The art of facilitating clinical simulation

As part of the hospital’s commitment to education, the Clinical Simulation Centre collaborated with teams of physiotherapists from Great Ormond Street Hospital (GOSH), The Royal Brompton Hospital and Sarah Wright, a physiotherapist based at Lady Cilento Hospital, Queensland, to deliver a series of training and simulation sessions.

Sarah Wright is a world expert on the use of simulation and has presented her work internationally. We caught up with Sarah to find out more about the importance of clinical simulation and where it’s heading.

Can you tell us a bit about your background working within clinical simulation?

I’ve been in Australia for 12 years, and before that was at The Royal Brompton Hospital. For the last 10 years I have been very fortunate to be involved with the use of simulation as a tool for learning and training. This has been within every university in Queensland for physiotherapists, and also for occupational therapists, speech pathologists, and through the Intensive Care Unit. 

Queensland is a large state and a lot of our regional centres take very sick children. Many of the staff are adult physios who don’t get a lot of exposure to children, so simulation is a very good tool to help train and support their capabilities. I’ve been going around the state for 10 years doing workshops like the one I’m doing here at GOSH, and training local staff to then be able to run them as well.

The research we’ve done around this area has led me outside of Australia – to Toronto, South Africa, Singapore – to promote the use of simulation, not only for physios but for all of allied health, to have them using it from the get-go.

What is your biggest driver for teaching simulation?

My biggest driver now is training others to learn the ‘art’ of facilitating simulation, and making it safe and effective in an environment that is enjoyable for learning. My job while I’m at GOSH is to help staff become trainers and facilitators of the future, and so that they can roll a similar model that fits the environment that they are in. There is no one size fits all, its about making it fit in context. 

What are the key advantages to simulation-based learning?

Changing culture is key. It’s about providing an environment that is safe to learn and grow. Simulation is about building skill-sets up in a safe environment and being able to think and reflect on what you’re doing, and what you could change. Simulation is not always about technical skills necessarily either, it’s about situational and relational awareness, team working, collaboration, and providing an environment where people are working together to problem solve and provide the best care for patients.

How is it useful for physiotherapists specifically?

Students often haven’t had exposure to engaging with say, a six year old, so might not know how to persuade them to do something. As therapists – we can’t do anything without working with the child. We don’t prescribe medication, we provide therapy and have to work together with the family and child for that to occur, and that’s a skill – it’s very hard to learn unless you practice it.

So providing that experience with a very life-like mannequin and a confederate parent for example can introduce more junior staff to that environment so that they are more comfortable and feel more confident.

I suppose I always say – “if that was your child, would you want it to be the first child that was ever treated?” And no one would really ever want that, so providing a safe environment for staff to get those practical skills is integral.

What does the future of simulation look like?

Technology is doing amazing things for simulation. For example, tetherless mannequins mean that we can move them like we would lift a child. For me though, it’s more that simulation used to be about crisis resource management, but now it’s moving more and more towards what we do every day – it’s more focused on the practical, and that’s a change I’ve definitely seen across the world.

I always use the example – in previous scenarios it used to be that you’ve turned a patient in intensive care and their tube comes out so they are not ventilated any more, how do you manage that crisis? But now we also use simulation to learn how to effectively ‘turn’ patients, as this is something we do every day.

It’s moving away from the crisis and focusing on the day-to-day and how can we reflect on those lessons learnt. It needs both [crisis management and day to day practice], but it’s important that the things we do regularly we are doing to the best of our ability. Simple things that can be very effective.

How do you feel about coming to GOSH to deliver the training?

It’s a significant privilege to be invited, as its recognised across the world as a centre of excellence. It’s an honour to work with the team here and it’s an organisation I can learn a lot from too!