Simulcast Journal Club Podcast 10 & November Wrap

Welcome to the Simulcast Journal Club Podcast and monthly wrap post.

Please read our pdf summary of the November Journal Club article, the month’s discussion and our expert commentary here.


In our November journal club podcast Ben and Vic discuss the paper of the month – a classic debriefing article.  

Rudolph, J., Raemer, D. and Simon, R. (2014).  “Establishing a Safe Container for Learning in Simulation” Simulation in Healthcare: Journal of the Society for Simulation in Healthcare, 9(6), pp.339-349. 

We tried to summarise a fantastic, multifaceted discussion and admired the wonderful expert article commentary from Chris Nickson.  


We then reviewed some recent papers 

  1. Cecilia Escheret al.  Method matters: impact of in-scenario instruction on simulation-based teamwork training Advances in Simulation 2017 2:25 

 – how should we provide ‘extra scenario information’ to close the gap between the simulator appearance and real life.? 

  1. Coffey F, Tsuchiya K, Timmons S, et alAnalysing voice quality and pitch in interactions of emergency care simulation BMJ Simulation and Technology Enhanced Learning Published Online First: 06 September 2017.  

– interesting question, using sim as a ‘test bed’ 

  1. Bean DM, Taylor P, Dobson RJBA patient flow simulator for healthcare management education BMJ Simulation and Technology Enhanced Learning Published Online First: 07 October 2017 

– learn about the factors affecting efficient patient flow through hospitals using computer simulation, but don’t go looking for an online game… 

  1. Christopher Hicks, AndrewPetrosoniak, The Human Factor: Optimizing Trauma Team Performance in Dynamic Clinical Environments, In Emergency Medicine Clinics of North America, Volume 36, Issue 1, 2018, Pages 1-17, 

– a MUST READ landmark paper 


We’re taking a break now til February when we’ll be back with more great Simulcast Journal Club 


9 thoughts on “Simulcast Journal Club Podcast 10 & November Wrap

  • Derek Louey

    Hello Chris,

    Thanks for an insightful and wider perspective of the external factors that constitute a psychologically safe environment. Many of your observations resonated with me. Several points of your points and the final conclusion stood out,

    “Psychological safety helps convert the Threat of socio-evaluative stress into a Challenge”
    “I’m well trained (did I mention I had great teachers?) and I have guzzled down plenty of the ‘prebrief’ Kool Aid.”
    “we are left with another confronting question, how do we really know if the Safe Container works?
    “despite the caveats, I can’t see myself wavering from the script anytime soon.”

    Casting aside the effect that socio-evaluative stress has on effective learning, observations of myself and others is that CHANGE is hard work and emotionally draining. And I mean true internal change, not the kind of change that is transiently required to please observers, examiners or supervisors. Anyone involved in a change management project can testify to this.

    Looking through the lens of an educator, when we wish to alter thoughts (and particular behaviour) we are essentially asking someone to learn something new that could radically alter their previously held conceptions and habits. This is not mere intellectual assent that involves putting down the ‘right’ answers in a written exam. It is something that will permanently alter clinical practice. Knowledge is not just constructed, it sometimes has to be laboriously deconstructed. Jane Stanford taught me this new phrase, ‘Unfreeze-Freeze’ at the GIC to describe the cognitive-behaviour dissonance I was experiencing from trying to incorporate the new educational concepts into my own teaching framework. My rueful reply was, ‘this thawing is painful!’.

    Which leads to my conclusion that there are many internal factors at play that prevents us from adopting new lessons or changing our behaviours. As humans we are entropic in nature. At a leadership conference it was stated, ‘People only change when the pain of not changing exceeds the pain of change’. We don’t like change because it may require significant mental and physical adjustments to the way we ‘do business’. There may be a lot of ‘unlearning’ that is initially effortful, sometimes not immediately beneficial (and even temporarily detrimental). It hurts. It is destabilising. It feels unsafe.

    And this is probably even harder for the experienced and proficient practitioner who holds a long-held belief or is accustomed to doing things one way. Being confronted in front of your peers (or subordinates) is threatening not only for the immediately apparent social dimension, but also for the deeper implications of having to alter life-long practices that are intrinsic to your identity as a clinician. Try advising a rural GP of over 30 years experience that bolus insulin is no longer indicated in Paediatric DKA!

    Hence, for highly experienced sim-educators (‘guzzling the Kool-Aid’), the statement that the psychologically safe pre-brief maybe part of but not the entire solution to all learning obstacles can equally be a disruptive statement even within the safe confines of this well-moderated blog. We cling onto habits “despite the caveats, I can’t see myself wavering from the script anytime soon.” because currently we don’t have an alternate or more sophisticated response to a problem (‘how do we know the Safe container works?’)

    One can easily manage the external conditions (the safe container, the pre-brief, the advocacy-inquiry debrief) that turns threat into challenge. What is uncertain is how we can manipulate the internal conditions of the student that allows them to be resilient, motivated and change-orientated learners that are willing to undergo long hard road of personal reflective learning long after that challenge was laid.

    • Chris Nickson

      Thanks, Derek – great reflections there!

      You have hit upon one of my fascinations – the concept of ‘unlearning’ (I have collected a bunch of ideas on this here:

      Apart from Lewin’s change model (freeze-unfreeze), I like Klein’s ‘snake skin’ metaphor too – in order to learn we have to shed our pre-existing mental models (skin) and grow new ones. The more intricate the mental model (often experts or experienced people) the harder it can be to shed. Often reality needs to bite in a pretty concrete way to make this happen… Figuring out how to teach people how to unlearn appropriately would be a good project for someone… I suspect it involves effective debriefing ;-)… and of course, it involves factors at levels of the individual and the organisation.

      Matthew Syed’s brilliant book ‘Black Box Thinking’ has some great stuff of cognitive dissonance too – esp the bit about the advent of DNA evidence and how hard it was to convince prosecutors that the people they had put on death row were actually innocent!

      All the best and have a great festive season,


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