All of the discussion on the Sim Connect Community networking site of the SSH inspired me to expound a little on the topic of death during simulation.
A number of years ago we had a poster at IMSH reporting our results of a survey given to 224 professionals (Emergency Physicians, Flight Paramedics and Flight Nurses) who attended courses that had some scenarios that ended in death depending on how the cases were managed. Overall 48% of them had experienced death during the courses. These were courses that did not include objectives on death, family/patient communications or teamwork. Thus, there was no focus on the death during the debriefing. PDF of Poster
They were asked a series of questions about experiencing death during the simulations. The four main conclusions that we reported were: 1) Participants disagreed that simulated death was distracting to the learning environment; 2) Participants strongly disagreed that students in their respective fields should be exempted from simulated death; 3) Participants strongly disagreed that experiencing simulated death would create a reluctance to participate in further simulation training; 4) Participants disagreed that a separate disclosure about the possibility of simulated death was necessary. On further analysis there was no difference in the perceptions of those who experienced simulated death and those who had not.
Bear in mind these are all practicing professionals and all from a high-acuity emergency profession. But, none the less this was their collective opinion. So maybe at times we should slow down and ask the participants their impression. I think many people take the phrase “safe learning environment” to extremes and try to make absolute rules that are very broad sweeping and thus become rate limiting steps in creating effective education.
Do I think that death in simulation is appropriate for all learners? Absolutely not! In the case of the learners participating in the courses we studied, it was the collective opinion of the subject matter experts involved in the design of the courses that it was appropriate. But importantly, it was a deliberate decision as part of the course design.
While there is significant passion, emotions, urban myths and beliefs surrounding this topic, like most things in simulation I think there is no one correct answer. I believe that those who profess to know “THE” way to do simulation and are unyielding in there methodology or offerings should be viewed with skepticism and doubt.
When programs carefully evaluate who their learners are, make realistic expectations, understand what is needed of the learner to provide the best patient care possible, remains attentive to the general emotional well being of the participants, and deliver the learning with well trained facilitators, I believe they are providing PATIENT CENTRIC SIMULATION. A concept which I believe is the most useful of all to the global healthcare community and will result in higher quality patient care.
My third year undergrad nursing students suggested during a focus group interview that we should allow them to practice and experience the emotions related to the death of a patient in simulation. Within in the South African context, this might be relevant, since they are placed in the clinical areas from the beginning of their training and might experience a patient dying during their first contact.
Anne-Marie,
Thank you for providing yet another example of why an all or none yes/no answer to death during Simulation would not be appropriate. While your example would obviously revolve around objectives examining feelings and experiencing death, it sounds like a great use of simulation!
Good luck with your efforts. -Paul