St Mary's Hospital is a general acute teaching hospital that diagnoses and treats a range of adult and pediatric conditions. The pediatric service includes a dedicated children's emergency department and pediatric intensive care unit, and a number of specialty services.


In situ simulations augment the relevance of simulation training 

The hospital already had a simulation center for anesthetic and surgical training, but Dr Claudine De Munter was convinced that in situ training had major advantages over training at the designated facilities, as training right on the wards allow healthcare professional to train together in their own environment using the tools and equipment they normally use. The opportunity to replicate incidents that occur in pediatric intensive care units would further augment the relevance of the training.    


First UK hospital to start a full in situ program

A grant from the UK neonatal charity organization 'Save the Baby' secured the purchase of their first human patient simulator in 2005 and the London Deanery funded the second one three years later.

SimBaby with all belongings.

Dr De Munter developed her own trolley set-up for the two simulators and started conducting in situ simulations right away.

The lockable trolleys are stored in a corner of the PICU when not in use.  



A collection of scenarios comprising the clinical conditions most frequently occuring in PICU was developed. The scenarios include:

  • Anaphylactic shock
  • Arrhythmia
  • Asthma
  • Bronchiolitis
  • Burns
  • Convulsions
  • Head trauma
  • Meningitis
  • Pneumothorax
  • Rashes
  • Respiratory failure
  • Septic shock
  • A mixture of the above  


In situ training enables weekly training sessions

Claudine De Munter preparing for in situ simulation.Because the training equipment is stored nearby and is quick and easy to set up, the preparation time is set to a minimum. In situ simulations can therefore be facilitated on a weekly basis and take place in the midst of the daily routines at St Mary's three different pediatric wards.  

Normally one nurse and one doctor train together as a team and all pediatric nurses and junior doctors at the hospital train at least twice a year.


Method and duration

The instructor provides a short introduction to what the upcoming scenario will be about and then uses the human patient simulator 'on the fly.' This way the instructor can adapt the scenarios to the various participants' different skills and performance levels. One in situ simulation takes about one hour including a 15-20 minute debrief session. Due to time constraints, the videotape recordings are used for documentation purposes rather than during the debriefing. Additional comments are emailed to the participants later on.


Benefits of in situ simulations

Pediatric Intensive Care Senior Staff Nurse Anne DowsonNot having to leave the workplace to train allows more multidiciplinary staff to participate. The merely 20 minutes it takes to set up the simulation trolleys and to tidy them up afterwards is another important time saving aspect. The trolleys are easily moved in between the three separate pediatric units, which adds further flexibility. Instructor and Pediatric Intensive Care Senior Staff Nurse Anne Dowson says: ''The best thing is that they have to get the equipment, monitors and meds that they would need and practicing in their own environment makes the training more transferable to the real world.'' About being new to simulation training, she says ''Participants may seem apprehensive at first, but after the debrief they see the purpose, and they really like it.'' Anne Dowson is also convinced that communication with the doctors is indeed transferable.