Three Benefits and Challenges of ‘in-situ’ Medical Simulation


Simulation in a clinical environment, otherwise known as in-situ simulation, is supported by various rationale.


One such motivation is Kolb’s theory of experiential learning. Experiential learning allows trainees in healthcare to engage in near actual practice. Training in real clinical spaces supports healthcare students’ and professionals’ education by using book-learned skills. The simulation experience is closely related to clinical duties and more reliably enhances training.

“The simulation experience is closely related to clinical duties and more reliably enhances training.”


In-situ simulation can be performed during the workday by clinical providers. Onsite simulation decreases the need to call in staff on a nonclinical day, saving the cost of overtime or the requirement to backfill clinicians’ schedules who would otherwise be offsite for training.

Onsite simulation training provided during all shifts is ideal for equal benefit. Conducting in-situ simulations regularly also allows for the necessary flexibility when using patient care environments.


In-situ simulations provide clinicians with training on how to respond more reliably to low-frequency high-risk events. For instance, just-in-time, psychomotor training of critical care skills such as pediatric intubation before a shift has demonstrated improved safety in advanced airway management(AAM). The successful outcome of simulated pediatric AAM correlated more significantly with practice within three months than years of training or specialty.


While there are many benefits to in situ simulation, there are also challenges. For one, there are technical issues with in-situ simulations.


Most human patient simulators (HPS) are not easily portable. Therefore, it would be beneficial to provide in-situ simulation in a select number of clinical units. Most programs cannot supply more than one clinical department with a human patient simulator at a time.

As a result, the human patient simulators are moved from place to place. They don’t operate well, and their constant movement can cause malfunctions with the devices. Often, programs must replace these costly simulator devices.


Another concern is the spread of infection based on transporting HPS devices. While simulation lab equipment might not pose a risk in an educational setting, it can spread disease in a critical care setting or the operating room.


Lastly, setting up and dismantling equipment for in-situ simulations can be lengthy, especially with most human patient simulators (HPS). As a result, simulation tools are increasingly designed for portability, some even for ultra-portability, making setup and implementation relatively quicker. Also, programming HPS takes particular expertise and is also time-consuming. Your simulations’ goal will inform the types of devices required to get the job done and deliver maximal benefit.

Relative to the setup time, the actual in-situ simulations are brief, typically less than 30 minutes. Hence, these sessions can be the proverbial long run for the short slide.

Alas, let us not forget about the patients. Performing simulations in patient care areas will impact patient care. If units are already overwhelmed with patients, finding the space and capacity for in-situ simulations may be challenging or not feasible. Reportedly, one institution reports a 10 to 15% cancellation rate of in-situ training events due to patient volume and acuity. Hence, the importance of weaving in flexibility and recurrence into any in-situ simulation training endeavor.

“…simulation tools are increasingly designed for portability, some even for ultra-portability, making setup and implementation relatively quicker.”


For these reasons, in-situ simulation training has been beneficial and has challenges in health care settings. Each program needs to carefully weigh the pros and cons as well as determine institutional support.


Patterson MD, Blike GT, Nadkarni VM. In Situ Simulation: Challenges and Results. In: Henriksen K, Battles JB, Keyes MA, et al., editors. Advances in Patient Safety: New Directions and Alternative Approaches (Vol. 3: Performance and Tools). Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Aug.

MedCognition welcomes the opportunity to explore innovation in healthcare, including in-situ simulation. Our mission is to help healthcare professionals save more lives. In this pursuit, we are rethinking medical simulation and created PerSim, the holographic patient assessment simulation system that is clinically intuitive, ultra-portable, and easy to use.


Paula Pinto is a writer and editor but above all a Christian and mama.

Hector Caraballo, MD is just another ER doc and Chief Medical Officer of MedCognition