The Virtual Resus Room
Facilitator Introduction
Sarah Foohey, MD, CCFP-EM
Emergency Medicine Physician, Trillium Health Partners
Lecturer, DFCM, University of Toronto
@SarahFoohey
What is the Virtual Resus Room?
SIM ANATOMY
PREBRIEF
DEBRIEF
RUN CASE
Review the principles of sim, objectives for the session,
and how the VRR works.
Discuss crisis resource management skills and medical content.
Think about what went well and what might have gone better.
Divide into roles and manage your patient as a team.
THE CARDINAL PRINCIPLES OF SIM
Willing suspension of disbelief will improve your learning.
Vegas Rules:
What happens in Sim,
Stays in Sim.
Mistakes are opportunities for learning.
The Basic Assumption:
We believe that everyone is intelligent, capable, cares about doing their best, and wants to improve.
TYPICAL SIM TEAM ROLES
TEAM LEAD
CHARTER
AIRWAY
MEDS & MONITORS
Depending on how many team members you have and your level of training, you may divide these tasks differently.
You might also need someone to call specialists, perform a procedure, or do a bedside ultrasound.
Pre-brief
Running the Case
What facilitators should say out loud
Running the Case
Using the VRR: What to do in the “room”
Slide 1
Delete the black box to reveal the rhythm strip underneath after tele leads have been placed
Type vital signs into the corresponding textboxes after monitors have been placed
Slide 4+
When prompted: delete grey box to reveal what is underneath (investigation, multimedia, procedure, etc)
As a reminder: what is hidden under grey box is listed in bottom right hand corner
Tip: Make sure grey box is highlighted in blue before you delete (you don’t want to delete entire slide).
Running the Case: Tips
You should be speaking very little.
Allow them to fill their own silences.
There is no “I would”, “I could”, “I would give appropriate dose” in Sim.
If they say this: prompt them to actually DO task, look up dose etc.
If they get completely off track (psychological safety compromised):
Do “time out”. Reframe, regroup, then restart.
Debrief Priorities
Debrief: PEARLS Framework
Reactions Phase
Description
Analysis
Summary: Takeaway
Reactions Phase
Reactions Phase
“Before we start talking about medical content, it can be helpful to discuss the emotions a Sim evoked. Sim can elicit strong feelings like being overwhelmed, anxious, imposter-y, stressed, calm, reassured, confident. Identifying these emotions can help us identify what lead us to feel that way, and then come up with ideas for future improvement”
Analysis Phase: Plus Delta Method
Questions:
Analysis Phase: Analysis Inquiry Method
From: Debriefing with Good Judgement, Rudolph et al.
Analysis Phase: Analysis Inquiry Method
From: Debriefing with Good Judgement, Rudolph et al.
Analysis Phase: Advocacy-Inquiry Method
From: Debriefing with Good Judgement, Rudolph et al.
Analysis Phase: Discussing CRM
Analysis Phase: Discussing CRM
CRM Prompts:�How did your team communicate?
What made this communication challenging?
Regarding how the team worked together - what went well? What could have been better?
CRM Observations:
“I noticed Judy recommended that you try antiarrhythmics before cardioversion, which was a very reasonable suggestion. What are ways you can leave space/make time for your team members to make suggestions like this during a busy case?”
Analysis Phase: Discussing Medical Content
Debrief: Common Pitfalls
Try to avoid these things:
Debrief: Wrapping Up
Debrief: Want to learn more?
If you are junior facilitator:
“This is a learning opportunity for me too: to practice running a sim and being a facilitator. So I’m happy to get your feedback about the debrief and overall experience at the end so we can learn together.”
If you are running a case for your peers or are new to Sim, consider including a statement like this in your pre-brief:
Next Steps: Facilitator To-Do List
Prep Time Required: 1-2 hours
What you need in front of you during session: