We run a weekly in-situ simulation programme in the RPA ICU, in a bed-space in the middle of the working unit, during working hours….

Our Sim bed-space

Simulation is a well-recognised and increasingly common educational tool for healthcare professionals. It is educationally effective; improving performance of technical and non-technical skills (1). Trainees also enjoy simulation training: in the latest CICM trainee survey, it was rated in the top three teaching methods, and the vast majority of trainees were keen for the College to create courses to address technical and non-technical skills.

“Bringing the mountain to Mohammed…”

Traditionally, simulation training has occurred in specialised centres, which offer a variety of courses aimed at healthcare professionals. These courses are usually expensive, involve taking study leave and usually do not provide team training: doctors and nurses tend to be trained separately and practitioners often end up training with strangers. In recent years, simulation training has been brought into the workplace. In 2005, Weinstock et al described how they took simulation training into various parts of their hospital using a mobile cart (2). Since then, this type of training, known variously as ‘point-of-care’, ‘in-situ’, or ‘mobile’ simulation, has gained momentum. As a result, several simulation programs have been set up in ICUs around the world.

The benefits

  • In-situ simulation occurs in the normal working environment, using normal workplace equipment. Healthcare professionals act in their normal roles, in ‘intact, multi-professional teams’, during normal working hours. These factors are thought to enhance realism and validity, improve working relationships, and decrease the anxiety that some practitioners associate with traditional simulation training (2). Feedback from our program and others reveals that participants enjoy training with staff from other disciplines, and gain insights into each other’s roles, skills, knowledge and attitudes.
  • Scenarios can be tailored to reflect local case-mix and critical incidents, and site-specific system errors may be identified.
  • You do not have to leave the workplace or get study leave. And its free!

Your participation

We very much hope that all trainees will want to be involved in Sim training on a regular basis. We understand that some of you might be anxious about simulation training, but we can assure you of a safe, friendly and supportive learning environment. We have some ‘ground-rules’ for training and an agreement that we don’t discuss the scenarios afterwards. This is so people do not comment on each other’s performance but also so that we can use the scenarios again! The ‘ground rules’ also establish the signs you might be expected to find in the manikin and those you will be told.

What we cover

Technical skills are practiced and clinical knowledge revised, but training sessions can also emphasise non-technical skills or ‘human factors’ such as situational awareness, decision making, task management, team working, communication skills and calmness under pressure. These skills are increasingly being emphasised in crisis management and life support training, and human factors training (also sometimes called ‘Crew Resource Management’ or CRM training) is being included in many undergraduate and postgraduate curricula.

The Debrief

We always have a non-threatening, relaxed debrief at the end of the scenario, where we discuss the learning points issues raised. We often concentrate on teamwork and communication; known to be vital for good patient outcomes. This is often where most of the learning takes place. We give (and receive) formative feedback here, which, according to the educationalists, is one of the top two strategies for enhancing learning (the other one being active participation) (3).

Tell us what you think!

We ask for feedback from all participants and observers so that we can keep improving the training. The charts below show feedback results from 200 participants and observers up to July 2012, which we are proud to say have been excellent. Please also leave comments about the training at the bottom of this page – we welcome your thoughts and and questions…

Jon Gatward and the Sim team


  1. Donaldson, L (2008). Safer Medical Practice: Machines, Manikins and Polo Mints. Chief Medical Officer’s Report 2008, 49-55.
  2. Weinstock PH et al. Simulation at the point of care: reduced-cost, in situ training via a mobile cart. Pediatric Critical Care Medicine 2005; 6: 635-41.
  3. Petty G. (2009). Evidence based teaching – a practical approach. Cheltenham: Nelson Thornes