In Situ Simulation: advantages, challenges and obstacles

Abstract

Medical simulation is increasingly recognized as a modality that can reduce medical errors in a variety of care settings. In situ simulation, which is defined as simulation-based training that occurs in a real clinical environment with participants who are onduty, is useful for identify gaps in training, systems issues and other areas for improvement. The aim of this paper is to describe the uses, advantages, and challenges of in situ simulation through the prism of our experience managing a variety of in situ programs in a tertiary care teaching hospital. We will also cover vital debriefing technics and logistics experiences we believe will benefit those hoping to create an in site simulation program of their own. The paper will describe how our own program has led to an improvement in the organization and assessment of our hospital’s code management systems. Among a number of lessons learned further described below are: Clear goals must be established, evaluated, and revised throughout the process;Debriefing improves team performance, helps identify problems as well as solutions and allows participants to contribute to and emotionally process their training, and; In situ highlights deficiencies in a way that can easily inform hospital leadership and risk management officers to a health system’s need. Our experience indicates that in-situ simulation is a valuable, safe and relatable tool to identify needs, promote effective communication, enhance technical skills and implement process improvements in a high-risk medical environment.