Browse the corpus

First described in the anesthesia literature in the late 1980s, medical simulation has become an essential part of training in medical education at the undergraduate and graduate levels and in nursing and pharmacy education.[1][2] Traditionally, simulation occurs in dedicated simulation centers. This center-based simulation offers the benefit of being separate from patients and focusing on learning for the individual and the team.[3] Dedicated time is scheduled to participate in this educational activity, and debriefing of the simulation can take part without the competing demands of the clinical work environment. In situ simulation differs from a center-based simulation in that it occurs in the actual clinical environment, often using providers and staff currently on shift. Because it occurs in the real working environment, it also provides opportunities for learning on the unit and organizational level.[3] In situ simulation has been used to improve teamwork and communication and to help identify system issues and latent patient safety threats.[4][5][6][7] In situ simulations like mock codes may ultimately improve patient outcomes.[8]

Key facts to keep in mind about in situ debriefing in medical simulation are as follows: Debriefing needs to occur following simulation exercises to be effective. The scheduled debriefing time should be for at least the anticipated duration of the simulation exercise. For example, a 10-minute simulation will need at least a 10-minute debriefing. Learner self-assessment, facilitator-directed feedback, and conversational feedback are 3 options that facilitators can use to address their feedback. These methods can be blended to best suit the needs of the simulation. Reflective observation allows simulation participants to reflect upon and evaluate their performance. The AIM seeks to understand why a simulation participant performed a particular action. Directive feedback is a valuable technique when addressing a gap in procedural knowledge, but it may be less preferred by learners than other models. Novice facilitators will need support to be proficient at debriefing simulation exercises. Written tools or formal training can provide a framework for a debriefing for novice facilitators.

In situ simulation has been shown to improve teamwork[4][5] and communication.[6] Essential to successful simulation is quality debriefing. An ineffective debriefing may fail to help learners close a knowledge or performance gap.[24] When debriefing is done poorly or perceived as critical instead of constructive can lower self-esteem.[25] It may also create anger or resistance, which can undermine the teamwork aspect of healthcare.[25]