Simulation Lab

A simulation lab is designed to provide immersive learning experiences for healthcare practitioners and students. A simulation center, which consist of realistic looking clinical sim lab rooms, manikins and equipment, allow learners to practice and development clinical expertise without any risk of patient harm. Learners apply their theoretical knowledge in carefully created hands-on scenarios that mimic various clinical situations inside these simulation laboratories. These scenarios range in complexity and/or skill level. For example, healthcare simulation may be used for undergraduate medical and nursing schools, internships, residencies and ongoing training for qualified practitioners. Some examples of simulation scenarios include asthma attacks in pediatric patients, GI bleed, labor and delivery complications, cardiac arrest and newborn hypoxia. In addition, medical simulation provides a unique opportunity for hospital staff and students to practice team communication, interdisciplinary care and patient safety.

Clinical Simulation may be divided into three main areas:

Prebriefing – information is provided to the learners about a patient situation. A review of standards may be included.
Simulation scenario – A case study with specific learning outcomes which can be reproduced in a simulation lab with a high fidelity patient simulator or actors. Learners, who assume varying healthcare roles, must respond to the scenario as if they were caring for a live patient. Additional learners may watch and listen either through a one-way mirror or remotely via a live video transmission
Debriefing – learners review and reflect on their actions during the scenario, identify what went well and not so well (aka practice gaps) and ways to improve future performance. Debriefing is a key component of simulation education where the learners themselves consider their own behaviors, learn from the experience, change future behaviors and become better healthcare practitioners.

The greater the similarity (fidelity) of the scenario and simulation laboratory to real life, the more likely the learners will suspend reality and behave as if they are in an actual clinical situation.

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Simulation labs are built to mimic various hospital locations such as emergency rooms, operating theaters, critical care units, labor and delivery rooms, general medical-surgical floors (wards) and pediatric intensive care units. Some academic healthcare institutions and hospitals have a single simulation lab with or without separate debriefing and control rooms. These simulation in healthcare programs usually change equipment around to match the desired clinical emphasis.

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Larger simulation centres have a cluster of medical sim labs or nursing sim labs, along with high fidelity simulation debriefing rooms, control rooms, preparation rooms and storage rooms. In addition, there may be patient examination rooms, separate labs for task trainers and surgical simulators as well as classrooms and computer rooms for computer assisted learning and virtual reality.

Simulation labs contain a variety of specialized manikins (models), electronics and audio video equipment. The quantity and type of equipment depends the learning needs of the participants, the available space and the budget to operate, build, maintain and staff each laboratory.

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Simulation Lab Equipment – examples equipment.

Human Patient Simulators or manikins – simulate symptoms and diseases.
- Examples: SimMan from Laerdal, Noelle from Gaumard, HPS from CAE Healthcare
- Fidelity – the degree to which the manikin mimics physiological functions
- High Fidelity Simulators – Manikins that mimic many complex biological systems such as cardiac and respiratory functions, measurable blood pressure, palpable pulses, EKG displays, pulse oximeter, arterial waveforms, pulmonary artery waveforms and anesthetic gases.
  - Possible interventions e.g. bag-mask ventilation, intubation, defibrillation, chest tube placement, cricothyrotomy and others.
  - Manikins are computerized, contain hydraulics and compressors and have external monitors which display various physiological waveforms.
  - Specialized manikins such as trauma manikins, birthing manikins, newborn, premature babies and pediatric manikins.
- Mid-fidelity – limited number of physiological characteristics such as cardiac and respiratory indicators.
Audio-video equipment such as cameras, microphones and speakers. This equipment is used during the scenario to provide information to the learners participating in the scenario, to relay sound and video to learners watching in other rooms and to record and playback the scenario for debriefing following the completion of the scenario.
Bedside computers for access to simulated electronic health records and lab results.
Medication dispensing device
Headwalls – typically mimics those found in hospitals – may contain oxygen and air outlets, suction, lights, diagnostic equipment such as blood pressure cuffs and sphygmomanometers.
Additional Medical Room Equipment
- Crash carts
- EKG machines and other diagnostic equipment
- Anesthesia equipment
- Surgical instruments
- Ventilators
- Defibrillators
- Telephone
- Furniture such as hospital bed, over-the-bed table, bedside cabinet, crib, bassinet, baby-warmer etc.
Equipment and supplies to be used during the scenario e.g. IV catheterization supplies and chest tubes.

Building a Simulation Lab

Clearly designing and building a simulation lab takes much planning and preparation. All stakeholders such as facilities, IT and pharmacy should be consulted and involved in the planning phase. Learning outcomes and learner levels should be identified as well as budget and available space. Faculty development is key to ensuring that simulation programs are successful. Fancy simulators will go unused if faculty do not understand simulation pedagogy such as scenario development and debriefing. Funds are needed for simulation technologists to operate, maintain, repair and replace equipment as it become obsolete. Annual maintenance contracts are helpful but costly. Budget for managers and administrative staff should also be included. In the past, some departments purchased expensive, complex manikins and then planned out their simulation programs. Many manikins sat unused in storage or had costly features that were never or rarely used. Consider less expensive mid-fidelity manikins which may work very well for some programs.

The use of a nursing simulation lab has increased dramatically in the past 15 to 20 years. The benefits of using simulation to improve medical education is now well documented. Clinical expertise comes with practice and experience. Clinical Sim Labs provide the ideal learning space where clinicians of all levels can practice and improve their clinical skills without any potential harm to patients.