HOW TO RUN A RURAL SIMULATION
You already have most of what you need.
A resuscitation room. A basic mannequin. Your usual equipment. Two facilitators. About 30 minutes.
The goal isn't to recreate a simulation centre. It's to practise where you actually work.
THE MODEL
Six steps. That’s the whole thing.
PRIME → PREBRIEF → SIMULATE → DEBRIEF → IMPROVE → SHARE
1 - PRIME
Tell the team the topic ahead of time. Give people the opportunity to refresh. This is preparation for success, not a test.
2 - PREBRIEF
Reset the room. Make expectations explicit. Establish respect, confidentiality and psychological safety.
3 - SIMULATE
Keep the case short and focused. Use the real room, real team and real equipment.
4 - DEBRIEF
Start with reactions. Explore one or two clinical decisions. Then ask what the case revealed about your system.
5 - IMPROVE
Capture latent safety threats. Fix the small things you can fix.
6 - SHARE
Give participants the clinical resource. Send the learning to the wider department afterward.
WHO RUNS IT
Find a partner.
In our model
Physician facilitator
Case progression
Clinical content
Medical decision-making
Participant observation
Nurse facilitator
Nursing workflow
Equipment and medication realities
Team observation
Operational coordination
Ours worked best as a physician–nurse partnership. Different eyes notice different things. Just as importantly, two facilitators make it much easier to run the case while still paying attention to the team.
In Espanola, this partnership developed between an ED physician and our ED/acute-care clinical manager. The interprofessional model became part of the strength of the program.
BEFORE THE SIM
Tell them what’s coming.
We usually told participants the clinical topic ahead of time.
Bradycardia might be introduced as a “slow” ACLS case. Septic shock was simply described as septic shock.
People sometimes arrived having reviewed the relevant guideline. Good - that was the point.
Simulation doesn't need surprise to create learning.
If the purpose is formative practice, giving people a primer can help them arrive ready to succeed - and ready to explore the harder questions together.
SET THE TONE
Make it safe before you make it hard.
We use a short prebrief every time - even with people who have done simulation with us before.
It explicitly tells participants that this is a learning environment, not an assessment; that mistakes are expected and useful; and that we see the people in the room as highly capable, intelligent professionals who have chosen to keep learning.
The repetition matters. It is a small ritual that resets the tone before every case.
“You are talented, intelligent professionals and lifelong learners. This is a place to practise, make mistakes, ask questions and learn together.”
THE SIMULATION
Keep the case small.
One clinical problem.
One or two learning objectives.
A simple, mostly linear case.
About ten minutes.
Simple cases are not lesser cases.
Even when we worried a scenario might be too obvious, useful discussion emerged - from clinical decisions, teamwork, equipment, workflow or the physical environment.
If someone leaves the resuscitation room to retrieve something, let them leave. In our simulations, they were unavailable to the team for about a minute — reproducing the real consequence of losing one pair of hands in a small rural ED.
AFTER THE SIM
Leave the room.
When the scenario ends, say clearly that it is over. Thank the team. Then physically move somewhere else if you can.
We leave the resuscitation bay and walk to the nearby lunchroom. Coffee and something to eat are waiting. The short walk creates a natural transition from the simulated emergency into conversation.
1 - Reactions
How did that feel?
2 - Reconstruct
What happened?
3 - Explore
What were you thinking at the key moments?
4 - Learn
Focus on one or two clinical teaching points.
5 - Test the system
What made this easier or harder here?
6 - Take it forward
What is one thing you'll carry into practice?
AFTER THE DEBRIEF
Don’t let the learning stay in the room.
Near the end of the debrief, give participants the short clinical resource for the case. It focuses attention on the one or two teaching points and gives them something they can return to later.
A few days later, send a concise recap to the wider ED team - not just the people who participated.
SIM → DEBRIEF → RESOURCE → RECAP → DEPARTMENT
READY TO TRY IT?
Start with one case.
Pick a topic.
Find a nursing or physician partner.
Tell them what’s coming.
Protect 30 minutes.