June 22, 2021By Dr. Kim Baily

Clinical Simulation Team Training: A Bad Idea?

Dr. Victoria Brazil, director of the Bond Translational Simulation Collaborative and professor of emergency medicine at Bond University, is a leading voice in the transition of healthcare simulation from simply an educational strategy to a tool for improving healthcare systems and outcomes. Dr. Brazil says healthcare simulation is more than a method to improve individual clinical techniques, communication and team behaviors; rather, simulation can be used to diagnose a healthcare problem, test a solution and then help train clinicians and nonclinical staff to embed the solution into existing practice. In January, Dr. Brazil posted an intriguing article on the Internal Clinician Educators (ICE) blog page titled, “Why Simulation-Based Team Training Might Be A Bad Idea.”

Dr. Brazil notes in her blog post that, although healthcare simulation is an accepted methodology for training healthcare teams, the process is not without considerable cost and use of institutional resources. In addition, the effectiveness of simulation is not that well-documented in the literature. Dr. Brazil began to wonder if “there are right and wrong ways to do simulation-based team training.” She offered six reasons why simulation-based training may not be effective. In addition, Dr. Brazil recommends strategies to address the six issues.

When interprofessional team training is focused on medical decision making and nurses are used as props: Frequently, healthcare simulation scenarios and the debriefing sessions that follow are based on medical interventions and/or decision-making. Learning objectives specific to nursing may be separate or absent altogether and nursing issues are an afterthought. Such a setup does not lead to collective competence. Dr. Brazil accepts that this issue is challenging but suggests that approaching the simulation using a Relational Coordination framework based on shared knowledge, shared goals and mutual respect can lead to improved personal and team learning and engagement as well as an improved collaborative culture.

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When the teams are ‘performing a show’ rather than truly practicing their work: For example, when a self-identified team leader dominates the simulation and the debriefing with expected behaviors. Determine if these behaviors translate to the real-world clinical situation. Use standardized and accepted debriefing methods to stimulate a deeper discussion may help with this issue. If participants remark that some process was done well or the leadership was excellent, ask them to analyze what they meant when they made the statement and why they thought the behavior was good.

When simulation debriefings are only based on Crisis Resource Management: Overall, evidence suggests team-training can positively impact healthcare team processes and patient outcomes. However, improved teamwork cannot be based entirely on improved situational awareness, closed-loop communication or improved knowledge of the environment. Simulation educators need to have a deeper knowledge about how teams operate, behave and change.

A Harvard Business Review article noted: “(Learning) organization is one that is skilled at creating, acquiring, and transferring knowledge, and at modifying its behaviors to reflect new knowledge and insights. The five elements to this process include systematic problem solving; experimentation with new approaches; learning from experience and past history; learning from experiences and best practice of others; and transferring knowledge quickly and efficiently throughout the organization.”

When the team training is soft rather than safe: In an attempt to create safe learning spaces, debriefers fail to identify learner interventions and behaviors that were not effective or potentially could cause patient harm. Dr. Brazil notes that building trust between educators and learners takes time. Educators need to demonstrate integrity and respect for the learners but also need to address practice gaps observed during the simulation.

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When real patients could be harmed: In situ simulation has the ability to identify practice gaps, missing equipment and latent safety threats. However, in situ simulation also has the potential to cause real patient harm. Examples include fake medications being unintentionally given to a real patient, code teams being called to a mock code or injury to a simulated patient. Clearly defined policies and procedures related to healthcare simulation are essential to protect patients as well as simulation learners and staff.

When simulation is used instead of real-world debriefing: When there is a lack of qualified debriefers, reluctance on the part of staff to participate or lack of time for real-world debriefing, opportunities for practice improvement may be missed. Dr. Brazil acknowledges that this issue is a challenge but with “a clear objective and carefully designed, consistent process for short conversations after specific ‘triggers’, and with leadership-level support and frontline ability to lead these conversations” situational debriefing offers a method for significant practice improvement.

Dr. Brazil acknowledges that, although simulation educators like herself are on a learning curve and mistakes may be made, simulation-based team training is beneficial. She challenges everyone to commit to “thoughtful and rigorous reflection on how we do it.”

Read Dr. Brazil’s Full Article on the ICE Blog Now!

Want to Learn More From Dr. Brazil? Check Out Her HealthySimulation.com Webinar:
Scenario Design for Translational Healthcare Simulation

Writing effective healthcare simulation scenarios is challenging. Clear learning objectives, attention to detail and balancing the cognitive load on participants is required. Clinical authenticity is critical. When planning translational simulation activities – directly targeting health service improvement – these same principles apply. However, our scenario design also needs adaptation to accommodate new objectives, and often different delivery contexts, including in situ simulation. This webinar session examines the principles and practice of designing scenarios within translational healthcare simulation programs. Participants will consider whether our objectives are to: Explore the work environment or people in it, Test a planned intervention/ pathway/ physical space, or To educate and train healthcare teams?


  • Dr. Victoria Brazil. “Why Simulation-Based Team Training Might Be a Bad Idea……” ICE Blog, 5 Jan. 2021, icenetblog.royalcollege.ca/2021/01/05/why-simulation-based-team-training-might-be-a-bad-idea/.

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