“Simulation refers to any reproduction or approximation of a ‘real’ event, process, or set of conditions or problems." 
In situ simulation, the delivery of simulation in the actual environment health care professionals normally work, has been utilised in the Leicester Royal Infirmary Emergency Department since 2014.
“Learners are expected to evaluate and act in the same way as they would in the real situation, thereby supporting learning in a ‘patient safe’ environment, as well as potentially increasing competence by deliberate and repeated practice..." 
The ED education team believe the integration of regular simulation into the normal working practice of the staff will:
Improve core knowledge,
Foster good inter-disciplinary team working,
Embed a culture of improved situational awareness.
The In situ Simulation Program
Following its introduction in April 2014 the PEST program has become truly embedded in the departmental working week and in the expectations of staff, achieving 16 high fidelity simulations that year.
In 2015, the faculty successfully delivered 32 in situ high fidelity simulations involving a range of scenarios based on real-life critical events. This year, fortnightly simulation sessions have reached over 35 medical candidates, 24 nursing candidates, 6 advanced nurse practitioners and 8 students.
Whilst each scenario has been designed based on real-life events, with planned learning outcomes, the most valuable learning has consistently come from the subsequent debriefing, and the discussion of human factors involved in each scenario. Our simulations are also blogged so participants can reflect further, and those who where unable to take part can still learn from the program.
Simulation Training Days
Following the success and positive feedback of the PED simulation day held in December 2014, a further 2 PED simulation days were held in 2015 in June and October.
In each simulation day, teams of medical and nursing staff from the Emergency Department were formed to deal with a series of high-fidelity paediatric emergency scenarios, followed by debriefing learning conversations.
These training days are held in the purpose-built LRI Clinical Skills Centre.
Participant Realised Learning
The following learning points were identified by the participants themselves:
Try to “look forward” when managing patients; have fluid boluses/drugs drawn up ready in advance.
Share your mental model: verbalise what you are planning/thinking then the whole team is in the loop and working towards the same goals.
The number of assumptions that are made by staff not present at the beginning of the scenario.
Use of our 'Sepsis box': it’s a one-stop-shop for the antibiotics we use most commonly including drug protocols and guidelines.
It is appropriate to speak up if you have concerns regarding a clinical situation whatever your grade/job title.
Try to verbalise your thinking as this helps keep the team focussed and ensures everyone is working towards the same priorities.
Importance of a “hot debrief”; don’t forget to include paramedics/pre-hospital staff.
“I learnt to be more confident when unsure of my role and to ask if unsure of anything.”
“Today has been extremely beneficial, it’s much better to make mistakes here than in real life!”
“Faculty should keep being clear that not trying to trick people up.”
“All about the things that slip under the radar for me. I concentrate on improving my clinical knowledge and often neglect improving things like communication and “speaking up” ... today has given me a lot to think about.”
“...THAT I FOUND IT HARD TO CHALLENGE SENIOR DECISIONS.”
The first full calendar year of in situ simulation has demonstrated it is not only sustainable but is welcomed by staff. Although an investment in clinician time must be made (once the programme is embedded in the department), this is offset by delivering of clinical governance and patient safety objectives.
The learning from simulation is easily shared with others via the East Midlands Emergency Medicine Educational Media (#EM3) social media platform’s – benefiting not only our own department, but throughout the region as well.
The next phase of implementation and evaluation will involve matching the teaching to specific learning outcomes and beginning to demonstrate improvement in relevant patient safety matrices.
HUGE THANKS to the Faculty and the #EM3 team:
Jonny Acheson, Amy Atkinson, Deborah Dakin, Anna Duke, Sam Jones, Gareth Lewis, Su McKinley, Aimee Pook, Rebecca Prest, Damian Roland, Rachel Rowlands, Jamie Sillett and Mark Williams.
SPECIAL APPRECIATION goes to:
Jonathan Cusack, Mark Fores, Tom Carter, Ryan Westhead, Lee Rowley and the LRI Clinical Skills Unit for all their support.
Looking forward to 2017...
Joint multidisciplinary in situ simulation incorporating Acute Paediatrics, Paediatric Intensive Care and Paediatric Anaesthetics.
Enhanced use of real patient simulation.
Special simulation scenarios testing emergency systems.
2 further simulation days, with multi-disciplinary teams.