Journal Club November 2020 – Activity Theory Within In Situ Simulation

Simulcast Journal Club : November 2020 

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. 

The Article : 

Gormley, G.J., Kajamaa, A., Conn, R.L. et al.Making the invisible visible: a place for utilizing activity theory within in situ simulation to drive healthcare organizational development?. Adv Simul5, 29 (2020). 

Discussion :  

In Situ Simulation has been lauded as a fantastic opportunity to build culture within health care teams and identify latent safety threats, but have you ever had an In Situ debrief that felt unproductive?  Helping teams get better can sometimes require alternative debriefing structures or a deeper understanding of the way healthcare teams interact and engage in their environment. 

In this month’s paper, Gormley et al explore the “Cultural-Historical Activity Theory” in order to promote deeper understanding of the way we engage with healthcare systems and how to facilitate your team’s understanding of how to improve it. 

It’s a complex new idea, but one we hope you’ll enjoy engaging with! 

Let us know what you think! 

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.

3 thoughts on “Journal Club November 2020 – Activity Theory Within In Situ Simulation

  • Dan Hufton

    Thank you for the prompt to look at this. CHAT was a new term for me and It took me some time to get my head around it (I still don’t think I’ve got it – so please excuse/forgive anything here that is elementary to others) I think this complexity/novelty may be relevant to its use in simulation, which I’ll come back to.

    I thought the paper did a good job of laying out why this may be a beneficial model. Your comment above Ben, definitely resonated with me, when I’ve tried to use simulation to test a system and the participants were ‘stuck’ in an educational mindset “we need to communicate better” etc. I’ve found that a clear focus on purpose (as they describe focus on the object) in the pre-brief really helps, we have even started calling participants ‘co-faculty’ in order to try and shift their mindset to one of systems thinking and maybe being really explicit about a common framework is a next step in helping that purpose be really clear? The key concepts in this model do seem to fit nicely with other systems models and the 2 way arrows nicely illustrate the ‘tensions’.

    As the authors point out the participants in the simulation may struggle to cognitively hold the triangle models in their head whilst doing the activity but they hypothesise that observers would be able to consider the key elements. I’m not sure how easy a task that might be for observers. I found it a struggle to understand the meaning of the terms rules, community, subject, object etc (and the interconnected triangles did baffle me when I first saw them) and I can imagine watching a simulation where I’m asked to think about these key concepts and what applies where might be tricky. Insitu simulation with the whole/real team is going to be key to understanding the ‘work-as-done’ and the team have the keys to improving that system. My concern would be that introducing new concepts/terms/diagrams in the prebrief may risk losing the common language and open communication you are looking for. It would potentially need a careful introduction or ground work? I notice how in figure 2 they have only drawn a single triangle on the flipchart to discuss.

    However, systems thinking is a challenge and if we want to improve maybe we need to all be pushing the boundaries together?

    I guess this was just a theoretical paper, I was left wanting to hear the authors reflections of when they have tried this how it went… maybe that is to come, maybe this reflects that I can see how it could be beneficial and keen to see data to prove that.

    So, overall, I like the idea of having a framework to “hook” systems focused discussion around. To really pull the simulation away from the ‘educational’ mindset. Is this the framework I would use? I’m not sure at the moment.

    • Benjamin Symon

      Daniel Hufton you are a national treasure, thankyou!
      You win the gold star and then some this month, and I’ve referenced you heavily in the podcast!

      • Sarah Janssens

        I’m sorry Ben, I tried! I had a go at reading this 4 times and kept getting lost, confused and overwhelmed 🙁 . Keenly awaiting the podcast to hear Steph’s explanation of this!

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