The Society for Simulation in Europe (SESAM) non-profit organization is holding their annual healthcare simulation conference this week in Prague, Czech Republic, which is designed to encourage and support the use of simulation in healthcare for training and research in the EU and the world. This HealthySimulation.com article by Teresa Gore, PhD, DNP, APRN, FNP-BC, CHSE-A, FSSH, FAAN, will provide highlights of this SESAM 2024 to advance healthcare simulation. Dr. Gore attended the conference as a representative of HealthySimulation.com, which is a proud media partner of the SESAM organization, with more updates coming daily!
SESAM Prague 2024: Supporting Excellence in Healthcare
One of the oldest healthcare simulation societies, SESAM 2024 celebrates the 30th anniversary of the Society and the 29th year of the SESAM. The theme “Supporting Excellence in Healthcare” takes place at the O2 Universum in the beautiful city of Prague in the Czech Republic. A record-breaking number of abstracts (450+) were submitted this year, which led to a rich, varied scientific programme and the chance to bring the clinical simulation community together. Attendance at SESAM 2024 reached 1,300, with 60 countries represented and 561 first-time attendees. Approximately 50 vendors were present in a busy, interactive exhibit hall. There were 385+ presentations with 81 workshops.
Opening Ceremony by SESAM President Matos
Francisco Maio Matos, President of SESAM, discussed that membership has grown by over 50% in two years. Organizational change to be more inclusive and representative occurred. The Special Interest Groups (SIG) have changed to Community of Practice (CoP) groups. The CoP groups are Pre-Hospital, Standardised Patients, Nursing, and Technology & Innovation. There were new board positions reflecting the mission and vision of SESAM. The Global Consensus statement was developed and published in May 2024 by 50+ societies and networks representing 67 countries. The Consensus Statement is available in four journals as open access. On behalf of SESAM, Fransicco stated, “To build the future of healthcare, Europe first always stands with peace and Ukraine. SESAM supported 92 Ukrainian colleagues to attend the conference.
Lou Oberndorf Lecture – Supporting Excellence in Obstetric Emergency Teams: Insights from Behavioural Science and Clinical Implementation
The presenters were Lisa Brogaard, Physician and PhD, Consultant Obstetric Associate Professor, and Tanja Manser, Director of the FHNW School of Applied Psychology, Olten, Switzerland, and foreign adjunct professor at CLINTEC, Karolinska Institutet, Stockholm, Sweden. The presentation highlighted how clinical practice and behavioral science collaborated to improve patient outcomes through simulation education. Their call to action is to provide safe and quality healthcare for obstetric patients.
Brogaard and Manser stated that working towards Excellence has some milestones to improve obstetric outcomes. These include:
- Technical advancement ultrasound, fetal monitoring
- Evidence-based Best Practice Guidelines
- Education through simulation with collaboration and interprofessional practice
- Human Factors – noise levels and peaks that impact fatigue
- Non-technical skills in healthcare
- High-performing team performance
Some aspects of patient care cannot be imitated in simulation. Therefore, their study included video recordings of live clinical care. The most important challenge with live recordings is ethical and legal. Recordings are conducted without the consent of participants, which presents many issues, including loss of confidentiality and privacy, data breach, and potential for recordings to be used in lawsuits. Recordings occurred, but permissions and consent were obtained at multiple points. The result included 640 high-risk situation recordings that have been analyzed since 2014.
View the LEARN CE/CME Platform Webinar EU Simulation Resources From the SESAM Organization to learn more!
The development of new tools for measuring outcomes incorporated a Delphi and professional content consensus followed by validity and reliability testing. The research team reviewed recorded cases of actual patient care to evaluate the impact of teamwork. The cases examined were:
- Non-technical performance in severe postpartum hemorrhage – 99 cases/teams
- Vacuum-assisted vagina delivery – 60 cases/teams
- Newborn Resuscitation – 43 cases/teams
- Shoulder Dystocia – only included 17 severe cases, which required physician involvement. The nurse midwives resolved most cases.
The key takeaway is that non-technical skills are imperative for better patient outcomes by high-functioning teams. Normal, high-functioning teams can sometimes be part of low—to average-performance teams. Communication is key to improving patient outcomes by high-functioning teams.
SESAM Special Events and Opportunities
- SIM University: SimUniversity is underway with teams of undergraduate students competing in simulation. This allows students to be exposed to simulation content from international experts.
- Fellows Meeting: midpoint touchpoint for the SSH Fellows attending SESAM.
- SiReN: The Simulation Research Network (SiReN) is a grass-roots, collaborative group of simulation researchers working at all levels who discuss hot topics and research findings in simulation, including debriefing, culture, patient safety, and more.
- SESAM Mentoring Programme: The SESAM Mentoring Programme is a working alliance in which individuals work together over time, on a one-to-one basis, to support personal and professional growth and development. On Wednesday evening, first-time attendees and SESAM members had a reception to allow collaboration and speed mentoring in a social environment. Those newer to simulation were able to meet international simulation experts.
Thursday Highlights of SESAM 2024
State of the Art Keynote – Framing the Use of Simulation for Healthcare: Rethinking Purpose and Process
Victoria Brazil, an emergency physician, educator, simulation specialist, co-founder of the Simulcast podcast, and healthcare team coach, and Sharon Weldon, Professor of Healthcare Simulation and Workforce Development, explored how to use clinical simulation in translation and transforming healthcare. The Seven Simulation Based I’s: Innovate, Improve, Intervene, Involve, Identify, Include, and Influence were discussed. During their work, one of the biggest obstacles is the appropriate terminology describing their work. There were 68 different terminologies used for transformative simulation. Simulation can be used outside of a patient scenario. Simulation can and should be used for conceptual framing. One example is simulating prone positioning with a ventilator patient with COVID. Simulation was used to assist in the development of the protocol. Simulation can also be used to determine or improve workflows.
Translational simulation is an iterative process and should be based on quality improvement science. This process is accepted as the reason we do this. However, work is required on how to do translational simulation. An example was given for an algorithm with multiple decision points that was not user-friendly. The same example was given with a design thinking approach that improved the ease of use for clinical practitioners and learners.
The call to action is to standardize the terminology used for transformative and translational simulation research and understand the concepts before immediately engaging in change. Simulation professionals should be curious about what is current and then what needs to change to improve the process or outcomes.
The Road to Quality Simulation: A collaborative workshop with the SESAM’s Nursing Community of Practice and the International Nursing Association for Clinical Simulation and Learning (INACSL)
Collaboration between INACSL and SESAM Community of Practice to advance nursing simulation globally. The presenters included Catia Botelho, Desiree Diaz, Rachel Hediger, Laura Gonzalez, Alan Platt, and Hanne Selberg. This presentation included a review of INACSL Healthcare Simulation Standards of Best Practice (HSSOBP) Cornerstones of Best Practice, and Core Four Endorsement Program. The session allowed participants to discuss and explore the development of quality simulation in small groups.
The Old is New Again- Psychological Safety is More Important in Learning Than Ever:
Facilitators for this session were Michaela Kolbe, Clement Buleon, Walter Eppich, Bastian Grande, Ranjeev Kainth, Colete Laws-, Julia Seelander, and Jenny Rudolph. The interactive workshop presentation focused on anticipating and repairing breaches of psychological safety for self and others. The presentation discussed psychological safety threats and breaches, psychological safety first aid for you, and psychological safety first aid for others. A definition of psychological safety was identified as a belief that a situation is safe for interpersonal risk-taking, with examples. Examples of what psychological safety is NOT were reviewed: withholding honest feedback, ignoring poor performance, avoiding uncomfortable conversations, being nice, and being soft. Steps to address psychological safety first aid were identified and shared in small, facilitated group work.
The Basic Assumption was reviewed using react, reset, and reframe. In the react phase, the facilitator notes there is something not right and notices the feeling. Then you name it. In reset, the facilitator needs to have specific standard skills that are personal to the facilitator, such as breathing, mantras, and using the tools you have already developed. Then, the simulation facilitator must reframe the threat or breach in a positive manner or state what is visualized. The next steps are to use the tools/skills required to identify threats and breaches internally and externally: Name It, Normalize It, and Navigate it.
- Name It requires you to own what you are feeling and then state this in a neutral or positive way. This requires one to state what they see visibly. An example is ‘I see that you are moving about in your seat, talking quickly, and are not maintaining eye contact when people are speaking.’ Versus ‘You are anxious, is something bothering you?’
- Normalize It is when you state or illustrate what you have named is common. An example is ‘Many people in simulation feel they are in the spotlight and being critiqued. This causes them to be anxious.’
- Navigate It refers to the ability of the facilitator to reframe, redirect, and guide the participant to regain psychological safety. An example of this is reestablishing the ground rules and reflecting on the simulation.
Friday Highlights of SESAM 2024
President’s Choice Hot Topic – Global Consensus Statement
Bob Armstrong, Past-President of the Society for Simulation in Healthcare and Cristina Diaz-Navarro, Anasethetist and Associate Dean for Simulation and Clinical Skills at Health Education and Improvement Wales (HEIW) presented an overview of the Global Consensus Statement on Simulation-Based Practice. The global consensus statement was developed from September 2023 and May 2024. This statement is by the simulation community for the simulation community. The Consensus Statement is open-access in four journals: Simulation in Healthcare, Advances in Simulation, International Journal of Healthcare Simulation, and Clinical Simulation in Nursing.
The consensus statement was developed for policymakers, leaders of healthcare organizations and health education institutions, and simulation practitioners. The intention of the statement is to articulate a global perspective:
• On the existing scope of simulation-based practice
• Simulation’s crucial role in enhancing healthcare practices and education
• Simulation’s broad impact
• Recommendations for simulation widespread adoption to benefit patients and healthcare workforces globally
The Consensus Working Group included Bob Armstrong, Sabrina Koh, Matt Charnetski, Jayne Smitten, Barry Issenberg, Cristina Diaz-Navarro, Kirsty Freeman, Gabriel Reedy, Pier Luigi Ingassia, and Francisco Maio Matos. The collaborative effort included 50 organizations and networks from 67 countries. The collaboration occurred through structured online and face-to-face meetings, surveys, and emails.
The current state of simulation practice in healthcare has a wide array of tools and practices used across all clinical disciplines and allied professions for education and non-pedagogical uses including device, process, system testing, system integration, quality improvement, research and innovation, and an adjunct to therapeutic interventions.
The universal challenges were surprisingly close and present across all disciplines and regional locations. These challenges to simulation practice in healthcare are:
• Disparities in access to simulation education and resources
• Uneven development of competencies
• Insufficient standardization of simulation training programs
• Inadequate quality assurance of practices
Simulation can be used as a tool to overcome global healthcare challenges. These challenges include the reduction of education inequities, improvement in patient experiences, optimize healthcare processes and systems, enhance organizational culture, enhance team performance, foster workforce well-being and resilience, improve healthcare practices, and help adapt to the ever-changing demands of healthcare.
Ethical considerations include global availability for equitable access to high-quality healthcare, simulation must be employed ethically and follow the Healthcare Simulationist Code of Ethics, safety culture mindset, the psychological and physical safety of all participants, protection of personal and private information, removal of blame and shame, transparency, diversity, equity, inclusivity, accessibility, and sustainability.
The recommendations of the Global Consensus Statement:
- Advocate
- Adopt and integrate
- Low-cost, high-impact simulation methods
- Support at institutional and governmental level: political, strategic, and financial commitment
- Appropriate simulation use
- Faculty development, evaluation, accreditation, credentialing, and certification
- Equitable and sustainable access to simulation-based experiences
- Equity, diversity, and inclusivity
- Renewed emphasis on simulation research and scholarship
There is a call to action for the three identified groups.
- For policymakers and leaders to formally acknowledge and embrace simulation, commit to support, and mandate the application of simulation in healthcare education, training, and clinical environments.
- The second group is for healthcare systems and education institutions. Their call to action is to commit to high-quality healthcare and improved patient outcomes, promote and resource simulation-based learning for individuals and interprofessional teams, and align with best practice standards.
- For simulation practitioners, the call is to champion healthcare simulation, adhere to best practice standards, promote lifelong learning, and advocate for patient safety.
Concurrent Session: Implicit Bias Education: Using Simulation
KT Waxman and Jayne Smitten facilitated a workshop focused on implicit bias and simulation education. Dr. Waxman explained that the California Simulation Alliance received grant funding from Kaiser Permanente a few years ago to write, validate, and test eight scenarios on implicit bias which are available on the CSA website www.Californiasimulationalliance.org. The workshop enabled participants to create a storyboard on a topic of their choice. Supplied with blank handouts and samples, several themes evolved around obesity, substance abuse, and racism. A dialogue ensued around how to facilitate these difficult scenarios and how to integrate IB into an existing scenario. KT Waxman plans to write another grant to continue this important work.
Concurrent Session: I’ve Always Wanted to Develop My Skills in Thematic Analysis: A Research Methods Workshop
Gerry Gormley and Debra Nestel presented a highly interactive workshop on how to conduct a thematic analysis. The session made thematic analysis fun to explore and learn. A thematic analysis can use different approaches, has specific steps, and requires important skills. The big takeaway: Themes do not emerge; they are constructed. The presenters discuss how a researcher must be curious and have an open mind. The qualitative research should read through the transcript without making notes, concepts, or ‘theme’. If this does not occur, then there is a possibility rich data can be missed. Participants were divided into small groups. Each group was given one apple and asked to describe the apple. Additional quantification tools were given to the group, such as a tape measure and color chart to help describe the apple. Then the small groups were given a transcript and asked to label important phrases and then to group for a theme. This session was a great way to experience thematic analysis.
Closing Keynote: Supporting the Development & Assessment of Communication Skills & Professionalism with Simulated Patients in All Health Professions
The closing keynote was presented by Kirsty Freeman, Associate Professor and Academic Coordinator of the Rural Clinical School of Western Australia, and Soledad Armijo Rivera, Nuclear Medicine Physician and the President of the Chilean Simulation Society (SOCHISIM). The two presented shared their personal experiences with the development and implementation of a Standardized Patient / Simulated Patient program. Soledad was the first Latin American female asked to present as a keynote at SESAM. The session started with a recorded message from Dr. Lou Clark, President of the Association of Standardized Patient Educators (ASPE). The importance of adhering to the Standards of Best Practice for Standardized Patient Programs was discussed, and the domains were reviewed. Soledad reviewed a survey of Latin American program’s use of standardized and simulated patients. With a 37% response rate, 57-59% stated standardized and simulations patients were used in their programs and 85% used them to promote communication and teamwork. Her work included the development of a holistic rubric focused on history-taking communication skills, the evolution of competencies assessment, the validation of the Communication Assessment Tool, and the inclusion of OSCEs in undergraduate programs.
Kirsty discussed her journey using Standardized Patients and participating as a Simulated Patient. She had a great way to explain the difference. A Standardized Patient portrays the same patient and has a script to give the participant a similar simulation-based experience. However, a Simulated Patient knows the scripts, objectives, and overall goals of the simulation-based experience (SBE) and portrays the patient with unique responses based on participants’ actions, responses, and treatment. Kirsty volunteers her time to take simulations to the rural areas of Australia to keep the healthcare professionals in their community and not traveling for educational purposes. Kirsty’s Simulated Patient’s name is Tamika, a female patient with a mental health diagnosis. Kirsty reminded us that she is an educator for didactic and debriefing and a Simulated Patient for the SBE. She provides a visual cue with her learners and the educators by wearing a wig or carrying ‘her bag’. This helps with role clarity. She stressed the importance of maintaining safety for the Standardized or Simulated patients, educators, facilitators, and learners. Kirsty’s three key takeaways are that SP interactions play a key role in the professional development of healthcare providers, and interactions with SPs offer immediate and personalized feedback to help the learners develop and use evidence-based standards to guide the design and delivery of the SP interactions.
SESAM 2024 Concludes
The SESAM 2024 Exhibit was open for the entirety of the conference. Vendors were busy explaining and demonstrating their products to help healthcare professional educators provide the best experiences for their learners. Vendor booths were well-attended, and there was high energy and engagement in the exhibit hall. A special thanks to all the vendors that supported SESAM 2024 for the advancement of the simulation community.
Francisco Matos, SESAM President, reflected on the work of the Executive Committee over the last year to prepare SESAM for the future with a strategic focus. SESAM 2024 was attended by over 1300 people from 63 countries, the 30th anniversary of the organization, and the Global Consensus Statement. The conference was a success. Incoming President of SESAM, Pier Luigi Ingassia, stated, “I strongly believe that science societies play a key role in the professionalization process of any economic sector, or in our case, scientific discipline. SESAM must play that role for simulation, not only promoting, facilitating, and communicating science but also dictating standards, interacting with and guiding industry, and talking to government authorities. This can only be achieved as a community where everybody makes a contribution, however small, and where simply being a member of the Society is an important contribution.” Ingassia is looking forward to seeing everyone at SESAM 2025.
