EC Clinical and Medical Case Reports

Simulation is the technique that can replace or amplify real experiences with guided ones, which is immersive and enable the replication of the real world situation in an interactive fashion. Many simulation activities focus on single clinical scenario simulation. However, as in the real world environment, clinical cases are complex and requires a continuum of management steps, more accurately depicted in a clinical pathway. Sequential simulation (SqS) addresses this and can focus on education/ training, assessment, research as well as healthcare systems integration. ‘Sequential’ means ‘in logical order and sequence’ as well as progression in a systematic fashion. SqS can simulate any combination or permutation of the care pathway. Often, certain aspects or points of care along the pathway are selected to be the focus, when these have been identified as the crucial learning points. SqS provides a lot of flexibility and options for trainers and simulation faculty in their planning of teaching scenarios. When properly conceptualized and planned, SqS can enact any combination of the work processes and clinical pathways in institutions and organizations.

The author shares her experience with training inter-professional teams using SqS as well as the general framework in planning such activities, within an institution. Essentially, SqS is able to enhance learners experience, increase realism, fidelity and satisfaction, beyond just improving the technical aspects of clinical practice.

Keywords: Sequential simulation (SqS); Clinical Pathways; Fidelity and Satisfaction

1. Lateef F. “Simulation based training: Just Like the Real Thing”. Journal of Emergencies, Trauma and Shock4 (2010): 348-352.
2. Pek JH., et al. “Simulation training for emergency teams”. Journal of Medical Education4 (2015): e39-e44.
3. Pothiawala S and Lateef F. “Simulation training in Emergency Medicine: an integral component of residency curriculum”. Hong Kong Journal of Emergency Medicine1 (2012): 41-46.
4. Tyerman J., et al. “Pre-simulation preparation and briefing practices for healthcare professionals and students: a systematic review protocol”. JBI Evidence Synthesis8 (2016): 80-89.
5. Nickson CP and Petrosoide A. “Translational simulation: from description to action”. Advances in Simulation1 (2021): 1-11.
6. Weldon SM., et al. “Collaborative healthcare remodeling through sequential simulation: A patient’s and frontline staff perspective”. BMJ Simulation and Technology Enhanced Learning3 (2016): 78-86.
7. Weldon SM., et al. “Sequential simulation: an innovative approach in educating GP receptionist about integrated care via a patient’s journey: a mixed method approach”. BMC Family Practice 16 (2015): 109.
8. Kassab E., et al. “Blowing up the barriers I surgical training: explaining and validating the concept of distributed simulation”. The American Surgeon - SAGE Journals 254 (2011): 1059-1065.
9. Allihaibi WG., et al. “Solving the emergency care pathway by a new integrated simulation: optimization method”. IEEE Access 9 (2021): 100895-100910.
10. Ahmed MA and Alkhanus TM. “Simulation options for an ED healthcare unit in Kuwait”. European Journal of Operational Research3 (2009): 936-942.
11. Gunal M and Pidd M. “Discrete event simulation for performance modelling in healthcare. A Review of the Literature”. Journal of Simulation1 (2010): 42-51.
12. Apsland E., et al. “Clinical pathway modelling: a literature review”. Health Systems1 (2021): 1-23.
13. Gomez-Hernandez JJ and Srivastava RM. “One step at a time: The implementation of sequential simulation and beyond”. Mathematical Geosciences 53 (2021): 193-209.
14. Weldon SM., et al. “Sequential simulation used as a novel educational tool customized at healthcare managers: a patient-centred approach”. BMJ Simulation 4 (2018): 13-18.
15. Kozan E and Diefenbach M. “Hospital ED simulation for resource analysis”. Industrial Engineering and Management Systems2 (2008): 133-142.
16. Andersen AR., et al. “Staff optimization for time dependent acute patient flow”. European Journal of Operational Research1 (2019): 94-105.
17. Bahari A and Asadi F. “A simulation optimization approach for resource allocation in an ED healthcare unit”. Global Health1 (2020): 14.
18. Ozcan YA., et al. “Improving the performance of a surgery based clinical pathway. A simulation optimization method”. Healthcare Manage1 (2017): 1-15.
19. Huddy JR., et al. “Sequential simulation of clinical pathway: a tool for public and patient engagement in point of care diagnostics”. BMJ Open 6 (2016): e011043.
20. Monks T., et al. “Evaluating the impact of a simulation study in emergency stroke care”. Operation Research for Healthcare 6 (2015): 40-49.
21. Fong AJ., et al. “Efficiency improvement in the operating room”. Journal of Surgical Research2 (2016): 337-383.
22. Dryver E., et al. “Medical crisis checklist in the ED: a simulation-based multi-institutional RCT”. BMJ Quality and Safety 30 (2021): 697-705.
23. Lateef F., et al. “Infection control measures in situ simulation and failure mode effect analysis to finetune change management during Covid 19”. Journal of Emergencies, Trauma and Shock4 (2020): 239-245.
24. Kinsman L., et al. “What is a clinical pathway? Developing a definition to inform the debate”. BMC Medicine 8 (2010): 31.
25. Lateef F. “At the core of interprofessional collaborative practice: How Emergency Physicians are leading the way during COVID 19 and into the new norm”. American Journal of Emergency Medicine and Critical Care1 (2021): 14-20.
26. Lavraga-Garcia B., et al. “Simulation-based education in trauma management: a scoping review”. International Journal of Environmental Research and Public Health 19 (2022): 13546.
27. Bentley S., et al. “A simulated mass casualty incident triage exercise. Sim Wars”. Med Ed PORTAL 15 (2019): 10823.
28. Purdy E., et al. “Taking simulation out of its ‘safe container’: explaining the bidirectional impact of psychological safety and simulation in an ED”. Advances in Simulation 7 (2022): 5.
29. Lateef F. “Robust ED framework for handling SARS, COVID 19, Monkey Pox and other threats. Making Resilience a Priority”. Journal of Medical and Research Publications5 (2022): 1-13.
30. Lateef F., et al. “In Situ simulation to plan Malignant Hyperthermia workflow in the ED”. Journal of Medical and Research Publications2 (2022): 1-13.
31. Colquhou HL., et al. “Method for defining interventions to change in healthcare professionals behavior: a systematic review”. Implementation Science 12 (2017): 30.
32. Seys D., et al. “Better organized care via care pathways: a multicenter study”. PLoS One 7 (2017): e0180398.
33. Ford SR and Pearse RM. “Do integrated care pathways have a place in critical care?” Current Opinion in Critical Care6 (2012): 683-687.
34. Nilsen P. “Making sense of implementation, theme models and frameworks”. Implementation Science 10 (2015): 53.