Simulcast

Equity, diversity and inclusion in healthcare simulation – reflecting on our values, beliefs and actions    Many in the simulation community are thinking about the ways we might work on equity, diversity and inclusion through healthcare simulation. We are tempted to try and ‘fix’ inequities and biases, but are also aware than if badly done – these ‘fixes’ may cause harm.  Ben Symon hosts this episode with Vic Brazil and Eve Purdy, and discuss the EDI-SIM tool they are trialling at the Gold Coast, and the collaborative autoethnography Eve is leading to explore the impact of this strategy.  We made reference to recent publications on Recommendations and Guidelines for the Use of Simulation to Address Structural Racism and Implicit Bias and ‘moving from safe to brave’ in Simulation in healthcare , applaud the work that many are doing in the area, and  look forward to more conversations on these issues. 

We recorded the September Journal Club during Healthcare Simulation Week – a chance to reflect on the amazing work of the healthcare simulation community.   Our first paper showcased the work of the STEPs (Simulation To Enhance Patient Safety) team at Fiona Stanley Hospital in Perth. Rory Trawber et al. write about Improving Simulation Accessibility in a Hospital Setting - Implementing a Simulation Consultation Service. They give us a practical guide to leveraging the impact of a small, skilled simulation delivery team through a formalised consultation service for clinical units seeking to use translational simulation for their quality and safety challenges in clinical care. Rory makes an ( audio) appearance in the podcast and describes the importance of using a quality ansafety based reporting tool, based on the work of Mel Barlow and colleagues on a documentation framework for healthcare simulation quality improvement activities.  As a nice example of using simulation as a test bed for planned clinical process improvements, Ben-Haddout and a team from Roeun, France offer us A Cognitive Aid Improves Adherence to Guidelines for Critical Endotracheal Intubation in the Resuscitation Room. We were impressed with the opportunities afforded by the in situ simulation setting, and the interesting ways to look at cognitive aids.  We discussed a paper on Online-synchronized clinical simulation: an efficient teaching-learning option for the COVID-19 pandemic time and: beyond. This is one of many articles currently being published that seek to tease out the benefits and drawbacks of online scenario-based activities for learning engagement and impact.  We covered a scoping review on Healthcare Provider Stress and Virtual Reality Simulation, and concluded that - despite a small literature base at present – this is a space to watch for those seeing to improve healthcare providers ability to mange stress in the clinical workplace. A highlight was a really useful table listing various tools used to measure healthcare professionals stress – in either simulation settings or the real world.    Happy Listening 

This special episode is s joint release from Simulcast and The Emergency Mind podcast, with Vic talking with co-hosts Dan Dworkis and Andrea Austin.  We start by discussing what Dan and Andrea mean by ‘Emergency Mind’ – “Leveraging the mental models and lessons from his own practice of emergency medicine—as well as from experts in the military, business, and athletic worlds—how to train mentally to perform at your best when you’re needed the most.”  For more check out the book and more podcast episodes. We chat about other resources – the book On Combat, Scott Weingart on Combat Aviation Paradigms - and how simulation can shape culture.  

In the August Journal Club episode Ben and Vic look at articles involving the clinical outcomes from simulation training, trauma team leadership and serious games. We applauded a study looking at the association of simulation training with rates of medical malpractice claims among obstetrician–gynaecologists. This segued nicely into discussion of return on Investment for QI/ educational interventions offer to us by Shah and colleagues. Team leadership was next on the agenda – with a deep dive into the development of a behavioural marker took for observation and feedback for trauma team leaders. We finished with a systematic review looking at learner engagement and learning outcomes from serious games.  Happy listening! 

How should we design and deliver healthcare Simulation Fellowships?   In this episode of the podcast we discuss the thoughtful approach taken by Michael  Meguerdichian, Komal Bajaj and Katie Walker at NYHHC Sim, and their recent paper on the topic in Advances in Simulation - Fundamental underpinnings of simulation education: describing a four-component instructional design approach to healthcare simulation fellowships.  We spoke with Michael and Katie from the author team about the background to their Simulation Fellowship program, their strategy for selection and development of Fellows and take a deep dive into the application of Cognitive Load theory and the 4 Component Instructional Design approach they use. We reflect on how the field is developing and what the future holds for issues like curricula and accreditation of Sim Fellowships.  Happy Listening! 

We revisit Plus Delta Debriefing in the July Journal Club and talk about some new perspectives on a classic technique. Thanks Adam Cheng and many of the team from @Debriefing Academy. We also discuss work demonstrating the association of sim training with improvement in clinical performance in cord prolapse emergencies, and some impressive (if confronting) work on how illness experiences inform simulated participants’ encounters in health profession education.   We also lamented the closure of BMJ STEL, but look forward to new endeavours by EIC Debra Nestel and team at the International Journal of Healthcare Simulation (IJoHS)  Happy listening and look forward to next month! 

We know that simulation debriefing can be hard. Poor facilitation risks psychological safety breaches or simply ineffective conversations. Faculty development probably helps us improve, especially if its part of a community of practice. The Meta Debrief Club in NHS Lothian draws on these principles in their monthly ‘debrief the debrief’ sessions.  Ed Mellanby, Nathan Oliver and Chris Schnieke-Kind offer us the story of how the Meta Debrief Club originated, how it works, and the transformative experience it has been for their faculty. We spoke about the way they enable psychological safety, how they use tools like the DASH and OSAD, and their hopes for broader collaboration.  Truly inspirational! 

Practising communication, with good feedback, helps us get better at our jobs in healthcare. This is especially important for ‘high stakes communication’ (but really is there any other kind 😊). In this episode of Simulcast, Vic speaks with Laura Rock about her recent paper - Communication as a High-Stakes Clinical Skill: "Just-in-Time" Simulation and Vicarious Observational Learning to Promote Patient- and Family-Centered Care and to Improve Trainee Skill.    Laura is a pulmonologist and critical care doctor who works in the intensive care unit at Beth Israel Deaconess Medical Centre in Boston, USA, affiliated with Harvard Medical School. Particular interest in communication and teamwork – teaches at her own institution and with CMS, also her writing and speaking.      Link to promo video here   https://vimeo.com/569125162     

Ben and Vic are joined by Eve Purdy this month to discuss the UK national strategy for simulation, how to prepare for for systems-based simulation (the ‘pre-work phase’) , cultural consideration in simulation debriefing, and how simulations in ACLS training may perpetuate gender bias in emergency medicine.  We give a shout out to ASPiH, the UK based learned sociality for healthcare simulation, and their conference in November 2021.  Ben impresses again with his tun of phrase including the ‘visual haiku’, ‘framework mashups’ and ‘paragraph of Purdy’.  Happy listening and look forward to next month! 

 In this episode Ben shares a lecture he’s given at The Prince Charles Hospital about his journey as an educator and the ways that some of simulation’s foundational concepts have influenced his practice outside of educational spaces.  Through an exploration of psychological safety, above the table negotiation and cultural compression, he invites us to reflect on the ways we generate trust in healthcare, how our words connect us to our colleagues, and how simple acts like clinical handover can impact how we see ourselves and each other.    References :   Edmondson, Amy C. Teaming: How Organizations Learn, Innovate, and Compete in the Knowledge Economy. Jossey-Bass, 2012.   Rudolph, J., Raemer, D. and Simon, R., 2014. Establishing a Safe Container for Learning in Simulation. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 9(6), pp.339-349.  Cheng, A., Palaganas, J., Eppich, W., Rudolph, J., Robinson, T. and Grant, V., 2015. Co-debriefing for Simulation-based Education. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare, 10(2), pp.69-75.  Purdy, E., 2021. Simulation and Cultural Compression. [online] ICE Blog. Available at: [Accessed 22 May 2021].  Purdy, E., Alexander, C., Caughley, M., Bassett, S. and Brazil, V., 2019. Identifying and Transmitting the Culture of Emergency Medicine Through Simulation. AEM Education and Training, 3(2), pp.118-128.