Sitting at the airport in Dublin I would like to highlight some of our take home points and thoughts from the in situ sim workshop I attended with my friend Martin a couple days ago. If you want to read that in German, click here for some German foam. It has been one of the best workshops I have participated in so far. When I was thinking to myself what made this workshop better than many of the others, three reasons have come to my mind:

  1. Pre conference preparation
    Although I didn’t enjoy it and I am pretty good at procrastination: it just makes sense. It gets you focused, you read something you would otherwise never read and highlights the learning objectives.
  2. Clear timetable, clear sessions with designated learning points
  3. Using more that just one media & interactivity
    Even though it was a social media conference and high tech was everywhere (even WIFI ;)) the teachers also used flip charts, pen and paper, discussion rounds and some acting. And of course (good) powerpoint presentations.

I think it is the right mixture of everything mentioned above that kept the participants (inter)active and focused.You also have to consider that it was quite a large crowd to be in just one room.

I will definitely try to implement those things in my own workshops.

Negative to mention:  as far as I know there has been no feedback possibility offered so far.

Now on to the actual workshop learning points:

  1. How to get started. It is important to have support. Senior support and nursing support. Get buy-in from the top and bring in motivated people, the other ones will follow with the recognition of its usefulness. Think about Kottter’s 8 ways to change.
  2. Preparation and design of a scenario.  Thoughtful design is vital. Really think through your learning objectives (define them ahead). Create a checklist for each scenario so you won’t forget technical tools or any items needed for the sim. Also think about your cancellation criteria and potential hazards that might occur. Declare them and mention them ahead of the simulation. Make clear what equipment is used and do not mix it with equipment used for real patients. A separate box for simtraining would be an option for that. Also don’t forget to explain and show the tools and manikin ahead of a scenario.
  3. Interprofessionality. Who is that simulation for? Patient care is team effort and so should be the team training. It is not  “team leader training”. In situ sim should be interprofessional: Create learning points for everyone: doctors AND nurses AND everybody else involved. Tasks for everybody should be realistic. Get representatives of every profession on board.
  4. Use a “confederate”. Which is a supporter. Integrate this person into your scenario in order to help the participants out and keep the scenario on track.
  5. How to bring realism into in situ sim
    Ultrasound: declare what you want to learn:

    • Interpretation of the image or
    • Integration of ultrasound into the sim

    This makes a difference: Both might be too much for one scenario. Split the learning objectives!

    • For interpreting images: There are a couple of useful apps:
      See KI doc’s review on simulation apps.This could also be an option. It is based on RFID technology. Once you find the correct position with the ultrasound probe an image will be sent to your tablet/computer. Also think about where to put the tablet: On the US machine? Somewhere else?
    • For integration: Learning points could be: indications for ultrasound, finding the US machine, how do I get it to the patient the most efficient way,who should get it and where do I position it in in the resus/operating room.Further reading here.
  6. Suboptimal manikin.There are typically 3 types of manikins: adults, babies and every once in a while an about 10 year old kid. But what if you want something in between? A 4 year old? Or an obese patient?
    • Show the participants a video.They will get some sense of age, pathology and appearance of the patient. is an option for that.
    • Print out a foto of the patient.
    • Or dress up like Chris Nickson does for obesity cases:

    chris nickson

  7. Pause if needed. If you want to switch from a simulated patient to the manikin during the scenario: pause and discuss the case and then continue the scenario with the manikin.
  8.  ANTS. For anesthetists this tool is an option to evaluate your non technical skills.
  9. Debriefings is everything. Learn how to debrief and train the debriefers first. FFAST was recommended by the teachers. The European Resuscitation Council used “the learning conversation” as a feedback tool. Be aware that it is not  team -leader- training  but  team – training.


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As you can imagine I was part of the “ultrasound” discussion group. But there were so many more good take home points from the other groups as well. If you can think of any, share them here with us and we can make a part 2 of this blogpost.

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