Box 1 Vignette of an inter-professional simulation

An inter-professional high-fidelity crisis simulation session was conducted with a group of senior medical and nursing students.

The learning objectives were to:

• Demonstrate management of a deteriorating ward patient

• Demonstrate advanced life support

• Demonstrate crisis resource management skills

The scenario involved a ward patient who is complaining of nausea and dizziness, but with normal vital signs. This was initially conducted with one medical and one nursing student.

During the first few minutes of the simulation, the medical student carried out initial diagnostic and therapeutic interventions with the assistance of the nursing student.

When the patient’s blood pressure dropped mildly, the students made intensive efforts to quickly establish intravenous access and set up intravenous fluids.

The medical student stated that he was unsure about the diagnosis and he re-examined the patient. The patient’s blood pressure briefly improved, but then rapidly declined and he progressed to cardiac arrest.

After the cardiac arrest was diagnosed, the medical student requested that the nursing student leave to call for help.

Resuscitation activities initially appeared to be very challenging in the face of limited human resources.

During debriefing in a separate room with all students present and watching, the facilitator used video playback to replay the scenario up to and including the initial cardiac arrest management.

The facilitator asked the lead medical student participant to discuss their experience. The student stated that he should have requested for extra assistance much earlier, as this would have helped with the arrest resuscitation.

The facilitator agreed, and in the subsequent discussion, several of the other simulation participants stated that they would call for help early in future.