Simulcast Journal Club October 2019


Introduction :  

Simulcast Journal Club is a monthly series that aims to encourage simulation educators to explore and learn from publications on Healthcare Simulation Education.  Each month we publish a case and link a paper with associated questions for discussion.  Inspired by the ALiEM MEdIC series, we moderate and summarise the discussion at the end of the month, including exploring the opinions of experts from the field. 

The journal club relies heavily on your participation and comments and while it can be confronting to post your opinions on an article online, we hope we can generate a sense of “online psychological safety” enough to empower you to post!  Your thoughts are highly valued and appreciated, however in depth or whatever your level of experience.  We look forward to hearing from you. 

Title :  “After Action Review 

The Case :  

Nimali’s head was reeling. 

“So you’re telling me there’s a sinister organisation working to overthrow democratic governments by infiltrating Simulation centres with sleeper agents who can weaponize healthcare mannequins and activate them for a robotic terrorist attack on hospitals and healthcare systems?” 

Nitin marvelled.  It had taken him the last 15 minutes to explain his mission.  “Your ability to synthesise complex concepts into single sentences is one of the main reasons I fell in love with you.”  He paused for a second.  “That, and your eyes.” There was a chance, after all, that hadn’t sounded as romantic as intended. 

“I’ve been undercover, tracking down sleeper agents for the last few years and retrieving them for deprogramming.  I was considered uniquely suitable for the job.  I was recruited to the secret service after my duel medical and criminal law degree was mentioned at my televised trophy presentation on India’s Next Ninja Warrior.”  He caught an impressed look from Nimali and smiled humbly.  “To be fair, Nimali, the medical degree was mainly just to please my parents.”. 

“I recruited Brad early in my tenure here, since he had a police background and it became clear Snythe was the sleeper agent : he’d developed a sudden interest in Sim, he had a pre-existing toxic personality that would be susceptible to recruitment, and he was making swift moves to become director of education in order to control the sim lab.  We knew we had proof when Brad found mannequin hacking software on Snythe’s office laptop.”. 

Nitin sighed and wrung his hands anxiously. 

“We were supposed to remove him for extraction, replace his body with a lifecast and make it look like an elaborate hoax/disappearance, but instead Snythe was somehow killed for real and I don’t know why.” 

Nimali held his hand.  “We debriefed the murder.” She said, “But we were so focused on keeping everyone calm that we haven’t analysed the data effectively.”. 

Nitin nodded.  “It’s been a busy few hours, but you’re right; It’s one thing to have an event debrief, but we need to act on the information.” 

Nimali paused.  “So let’s look at the facts : Snythe was murdered with a trocar.  Only you and Brad knew about the Lifecast mannequin.  Brad found the data on Snythe’s laptop without you, and you both planned the extraction together?  Brad was applying for the same job that Snythe did, and you were with me when the murder happened.  So that only really leaves one suspect : Brad.” 

Nitin’s eyebrows frowned.  “But that makes no sense, Brad wouldn’t kill Snythe over a job rivalry?  He knew how important it was for us to extract information, and the flashdrive he found checked out as legit.” 

Nimali thought for a minute, then clicked her fingers. 

“Nitin.” She whispered.  “Every sleeper agent needs a handler.  And we’ve left Brad alone with our friends for the last 20 minutes”. 

The Articles : 

Brindle, M., Henrich, N., Foster, A., Marks, S., Rose, M., Welsh, R. and Berry, W. (2018). Implementation of surgical debriefing programs in large health systems: an exploratory qualitative analysis. BMC Health Services Research, 18(1). 

Rose, M. and Rose, K. (2018). Use of a Surgical Debriefing Checklist to Achieve Higher Value Health Care. American Journal of Medical Quality, 33(5), pp.514-522. 

Discussion :  

Clinical Event Debriefings are becoming increasingly prominent in healthcare systems, and simulationist experts are increasingly driving (or being driven) towards providing guidance within this space.  Often pitched as a combination of psychological first aid and after action review, it’s a rapidly evolving space with multiple controversies and barriers towards effective implementation. 

This month we explore both a qualitative and quantitative paper exploring the outcomes and challenges involved in large scale clinical debriefing programs.  The results seem impressive, so it will be interesting to hear your thoughts on the papers and clinical event debriefing programs in general. 

References : 

Brindle, M., Henrich, N., Foster, A., Marks, S., Rose, M., Welsh, R. and Berry, W. (2018). Implementation of surgical debriefing programs in large health systems: an exploratory qualitative analysis. BMC Health Services Research, 18(1). 

Rose, M. and Rose, K. (2018). Use of a Surgical Debriefing Checklist to Achieve Higher Value Health Care. American Journal of Medical Quality, 33(5), pp.514-522. 


About Ben Symon

Ben is a Paediatric Emergency Physician at The Prince Charles Hospital in Brisbane and a Simulation Educator at Lady Cilento Children's Hospital. He currently teaches on a variety of paediatric simulation based courses on paediatric resuscitation, trauma and CRM principles. Ben has a growing interest in encouraging clinical educators to be more familiar with simulation research.

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