In Situ Simulation in Emergency Medicine: 2023 State of the Art and Practical Guide for the Trainers

In situ simulation is defined as a simulation that "takes place in the actual patient care setting or environment in an effort to achieve a high level of fidelity and realism". In situ simulation is a pragmatic solution to facilitate access for all emergency professionals for continuous training aligned to their educational needs working in interprofessional teams. It offers professionals the opportunity to identify areas of improvement. It may also serve as a tool to identify potential safety threats, to crash test future organizations or systems, and to evaluate individual skills. A specific setup is required starting with the identification of clinical, training, and administrative resources, followed by the identification of educational objectives and appropriate time slots to ensure patient safety. The psychological safety of the participants must be ensured by trained instructors through well-conducted debriefings. Finally, as with any health-care intervention, certain precautions must be considered. Indeed, in situ simulation must in no way jeopardize the safety of patients present in the emergency room during training. For this reason, there are a certain number of no-go criteria that must be respected to avoid any risk to patient safety. The impact of in situ simulation on patient outcome remains to be demonstrated, but it nevertheless allows a relevant transfer of learning, a realism appreciated by the participants and the reflection on systemic elements, which is not always possible in a simulation center.