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A time critical emergency!

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Eight RCPCH approved scenarios!

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Simulation and technology enhanced learning (TEL) - resources and scenarios

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Simulation and TEL have an increasingly important role in paediatric training, and can help ensure improved patient and family experience, safety and outcomes.

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RCPCH Quality Assurance and Standard Guideline for Simulation

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Have you participated in a sim? Please leave us some feedback!

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A comprehensive guide on how to run an MDT in-situ simulation at the Leeds Children's Hospital!

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How to Run an In-Situ MDT Simulation at LCH

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A great article on Simulation

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Author: Charlotte Davies / Editor: Liz Herrieven / Codes: CC23, SLO9 / Published: 28/05/2019

Immersive manikin simulation is a popular teaching modality in healthcare, with lots of tips everywhere. It's so popular RCEM does have a simulation committee, and regional leads have been appointed. We thought a brief overview about simulation considerations would help beginners to set out. Much time is devoted to writing the "right" scenario. At our institution it was felt that the amount of time spent writing the scenario was not always proportional to the success of the scenario. There is much literature validating the use of simulation in a wide variety of clinical settings, with many suggestions as to the way each scenario had been run. Here, we look at the existing literature about how to write a simulation scenario, and share some of our tips for success.
1. Check modality?
Immersive simulation is great for situated learning and applying existing skills. It is not a useful modality for teaching new skills, or gaining skill mastery. It is useful at integrating all skills into a realistic environment. Well designed simulation training can contribute to stress inoculation training.

Simulation requires equipment, and a high faculty to learner ratio. Whilst you may think simulation is the ideal training modality, you may not have the resources, including faculty, available to you - and this must be considered.
2. Identify your learners
Think about whether your course is going to be open to the whole multidisciplinary team, or just a single healthcare group. If you are writing scenarios for the entire MDT, there must be roles for everyone - if the only thing your Nurses can do is to take baseline observations or call the Doctor, they will not feel engaged with the process, and the scenario will not be realistic. Having Nurses or other MDT members in the simulation often adds a greater richness to the debrief.

The level of the group must also be taken into account. The learning around a sepsis scenario for an FY1 is very different to that of an ST6.

If you are writing scenarios for juniors and seniors, think about how you will manage that interaction - do you want the junior to hand over to the senior, or do you want them to work together, and display teamwork? You can find scenarios already online ( emsimcases, em3, Oxford,)- but check they have the right aim, context and objectives etc.
3. Outcomes and Aim
This is a very broad look at why you are running this scenario. It might be that you've set the scenario up in response to an adverse incident, or just because it is a topic that interests you. There should be an intended learning outcome e.g. manage an acute asthma attack and demonstrate an ability to prioritise. Often it works well to have one clinical objective e.g. manage anaphylaxis, with one human factors objective e.g. placate an angry relative. Try to limit the amount of learning objectives, to ensure you have time to cover everything in your debrief.

When thinking of your aim, make sure you include both knowledge and behaviours that you wish to address.
4. Add context and location
You need to make sure you add some authenticity to your scenario to enable you to capture the imagination of your learner. Write down any clinical content - if you base your scenario on a real clinical situation you have encountered, there will be much more authenticity and the learners will notice. Add in features and props to make the scenario realistic. Think about all the sensory modalities. Do you need background noise to make it sound realistic? What props do you need to make it look realistic? What smells do you need? What textures do you need to find?
5. Write objectives
These, like any objectives, need to be SMART. Make sure they cover the main categories of clinical, human factors and management, as dictated by your session aim. Do not try to cover too much in your learning objectives - 3 - 4 in each domain is more than enough.
6. Create flow
Decide how long you would like your scenario to aim for. We normally run for 10 - 15 minutes. Make sure you have a beginning, middle and an end to your scenario:
Beginning - This is your scene setting. You need to think about how you want to introduce this.

Middle - You need to have a change after a trigger action - this is the core challenge of your sim scenario. You need to make sure you embed suitable clues in the scenarios to make sure the right action happens, and these can be subtle or obvious depending on your learner group. A trigger might be a patient saying "I'm really itchy" which may trigger treating anaphylaxis. Observations are useful if you will pre-program your scenario, or if you don't have clinical input in your control room, but most of the time the simulation technician can change them quickly.

Ending - Attempt to anticipate the ending of your scenario, and think of some alternative endings. Your learning objectives will help with this - you might want to stop an anaphylaxis scenario after the second dose of adrenaline has been given, or you might want to wait a bit longer. It is impossible to anticipate all alternative endings.
Some find it easier to write this scenario progression as a flow chart.
7. Add details
You need to add contextual details to add realism to the scenario. Experienced simulation faculty may be able to "make this up on the day", but to ensure adequate realism, planning this in advance is advised.

Collate all the information you have so far, and write a scenario overview, list of props, and any notes needed.
8. Add complexity
The basic scenario is likely to run very well, but think about how you will add complexity to the scenario. This might be complexity that happens every time you run the scenario, or complexity that can be added in or not depending on how the learners are doing. It might be that if they're doing well, you throw in an angry relative, or a drug error - but stick to your learning aim and objectives.
9. Review
Mentally run through the scenario and check it works. Get your fellow faculty members to read the scenario, and see if they think it will work or not.
10. Debriefing and Evaluate
Choose your debriefing model- there are lots of different models that are aimed at different aspects of the scenario. Think how your scenario fits in with the rest of the day - if you have five scenarios that all look at teamworking, your students are going to get very bored! I'm most used to using the debrief diamond which is great for debriefing human factors, but it is rubbish for technical skills. The tables below talk about some different debriefing models, and how which you use will depend on what your debriefing focus is, and your preferred method. Which ever method you use, don't be afraid to re-inforce good practice.

(Image reproduced with permission from Dr Reedy, Kings College London)

If short of time in debrief, ask the students to set the agenda - "what should we cover in 15 minutes?". Use signposts to branch out - I have a review article on XYZ I will email out - let's now move on and talk about...

Whichever method you use, before the first debrief set expectations and say why you've chosen the model - it helps. Allocate a faculty member to help keep timing - otherwise it's easy to waffle on. It's good practice to go very meta, and to "debrief the debrief". " OSAD" is a tool to help when done formally, and DASH is a great tool for promoting reflection. Focus areas might involve looking at the energy of the group, any poor debrief practice, any good practice. You might want to comment on whether contributions from the entire MDT were acknowledged in an open, curious, enquiring and non-judgemental tone, with the debriefer talking just enough and not too much.

Evaluation of the entire day, after you've run it, is the next important part of the day. Our local sim network encourages this, and has a form prompting reflection on specific debrief elements.

Which ever model you use, you'll need to know something about some of the non-clinical, or non-technical topics you mention. These are the human factor elements. We've got blogposts already on stress, time management, situational awareness, decision making, prioritisation, and the emj has some thoughts on distraction . What else would you like us to write about?

There's lots of further resources you can visit - have a look at EM sim cases for a start.

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Author: Charlotte Davies / Editor: Liz Herrieven / Codes: CC23, SLO9 / Published: 28/05/2019 Immersive manikin simulation is a popular teaching modality in healthcare, with lots of tips everywhere. It's so popular RCEM does have a simulation committee, and regional leads have been appointed.

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If you would like to brush up on your LP skills please contact the paediatric simulation fellow: sindugaa.s@gmail.com

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A scenario inspired by a real case!

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Phil Hammond
phil.hammond1@nhs.net
Phil's office is in the Postgraduate centre. Please liaise with him to borrow a manikin.
P.S. - never call him Phillip!

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New BSPED Guideline:
https://www.bsped.org.uk/media/1742/dka-icp-2020-v1_1.pdf

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The following are a collection of scenarios written by various members of the Leeds Children's Hospital MDT. These are accessible to faculty only. Please contact a Sim Fellow or Emma McQueen to gain access.

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The non-technical skills section of this page is an excellent read!

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American Academy of Pediatrics: Simulation Scenarios 

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American Academy of Pediatrics: Simulation Scenarios 

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A free app with numerous simulation scenarios!

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Paediatric Innovation, Education and Research Network

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​Welcome to STAR, the
free app for iPad, iPhone and Android devices, which makes it easy to deliver and share in-situ simulation, in any environment.

STAR provides a quick and simple way of accessing all your simulation material in one place, on a device that is always with you. The simulations contained in the app have been submitted by experienced clinicians and educators, and form part of a growing collection which is freely accessible to all users.

STAR simulations are able to contain rich media (photos, video, audio) to enhance the fidelity of in-situ simulation. High fidelity simulation manikins are great, but can make delivering in-situ simulation difficult, time-consuming and require multiple faculty. STAR bridges this gap and allows enhanced low fidelity simulations to be delivered easily in-situ.

STAR is built to allow easy uploading of new simulation material, meaning that your simulations are always available at your fingertips. Simulations can be uploaded to the app via a simple online submission form and are then downloaded to all STAR devices when the app is next opened. We aim for STAR to continue to develop into an extensive bank of high quality simulation material which can be used to deliver simulation education in a variety of locations.

STAR is now able to categorise and filter simulations by adult and paediatric age groups, and allows you to create your own collections of simulations to use in regular teaching courses or programmes.

STAR also contains curated links to useful simulation resources - moulage recipes, media, simulation templates, partner websites and more - to ensure the information you need is always available in one place.

Ollie Bevington, MB/ChB (Apple App Store)"The STAR app is the most comprehensive simulation app that I have seen. As a big proponent for medical simulation, I strongly recommend this app to anyone who is interested in medical simulation-specifically pediatric simulation. This is really an exciting app and a fantastic idea of how to collate simulation scenarios for in-situ medical simulation of pediatric trainees, multi-professional teams, etc." - Douglas Maurer, DO/MPH/FAAFP (iMedicalApps) - Read the full review "A brilliant App! I run a monthly simulation session for Paediatric SHOs at my Trust and used this app for the first time last week. Excellent! Made my life so much easier & saved me so much time- no thinking of scenarios, prepping material etc. Will definitely use it for next month & be recommending it to colleagues" -

"This tool is designed for use in paediatric SIM but it is also a great information resource. It's a fantastic app" - British Belle (Apple App Store) with any comments or questions about STAR, or with suggestions about what you would like to see in the next upgrade.

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Simulation Tools And Resources (STAR) app - a free app to improve in-situ simulation education

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STAR provides a quick and simple way of accessing all your simulation material in one place, on a device that is always with you. STAR is built to allow easy uploading of new simulation material, meaning that your simulations are always available at your

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The Improvement Academy’s Bronze Human Factors online course (FREE)

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The Improvement Academy’s Bronze Human Factors online course (FREE)

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“Keeping patients safe in our NHS healthcare systems is a huge priority. There is an emerging consensus that advancing the implementation of Human Factors across the healthcare workforce may have a large impact on reducing harm. Training in Human Factors has been shown to improve safety in various industries but we are still learning about how to adopt and implement this within our NHS.”

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Bronze level Human Factors Training

In a nutshell: The Improvement Academy is working collaboratively with experts, organisations, frontline staff and patients to explore how Human Factors can be embedded within healthcare delivery. Our Human Factors training is designed to meet the needs of organisations and frontline staff and, most importantly, ontribute to reducing patient harm. Bronze Human Factors training is our entry level introductory course, is accessed online, and takes no more than one and a half hours to complete.

The Challenge

Keeping patients safe in our NHS healthcare systems is a huge priority. There is an emerging consensus that advancing the implementation of Human Factors across the healthcare workforce may have a large impact on reducing harm. Training in Human Factors has been shown to improve safety in various industries but we are still learning about how to adopt and implement this within our NHS.

In our region we already have significant Human Factors expertise and enthusiasm on this subject. There are already organisations that have started exploring, developing and implementing some great Human Factors approaches across the region but much of this work is not widely known about or is not easily accessible to all our organisations and the frontline teams who deliver care.

What we are doing about it?

Working collaboratively across Yorkshire and Humber to develop access to Human Factors training and resources to enable/support front-line staff to improve the safety of their care.

1) Our Human Factors training is suitable for all healthcare staff across Yorkshire and Humber and consists of two courses:

Bronze level e-learning which is entry level, comprised of 6 modules, certificate on completion. To access Bronze Human Factors training click here.

Silver level training which is delivered face to face during a one day workshop, certificate on completion. To find out more about Silver Human Factors training and to register to attend a course click here.

2) We support learning and signposting to information about Human Factors.

3) We explore and build on some of our current improvement work which already includes various Human Factors elements e.g. Safety Huddles (HUSH) Behaviour change, Quality Improvement Training, Medicines Safety and Significant Event Audit in Primary Care.

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Improvement Academy - Bronze level Human Factors Training

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In a nutshell: The Improvement Academy is working collaboratively with experts, organisations, frontline staff and patients to explore how Human Factors can be embedded within healthcare delivery. Our Human Factors training is designed to meet the needs of organisations and frontline staff and, most importantly, ontribute to reducing patient harm.

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Simulation Faculty Development (HEE North West) e-Learning (FREE)

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Simulation Faculty Development (HEE North West) e-Learning (FREE)

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“HEE North West have developed five e-learning resources to help in simulation faculty development and CPD. The aims of these resources are to introduce certain key areas and ensure staff have a common mental model of simulation and the educational process that under pins it. These resources are used in the North West as pre-learning prior to a face to face session by the North West Simulation Education Network's”

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This programme is in partnership with...

About the Simulation Faculty Development programme

These resources are available to assist with Simulation Faculty Development and education. The individual modules can be used on their own to increase knowledge for instance as CPD of those with simulation-based education roles or as prelearning before face to face sessions. Additionally the elearning modules can be used together as prelearning for an introductory level faculty educational focussed session.

The recently developed Simulation-based Education Design Toolkit features videos and developmental resources including the Integrated Simulation and Technology Enhanced Learning (ISTEL) Design Framework worksheet, example scenarios and workshop activity cards. These resources promote discussion around inclusivity, scalability and sustainability of simulation and technology enhanced learning in healthcare. Learning is consolidated through the completion of exercises and reflections contained in an editable and printable workbook, which may be used as evidence of continued professional development (CPD).

About the modules

In addition to the 6 modules within the programme, a face to face session is delivered to develop skills however the modules may be used to support other relevant sessions.

Introduction to Human Factors

The following film was developed to provide a brief introduction to principles of human factors and implementation in healthcare. It is designed to help those working in healthcare understand the basic principles of human factors and implement changes to improve patient safety. Dr Rob Galloway is a Consultant in Emergency Medicine at Brighton and Sussex University Hospital NHS Trust and offers extensive training at the Trust in human factors. Dr Cassie Lawn is a Consultant Neonatologist at Brighton & Sussex University Hospital NHS Trust Trust and is lead for human factors at the Trust.

Please complete this short survey to provide feedback about this film.

How to access

In order to access the Simulation Faculty Development programme, you will need an elfh account. If you do not have one, then you can register by selecting the Register button below.
Register >
To view the Simulation Faculty Development programme, select the View button below. If you already have an account with elfh, you will also be able to login and enrol on the programme from the View button.
View >
NHS healthcare staff in England

The Simulation Faculty Development programme is also available to NHS healthcare staff via the Electronic Staff Record (ESR). Accessing this elearning via ESR means that your completions will transfer with you throughout your NHS career.

Further details are available here.

Not an NHS organisation?

If you are not an NHS health or care organisation and therefore do not qualify for free access elfh Hub, you may be able to access the service by creating an OpenAthens account.

To check whether or not you qualify for free access via OpenAthens, you can view the eligibility criteria and register on the ' OpenAthens ' portal.

Registering large numbers of users

If you are a HR, IT or Practice Manager and would like to register and enrol large numbers of staff within your organisation for access onto the Simulation Faculty Developmentprogramme, please contact elfh directly.

Organisations wishing to use their own LMS

For HR departments wanting to know more about gaining access to courses using an existing Learning Management System please contact elfh directly to express interest.

More information

Please select the following link for more information on how to use the elfh Hub.

elfh is a Health Education England programme in partnership with the NHS and professional bodies

© elearning for healthcare 2021

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Simulation Faculty Development - elearning for healthcare

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This programme is in partnership with... These resources are available to assist with Simulation Faculty Development and education. The individual modules can be used on their own to increase knowledge for instance as CPD of those with simulation-based education roles or as prelearning before face to face sessions.

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This sim was live streamed to doctor's offices to allow others to take part in learning!

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The iSimulate can be borrowed from the LIMIT team. It is stored in the Postgraduate Centre. Contact: leedsth-tr.LIMIT@nhs.net

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Jack Holmes
jack.holmes1@nhs.net
leedsth-tr.LIMIT@nhs.net

Jack can help you become familiar with the simulation equipment, facilitate a scenario, and teach you how to use the iSimulate technology.

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Post-op cardiac tamponade MDT in-situ simulation with our anaesthetist and cardiothoracic surgical colleagues today. Cracking team, cracking chests!

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November 8-10th 2021
https://aspih.org.uk/aspih-2020/

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Improving Paediatric Patient Outcomes with Sim 

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Improving Paediatric Patient Outcomes with Sim 

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Developing an Undergraduate Paediatric Sim Workshop

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Developing an Undergraduate Paediatric Sim Workshop

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Developing an undergrad paed sim workshop

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Identfying latent risk through simulation

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Share the learning points from your sim with a Sim News Alert!

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Why not write your own scenario!

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Infant PAWS chart

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A collection of different paediatric CXRs you can use in your scenarios

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Sindy Siva
sindugaa.s@gmail.com

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Arrhythmias in a Post-Op Cardiac Patient on PICU

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Arrhythmias in a Post-Op Cardiac Patient on PICU

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Oncology Sim: Fluid Management in a Septic Adolescent 

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Oncology Sim: Fluid Management in a Septic Adolescent 

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Introduction to Simulation Debrief at Leeds Children's Hospital

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Introduction to Simulation Debrief at Leeds Children's Hospital

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May 4, 2021

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Virtual Paediatric Simulation Conference Sept 17-19, 2021

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Run a sim with just your phone and a tablet!
https://www.simplsim.com/