Best Practices for Simulation: Planning a Meaningful Simulation
Effective medical simulations are critical to enabling optimal responses to emergencies. Simulations provide necessary experiential learning to all health care team members and promote team functioning. Meaningful simulations require extensive planning before simulation day, including securing adequate institutional support, resources, and participant engagement. To garner key stakeholders’ commitment, simulations should be designed based on recent adverse outcomes, near misses, local or published lawsuits, and/or national focal points for care improvement.
I. Institutional Support
A successful simulation requires leadership’s visible, strong support. Such support includes resources specifically dedicated to simulations: titled champions with supported time, money, equipment, and consumables; instructors; supported time for participants; etc. Institutions often expect physicians to donate time for simulations, while other staff are paid. The most supportive institutions adjust providers’ schedules and/or offer compensation. To excite leadership, these events can be promoted as “good news” stories that demonstrate commitment to improving patient care. Being featured within such communications may foster both leader and participant engagement.
Effective simulations that actively engage attendees require thoughtful use of resources. Collaboration with a “simulation center” should be considered if available.
Successful simulations promote realism. Actors can be hired to play the roles of patients and family members, and local colleges and theater groups may offer cost-effective options. Moulage can be used to simulate conditions such as pallor and bleeding. Use of actual equipment rather than low-fidelity replacements should be considered. The American College of Obstetricians and Gynecologists Simulations Working Group offers ideas for both low- and high-fidelity obstetric and gynecologic simulations.
Conducting simulations in clinical spaces allows participants to practice with the actual equipment, enables in situ testing of intended workflows, and best uncovers problems within systems. If a separate space must be used, the setup should mirror the clinical space as much as possible. Checklists in clinical use should be vetted and participants should practice using them. To make simulations as real as possible, use of supplies (medication vials, intravenous lines, transfusion kits, etc) should be planned thoughtfully and participants should model the time required to collect and assemble these supplies. For example, a technician can be held outside of the room for 45 seconds after an intrauterine balloon is requested, and then the technician and provider can be occupied for another 45 seconds to model its placement. For scenarios in clinical spaces, supplies separate from those used in the clinical space should be procured to avoid depleting items used for patient care.
To promote efficient flow of simulations, participants should be able to easily distinguish facilitators from participants with visual cues (eg, vests, hats). A checklist should be used to track the simulation’s progress and facilitate notetaking for the debrief. A video, even if created with a phone, may enhance the debrief.
III. Participant Engagement
Successful simulations involve the entire care team: obstetricians and gynecologists, nurses, anesthesiologists, pediatricians, blood bank technicians, laboratory technicians, etc. Participants may respond differently; some may welcome the simulation, while others may require external inducement or be uncooperative. Focusing on scenarios that address well-recognized issues promotes engagement. However, replicating actual events should be avoided, as individuals who were involved may feel punished or experience distress with the reenactment.
Before the event, allies should be recruited within the participant group to help build support among their colleagues. Potentially uncooperative participants should be approached before the event to minimize any negative effects they may have on the simulation. Consideration should be given to including them in scenario development or inviting them to be facilitators to give them responsibility for the event’s success.
Value for attendees can be maximized by ensuring that simulations fulfill additional obligations such as continuing education credit, employment and credentialing requirements, and American Board of Obstetrics and Gynecology Maintenance of Certification Part IV.
ACOG Simulations Working Group. Surgical curriculum in obstetrics and gynecology. https://www.acog.org/education-and-events/simulations/surgical-curriculum-in-ob-gyn. Accessed December 2021.
Committee Opinion No. 680: the use and development of checklists in obstetrics and gynecology. Obstet Gynecol. 2016;128(5):e237-e240. PMID: 27776075
Satin AJ. Simulation in obstetrics. Obstet Gynecol. 2018;132(1):199-209. PMID: 29889745
Published January 2022
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This document is designed to aid practitioners in providing appropriate obstetric and gynecologic care. Recommendations are derived from major society guidelines and high-quality evidence when available, supplemented by the opinion of the author and editorial board when necessary. It should not be construed as dictating an exclusive course of treatment or procedure to be followed.
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