Patient Safety Simulation Masterclass - Innovation in challenging times brings new possibilities to light

Alex Rawlings
ESAIC Patient Safety and Simulation Project Manager

When faced with the problem of continuing valuable simulation training during the pandemic, the ESAIC had to look for innovative solutions. 

We had previously collaborated with Madrid’s University Hospital of Alcorcón, and its experienced high-fidelity simulation centre IDEhA, for the 2017 ESAIC Simulation Masterclass on Procedural Sedation and Ventilation Techniques.

IDEhA is a space for virtual training in a simulation and technological innovation environment that offers teaching based on a simulation environment in different areas of care, surgery, medicine and technical skills. It was created in 2015 and its name is the acronym that corresponds to Innovation, Teaching and Training at the University Hospital of Alcorcón (Madrid), being a pioneering initiative in the Madrid public system.  

We knew it was perfect for our needs. It is a large well-equipped centre. It has an operating room, multi-purpose hospitalization room, consulting room, technical skills room, control room, debriefing rooms, classrooms and convertible seminars. It is equipped with high-end adult and pediatric simulators and simulation with standardized patients and role-play techniques. 

The faculty at IDEhA have a wealth of experience. In combination with our own faculty, Dr Daniel Arnal and Dr Julien Picard, we were certain this would make a winning combination.  

However, we still needed to find a solution to running engaging scenarios online. Our answer came through IDEhA’s technical director, Dr Marta Bernardino. Marta had recently completed a course on running the online simulation using Laerdal’s SimCapture software. SimCapture enables the lives to feed from the centre’s cameras and monitor to integrate into Zoom. This would give the attendees a direct connection to the sim suite and virtual monitor. With Marta’s experience and Laerdal’s support IDEhA was set up with SimCapture, so it was ready to run an online simulation. 

SimCapture allows you to effectively manage, record, and assess simulation training, both on-site and in-situ. Capture audio, video, annotations, patient monitors, and simulator data in a single web-based interface. 

On 20 -21 April 2021, we ran our first online masterclass. The plan was unique and effective. Actors/avatars and a supporting nurse were physically located in the simulation centre. Each of the 2 actors was connected to a participant on Zoom and identified with a white or black surgical cap. As per normal simulation, the participants were given a briefing before the scenario. During the scenario, they would ask for information and give commands to their actor to interact with the patient. The information would also come back to them through a monitor view from the sim centre that would be visible on their Zoom screen. 

We ran scenarios based on anaesthesia CRM training: Anaphylaxis, Malignant Hyperthermia, Local Anaesthetic Toxicity, and Can’t Ventilate/Can’t Intubate airway. The scenarios and the debriefing approach had to be reworked to suit this new format. Scenarios had to be clarified and simplified, and their learning outcomes were even more well-defined. The faculty had to be very clear about the flow of the scenario and that it would be manageable under these new conditions.  

Debriefing had to become less personal and more a collective discussion about a particular scenario’s technical and human factors issues. However, we discovered that excellent discussion points were raised through the participants’ interactions. Leadership, communication, teamwork, and protocols all had the same relevance but had to be approached in different ways in the debriefing. Participants still took away personal learning points. Participants still experienced that adrenaline rush, even though they were removed from the actual sim centre.  

Feedback from this event was highly enthusiastic. We received some excellent suggestions to evolve the course and strong support to continue to provide this online option, even when travel and face2face sessions were permitted again. We had attendees from Dubai, United Arab Emirates, Australia, and Greece. Romania and Turkey. It allowed ESAIC members to get access to high-quality simulations without the need to travel.  

Our latest online simulation masterclass took place on 11 – 12 May 2022. Through building on our previous experience, we were able to again run a very effective session. The overall quality of the event, the organisation, the educational relevance and the quality of the scenarios all received an average rating of excellent in our feedback from attendees.  

 “I think the tram did an excellent job. I felt it was an impossible task to conduct a SIM based teaching session online, but well done, it was very close to actually being in the same room.”  

Now restrictions in most countries have been lifted, we will return to offering this masterclass as a face2face event. However, we are investigating whether there continues to be a demand for running online simulation masterclasses for anaesthesiologists and other healthcare professionals from countries outside of Europe or where simulation is still hard to access. If you know your national society may be interested in exploring options for this, please contact us: simulation@esaic.org  

The Online Anaesthesia and Intensive Care Crisis Simulation Masterclass is part of the Safer Care to Save Lives education project.  The development of this project is supported through unrestricted educational grants from our key ESAIC Patient Safety Partners: Medtronic, Philips Healthcare, Edwards Life Sciences, Mindray and Getinge. 

Our faculty 

Daniel Arnal, M.D., is the chair of the ESAIC Patient Safety and Quality Committee. He is also co-founder and past chair of the Spanish Anesthesia Incident Reporting System (SENSAR). He is also Chair of the Patient Safety Movement Foundation Regional Network for Spain and Latin America and Vice President of Quality, Patient Safety and Ethics of the Spanish Society of Anesthesiology and Reanimation (SEDAR).  He completed his anaesthesiology training at Hospital General Universitario Gregorio Marañon in Madrid, Spain, and has worked as an Anaesthesia Consultant in the Hospital Universitario Fundacion Alcorcon since 2005. He coordinates and teaches simulation training programs in the IDEhA Simulation Center.  Dr Arnal’s publications and scientific interests focus on patient safety and quality, and he co-edited the Spanish Anesthesia and Critical Patient Crisis Manual. 

Julien Picard is Anaesthesiologist and Intensivist at the Grenoble – Alpes Universitary Hospital, France. He has ais clinical activity in Trauma ICU and Emergency. He is a Professor of Anaesthesiology and Critical Care Medicine at Grenoble Alpes University. Julien earned his Doctor of Medicine degree at Grenoble-Alpes University in 2007 and his PhD in Engineering of Cognition, Interaction, Learning and Creation in 2020. He also has a Diploma in Specialised Studies in Anaesthesiology and Critical Care, and Universityary Diplomas of Medical Pedagogy and Medical Law and an aptitude for Expertise. He is the head of the Simulation Center (CESAR – Centre Evaluation et Simulation Alpes Recherche) that he co-founded in 2008. He is involved in the French Society of Anesthesiology and Critical Care (Société Française d’Anesthésie et de Réanimation) as the Secretary of the Patient Safety Committee (Comité Analyse et Maitrise du Risque). He contributes to the European Society of Anaesthesiology and Intensive Care (ESAIC) as a member of the Simulation Committee. He is also a member of the Board and of the Scientific Committee and Pedagogical Committee of the French Speaking Society of Simulation in Health (SoFraSIMS – Société Francophone de Simulation en Santé). His publications and scientific interests focus on Trauma, Haemostasis, Risk Management and Patient Safety. 

Marta Bernardino is an Anaesthesiology and Reanimation MD and Director at the Hospital Simulation Centre (IDEhA), University Foundation Hospital Alcorcón (Madrid- Spain). She is an Advanced Simulation Instructor with the Center for Medical Simulation & Harvard-MIT with the Hospital virtual Valdecilla program. She has a European Diploma in Anaesthesiology and Intensive Care with the European Society of Anaesthesiology and Intensive care ESAIC. Spanish Society of Simulation and Patient Safety (SESSEP) Safety committee chair, Executive Committee. https://sessep.com/junta-directiva/. 

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