Innovations in Sim_November 12, 2025 EM Recording 2

Main ideas, concepts, and lessons

• Simulation facilitation is continuous and guided

  • Facilitation begins with pre-briefing, but continues throughout the simulation and even after—during debrief and follow-up conversations.
  • Even after a scenario ends, facilitators may still support learners in building trust and relationships (e.g., a shy learner asks a strong question after the formal session).

• Build trust and psychological safety early so learners can act naturally

  • In real settings (e.g., hospital/clinical or first meetings), facilitators need quick ways to build trust.
  • Psychological safety is framed as necessary for learners to participate actively and respond as they would in real practice.

• Use “teachable moments” instead of brushing issues aside

  • Errors or unexpected events can become learning opportunities.
  • If a critical mistake or something catastrophic happens, facilitators must address it, not ignore it—learners still need to learn from it.

• A strong pre-brief improves performance

  • If learners are confused, unsure, or nervous—and this isn’t resolved—those feelings carry into the simulation.
  • Repeatedly asking “Do you have any other questions?” helps learners buy in and participate as intended.
  • Pre-briefing should be prepared/practiced, not assumed.

• Facilitation goals emphasized by participants

  • Ensure everyone participates, ideally equally.
  • Treat participation as a team sport; guide learners to perform alongside one another.
  • Maintain realism/fidelity while adapting when something fails (e.g., “dig on your feet” if a device breaks or a character slips).

• Realism and fidelity support engagement (not imagination)

  • Realism is described as crucial because the scenario is stress-inducing, and learners may enter with low desire or resistance.
  • Realism helps learners buy in and reduces disengagement.
  • Fidelity does not require flashy/expensive equipment—only what is tangible, reasonable, and consistent with the scenario.

• Cognitive load and matching learner pace

  • Learners have different thresholds for cognitive load; facilitators must avoid overwhelming them.
  • Facilitation includes learning each learner’s pace and style, reducing anxiety by calibrating difficulty and timing.

• Simulation prepares learners to make safe mistakes

  • Learners (and groups) learn from mistakes because simulation allows practice without harming patients.
  • Normalizing mistakes is framed as an important professional (and life) lesson.
  • Psychological safety is highlighted as essential so learners can try without fear of retaliation.

• Pilot testing: when and why

  • Pilot test simulation activities:
    • When there are significant changes
    • When designing new scenarios
    • Not only when created internally, but—when possible—with people/learners outside the design team (best practice)
  • Rationale: pilot participants may reveal gaps facilitators didn’t anticipate.
  • Pilot findings should feed into a review/update process, including:
    • Facilitator “debrief after the debrief”
    • Documented scenario revisions

• Embedded participants replace the older “confederate” concept

  • An embedded participant is inserted into the scenario to keep learners on track (e.g., respiratory therapist, housekeeping, provider, nudging voices/providers).

• “Lifesavers” for when simulations go off track

  • If something doesn’t go as intended (simulationist error, oversaturated/anxious learners, missing resources), facilitators should have planned interventions to regain control.
  • Examples of lifesavers and steering tactics include:
    • Provide physical copies of medical history rather than only verbal report
    • Use paper/handwritten report when EM charting resources aren’t available
    • Modify patient condition cues (vitals/monitor alerts) to regain attention and alignment with intended events
    • Give redirections (e.g., don’t go down a hallway; adjust immediate focus)
    • Provide accessibility to support (e.g., a phone to call for help; facilitator or “mom” role as scripted support)
    • Clarify and verbalize facilitator thinking so learners understand if they’re on the right track
    • Offer scenario support through environmental cues consistent with realism (what they see/smell/hear/monitor)

• When to stop or intervene

  • Stopping is tied to:
    • Hitting an agenda endpoint / planned time allocation
    • When facilitators believe they can no longer meet criteria/objectives
    • When psychological safety is at risk (e.g., learner leaves the room)
  • “Let it play out” can be appropriate when it supports learning—with boundaries.

---

Methodology / instruction-style content

A) Facilitation workflow across the simulation

• Pre-brief

  • Prepare a solid pre-brief (practice it; ideally write/script key parts).
  • Resolve questions early; repeatedly prompt: “Do you have any other questions?”
  • Establish psychological safety:
    • Set expectations such as equal participation
    • Frame teamwork expectations (“team sport”)
  • Clarify what learners will do and what will guide them (objectives/checklists may be shared depending on evidence and context).

• During the simulation

  • Continue facilitation as a guided process, not something that ends after pre-brief.
  • If learners become confused/nervous, recognize that anxiety carries through unless addressed.
  • If something goes wrong (device failure, broken character), adapt while maintaining realism (make it seem as if it was always part of the plan).

• Debrief and after

  • Debrief must include discussion of mistakes/catastrophic moments when necessary.
  • Facilitation continues in post-scenario conversations where learners ask questions or process learning.

B) Goals for facilitating a SIM activity (as articulated by participants)

• Ensure everyone participates and aims for equitable participation.
• Encourage learners to view simulation as team-based collaboration.
• Maintain learner confidence through guidance (without “giving answers”).
• Use realism/fidelity while allowing improvisation if props/characters fail.

C) Pilot testing policy (discussion conclusions)

• Pilot test (run-through) when:

  • Significant changes occur to a scenario
  • You create or redesign a new scenario

• Best practice emphasis:

  • Pilot should involve people who did not design the scenario (to expose blind spots).
  • Pilot requires availability of bodies/learners, which can be difficult in some real settings.

• After pilot:

  • Make necessary adjustments “on the block.”
  • Then return to update the scenario.
  • Use a review process (including facilitator discussion/debrief-after-debrief):
    • Did it run as intended?
    • Were objectives met?
    • What must be improved?
    • Capture not only what changed, but why.

D) Enhancing realism and fidelity (practical levers)

• Use realism to increase engagement, not because the scenario must look flashy.

• Ensure the environment is:

  • Reasonable
  • Rational
  • Consistent with what learners should experience

• Tactics:

  • Let learners see the environment before starting.
  • Provide time to play/locate resources (where items are, what’s available).
  • Provide a safety net when learners feel stuck (e.g., phone, “call for help” option).
  • Adjust realism incrementally based on learner experience:
    • Novices may need less complexity and can “buy in” with simpler tangible cues.
    • Experienced learners may notice missing equipment/realism more sharply.
  • Consider embedded participants (formerly confederates):
    • Insert support roles to nudge or keep learners aligned to the scenario.

E) Managing off-script problems with “lifesavers”

• Plan how you’ll intervene when the scenario drifts.

• Include lifesavers such as:

  • Provide medical history on paper (or other physical format)
  • Switch to old-school documentation when EM systems aren’t available
  • Use cues that match the scenario and monitor environment:
    • Adjust vitals/alarms or visual indicators to guide attention
  • Provide structured redirection:
    • Tell learners what not to do / where not to go (prevent dead ends)
  • Clarify/verbalize your thinking in the room so learners know they’re oriented
  • Add support access:
    • Provide a phone to call resources (including a scripted “mom” or facilitator as support)

• Decide whether to:

  • Let events unfold briefly for learning
  • Or intervene to stop/reset when learning goals or safety are compromised

F) Decision rule: when to stop an error/intervention

• Stop when:

  • The session reaches the agenda/time endpoint
  • You cannot meet both objectives/criteria anymore
  • Psychological safety becomes a risk (e.g., learner leaves)

• Otherwise:

  • Consider letting it play out if it supports learning, followed by debriefing.

---

Speakers / sources featured (as identifiable from subtitles)

• Lee
• Haley
• Megan
• Rita
• Nicole
• Ashley
• Lori
• Liz
• Joanna (source of referenced “great article” and next-session content)
• Lucan faculty / “our Lucan faculty”
• Healthcare Simulation Standards of Best Practice
• High Reliability Organizations / HRO (referenced conceptually)
• White paper (mentioned as a visible document/source in the workshop environment)