Simulation Approaches to Enhance Team and System Resilience

How theories of complexity and resilience affect interprofessional simulation-based education: a qualitative analysis of facilitators’ perspectives

“…This is exemplified in cardio-pulmonary resuscitation-training (CPR) and expressed clearly in deliberate practice and mastery learning in controlled simulated environments [ 44 – 47 ]. Several studies have pointed out that while such training is important part of skills acquisition, only training such methods may not convey, prepare, teach or train students for the complexity of health care work and the needs for teams to adapt to its ever-changing nature, thus stressing the importance of incorporating the innovative dimension of teaching [ 18 , 23 , 28 , 48 , 49 ]. The difference in these approaches corresponds to the difference between looking at how “work is done” in everyday clinical life and looking at how work should be done or “work-as-imagined” [ 3 , 18 ].…”

“…Several studies have pointed out that while such training is important part of skills acquisition, only training such methods may not convey, prepare, teach or train students for the complexity of health care work and the needs for teams to adapt to its ever-changing nature, thus stressing the importance of incorporating the innovative dimension of teaching [ 18 , 23 , 28 , 48 , 49 ]. The difference in these approaches corresponds to the difference between looking at how “work is done” in everyday clinical life and looking at how work should be done or “work-as-imagined” [ 3 , 18 ]. The facilitators in our study seem to be saying that simulation unfolds its potential better, if it relates as closely as possible to the actual challenges of “work-as-done”.…”

“…This line of argumentation supports our findings in which the facilitators argued that students mostly interpret their own uncertainty and experience of messiness as rooted in their own lack of skills, frequently blaming themselves for their perceived inadequacy. This would entail supplementing discussions of what the ideal solution of the case would be and what the individual can improve to reach it with discussions that emphasize the value of “muddling through”, working towards local and temporal optima [ 3 , 18 , 53 , 54 ].…”

“…It has also been suggested that capacity for resilience can be increased through training health care staff to manage disturbances [ 16 ]. In situ patient simulation has been proposed as a tool to examine complexity and resilience in every day clinical work [ 17 , 18 ]. SBE was also suggested for the training of resilient skills in other domains, such as electricians [ 19 ].…”

“…Although SBE may have paid some attention to complexity by exploring variations and participants’ perspectives [ 26 ], and even though it is a widespread praxis to highlight (but not necessarily to analyse) what went well in a scenario, the main focus is often put on training the right course of actions by adhering to particular sets of prescribed recommendations, guidelines or algorithms [ 3 ]. A major criticism of this approach is that when the complexity that is found in everyday clinical work is not taken into consideration there is a risk of favouring imagined challenges and simplistic learnings which are not relevant in reality [ 18 , 23 , 27 – 31 ]. An objection is that courses with this approach might be effective in teaching pre-defined learning goals but might fail to help participants to apply the newly acquired skills and might be too rigid to be applied in different contexts.…”