Special Cases

  • Austin J. Adams
  • James N. Sullivan
  • Amy Duhachek-StapelmanEmail author
Part of the Comprehensive Healthcare Simulation book series (CHS)


Simulation has been utilized in medicine for over 30 years (Krage R, Erwteman M. State-of-the-art usage of simulation in anesthesia: skills and teamwork. Curr Opin Anaesthesiol. 2015;28(6):727–34), but as interest in and experience with simulation have increased, medical simulation has taken on a greater role in medical education. Advancements in technology, decreased costs, and increased utility of simulation have allowed for the advent of mobile simulation. Mobile simulation provides for increased participation in simulation experiences, especially among rural providers. Practitioners no longer have to travel long distances to participate in simulation experiences, as mobile simulation allows for the simulation equipment to be brought to the learners. Acquisition and maintenance of technical and non-technical skills can all be gained through mobile simulation. Greater emphasis is now being placed on interprofessional simulation, which encourages improved teamwork, communication, and situational awareness. Additionally, in situ simulation allows hospitals and teams to test for systems processes and latent safety threats. Further development of mobile simulation may allow a broader population to learn basic life support skills and the proper use of automatic external defibrillators.


Mobile simulation Skills maintenance Technical skills Non-technical skills Interprofessional simulation In situ simulation Shared mental models Debrief 



automatic external defibrillator


basic life support


extracorporeal membrane oxygenation


focused trans-thoracic echocardiography


latent safety threat


neonatal intensive care unit


non-technical skills


team-based simulation training


  1. 1.
    Bhangu A, Bhangu S, Stevenson J, Bowley DM. Lessons for surgeons in the final moments of Air France Flight 447. World J Surg. 2013;37(6):1185–92.CrossRefGoogle Scholar
  2. 2.
    Weinstock PH, Kappus LJ, Garden A, Burns JP. Simulation at the point of care: reduced-cost, in situ training via a mobile cart. Pediatr Crit Care Med. 2009;10(2):176–81.CrossRefGoogle Scholar
  3. 3.
    Haerkens MH, Kox M, Lemson J, Houterman S, van der Hoeven JG, Pickkers P. Crew resource management in the intensive care unit: a prospective 3-year cohort study. Acta Anaesthesiol Scand. 2015;59(10):1319–29.CrossRefGoogle Scholar
  4. 4.
    Winkelmann M, Friedrich L, Schroter C, Flemming A, Eismann H, Sieg L, et al. Simulator-based air medical training program Christoph life: from concept to course. Air Med J. 2016;35(4):242–6.CrossRefGoogle Scholar
  5. 5.
    Macfie R, Walcott-Sapp S, Watson J, Haley C, Dewey E, Schipper P. Association between simulation curriculum and learners’ confidence and interest in cardiothoracic surgery. JAMA Surg. 2018;153(10):968–9.CrossRefGoogle Scholar
  6. 6.
    Martin D, Bekiaris B, Hansen G. Mobile emergency simulation training for rural health providers. Rural Remote Health. 2017;17(3):4057.PubMedGoogle Scholar
  7. 7.
    Whitelaw C, Calvert K, Epee M. Keeping in time: issues affecting the sustainability of obstetric emergency simulation training in outer metropolitan, rural and remote centres in Western Australia. Aust N Z J Obstet Gynaecol. 2018;58(1):98–101.CrossRefGoogle Scholar
  8. 8.
    Masters SC, Elliott S, Boyd S, Dunbar JA. Using local clinical educators and shared resources to deliver simulation training activities across rural and remote South Australia and south-west Victoria: a distributed collaborative model. Aust J Rural Health. 2017;25(5):311–6.CrossRefGoogle Scholar
  9. 9.
    Nathan LM, Patauli D, Nsabimana D, Bernstein PS, Rulisa S, Goffman D. Retention of skills 2 years after completion of a postpartum hemorrhage simulation training program in rural Rwanda. Int J Gynaecol Obstet. 2016;134(3):350–3.CrossRefGoogle Scholar
  10. 10.
    Issenberg SB, McGaghie WC, Hart IR, Mayer JW, Felner JM, Petrusa ER, et al. Simulation technology for health care professional skills training and assessment. JAMA. 1999;282(9):861–6.CrossRefGoogle Scholar
  11. 11.
    Mitchell EL, Lee DY, Sevdalis N, Partsafas AW, Landry GJ, Liem TK, et al. Evaluation of distributed practice schedules on retention of a newly acquired surgical skill: a randomized trial. Am J Surg. 2011;201(1):31–9.CrossRefGoogle Scholar
  12. 12.
    De Win G, Van Bruwaene S, De Ridder D, Miserez M. The optimal frequency of endoscopic skill labs for training and skill retention on suturing: a randomized controlled trial. J Surg Educ. 2013;70(3):384–93.CrossRefGoogle Scholar
  13. 13.
    Ericcson K. How experts attain and maintain superior performance: implications for the enhancement of skilled performance in older individuals. J Aging Phys Act. 2000;8(4):366–72.CrossRefGoogle Scholar
  14. 14.
    Cecilio-Fernandes D, Cnossen F, Jaarsma D, Tio RA. Avoiding surgical skill decay: a systematic review on the spacing of training sessions. J Surg Educ. 2018;75(2):471–80.CrossRefGoogle Scholar
  15. 15.
    Stefanidis D, Korndorffer JR Jr, Markley S, Sierra R, Scott DJ. Proficiency maintenance: impact of ongoing simulator training on laparoscopic skill retention. J Am Coll Surg. 2006;202(4):599–603.CrossRefGoogle Scholar
  16. 16.
    Yamamoto R, Clanton D, Willis RE, Jonas RB, Cestero RF. Rapid decay of transthoracic echocardiography skills at 1 month: a prospective observational study. J Surg Educ. 2018;75(2):503–9.CrossRefGoogle Scholar
  17. 17.
    Glazebrook RM, Harrison SL. Obstacles and solutions to maintenance of advanced procedural skills for rural and remote medical practitioners in Australia. Rural Remote Health. 2006;6(4):502.PubMedGoogle Scholar
  18. 18.
    Roberts J, Sawyer T, Foubare D, Reid J, Stone K, Stephanian D, et al. Simulation to assist in the selection process of new airway equipment in a children’s hospital. Cureus. 2015;7(9):e331.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Finan E, Bismilla Z, Whyte HE, Leblanc V, McNamara PJ. High-fidelity simulator technology may not be superior to traditional low-fidelity equipment for neonatal resuscitation training. J Perinatol. 2012;32(4):287–92.CrossRefGoogle Scholar
  20. 20.
    Mahmood O, Dagnaes J, Bube S, Rohrsted M, Konge L. Nonspecialist raters can provide reliable assessments of procedural skills. J Surg Educ. 2018;75(2):370–6.CrossRefGoogle Scholar
  21. 21.
    Sevdalis N, Hull L, Birnbach DJ. Improving patient safety in the operating theatre and perioperative care: obstacles, interventions, and priorities for accelerating progress. Br J Anaesth. 2012;109(Suppl 1):i3–i16.CrossRefGoogle Scholar
  22. 22.
    Mokadam NA, Fann JI, Hicks GL, Nesbitt JC, Burkhart HM, Conte JV, et al. Experience with the cardiac surgery simulation curriculum: results of the resident and faculty survey. Ann Thorac Surg. 2017;103(1):322–8.CrossRefGoogle Scholar
  23. 23.
    Bleakley A, Boyden J, Hobbs A, Walsh L, Allard J. Improving teamwork climate in operating theatres: the shift from multiprofessionalismto interprofessionalism. J Interprof Care. 2006;20(5):461–70.CrossRefGoogle Scholar
  24. 24.
    Gordon M, Darbyshire D, Baker P. Non-technical skills training to enhance patient safety: a systematic review. Med Educ. 2012;46(11):1042–54.CrossRefGoogle Scholar
  25. 25.
    Flin RH, O’Connor P, Crichton M. Safety at the sharp end: a guide to non-technical skills. Aldershot/Burlington: Ashgate; 2008. p. x, 317.Google Scholar
  26. 26.
    Kohn LT, Corrigan JM, Donaldson MS, editors. To err is human: building a safer health system. Washington, D.C: National Academies Press; 2000.Google Scholar
  27. 27.
    Stefanidis D, Heniford BT. The formula for a successful laparoscopic skills curriculum. Arch Surg (Chicago, Ill: 1960). 2009;144(1):77–82; discussion.CrossRefGoogle Scholar
  28. 28.
    Pena G, Altree M, Babidge W, Field J, Hewett P, Maddern G. Mobile Simulation Unit: taking simulation to the surgical trainee. ANZ J Surg. 2015;85(5):339–43.CrossRefGoogle Scholar
  29. 29.
    Patterson MD, Geis GL, Falcone RA, LeMaster T, Wears RL. In situ simulation: detection of safety threats and teamwork training in a high risk emergency department. BMJ Qual Saf. 2013;22(6):468–77.CrossRefGoogle Scholar
  30. 30.
    Sorensen A, Poehlman J, Bollenbacher J, Riggan S, Davis S, Miller K, et al. Training for teamwork through in situ simulations. BMJ Innov. 2015;1(3):144.CrossRefGoogle Scholar
  31. 31.
    Reed DJ, Hermelin RL, Kennedy CS, Sharma J. Interdisciplinary onsite team-based simulation training in the neonatal intensive care unit: a pilot report. J Perinatol. 2017;37(4):461–4.CrossRefGoogle Scholar
  32. 32.
    Nakarada-Kordic I, Weller JM, Webster CS, Cumin D, Frampton C, Boyd M, et al. Assessing the similarity of mental models of operating room team members and implications for patient safety: a prospective, replicated study. BMC Med Educ. 2016;16(1):229.CrossRefGoogle Scholar
  33. 33.
    Sawyer T, Eppich W, Brett-Fleegler M, Grant V, Cheng A. More than one way to debrief: a critical review of healthcare simulation debriefing methods. Simul Healthc. 2016;11(3):209–17.CrossRefGoogle Scholar
  34. 34.
    McKechnie A. The importance and practice of debrief in medical simulation. Br J Hosp Med (London, England: 2005). 2016;77(3):184–7.CrossRefGoogle Scholar
  35. 35.
    Kolbe M, Marty A, Seelandt J, Grande B. How to debrief teamwork interactions: using circular questions to explore and change team interaction patterns. Adv Simul (London, England). 2016;1:29.CrossRefGoogle Scholar
  36. 36.
    Shekar K, Mullany DV, Thomson B, Ziegenfuss M, Platts DG, Fraser JF. Extracorporeal life support devices and strategies for management of acute cardiorespiratory failure in adult patients: a comprehensive review. Crit Care. 2014;18(3):219.CrossRefGoogle Scholar
  37. 37.
    Ouweneel DM, Schotborgh JV, Limpens J, Sjauw KD, Engstrom AE, Lagrand WK, et al. Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis. Intensive Care Med. 2016;42(12):1922–34.CrossRefGoogle Scholar
  38. 38.
    Hemmila MR, Rowe SA, Boules TN, Miskulin J, McGillicuddy JW, Schuerer DJ, et al. Extracorporeal life support for severe acute respiratory distress syndrome in adults. Ann Surg. 2004;240(4):595–605; discussion -7.PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Austin J. Adams
    • 1
  • James N. Sullivan
    • 1
  • Amy Duhachek-Stapelman
    • 2
    Email author
  1. 1.University of Nebraska Medical Center, Department of AnesthesiologyOmahaUSA
  2. 2.University of Nebraska Medical Center/Nebraska Medicine, Department of AnesthesiologyOmahaUSA

Personalised recommendations