“Space, is big. Really big. You just won’t believe how vastly, hugely, mindbogglingly big it is. I mean, you may think it’s a long way down the road to the chemist’s, but that’s just peanuts to space.” – A Hitchhiker’s Guide to the Galaxy


To medical students, the idea of simulation-based education can seem completely mindboggling. How do I write a scenario case? What resources are available? What even is simulation-based education?! Luckily, I’m joined with the lovely Dr Victoria Brazil who will take us on a quick journey through the universe of simulation in this blog post series.


The night sky

My goodness, looks like we’ve got a lot to explore…!

So before we get started, it’s only fair to introduce our guide. Dr Brazil, can you tell us a bit about yourself and what you do?

I am an Emergency Physician and the Director of Simulation at Bond University and the Gold Coast Health Service. I spend my time doing clinical work in the Emergency Department, teaching students in simulated learning environments, and using simulation for quality improvement in the Gold Coast University Hospital through working with teams and improving systems.


Sounds like you’re very busy! To kick us off, can you explain what exactly healthcare simulation is?

There is an enormous range of activities encompassed by the term. We can categorise it by simulation technique – eg whether we use mannequins, simulated patients, or virtual reality platforms. We might also look at it from a learning focus viewpoint – eg procedural skills, teamwork training, communication skills training, or testing hospital systems across a patient journey. And we might also consider the range of participants – junior to senior levels, single profession or interprofessional, and individual training or teams. Different combinations of these variables mean there is a diverse array of simulation applications.


Can you tell us what the benefits of simulation-based education are?

It really depends on what type of simulation you’re thinking about.

For a typical scenario based format involving team based care – it’s a highly engaging format, participants can practice safely without harm to patients, and the focus is on learning. Leadership, communication and teamwork can be practiced. There is generally a structured process in the subsequent discussion or debrief to provides feedback to learners. The skill of the simulation educator is to choose formats and scenario design that really do ‘hit the mark’ for these learning outcomes – that’s more challenging than most educators realise.


Clearly there are plenty of benefits of simulations! But I guess we also have to think the challenging aspects of it as well… What do you find challenging in simulation?

Healthcare simulation can be very resource intensive – it takes staff and equipment and time. The main challenge I see is not matching the required learning or quality improvement objective with the simulation or other modality chosen. For example, you wouldn’t use a high-end, complex, mannequin-based simulation to teach ECG interpretation. But it’s worth it if outcomes are related to teamwork, communication, and translation of knowledge into actual practice around the patient bedside, which are hard to achieve any other way.


You were talking about mannequin-based simulation and I’ve also heard of people using something called “iSimulate”. What other resources are available for us to use?

Technical aspects of simulation can be complicated. The expertise of the simulation educator is about picking a modality that fits the objective of the simulation activity. So for a communication scenario involving junior learners, you would pick an actor or simulated patient to work with. If you were doing a trauma simulation involving emergency department, anaesthesia and surgical participants, and requiring invasive procedures, then you would probably use a mannequin-based format. There are hybrid approaches eg iSimulate, where monitor emulators can be used in combination with simulated patients to give ‘fake’ vital signs or cardiac rhythms, but with the high realism of real human interaction.


Procedural skills trainers range from the simple IV arm to complex virtual reality and haptic technology equipment. 3D printing shows promise for future procedural skills training applications.


SimMan is taking a nap
SimMan, are you ready for the next scenario or are you having a snooze?


There are plenty for interesting medical cases out there, but how to do choose cases that are good for simulations?

My top tip – Keep it simple.

Why do I say that? Don’t confuse learners with ‘noise’ of a complex scenario when you want a strong signal to guide their expected actions. Complexity can just add cognitive load and anxiety for simulation participants. Make sure you stick to your focus, and ensure any complexity is appropriate for the learner level.


Do you use a typical structure when writing scenarios?

A ‘typical’ scenario has an introductory phase – where the participants get used to the patient, they get a little bit of backstory, and they establish their roles in the simulation. There is usually then some change is the ‘simulator state’ (whatever kind of ‘simulator’ you use) requiring participants to recognize and respond.

This doesn’t have to be something dramatic – it can be a piece of history emerging, it can be something like a change in conscious level of the patient, or a change in heart rhythm. The participants are required to respond to that change, and the move to a ‘resolution’ phase. That would be a typical structure of a 10 to 20 minute scenario, which are prevalent in many simulation education programs. It’s not the only structure, but it is a common and sensible approach for acute care scenarios.


Wonderful! Thanks Dr Brazil for taking us through an introduction to simulation-based education! Stay tuned for future blog posts where we will discuss delivering simulations and debriefing. In the meantime, here are some resources that you might be interested in checking out!



Written by Arielle Tay

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The Medical Student’s Guide to Simulations
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