencies will presumably be included in the second edition… 😉

How to use the book

It is hard to see how this book could be better (unless of course it was a FOAM website!). The book is ‘fit for purpose’, it succeeds in enabling clinicians to provide brief, effective mini-simulation learning episodes in the workplace. Many of the scenarios can easily be used as part of ‘deliberate practice’ by repeating them, with feedback, until the learners are expert. Recently I ran a few junior doctors new to ICU through sessions designed to encourage them to be skeptical about what monitors tell them and to remember that in every ICU encounter there is a tension between ‘man and machine’ – is the patient actually in trouble or is there a problem with the monitors and equipment? We ran through some scenarios from this book (an arterial line transducer that fell on the floor, and a leaking stopcock from the noradrenaline line) together with some of my home-made efforts, to help create a memorable 20 minute learning experience for doctors who have never really considered these problems before. Furthermore, the scenarios in the book can easily be built upon or combined to create truly immersive experiences and to tailor the ‘signal-to-noise’ ratio to the level of the learners. There are potential downsides to in situ simulation, but these are largely overcome by instructors obtaining adequate training and ensuring that simulation experiences are authentic.

Conclusion

The bottom line is clear: a copy of this book should be in every ICU. We need to ‘make sim happen’ in the workplace and this book is a great entry point. However, nothing replaces the need for clear learning objectives and a skilled teacher, so I encourage clinicians to seek further training in simulation education… Books and mannequins don’t teach themselves.

Disclosures

The authors of the book provided LITFL with a review copy free-of-charge.