Goal Directed Simulation at TTC Downunder


On July 13th we will be facilitating a super-charged techniques of simulation workshop to some brilliant clinician educators at The Teaching Course Downunder. In order to maximise our 4hrs together, we have curated some of the best FOAM simulation resources available.

Learning Objectives

1)      Participants will learn how to identify opportunities for quality improvement that may be addressed through simulation.

2)      Participants will learn how to manipulate stress to optimise learning outcomes in simulation.

3)      Participants will learn the importance of pre-brief and debrief in simulation and how this differs between workplace and simulation centre course.

4)      Participants will learn how to enhance the psychological realism of simulation.

homeworkThe course participants are asked to complete the following exercise in readiness for the workshop: SMART Goals for Simulation. We will be reviewing and discussing examples in the small group break out sessions.

The sessions will include:

Goal Directed Sim – Jesse Spurr & Clare Richmond

Titration of Stress – Chris Nickson

The Fiction Contract – Confederates, Acting and Simulated Patients  – Clare Richmond & Will Sanderson

Pre-brief – the Foundation of Safe and Effective Sim – George Willis & Jen Williams

Debriefing Q&A Panel – George Willis, Clare Richmond, Jen WIlliams and Ross Fisher – moderated by Jesse Spurr


General Overview of In Situ Goal-Directed Sim

Injectable Orange –  Simulation Basics – Back to the Future Podcast

St Emlyn’s – Top Ten Tips for In Situ Sim Blog and Podcast

Injectable Orange – Tips for Team Simulation blog

ICN — Guerilla Sim: Anyone, anytime, Anywhere (Jon Gatward’s talk at SMACC 2013)

LITFL CCC — In situ simulation (overview of pros and cons and safety issues in in situ simulation)

Building Fidelity in In Situ Simulation – Fiction Contract

Injectable Orange – Plants in Simulation Vodcast

St Emlyn’s – Actors in Simulation (Nice review of Natalie May’s simulation experiences at SWEETs 15)

KI Docs — Tim Leeuwenburg’s excellent Simulation apps review

Sanko et al Establishing a Convention for Acting in Healthcare Simulation

Titration of Stress in Simulation – Stress Inoculation

SMACCUS Stress Inoculation Training – Intro podcast from the Swami

Life in The Fast Lane – Review of Stress Inoculation Training workshop + resources a plenty

EMCrit – Stress Inoculation Training (a brilliant post from Mike Lauria)

Pre-briefing and Debriefing – The Bread of the Sandwich

Jenny Rudolph and Harvard Sim Team – Establishing a safe container for learning in simulation: The role of pre-simulation briefing – Journal article 

iTeachEM  Thorough Vodcast overview of Simulation Debriefing from Sim expert Danielle Hart

St Emlyn’s – A great blog on real world Debriefing from Natalie May – not specific to simulation, but incredibly applicable to In Situ sim.

MobileSim – Excellent blog resource on Debriefing with a great structured approach to In Situ Sim debrief

Injectable Orange – Debriefing: a little carrot, a little stick – blog with quick beginners guide tips for debrief.

In Situ Simulation Resources for Quality Improvement

MobileSim –  MobileSim (Jon Gatward’s excellent in situ simulation website including guides, templates and scenarios

INTENSIVE – ICU-IS-SIM (resources for the in situ simulation program at The Alfred ICU, including scenarios)

EMSimCases – EM Sim Cases(ever growing repository of free peer-reviewed simulation cases)

SMACCDUB – Leave the Sim Lab Behind Workshop Scenario Template (Template optimised for In Situ Simulation)

Clinical Trials Worth Knowing – CRICU Sepsis Nursing Workshop

This post is a collation of references and resource material from my second presentation in the inaugural Caboolture Redcliffe ICU Sepsis Workshop for nurses. The objective of this session was to work through critical appraisal of 5 prominent critical care trials with particular significance to our practice context. The completely unambiguous overtone of this session was to practice critical appraisal and engage with the literature that informs the medical decisions in our ICU.

Following a brief introduction and overview of the constructs of evidence based practice and grading of evidence, I lead the group through a structured critical appraisal of the SPLIT Trial (Young et al 2015). We used the Critical Appraisal Skills Programme (CASP) Randomised Contol Trial (RCT) Appraisal Tool to dissect the study. Following this, the participants were broken into four small groups and each given a prominent sepsis trial to appraise and feedback to the whole group in 30 minutes time.

The trials were purposely selected for discussion as they all hold specific relevance to practice in our ICU. These trials also share one commonality – they were all ‘negative’ or no difference trials. One key aspect discussed was the importance of no difference trials. During the group feedback particular focus was drawn to identifying the Population, Intervention, Comparison and Outcome (PICO), whether the study was believable (internal validity and biological plausibility), and whether it should change practice or confirmed our current practice.

About 20 minutes into the appraisal activity the groups were provided with the Bottom Line review for their relevant study to aid in synthesising final feedback and as an example of an excellent critical appraisal. The Bottom Line is an excellent critical appraisal and literature resource for Intensive Care. Founded by members of the Wessex Intensive Care Society and now with international authorship, this is one of my absolute go-to resources to help filter and process the swathe of ICU trials.

Primary Literature

Secondary Appraisal

HEAT Trial – Acetaminophen for Fever in Critically Ill Patients with Suspected Infection (Young et al 2015) Bottom Line on HEAT – Steve Mathieu
ARISE Trial Goal-Directed Resuscitation for Patients with Early Septic Shock (Delaney et al 2014) Bottom Line on ARISE – Steve Mathieu
CORTICUS Trial – Hydrocortisone Therapy for Patients with Septic Shock (Sprung et al 2008) Bottom Line on CORTICUS – Duncan Chambler
BLISS Trial – Beta-Lactam Infusion in Severe Sepsis (BLISS): a prospective, two-centre, open-labelled randomised controlled trial of continuous versus intermittent beta-lactam infusion in critically ill patients with severe sepsis (Abdul-Aziz et al 2016) Bottom Line on BLISS – Adrian Wong
SPLIT Trial – Effect of a Buffered Crystalloid Solution vs Saline on Acute Kidney Injury Among Patients in the Intensive Care Unit (Young et al 2015) Bottom Line on SPLIT – Adrian Wong

Anthony Crocco from Sketchy EBM – How to read (most) research papers

Detecting Sepsis in 2016 – CRICU Sepsis Nursing Workshop

This post is a collation of references and resource material from my first presentation in the inaugural Caboolture Redcliffe ICU Sepsis Workshop for nurses.

The objective of this talk was to provide an update on triage and screening for sepsis, the current International standards and how this filters into ongoing refinement of diagnosis and treatment in our ICU.

JAMA Network Consensus Definitions for Sepsis and Septic Shock

Primary Literature:

Secondary Sources:

Extra Reading:

Social Learning for Educators

This blog post was created for and during the Social Learning for Simulation Educators workshop at the Laerdal SUN Meeting Sydney 2016. Here are the fabulous editorial team.


Some great simulation education blogs:

Extensive collection of simulation content resources from Injectable Orange

Simulating Healthcare – blog by Paul Phrampus

The Simulated Man – blog by Pete Dickens, Swedish sim technician

EM SIM Cases – Peer-reviewed clinical simulation scenarios


ICENET – Personal Learning Networks: A hack to maintain competence 

Teaching Course Podcast – Personalised Learning Networks

ICENET – Building effective communication networks: Part 1

Injectable Orange – Lose the egg: take off on Twitter

smaccRUN Dublin


Important: please complete run disclaimer and expression of interest form here

Day: Sunday

Date: 12th June 2016

Time: 14:00

Distance: 5.2K

Meeting Point: Convention Centre Dublin

Route Map:

SMACCRun Route

Route Details:

(adapted from this site) NOTE: different start/finish points!


Just in front of Dublin Convention Centre is the sleek new car bridge, the Samuel Beckett Bridge. Cross it to get to the south side of the Liffey, and continue running eastwards from there.

 Beckett Bridge
Samuel Beckett Bridge to Grand Canal Quay

Pass the Ferryman pub and hotel and run along Sir John Rogerson’s Quay till the road ends, where you turn right on Benson Street.

 Rogerson's Quay
Rowers along Sir John Rogerson’s Quay

In 2 blocks you’ll hit the Grand Canal Quay basin, where you turn right. Don’t forget to heed the warning sign!

Don’t forget to turn right at the water!

Now you run towards that huge new glass building with the red sticks growing out front: the Bord Gáis Energy Theatre in Grand Canal Square.

 Energy Theatre
The Bord Gáis Energy Theatre

Continue past the theatre, along its right side, till the street ends at Cardiff Lane, where you turn right and run the two blocks to the river. Here, near the Ferryman again, turn left on Sir John Rogerson’s Quay and run the whole way back along the riverside to the Ha’penny Bridge.

 Ha'Penny bridge
The Ha’penny Bridge

You’re going to need to cross the spiritual heart of Dublin, at the old Ha’penny footbridge at Temple Bar. Standing on the bridge, with Temple Bar to your right, you can look over the whole route.

The new boardwalk along the Liffey

So, cross the bridge and turn right to run along the new wooden boardwalk over the river. The boardwalk goes all the way to the Custom House.

 Custom House
The Custom House

At the imposing, classical Custom House, the boardwalk ends, so cross the street to continue along the pavement. In just a block past the Custom House, you’ll run over an old iron draw-bridge. Immediately after the bridge, turn left to run north into the big open square surrounding the Custom House Quay.

 Custom house quay
Custom House Quay

You’ll run right through a stone archway. On the other side of the quay, cross Mayor Street with its modern tram line (Luas Red Line). You’ll see the Harbour House restaurant on the left, with the glass-room on the waterside. Continue running north past the restaurant along the other side of the canal leading to the next basin in just a hundred meters.

 Custom House Harbour
In Custom House Harbour

Turn right here, between new Custom House Harbour apartment buildings, and run along the basins until the path ends. You take the steps going down to the right, on Commons street. Run right back to the riverside, where you turn left to continue running along the water.

The Jeannie Johnston

A tall ship, the Jeannie Johnston, is anchored here, serving as a museum for the great emigration wave that resulted from the potato famine in 1845. Just behind you is the sleek new pedestrian bridge, the Sean O’Casey Bridge. Continue with the Jeannie Johnston on your right and you’ll soon see the Convention Centre Dublin up ahead on your left – hurrah!


We look forward to joining you all for a hot lap of the Dublin Quays. Make sure to follow @smaccRUN for updates and use #smaccRUN to organise runs during the week with your fellow SMACCDUB attendees.

Remember, IT’S NOT A RACE.

Important: please complete run disclaimer and expression of interest form here

Cheers, Jesse and Natalie