Stay Sharp with Focused Sim Education

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altIf you think that simulation training is “playing with dummies” or is just for residents, it may be time to take another look. Simulation gets more advanced every year, and is available at every experience level. 

If you think that simulation training is “playing with dummies” or is just for residents, it may be time to take another look. Simulation gets more advanced every year, and is available at every experience level. 


“We’ve got business,” the charge nurse yells to you as she starts rolling the code cart to the room of your next patient. The paramedics quickly give you the low down: elderly female in complete heart block who is unresponsive to meds and transcutaneous pacing, When you touch her clammy skin and feel her thready pulse you quickly realize you have exactly two choices, transvenous pacer now or CPR in 5 minutes. As you call for the pacer you try to remember the last time you actually floated one. Your thoughts start to scramble, “Cordis, alligator clips? When do I put the balloon up? Or is it down? And how do I use those dials on that box again?” You swear under your breath as you realize that it is show time and that you’ll just have to muddle through it … you just pray that you won’t make things worse.

altWe’ve all been there – the difficult airway, the precipitous delivery, the stat chest tube. By its nature emergency medicine involves many skills we learn but use infrequently. How to remain technically proficient in these rarely used critical skills is challenging. One important solution is the simulation lab. Simulation is a great way to refresh skills that have gone unused, and even gain a few new ones.

Traditionally, sim training has been reserved for residency training, but now seasoned EPs can take advantage of it too. Yes, you will be playing with a plastic doll, but the new generation of simulators have pulses, breath sounds, and incredibly accurate airways that can be scaled to the learner. If you can buy into the game, simulation can be an incredibly worthwhile, hands-on learning activity. It’s not Power Point with a latte, or listening to a lecture while texting, half asleep in the back row. Simulation offers active, catecholamine-charged learning in a challenging but supportive environment. A good sim course will inspire your reading, application, and exploration. In this unique learning environment, you can review the cognitive logistics of a procedure, revise technical dexterity and feel a bit of the adrenaline associated with learning something under pressure. All these things help imprint knowledge and are a distinct advantage over traditional learning modalities.


Step #1: Do Your Homework
There are a lot of great sim programs available, each tailored to different needs and levels of experience. Take the time to find one that is at or just above your current knowledge base so that you maximize your gain without being bored or intimidated. Begin by searching for courses that specialize in a critical procedure that you haven’t done in the past two years like a pediatric resuscitation or a cricothyroidotomy. Look at the course brochure to see what experiences they have, making sure that some are at your level and some areas you have yet to master. There are a host to choose from, many presented at Universities.

Step #2: Pick your Program
The next decision is location, location, location. Since most of us don’t have a sim lab next door, you’ll probably have to pack your bags to find a course that fits your needs. Stand alone sim courses tend to be expensive because of the equipment costs (manikin’s can cost $200,000 each), high faculty-to-student ratios, and space needed for simulation scenarios. Stand alone courses can run $600-1500 depending on their length and type of workshops. Airway and procedural sedation courses are the most popular with The Airway Course being one of the most well known. Boston Children’s Hospital and Harvard Medical School offer a pediatric sedation course with an optional full day as well as partial day simulation workshops for sedation and airway techniques in the pediatric population. Look for programs geared for EPs specifically to avoid information and techniques not applicable to EM. If you want to save some money, find a sim lab that’s an add-on course to a national conference – ACEP’s Scientific Assembly and AAEM’s Scientific Assembly both offer sim add-on programs.

Step #3: Consider a Custom Simulation Program
Another sim option – albeit a pricier one – is to have a sim program tailor made for your group. Many academic centers with established sim programs will offer such courses starting at about $300 dollars/hour. The latest innovations allow simulations to be run on an iPad making it portable in an entirely new way. These DIY programs can now come to you, or, if you want a greater compliment of tools to replicate your department, you can book time in the center’s lab. The advantage of these programs include team building and an immediate elevation of group-wide technical and knowledge based skills. To get an idea of what kind of sim experiences are available, go to the SAEM Simulation Interest Group at To find sim centers nearby, go to The Society for Simulation in Medicine website ( which has an extensive list of national and international simulation centers.

In emergency medicine we can’t possibly prepare for everything, but sim allows us a way to take ownership of our life long learning and to help keep the cob-webs off our rarely-used technical skills. The options are wide open – from a weekend of airway to a pre-conference workshop on procedural sedation. With sim you can pick what you need most and in just a few hours be back at the top of your game. What’s more, new skills are contagious. When you return to your home shop you’ll get out the pacer, the pedi LMA, and the IO drill and spread your new skills to your group. In the end, chance favors the prepared mind. You don’t know when the breach delivery will present, but how much better will you feel in that moment knowing that you practiced it in the last decade. We all need to take the time and invest in sharpening our tools over the entirety of our careers. Simulation training is readily available at a cost quickly outweighed by the gains in knowledge and hands-on experience.


Mark Your Calendar: SIM Courses Over the Next 6 Months


2012 The Difficult Airway Course Emergency
(Ron Walls Course with multi-day simulations)
October 26 – 28, 2012
Grand Hyatt Atlanta
Las Vegas
November 16 – 18, 2012
Caesar’s Palace

Practical Emergency Airway Management
(cadaver airway course with Rich Levitan)
Baltimore, MD
December 6-7, 2012
Hampton Inn Convention Center


ACEP Scientific Assembly Denver 2012

Venous US in the ED: DVT Skills Lab (WE-182)
Wednesday, October 10
08:00 AM – 09:50 AM
12:30 PM – 02:20 PM
03:00 PM – 04:50 PM

Advanced Airway Techniques Lab (WE-324)
Wednesday, October 10
08:00 AM – 09:50 AM
12:30 PM – 02:20 PM
03:00 PM – 04:50 PM

Emergency Dental Skills Lab (WE-237)
Wednesday, October 10
03:00 PM – 04:50 PM

Pediatric Procedures Lab (TH-308)
Thursday, October 11
11:00 AM – 01:30 PM


Procedural Cadaver Labs
Sunday, October 7
8:00 am – 12:00 pm
1:30 pm – 5:30 pm
4-hour lab: $1,295.
Space is limited to 60 participants per lab


Rocky Mountain Winter Conference on Emergency Medicine 2013
With faculty from across the country including Denver Health Medical Center, Cook County, Emory University, Hennepin County Medical Center, Massachusetts General Hospital, and University of Colorado at Denver
Village at Breckenridge
Breckenridge, CO


Boston Children’s Hospital And Harvard Medical School: Pediatric Sedation Outside Of The Operating Room
InterContinental San Francisco Hotel
San Francisco, CA
September 8-9, 2012
This conference has plenty of add on options including full and partial day sedation sim and break out sessions ranging form $50- $679

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