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Table 4 The facilitator’s experiences with in situ on-call simulation-based training

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

Themes Citations about challenges Citations about expedient factors
Pedagogical issues Some crew members were sceptical before the simulations Crew members go smoothly in and out of simulations
Simulation is not dangerous
Some crew members have managed to avoid participation in the simulations The doctors work very independently—good to get feedback
Some crew members are sceptical to simulation Big difference between the first simulations and the last
Positive experience with one team observing another team and providing them feedback afterwards. This was a positive experience—the best moment of learning to receive feedback from a colleague.
An advantage to receive the scenario before the training
I expected that it was difficult to get crew members engaged in the simulation and that they would want a high degree of realism. That was not the case.
In the beginning, the scenarios were easier to make crew members familiar with the setup. To create a safe learning environment. To get the crew into learning mode and not be afraid of showing their weaknesses. Then they were ready to increase their competence
The more the crew is familiar with simulations, the less they need information beforehand is less
The more familiar the faculty is with simulations, the easier it is to get the simulation started
It works, the feedback from the crew is that they have experienced scenarios which they have handled differently after the simulations. The flow and the solutions have not been the same as if we had no training and discussion after the simulations
Training does not equal simulation—other methods can be used.
Big-scale scenarios could be useful. Others find it more useful with the small-scale simulations.
Time and planning It is difficult to plan and conduct simulation-based training It is an advantage if an external facilitator comes and initiates the training
You spend a considerable amount of time to plan the training, and end up with no simulations on a given day Best to start at 10-12 and on faculty’s day off.
  There are many interruptions such as visits, inspections and meetings on a busy base To substitute other types of training with this.
  Crew members mention that they have other on-call duties Simulation-based training during on-call is not a hindrance to other duties.
Crew members expectations and motivation   The pilot and medical assistant have trained to prepare medication and equipment for introducing an arterial line.
Pilot and medical assistant have used their new skills in critical situations after the training.
The pilots might have fewer expectations to their own medical skills and hence see it as a less dangerously exposing situation
They ask for training now.
The training is well received.
Crew members like to train, get experiences and reflect
Medical discussion was needed—“how should this scenario be handled”. An example is provided where the wrong dose of medication and fluids were administered to a child in a simulation.
The learning gain was considerable—two hours after the training a clinical case where the learning was applied. We knew what we should do.
The system, organisation and equipment were tested
Faculty expectations and motivation Do we get enough training during the facilitator course? It was good that we were trained before we started. The tips were useful. Then I had the strength to do it even though the crew was more experienced than me
It would have been useful to develop the scenarios with another instructor and to be able to discuss the scenario and think of the learning objectives. It is crucial that you are well prepared—to be able to give the crew something to work with. It is important for the discussions, where to set the level. You must have something with you back as a participant.
More simulations could be conducted if there were more instructors at the base. Interesting to see how differently similar scenarios evolve with different crews.
Can I stay motivated as facilitator? Faculty has an opportunity to see things from a broader perspective.
Beneficial to see how others work, see different ways of solving a problem. You get many tips.