Simulation in Critical Care Education

Simulation is a great tool for training in critical care. It allows us to practice performing procedures and dealing with high-risk situations in a safe place without exposing patients to harm. But, it offers so much more than that. I’ve been interested in simulation training for years. In fact, I did my doctoral project on simulation training in critical care.

Studies show that simulation is as good or better at training than actual clinical experience. In one study of medicine residents, 1st year residents without ICU experience outperformed 3rd year residents with ICU experience in clinical scenarios. The difference? The 1st years had a simulation course whereas the 3rd years had only real-world experience.

But, a lot of us in critical care training only scratch the surface of what sim can do. Although beneficial for the high-risk, low-frequency events, sim offers much higher yield in the more everyday scenarios. This includes things like teamwork and communication, but also the concept of “practice like you play.”

“Practice like you play” is the idea that if you practice common situations and scenarios enough, then when you’re confronted with them in real life, they will be automatic. This is the same concept that makes experienced providers generally better than novices. When someone has been practicing critical care for years, that experience allows them to pick up on things that novices miss. It also allows certain things to be automatic. You don’t have to sit and think through all the steps in working up a given condition, they’re automatic.

The Emergency Mind Podcast recently did a great episode on using simulation training. Drs Victoria Brazil and Andrea Austin joined host Dan Dworkis to discuss all the ways we can use simulation. They talk about “practice like you play,” creating psychological safety, in situ simulation, low-fidelity simulation, and much more. Give it a listen.

There are several websites out there where you can download premade simulation scenarios. This is fantastic because building scenarios is the hardest part of developing a simulation curriculum. But, the problem is, these scenarios tend to be fairly algorithmic. “If this, then that” situations are ideal for sim because they are straightforward cases to build. But, what if you want to teach your learners more critical thinking? This is an aspect of simulation that isn’t as well explored. Don’t get me wrong, there is lots of value in the first type of cases. If you do enough a-fib with RVR scenarios in the sim lab, when it happens in the ICU, you’re on autopilot. But, that’s also the problem. How do we use sim to teach nuanced thinking? That requires more detailed scenarios.

I’m not sure I have the answer. Scratch that, I know I don’t have the answer. But, this is where we’re going. In our Critical Care APP Fellowship, our fellows spend a significant amount of time in the sim lab. We do a dedicated sim lab day every month, but mostly, the scenarios are the “if this, then that” type. We’re in the process of redesigning our simulation curriculum to include more scenarios on leadership, communication, teamwork, and critical thinking.

There are lots of great things out there in the world of simulation. Are you using sim in your training program? How are you using it? Have you had any success with new and innovative methods? Tweet @CritCareNotes and let me know what you’re doing. Let’s share these successes and help all of us become better educators.

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