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The potential and challenges of utilising multiprofessional in situ simulation
  1. Andrew Gordon Dawes1,
  2. Eleanor Wood1,2
  1. 1 Gastroenterology, Homerton University Hospital NHS Foundation Trust, London, UK
  2. 2 Simulation Centre, Homerton University Hospital NHS Foundation Trust, London, UK
  1. Correspondence to Dr Eleanor Wood, Gastroenterology, Homerton University Hospital NHS Foundation Trust, London E9 6SR, UK; eleanor.wood3{at}nhs.net

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Simulation allows the practice of clinical skills in a risk-free, controlled environment. It is followed by facilitated self-reflection and constructive feedback via a ‘debrief’ from trained faculty. Initially pioneered by the aviation industry, it has now been enthusiastically embraced by healthcare as an approach to dealing with safety critical and complex clinical scenarios. Simulation is widely adaptable and its use has been applied to diverse clinical areas, specialities and topics from communicating in difficult circumstances to major incident responses.

Realisation that fidelity of simulation is improved if it accurately reflects real clinical working environments has led to the transition of simulation out of the skills laboratory into the workplace, and the inclusion of the complex multidisciplinary teams which deliver care in the clinical setting. By increasing the complexity of the environment, we provide an immersive experience which allows us to explore performance in the context of the full breadth of competing tasks/priorities/resource difficulties which happen in real life. Testing the team's responses in real clinical environments gives an unprecedented ability to analyse failures of care as and when they occur, that is, latent error identification, and can direct targeted remedial improvement projects to remedy them. Practical skills and theoretical knowledge will always be a feature of simulation; however, awareness that a high proportion of clinical incidents arise from failures of situational awareness, leadership, judgement, decision-making, communication and teamwork has meant an increasing component of simulation is exploring and developing human factor skills.

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Footnotes

  • Twitter @andrew_dawes, @@wood_eleanor

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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