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Best Practices for Simulation: Planning a Meaningful Simulation

Author: Timothy E. Klatt, MD and William Leininger, MD

Editor: Shireesha Reddy, MD

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Effective medical simulations are critical for optimal responses to emergencies. Simulations provide experiential learning while promoting team functioning. Meaningful simulations require planning before simulation day, including securing adequate institutional support, resources, and participant engagement. To garner stakeholders’ commitment, simulation design focuses on learning from adverse outcomes, near misses, local or published lawsuits, and national focal points for care improvement.

  1. Institutional Support

Simulation requires support from institutional leadership. Support includes resources specifically dedicated to simulations andtitled champions (instructors, participants) with supported time, money, equipment. Supportive institutions should adjust providers’ schedules and offer compensation. for institutional buy-in, 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.

  1. Resources  

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) 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, and laboratory technicians. Participants may welcome the simulation and 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.  

Further Reading:

ACOG Simulations Working Group. Surgical curriculum in obstetrics and gynecology. Updated February 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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The Society for Academic Specialists in General Obstetrics and Gynecology, Inc. (“SASGOG”) is committed to accuracy and will review and validate all Pearls on an ongoing basis to reflect current practice.

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.

Variations in practice may be warranted when, in the reasonable judgment of the treating clinician, such course of action is indicated by the condition of the patient, limitations of available resources, or advances in knowledge or technology. SASGOG reviews the articles regularly; however, its publications may not reflect the most recent evidence. While we make every effort to present accurate and reliable information, this publication is provided “as is” without any warranty of accuracy, reliability, or otherwise, either express or implied. SASGOG does not guarantee, warrant, or endorse the products or services of any firm, organization, or person. Neither SASGOG nor its respective officers, directors, members, employees, or agents will be liable for any loss, damage, or claim with respect to any liabilities, including direct, special, indirect, or consequential damages, incurred in connection with this publication or reliance on the information presented.

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