SIMULATION
Crash Testing the Dummy” In-Situ Simulation in the Emergency Department By Suzanne Bentley, MD, MPH, Kate Lin, Muhammad Waseem MD, and Miriam Kulkarni, MD, on behalf of the SAEM Simulation Academy Emergency Medicine teams are experts in the management of critically ill and injured patients, relying heavily on maximized teamwork and communication to work effectively and collaboratively in an expedited fashion. In addition to team factors and dynamics, physicians must be prepared to identify and manage an extensive range of clinical pathologies including high acuity, low occurrence (“HALO”) procedures, and rare, timecritical, but life-threatening conditions, some of which clinicians may never have previously encountered. Medical education in teamwork training has evolved significantly over the years, with simulation education as an established standard and recognized technique for conveying necessary knowledge about teamwork, developing the skill of teamwork among participants,
and enhancing attitudes and shared understanding regarding teamwork.
departmental and hospital processes in real-time and in real locations.
Simulation is a technique, not simply a tool, that can be employed to meet a variety of educational and systemsbased objectives for practice, learning, evaluation, testing, or to gain an understanding of systems of human actions. In-situ or unit-based simulation training takes simulation directly into the workplace environment. Potential applications include its use to examine workflow, improve culture, practice teamwork, familiarize oneself with equipment, improve communication, orient staff to new policies and procedures, assess the efficiency of a system, identify gaps, and practice rare events, without risk of patient harm. It allows teams to test their effectiveness in a controlled manner and to interrogate
In-situ simulation can formally be used as a “team-based training technique conducted in actual patient care units using equipment and resources from that unit and involving actual members of the healthcare team.” Less formally, in-situ simulation has been described as “crash testing the dummy.” Deliberate practice and integration of teamwork skills in a time-pressured environment generates realism and is a rich resource for identifying latent threats and system issues. While simulation has often been used as a strategy to train individuals in both technical and nontechnical (e.g., leadership, communication, and
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