title: Design of simulation-based medical education and advantages and disadvantages of in situ simulation versus off-site simulation.
abstract: BACKGROUND
  Simulation-based medical education (SBME) has traditionally been conducted as off-site simulation in simulation centres. Some hospital departments also provide off-site simulation using in-house training room(s) set up for simulation away from the clinical setting, and these activities are called in-house training. In-house training facilities can be part of hospital departments and resemble to some extent simulation centres but often have less technical equipment. In situ simulation, introduced over the past decade, mainly comprises of team-based activities and occurs in patient care units with healthcare professionals in their own working environment. Thus, this intentional blend of simulation and real working environments means that in situ simulation brings simulation to the real working environment and provides training where people work. In situ simulation can be either announced or unannounced, the latter also known as a drill. This article presents and discusses the design of SBME and the advantage and disadvantage of the different simulation settings, such as training in simulation-centres, in-house simulations in hospital departments, announced or unannounced in situ simulations.
  
  
  CONCLUSIONS
  Non-randomised studies argue that in situ simulation is more effective for educational purposes than other types of simulation settings. Conversely, the few comparison studies that exist, either randomised or retrospective, show that choice of setting does not seem to influence individual or team learning. However, hospital department-based simulations, such as in-house simulation and in situ simulation, lead to a gain in organisational learning. To our knowledge no studies have compared announced and unannounced in situ simulation. The literature suggests some improved organisational learning from unannounced in situ simulation; however, unannounced in situ simulation was also found to be challenging to plan and conduct, and more stressful among participants. The importance of setting, context and fidelity are discussed. Based on the current limited research we suggest that choice of setting for simulations does not seem to influence individual and team learning. Department-based local simulation, such as simulation in-house and especially in situ simulation, leads to gains in organisational learning. The overall objectives of simulation-based education and factors such as feasibility can help determine choice of simulation setting.
authors.affiliation: Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, 2100, Copenhagen, Denmark. Jette.led.soerensen@regionh.dk.
authors.forename: Jette Led
authors.identifier: http://orcid.org/0000-0002-7320-2784
authors.initials: JL
authors.lastname: Sørensen
authors.affiliation: Copenhagen Academy for Medical Education and Simulation, Herlev Hospital, Capital Region of Denmark and University of Copenhagen, 2730, Herlev, Denmark.
authors.forename: Doris
authors.initials: D
authors.lastname: Østergaard
authors.affiliation: Department of Innovation in Medical Education, University of Ottawa, Ottawa, Canada.|University of Ottawa Skills and Simulation Centre, The Ottawa Hospital, & University of Ottawa, K1Y 4E9, Ottawa, Canada.
authors.forename: Vicki
authors.initials: V
authors.lastname: LeBlanc
authors.affiliation: Juliane Marie Centre for Children, Women and Reproduction, Rigshospitalet, University of Copenhagen, 2100, Copenhagen, Denmark.
authors.forename: Bent
authors.initials: B
authors.lastname: Ottesen
authors.affiliation: Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, Capital Region of Denmark and University of Copenhagen, 2100, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Konge
authors.affiliation: Copenhagen Academy for Medical Education and Simulation, Herlev Hospital, Capital Region of Denmark and University of Copenhagen, 2730, Herlev, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Dieckmann
authors.affiliation: Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6200, Maastricht, Netherlands.
authors.forename: Cees
authors.initials: C
authors.lastname: Van der Vleuten
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards; D004502:Education, Medical, Continuing / Q000379:methods*; D006126:Group Processes; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D033183:Interdisciplinary Communication; D017145:Models, Educational; D010348:Patient Care Team / Q000458:organization & administration; D061214:Patient Safety; D016544:Patient Simulation; D012189:Retrospective Studies; D017132:Workplace
keywords: Context; Cross-training; Curriculum; Fidelity; In situ simulation; Inter-professional; Simulation-based medical education