Simulation: the act of imitating the behaviour of some situation or some process by means of something suitably analogous (especially for the purpose of study or personnel training).

BACKGROUND

Simulation provides a valuable opportunity to practice your approach to various emergency situations in a controlled environment. This includes common presentations as well as those that are rarely seen in clinical practice but remain important nonetheless.

As a means of learning; simulation has been adopted by other industries but remains a relatively recent development in medical circles. It can range from the very simple (low fidelity) to an all singing all dancing high fidelity simulation in a purpose built centre.

Simulation allows us to be exposed to a range of learning opportunities, such as clinical skills that are uncommon. Often however it is not the clinical medicine that simulation excels at but the non-technical skills that come with the interactions in a team. Leadership, team working, communication and critical incidents can all be trialled in what is a safe environment without putting patients at risk.

The simulation day will cover the whole of the CT3 curriculum, adult as well as paediatric. The simulation suite will enable you to practice a range of scenarios that may not be seen commonly in clinical practice across a whole range of patients.


LEARNING OUTCOMES FROM COMPLETING THE TASKS

  • Recognise the developing role of simulation within medicine and emergency medicine specifically.

  • Identify the role of non-technical skills and how these are crucial in the management of "critical incidents".

  • Assess and manage a variety of emergency conditions in adults and children.

  • Implement management of emergency presentations in accordance with local and national guidelines.

LEARNING OUTCOMES FROM FACE-TO-FACE TEACHING

  • Diagnose and manage emergency presentations in children and adults.

  • Develop and reflect on the non-technical skills associated with team working.


TASKS

Complete the following before the face to face session:

TASK 1: Just A ROUTINE Operation

Duration: 15 mins

This video has been produced by the husband of a patient who died during a "routine operation". It is difficult to watch at times and although it is an anesthetic case it is a good illustration of how non-technical skills can compound a "critical incident" and lead to increased morbidity and mortality.

Identifying these skills and developing them can be achieved through simulation, and this is recognised in other industries (in particular the aviation industry). Simulation is an up and coming area and will play an increasing role in all our careers and training. 

task 2: Simulation In Emergency Medicine

Duration: 10 mins

This article from the EMJ in 2008 is a good introduction to the role of simulation in emergency medicine and why we should be using it more!

 

Task 3: How To Run a Code (an American Cardiac Arrest)

Duration: 35 mins

Check out this American podcast discussing some of the non-technical skills for managing teams. The authors acknowledge that most of the content is cut from a "Resucitationists Awesome Guide to Everything" (RAGE) Podcast, which if you haven't found before are also worth listening to.

It covers some pre-hospital and in hospital settings, and suggests some little changes to make that might make big differences to team dynamics.

Also worth listening to is their description of Advanced Cardiac Life Support (ACLS), which seems to be their equivalent of ALS. At one point they refer to the use of vasopressin at cycle 3 of CPR, something we have not adopted in the UK yet.

Finally, at about 18 minutes in the author demonstrates a technique which he calls "Running Dialogue". I am sure we do this in our heads, but how many of us verbalise it that well?

Try to apply the skills mentioned in the simulations and at work.

Task 4: Relax, Children are just little Adults

Duration: 27 mins

Paediatricians everywhere will tell you the title of this podcast is all wrong, however Simon Carley presents a persuasive argument. Most of us have a background in adult emergency medicine, there are certain standards of care we would never question in our adult practice yet in children we sometimes pause. Perhaps this podcast will convince you that if interventions are needed then drawing parallels to your adult practice might just save lives.


ADDITIONAL RESOURCES

Here are some extra resources to review if you want more information:

eUHL: Simulation Faculty Training

A FREE course run by our own clinical skills faculty, run over two days it gives a great insight into developing and running simulations and is also an opportunity to volunteer for FY1/ FY2 teaching. Just search for "Simulation Faculty Training".

TRAUMA.ORG

A great website for all things Trauma!

APLS Algorithms

This Australian site provides PDF files of all the APLS protocols.

Cambridge Courses

A variety of courses provided by University Hospitals of Cambridge covering various topics and competencies relevant to Emergency Medicine.


COURSE FEEDBACK

Once you have worked through the exercises, discussed the example cases and attended the face-to-face teaching, please complete the following form: