Getting started in Simulation

Published 02/08/2022

Getting started

  • A mannequin – this can be anything from a simple resuscitation mannequin borrowed from the resus department through to an all singing, all dancing high fidelity model that has pulses, breath sounds etc. Nice to have, but not essential in the slightest 

  • A monitor – this can be set up using an old computer and TV screen, the right cabling, and someone savvy enough to download the relevant software from LaerdalTM. A guide to what’s out there on the market for varying budgets can be found at the bottom of the page.

  • A basic collection of kit – using an old resuscitation/airway trolley and collecting expired pieces of kit as you go along is a good start. It can then be stored away from equipment in clinical use to avoid any errors. 

  • An enthusiastic team 

  • A clinical area (or mock-up) identified for the simulation to happen  

The Team

Ideally three team members are needed as a minimum: 

  • One to run the monitor/observations and to react to the evolving scenario and actions of the learners 

  • One “in the scenario” as a bedside nurse or junior doctor, who is briefed and experienced with the scenario, and who can answer questions and give out relevant information (eg. “the patient’s left pupil looks bigger than the right”) as well as assist if technical issues arise 

  • One primary debriefer. Ideally should not be involved in the running of the scenario so they can focus on observing and making notes for debrief 

It is possible to run scenarios with as few members of faculty as this. 

The scenario set up

Once you have identified the scenario you are going to run (many Simulation Scenatios can be found here), ensure that you have all of the required equipment in place and set up ahead of time.

Having the team member in the scenario frantically trying to locate a piece of integral kit on the fly might be amusing but can seriously hinder the experience! 

The team brief

Before starting the simulation, perform a team brief. This is to outline the scenario, learning objectives, how you see the scenario playing out and role allocation.

A final check should be performed before starting to ensure that everyone is clear in their roles and that the area is set-up correctly; using a scenario briefing template can be a useful aide-memoir.

These are integrated into the scenario templates that can be found here. 

Pre-scenario brief

Before you start the simulations, bring the learners and faculty together in an area away from the bedspace/area where the simulation is to occur to go through the Rules of Engagement.

This allows the faculty to clear up any questions, alleviate any anxiety, and ensure a safe learning environment. The learners then need to be orientated to the bed space/environment where the simulation will occur.

The scenario

It’s essential that observers can see the both the monitor and everything that the participant is doing.

If the participant’s thought process is not clear to the observers, the faculty member in the scenario should ask them what they are doing and encourage them to verbalise their actions.

If the scenario uses props such as x-rays or blood gases, ensure they are clearly displayed on a screen for all to see or make duplicate handouts (one for the participants in the scenario, and one for the observers). 

The debrief

The debrief should occur away from the bed space in as soon as the scenario ends (whilst still giving the learners a minute to catch their breath!).  This gives the faculty an opportunity to share thoughts about what has just occurred. 

When going into a debrief, have a tool to use and a plan in mind to direct the debrief.  Don’t be afraid to deviate from that however if it allows the learners to explore themes that you might not have even thought of. Practice really does make a huge difference in debriefing and is often the main determinant of the learners’ experience.

Debriefing can be easy, but it can also be gruelling and difficult To gain more experience in debriefing there are a number of courses that you can attend, a wealth of literature and a number tools that you can use. You could also Visit centres who are running regular in-situ simulation, or simulation courses to gain more experience.

Thank you to Dr Jon Gatward, much of this information is adapted from his work.