9 – Put the Rubber to the Road – In Situ Simulation

Be open and honest with the team about the true objectives you are trying to achieve. When these are focused on doing better for the patient, people will join the ride.


You’ve been running fortnightly scenarios in the nearby simulation centre. These are part of the resident training program and from time to time may get a nurse or two along depending on how busy the department is. While well evaluated, you see the residents go back to the shop floor and struggle to apply any of the lessons that the group agreed had been take homes from the previous sim session. They can’t find equipment, struggle to coordinate the multidisciplinary team and seem much slower to achieve critical actions in the real resus. You approach the Department director and the nurse manager and suggest starting to conduct one of the sim sessions in the department in a real resus bay once a month. This is met with resistance, “we’re too busy theirs not enough staff or time”, “the staff have done mock codes before, they really disrupt things and they hated them”. You go back to your office and try to come up with how you will make this happen.

Welcome to Episode 5 of Simulcast. In this episode we discussed how moving some simulation efforts out of the lab and into the workplace can yield big benefits and get some tips on how to drive change management and make a sustainable in situ simulation program.

Our guest for petroepisode 5 was Andrew Petrosoniak, an emergency physician and trauma team leader at St. Michael’s Hospital, and Assistant Professor in the Department of Medicine at the University of Toronto. Petro has a strong grounding in the sim lab, but is a vocal advocate for point of care or in-situ simulation. Petro is the taller, better looking, and all round more refined co-lead on TRUST, an in-situ simulation-based study examining design ergonomics, human factors and latent safety threats in trauma resuscitation. Petro and his colleagues have also recently published a great article on in situ sim in Emergency Medicine Australasia.

Through this episode we give a brief overview of in situ simulation, what can you get out of it that isn’t possible in the lab and how would you assess the functional alignment of in situ versus sim lab. We also look at some functional domains that can help better understand objectives for in situ sim.

We picked Petro’s brain about the TRUST study and try to answer the big question – how hard has the change management process been in bringing sim out of the lab and into the department?

More resources

Spurr, Gatward, Joshi and Carley EMJ Article –Top 10 (+1) tips to get started with in situ simulation in emergency and critical care departments – http://emj.bmj.com/content/early/2016/03/11/emermed-2015-204845.full.pdf

A process tracking video from TRUST simulation – https://www.youtube.com/watch?v=itLtqAAwe_w&feature=youtu.be

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