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Table 3 Individual and organisational factors, barriers and expedient factors expressed in the interviews with faculty before the simulation training period started

From: Challenges to the implementation of in situ simulation at HEMS bases: a qualitative study of facilitators’ expectations and strategies

  Themes Barriers Expedient factors suggested by the facilitators before the simulation period
Crew members Workload High workload on the base The facilitator and the crew members have to be flexible
Accept variation on workload. Plan less training in high seasons and more training in quiet periods
Expectations and motivation Pilots are used to frequent simulation of technical skills, and it can be a challenge to involve them in the medical treatment of patients Involve the pilot in the development of the scenarios
Clear learning objectives for each crew member
Pilots are the leader of the crew and can decide that other things should be trained  
Participants who have a passive role in the training, may lose interest
The physician might be the most motivated for training Focus on both medical, non-technical and technical skills
The physician is afraid to be tested in their role as a medical expert their knowledge and skills will be exposed to the crew  
Some pilots will feel exposed. It is expected that they know where things are You see that the pilot is asked to fetch things, and you will have questions, they have never dared to ask. They ask about the treatment, CRM challenges and other issues that have not been discussed openly before
Facilitators Workload My own calendar is full To involve another instructor
  An advantage to have two facilitators, because they can share the workload. A secondary benefit is that they can try both the role of the facilitator and course participant
The distance to the base is long Train either before or after being on call myself
Only one instructor on the base Facilitation by distance solutions
Create a facilitator network; a buddy to contact and discuss with would help, could be from another base
Expectation and motivation High personal expectations  
It can be difficult to get started Be more enthusiastic in the beginning, and then, later, it will be easier for the facilitator
Expertise in simulation-based training Lack of routine in/habit of conducting training Participate in a 3-day instructor course
It will be easier when you have more routine
Exchange or visit a facilitator on another base, see how others do it. In addition, you discover the culture at other bases
Logistical challenge to get the technical things ready  
Manage to structure the debriefing Contact other facilitators that can guide you
Continuous development with the help of other more skilled facilitators from other bases to ensure that I learn from my mistakes. To help me develop my competence
Development of own competence Participate in training myself  
Learning from being a facilitator The facilitator learns from conducting simulations; they see different solutions and hear reflections. You discover how your colleagues work and you learn a lot from seeing how they solve the tasks
Learning from colleagues is a benefit—we have to talk more about medical skills in the group on the base. The CRM aspect can also be useful
Leaders Expectation and motivation Some leaders might be sceptical and do not fully support it My leaders are very positive—they fully support me and have sent mail stating that simulation is planned and to be seen as equal to other training activities
Competition with daily missions In the weekly plan, the facilitator should be free to run the training at least once a week
Another simulation project is running already We have to find a way so both projects can run
  If there is maintenance on the helicopter, the crew can still train
Financial issues Payment of the facilitators The project is financed for one year
At the end of the project, the payment will stop If the crew members see the training as a positive, a learning experience, they will ask for training after the project has ended