Sim Suite vs. In situ
why choose one over another?
The centre of the problem originates from the challenges and benefits each environment provides.
The simulation suite is the heart of your simulation department. No two simulation suites look, work or feel the same as another. Their uniqueness, however, is part of the problem. Many sim suites are developed from repurposed wards or non-clinical areas. During their development, they are often based on the clinical environment, however, as they are multi-functional and have to be adaptable so that they can support many different training programmes. Therefore, while trying to look like everywhere, they equally look like no where. The simulation team will try their utmost to emulate each environment, but by their very nature of being away from the learner's clinical areas, they are not as good as the real thing.
While not a deal breaker, these differences offer new challenges. This includes:
What they themselves are allowed to do with an increased reliance on 'stooges' to locate resources
Who they can contact - not through their usual routes of support or available guidelines
Increased cognitive burden accounting for the above with reduced situational awareness
While the above is true, the counter arguments to the above are that learners cannot do everything and therefore stooges can help, sim designers can account for these behaviours and with good user design find ways to help alleviate cognitive burden so that learners can function at optimal performance.
Many manikins and scenarios can be undertaken within the learner's normal clinical environment. The benefits of this include, time, convenience, access to normal help, resources and guidelines. It situates the learning in the workplace and therefore has the potential to provide direct benefit to patient care in that area.
The core challenges to in situ simulations are finding enough space, support, time away from patients, against service provision, and mentally preparing learners to learn where they work...
In situ specifically provides you with the insights of the challenges while working in the clinical area and can help simulators find service improvement opportunities, latent error risks and with repeated attendance deliver measurable improvements to patient care.
Top Tips for making it work
Think about the environment you want to work it - what preparation is required, what clinical needs might occur...
Engage departmental/service leaders and if possible engage local teams to support delivery
Plan learning objectives which are relevant to your learners and consider a needs analysis, this in part may come from point 2
If possible aim for inter-professional / MDT opportunities but do not simply use the extended healthcare teams as your stooges - consider their learning needs to guarantee success
Embrace realism - get the learners to find as many of their own resources and guides as possible
Keep it simple, then, once your teams and wards are ready, build to more complex scenarios
Make sure the ground rules are clear and well communicated - safety must always be a high priority, both physically and emotionally
Consider latent safety threats, observe and document
Debriefing is your friend - don't forget it's importance even with clinical needs
Saying that - patients first, at all times an simulations can always be rearranged
There is no right or wrong, only what is best for you - and don't forget to have fun!
More learning resources are available below:
In Situ Simulation: Challenges and Results - https://www.ncbi.nlm.nih.gov/books/NBK43682/
LITFL, In Situ Simulation, by Dr Chris Nickson - https://litfl.com/in-situ-simulation/
In situ simulation and its effects on patient outcomes: a systematic review - https://stel.bmj.com/content/bmjstel/6/1/3.full.pdf
Simulation in healthcare education: A best evidence practical guide. AMEE Guide No. 82 - https://www.tandfonline.com/doi/pdf/10.3109/0142159X.2013.818632?needAccess=true
Designing in situ simulation in the emergency department: evaluating safety attitudes amongst physicians and nurses - https://advancesinsimulation.biomedcentral.com/track/pdf/10.1186/s41077-017-0037-2
Laerdal, Prepare for the unexpected - https://www.laerdal.com/gb/learn/in-situ-training/
RCEM Learning, In-situ simulation: A beginner’s guide - https://www.rcemlearning.co.uk/foamed/in-situ-simulation-a-beginners-guide/
Using Fully Immersive ‘In Situ’ Simulation to Prepare New Foundation Doctors to Work in an Acute Setting - https://scientificliterature.org/Anesthesia/Anesthesia-18-114.pdf
Simulation - In Situ Vs In Lab, What Do The Participants Think? - https://smacc.net.au/wp-content/uploads/2018/06/Simulation-In-Situ-Vs-In-Lab-What-do-the-participants-think.pdf
Role of in-situ simulation for training in healthcare - https://journals.lww.com/co-anesthesiology/Abstract/2017/12000/Role_of_in_situ_simulation_for_training_in.21.aspx
IN-SITU SIMULATION: A DIFFERENT APPROACH TO PATIENT SAFETY THROUGH IMMERSIVE TRAINING - https://pdfs.semanticscholar.org/e638/c8bbbd03f8bef5ec75e32b2935d07b951db3.pdf
In Situ Simulation: Bridging the Gap between Learning and Practice - https://em3.org.uk/foamed/8/2/2019/in-situ-simulation-bridging-the-gap-between-learning-and-practice
Top 10 (+1) Tips to Get Started With in Situ Simulation in Emergency and Critical Care Departments -https://pubmed.ncbi.nlm.nih.gov/26969169/