SMART Goals for Simulation Learning Objectives


As educators move to use simulation as a teaching modality, there can be a tendency to start with the simulator (mannequin) and work backward, allowing the tools to define the goal. With the rise of modern the healthcare simulation “industry”, many hospitals have invested heavily in simulation technology, with less attention paid to technique.

In attempting to develop and refine goal-directed simulation, we can learn from long-standing practices in other domains. First published by Doran in 1981, the S.M.A.R.T. Goals mnemonic aids in the refinement of an objective into a statement of anticipated results. SMART, grounded in the project management sector, has reasonable applicability to the development of learning objectives for education in it’s generic form. For the Teaching Course New York, I have paired up with Brent Thoma (@Brent_Thoma) for a breakout session focusing on quality improvement through simulation. As a Flipped Classroom teaching exercise we are circulating the below exercise to participants to take home, develop an objective, and return to the course tomorrow to present, discuss and revise. As part of this process, Brent and I have created a modified SMART template aimed specifically at the development of learning objectives for simulation education. We would love your feedback and suggestions (in the blog comments) to keep refining this tool.


Doran, G. T. (1981). “There’s a S.M.A.R.T. Way to Write Management’s Goals and Objectives”, Management Review, Vol. 70, Issue 11, pp. 35-36.

Wikipedia (Last modified Nov 2015), “SMART Criteria”, accessed 12th Nov 2015.

Goal Directed Simulation at The Teaching Course New York


It is with great excitement and a healthy case of imposter syndrome, that I will be coordinating the simulation workshop at the Teaching Course in New York on the morning of November 13th. In what could only be described as a Dream Team faculty, we will be running 2hrs of small group mini-workshops, followed by a super panel Q&A focusing on debriefing. We want to supercharge the workshop and maximise the participants access to some of the best clinician educators in the business, so I have curated this Flipped Classroom curriculum for In Situ Sim. These are a selection of some of the best FOAM resources to broaden knowledge on the topics that will be workshopped at #TTCNYC15

The first two hours will comprise a brief introduction and overview to the concept of Goal-Directed In Situ Simulation followed by four break out mini workshops:

The Fiction Contract – Confederates and Simulated Patients  – Natalie May & Salim Rezaie

Titration of Stress – Chris Hicks & Swami

Pre-brief and Debrief the bread of the Sandwich – George Willis & Simon Carley

QI through Simulation – Jesse & Brent Thoma


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


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


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)

Injectable Orange Templates – These documents are pro-formas that may assist with planning and evaluating scenarios Scenario Template (doc) & Post Scenario Report (doc)


SMACC Dublin Registration


Follow this link for all the details about how to register for the best Critical Care Conference in the World

The countdown has begun: #smaccDUB registration opens next week! At last the final countdown has begun with less than 7 days to go until registration opens for SMACC Dublin. Registration will open on Wednesday, 28 October at 0900 Sydney AEST. Given the multitude of different time zones, the best way to be  sure you don’t miss out is to synchronise your alarms with the countdown timer on the SMACC website
Information on the program, workshops, accommodation options, smacchendise, affiliated pre-SMACC meetings, the SMACC Kids club and registration pricing is all available now on the website – so check it out and be ready!

download-brochure-buttonDownload, print and share the Registration Brochure with your less technically engaged colleagues.

Although not a SMACC Talk, I think this brilliant call to action from my friend Dr Daniel Cabrera @cabreraERDR captures the spirit and community of FOAM and SMACC. Tear down the walls and share knowledge.




Why Nurses Need to be Politically Active


Follow Jennifer on Twitter @JJackson_RN

Editor: It is with great pleasure that Injectable Orange welcomes back guest author Jennifer Jackson. In this post Jennifer implores us, as nurses, to take an active interest in politics, as it really does impact right down to our capacity to provide care and treatment. This is a very timely post, as many of our junior doctor colleagues throughout the UK are in the midst of a political struggle around threats to their contractual provisions. In my home state we have seen major threats to senior doctor contracts and significant cuts to nursing jobs. The medical profession are often galvanised in their political missions to preserve the integrity and entitlements of their profession. Unfortunately nursing often seems to rely on unions or figureheads to represent our professional interests and often feel disempowered or disinterested by the politics of healthcare. Jennifer offers a call to action – stand up and be counted as a profession #NursesUnite.

Voters cartoon

Why Nurses Need to be Politically Active – Jennifer Jackson

After a thesis-writing hiatus, I’m back for more discussion about professional issues in nursing! First on my list is nursing and politics. We are about to have a federal election here in Canada, which is promising to be one of the most interesting and important elections in a long time. In most countries, there are many opportunities to vote and be part in the political process. This blog post will look at some reasons why nurses need to be politically active, and what political action in nursing can look like.

It is a great thing to be able to participate in a general election. The ability to have women, Indigenous persons, and Persons of Colour vote are fairly recent historical developments. There are fragile democracies around the world, where people are fighting to have political rights. Many people have devoted their lives to the support of these rights, and I think we do them a great disservice if we take our democratic power for granted.

I also believe that voting and political engagement DO make a difference. If we look to the Greek meaning of democracy, demos refers to the people, while –cracy is government, meaning the government of the people. Our political opportunities, such as voting, give each person a voice in what happens in our systems. Whether you are male or female, rich or poor, rural or urban, you have an equal vote in how your country and your municipality are run.

It is great to encourage general political participation, and there are lots of reasons that nurses can benefit from voting and being politically active. Political activity is as old as the nursing profession. Florence Nightingale developed the world’s first graphs, and showed them to the British Parliament, convincing politicians to continue funding her work in Crimea. There is a legacy in health care that is the result of political activity, and nurses can continue these efforts today.

Here are my top 3 reasons why nurses need to be politically active:

  1. Politics can change the work we do.

Political factors can have a substantial impact on what type of work we do as nurses, because of the impacts on society. A prime example? Texting and driving. Laws were enacted in Canada to decrease distracted driving, and there have been fewer car accidents as a result. This means fewer trauma codes, fewer ICU admissions, fewer fatalities. Laws and political decisions impact care we need to provide as nurses. As nurses, we can ask ourselves, who is coming through our doors? What could be done to address preventable illness and injury?

  1. We can represent the interests of the nursing profession.

Most nurses are experiencing, or have experienced a period where there have been health care cutbacks. Wage freezes, working without a contract, decreases to hospital funding, strikes- most of us have been there. Nurses can follow these funding decisions directly to their impact on patient care, because of our role providing patient care. When we vote, we elect people who will make budgeting decisions. We can vote for people who will support our job security, and adequate funding for health care. We can also reinforce the importance of the nursing profession by contacting politicians to share information and let them know that nurses vote. Political activity gives nurses an opportunity to represent and advance our professional values.

  1. We can advocate for our patients.

For me, the most important reason to be politically active is because politics is a means for nurses to advocate for patients. Advocacy is very important for nurses because social justice is a core value of the nursing profession. When we work in clinical settings, we can help one patient at a time, and this work is central to our profession. When we vote, sign a petition, or participate in a political event, we can potentially help thousands of people at a time. Political activity takes the work of nurses from being a discreet event in one setting, and raises it to a societal level.

A lot of the social determinants of health can be impacted through political decisions. Nurses can help to protect health care access for vulnerable populations. An example of this is refugees. In Canada, funding was cut to refugee health care programs. An outcry from multiple professions took the case to the Supreme Court of Canada, where the decision was overturned. This is an example of when political action was effective to advocate for a vulnerable population.

So what can we do?

There are many ways nurses can be politically active.

Some suggestions include:

  • VOTE! (Especially on October 19 if you are Canadian).
  • Encourage your friends to vote, too!
  • Call or email your elected representatives, and tell them about an issue that matters to you.
  • Engage with a political party or organization on social media, and share information with your followers.
  • Actively participate in your nursing union or association.
  • Join a protest or demonstration.
  • Write a letter to the editor about an issue in your community.
  • Run for a political position or office- can be anything from your local union chapter to a federal seat in parliament.
  • Talk about politics with your coworkers, friends, and neighbors. Encourage them to get involved too, even if they have different views.

Other resources include:

Samara, a non-partisan organization dedicated to improving political participation.

Vote Compass, to help you determine whom you should vote for on election day.

Nursing union and association election resources

United Nations, Department of Political Affairs


These are just a few of the ways that nurses can be politically active. I encourage you to use political activity as part of your nursing practice, to advocate for our patients and our profession!


United Medicine – Combining opinion to translate evidence into practice


Follow @united_medicine  on Twitter

Editor: This post hosts an open letter of sorts to spread the word about an ambitious and inspired project that looks to build a forum for knowledge translation in medicine. Very quick and easy to register and completely free. In many ways my initial observations are that this is a formalisation platform for many of the discussions that occur on a daily basis in the #FOAMed community on Twitter. I see United Medicine as holding enormous potential to fill a void often noted by users of Twitter to articulate the nuances of Evidence Based Practice within 140 character microblogs. I have absolutely no conflicts of interests or disclosures related to this venture – I just think it is a great idea, well worth the price of registration – FREE is definitely the right price!

Combining Opinion to Translate Evidence into Practice

Alongside formal resources and guidelines, many of the most useful insights come from the informal discussions on healthcare evidence that occur on the shop floor, meetings, conferences or even coffee rooms.

Often we say “What’s the evidence for that?” or “What difference does this trial make to us and our patients?”. The outcomes of those discussions being key to ongoing learning and our clinical decision making. However, if you are off shift, late to the conference, or just choose to go to the costa instead of the coffee room you may miss those important insights that go no further.

A new platform is now available to facilitate consensus on the ‘coalface’ implications of the newest evidence, and makes those insights available to all healthcare professionals 24/7. You don’t have to be a professor or trialist to contribute; it’s all about creating a bigger audience for the discussion that happens in day to day practice.

The story started at 2am on a night shift in the Emergency Department with staff chatting to their colleagues about the latest trauma study. It struck them as odd that the same discussion was likely taking place in many other places around the world, but the dialogue never gets joined up in any way.

United Medicine was created to address this problem. It is completely free and open to all registered healthcare professionals providing a structured, guided review process that combines individual opinion of evidence and presents them in intelligent feeds tailored to your speciality and interests. A voting system within UM allows the very best comments to come to the fore, and to be shared with a wide base of peers.

In short, the ultimate aim is to facilitate the transformation of evidence into practice, with the end outcome being more consistent, better patient care.


Dr Matt Wilson

Co-founder United Medicine


About the man behind United Medicine. Matt qualified as a doctor from Cardiff University back in 2009.  Following foundation he spent 3 years as a military doc, mostly with the Royal Marines (42 Commando) in a number of places including Somalia, Albania, Middle East, Norway and Kenya. Matt now works in Poole Hospital ED in the UK and is a big advocate of FOAM & evidence based medicine. Matt has recently become Dad and enjoys getting out on the water when he can!

Podcast Ep. 6 – Reconciling Social Media With ‘Traditional’ Education

In this episode of the podcast I am joined by once again by my friend, British Paediatrician, educationalist and philosopher, Dr Damian Roland (see his site Rolobot Rambles). As well as Damian this episode gets an extra helping of awesome from Damian’s co-author, Medical Education rockstar, Emergency Physician, Associate Professor at Bond University, Dr Victoria Brazil. Damian and Victoria recently published a very interesting paper suggesting ten ways by which we may reconcile the groundswell of social media with ‘traditional’ medical education.

Top 10 ways to reconcile social media and ‘traditional’ education in emergency care

Both Damian and Victoria are passionate advocates for open access knowledge sharing and, as such, were very keen to translate the key messages via a FOAM platform. Below is also a visual accompaniment that Damian posted on Slideshare.

In the podcast I mentioned I would give a brief update on some projects that have been keeping me busy of late. There is a lot to get through, so instead I’ll keep it short here and write a separate post soon.

The first and most relevant to this podcast is the very exciting news of winning the Stanford Medicine X – Simpler Signals Research ChallengeI was very lucky to work with Damian, and Dr Daniel Cabrera on a research project in which we used the Symplur Signals analytics tool, to validate the Free Open Access Medical education (FOAM) community as a digital community of practice (dCOP). Damian will be presenting this at the Stanford Medicine X Conference on the 27th September this year.

“Defining digital communities of practice using a Netnographic framework for hashtag analytics”

As well as this research with Damain and Daniel, I have recently commenced in a new role as the Clinical Nurse Consultant in Intensive Care across two geographically split ICU pods, the Caboolture Redcliffe ICU (CRICU). It is very exciting to be back ‘at home’ in the Intensive Care.


Episode 6 – Reconciling Social Media With ‘Traditional’ Education (32.35)