Future directions for simulation in healthcare: A critical review.

There was a widespread discontinuation of simulation programs during and after the COVID-19 pandemic. The objective is to explore how to facilitate greater integration of simulation in healthcare organizations. A literature review was conducted in PubMed, MEDES, IBECS and DOCUMED databases. Twenty-three articles published after the pandemic were selected, categorized in seven themes and critically reviewed. In order to consistently and fully integrate simulation into the organizational culture it is recommended to prioritize the development of new strategies that enhance the efficiency and safety of healthcare delivery. And also strategies that enhance the satisfaction and well-being of all stakeholders.

Use of clinical simulation to train healthcare teams in conflict management: A scoping review.

OBJECTIVE: To assess and analyze the impact of clinical simulation as a training tool in healthcare teams ability to resolve and manage conflicts, through an exploratory systematic review. METHODS: A structured literature review was performed with the terms [Clinical Simulation OR Patient Simulation OR Simulation Training OR High Fidelity simulation Training] AND [Conflict OR Conflict Resolution] in the following databases: MEDLINE, LILACS, Cochrane, Scielo, PubMed, CINHAL, ScienceDirect, MEDES, IBECS y DOCUMED. Articles were considered if they involved clinical simulation oriented to training of healthcare professionals or trainees in conflict management, using clinical scenarios, and excluding those studies older than 20 years. Absence of debriefing was not considered an exclusion criterion, neither the use of simulation along with other methodologies. A quantitative analysis was performed. RESULTS: 10 articles were retrieved, mostly with quasi-experimental designs, in which clinical simulation was designed as an interprofessional training and was used with multiple other methodologies like roleplay, reflexive practice and audiovisual aids, strategy that suggest an increase its effectivity. Different scenarios have been recreated, like decision-making divergences and management of medical errors, in order to apply the competences of mediation, communication, emotional skills among others, and followed by debriefing. The use of validated scales and conventional assessment methods reveal a positive impact on satisfaction, perception and learning of students, as well as transfer to clinical practice and decrease in errors. CONCLUSION: Multiple studies describe and support the use of clinical simulation for training in management and resolution of conflicts among healthcare professionals. Simulation is accepted by participants, developing transfer of skills and competences and impact at the organizational level. Nonetheless, studies are recent and limited in number, making this area a developing field that promotes future research.

Uso de la simulación clínica para entrenar equipos en el manejo de conflictos durante los cuidados en salud: una revisión sistemática exploratoria / Use of clinical simulation to train healthcare teams in conflict management: a scoping review

Objetivo:Explorar y analizar el uso de la simulación clínica para la formación y/o capacitación de equipos clínicos en el manejo y resolución de conflictos en salud, mediante una revisión sistemática exploratoria.Método:Se realizó una búsqueda con los términos: clinical simulation OR patientsimulation OR simulation training OR high fidelity simulation training AND conflict OR conflict resolution en las bases de datos MEDLINE, LILACS, Cochrane, Scielo, PubMed, CINHAL, ScienceDirect, MEDES, IBECS y DOCUMED. Los límites fueron el uso de la simulación clínica orientado a la formación en el manejo de conflictos en estudiantes o profesionales de la salud, con uso de escenarios clínicos, excluyendo aquellos con más de 20 años. No se consideró excluyente el uso o no de debriefing, ni el uso de simulación junto a otras metodologías. Se realizó un análisis cualitativo.Resultados:Se obtuvieron diez artículos, mayoritariamente cuasi-experimentales, en los cuales la simulación clínica se utiliza prioritariamente de forma interprofesional para la capacitación en manejo de conflictos clínicos, en conjunto con otras metodologías tales como role play, práctica reflexiva y uso de recursos audiovisuales, lo cual sugiere aumentar su efectividad. Se han recreado situaciones como discrepancia en la toma de decisiones y manejo de errores médicos, buscando aplicar competencias de mediación, comunicación y habilidades emocionales, entre otras, seguidas de debriefing. La aplicación de escalas validadas y métodos convencionales revelan un impacto positivo en la satisfacción, percepción y aprendizaje de los participantes, así como en la transferencia y disminución de errores atribuidos a la atención.

Objective:To assess and analyze the impact of clinical simulation as a training tool in healthcare teams ability to resolve and manage conflicts, through an exploratory systematic review.Methods:A structured literature review was performed with the terms clinical simulation OR patientsimulation OR simulation training OR high fidelity simulation training AND conflict OR conflict resolution in the following databases: MEDLINE, LILACS, Cochrane, Scielo, PubMed, CINHAL, ScienceDirect, MEDES, IBECS and DOCUMED. Articles were considered if they involved clinical simulation oriented to training of healthcare professionals or trainees in conflict management, using clinical scenarios, and excluding those studies older than 20 years. Absence of debriefing was not considered an exclusion criterion, neither the use of simulation along with other methodologies. A quantitative analysis was performed.Results:10 articles were retrieved, mostly with quasi-experimental designs, in which clinical simulation was designed as an interprofessional training and was used with multiple other methodologies like roleplay, reflexive practice and audiovisual aids, strategy that suggest an increase its effectivity. Different scenarios have been recreated, like decision-making divergences and management of medical errors, in order to apply the competences of mediation, communication, emotional skills among others, and followed by debriefing. The use of validated scales and conventional assessment methods reveal a positive impact on satisfaction, perception and learning of students, as well as transfer to clinical practice and decrease in errors.

[Interprofessional team training with in situ simulation to improve the quality of cardiopulmonary resuscitation]. / Entrenamiento de equipos interprofesionales con simulación in situ para mejorar la calidad de la reanimación cardiopulmonar.

INTRODUCTION: In situ simulation facilitates training in clinical settings under similar emotional pressure that occurs in real life situations. The objective of the present study was to assess the feasibility, implementation, facilitators self-confidence and teaching challenges of a training program of cardiopulmonary resuscitation through an in situ simulation plan. METHOD: A training program was designed for the facilitators. The number of professionals trained and in situ simulations performed were recorded, as well as the logistical challenges. An ad hoc survey was designed to assess facilitators self-confidence and educational challenge which were classified using the debriefing assessment for simulation in healthcare©. RESULTS: During a period of 3 years, 95 trained facilitators implemented 378 in situ simulations that allowed to train 1281 nursing professionals working at inpatient units. Integration of in situ simulations with daily activities and availability of facilitators were the main logistical challenges. Stablishing and maintaining a stimulating learning environment and structuring the debriefing in an organized way were the main educational challenges. CONCLUSIONS: In situ simulation helps to train the coordination of nursing teams taking care of patients in cardiorespiratory arrest and to identify the risks that may affect patient safety. Identifying the educational challenges during the implementation of in situ simulation facilitates the design of specific educational and monitoring strategies.

Use of clinical simulation to train healthcare teams in conflict management: a scoping review. / Uso de la simulación clínica para entrenar equipos en el manejo de conflictos durante los cuidados en salud: una revisión sistemática exploratoria.

OBJECTIVE: To assess and analyze the impact of clinical simulation as a training tool in healthcare teams ability to resolve and manage conflicts, through an exploratory systematic review. METHODS: A structured literature review was performed with the terms clinical simulation OR patientsimulation OR simulation training OR high fidelity simulation training AND conflict OR conflict resolution in the following databases: MEDLINE, LILACS, Cochrane, Scielo, PubMed, CINHAL, ScienceDirect, MEDES, IBECS and DOCUMED. Articles were considered if they involved clinical simulation oriented to training of healthcare professionals or trainees in conflict management, using clinical scenarios, and excluding those studies older than 20 years. Absence of debriefing was not considered an exclusion criterion, neither the use of simulation along with other methodologies. A quantitative analysis was performed. RESULTS: 10 articles were retrieved, mostly with quasi-experimental designs, in which clinical simulation was designed as an interprofessional training and was used with multiple other methodologies like roleplay, reflexive practice and audiovisual aids, strategy that suggest an increase its effectivity. Different scenarios have been recreated, like decision-making divergences and management of medical errors, in order to apply the competences of mediation, communication, emotional skills among others, and followed by debriefing. The use of validated scales and conventional assessment methods reveal a positive impact on satisfaction, perception and learning of students, as well as transfer to clinical practice and decrease in errors. CONCLUSION: Multiple studies describe and support the use of clinical simulation for training in management and resolution of conflicts among healthcare professionals. Simulation is accepted by participants, developing transfer of skills and competences and impact at the organizational level. Nonetheless, studies are recent and limited in number, making this area a developing field that promotes future research.

Linguistic Validation of the Debriefing Assessment for Simulation in Healthcare in Spanish and Cultural Validation for 8 Spanish Speaking Countries.

INTRODUCTION: Debriefing Assessment for Simulation in Healthcare (DASH) is an instrument to assist in developing and evaluating faculty debriefing and instructional skills that, in the context of trained raters, yields reliable data and internal consistency. Support for its validity is grounded in both its content and the scores arising from its use. The utilization of this and other assessment tools, guidelines, and protocols is expanding internationally, but most of them are available only in English and there is not a single established methodology for translation. The objectives of this study were to demonstrate a translation technique and conduct a linguistic validation of the translation of the DASH from English to Spanish and to demonstrate and conduct a cultural validation across 8 Spanish-speaking countries. METHODS: A forward translation and review of the DASH score sheets and Rater's Handbook defined the consensus harmonized version. A backward translation was reviewed by the original authors and discussed with the translators to produce the approved harmonized version. This was then tested through a questionnaire to assess clarity, comprehensiveness, appropriateness, and cultural relevance among 5 monolingual subjects from 8 Spanish-speaking countries. RESULTS: During the forward translation, 16 discrepancies were detected in the Spanish DASH. Sixty-two participants were sent the Spanish cultural questionnaire and 48% responded. A total of 82 different interpretations and 57 extra recommendations (42% terms, 16% concepts, and 42% syntax) were made. Twenty-seven percent of them were applied. CONCLUSIONS: The translated DASH has undergone a linguistic validation into Spanish, and a cultural validation across 8 Spanish-speaking countries. It may be used to assess debriefings in healthcare settings in these countries. The methodology used is applicable for translating and assessing a cross-cultural validation of assessment instruments.

The emotional and cognitive impact of the unexpected death in the simulation lab / Impacto emocional y cognitivo de la muerte inesperada en el laboratorio de simulación

INTRODUCTION: The impact of animal death on surgeons during training in laparoscopic techniques is unknown. METHODS: Emotions and cognitive load were assessed depending on animal survival. RESULTS: Those exposed to animal death (n=14) had higher levels of sadness (1.3) and anxiety (2.4), and lower levels of happiness (6.1) on a one-to-ten scale, compared to the 56 that were non-exposed (1.0/2.0/7.5). Mean cognitive load was 68.21±12.865 in the exposed and 64.74±14.632 in the non-exposed (p > 0.05). CONCLUSIONS: Emotions and cognitive load among surgeons training in laparoscopic techniques were similar, regardless animal survival after the surgical procedure

INTRODUCCIÓN: Se desconoce el impacto de la muerte animal en los cirujanos durante el entrenamiento en técnicas laparoscópicas. MÉTODOS: Se evaluaron emociones y carga cognitiva dependiendo de la exposición a la muerte del animal. RESULTADOS: Los 14 expuestos tuvieron niveles de tristeza (1,3) y ansiedad (2,4) más altos, y de felicidad más bajos (6,1), que los 56 no expuestos (1,0/2,0/7,5). La carga cognitiva fue 68,21±12,865 en los expuestos y 64,74±14,632 en los no expuestos. (p > 0,05). CONCLUSIONES: Emociones y carga cognitiva de cirujanos durante el entrenamiento en técnicas laparoscópicas fueron similares independientemente de la supervivencia del animal

Desarrollo y validación de una herramienta para la evaluación de la anastomosis intestinal laparoscópica en simulación / Development and Validation of a Tool for the Evaluation of Laparoscopic Intestinal Anastomosis in Simulation

INTRODUCCIÓN: La anastomosis intestinal laterolateral laparoscópica es una práctica habitual en la clínica y entrenada en simulación. El objetivo del estudio es el diseño y posterior validación de una herramienta fiable y reproducible para su evaluación. MÉTODOS: Se utilizó un método Delphi modificado para desarrollar los elementos de evaluación al que finalmente incluyeron 5 apartados (separación entre puntos, eversión, tensión, estanqueidad y iatrogenia). Se incluyeron 21 participantes, 10 residentes quirúrgicos de primer año y 11 expertos. Realizaron anastomosis enteroentéricas laterolateral laparoscópica en víscera ex-vivo porcina de 5 cm. Las evaluaciones fueron ciegas y realizadas por 2 evaluadores de forma independiente. RESULTADOS: Las medias obtenidas por noveles y expertos fueron respectivamente: separación entre puntos 3,2 vs.5,7 (p < 0,001), eversión 3,3 vs.5,9 (p = 0,004), tensión 2,9 vs.5,9 (p = 0,001), estanqueidad 3,2 vs.5,7 (p = 0,005), iatrogenia 6,9 vs.7 (p = 0,47). El parámetro iatrogenia no es discriminatorio, por lo que fue eliminado de la herramienta. Los resultados totales fueron 12,5 los noveles y 23,2 los expertos (p = 0,001). La correlación entre observadores presenta un coeficiente de correlación intraclase de 0,99 para la separación entre puntos, 0,94 la eversión, 0,98 la tensión y 0,99 la estanqueidad. La relación entre la puntuación y la fuga anastomótica sin presión: presenta una R de Rosenthal de -0,71 (p < 0,001); con presión se obtiene una R = 0,55 (p = 0,01). CONCLUSIONES: La herramienta diseñada es válida para discriminar entre participantes noveles y expertos, presenta muy alta concordancia entre observadores y se correlaciona con el riesgo de fuga

INTRODUCTION: Laparoscopic side-to-side intestinal anastomosis is a common in clinic practice and training simulation. The aim of this study is to design and validate a reliable and reproducible tool for its evaluation. METHODS: A modified Delphi method was used to design a tool with elements that determine quality, including 5 items: separation between stiches, eversion, tension, leak and iatrogenesis. The study included 21 participants (10 first-year residents and 11 experts) who performed a 5 cm laparoscopic intestinal side-to-side anastomosis with porcine viscera. The evaluations were blinded and done independently by 2 evaluators. RESULTS: The means obtained by novice and expert participants were, respectively: separation between stiches 3.2 vs.5.7 (P < .001), eversion 3.3 vs.5.9 (P = .004), tension 2.9 vs.5.9 (P = .001), leak tightness 3.2 vs.5.7 (P = .005), iatrogenesis 6.9 vs.7 (P = .47). The iatrogenesis parameter was not discriminatory, so it was removed from the tool. The total results were 12.5 for novices and 23.2 for experts (P = .001). The correlation between observers presented an intraclass correlation coefficient of 0.99 for the separation between stiches, 0.94 for eversion, 0.98 for tension and 0.99 for leak. The correlation between the score and the leak without pressure presented a Rosenthal's R of -0.71 (P < .001); with pressure R = -0.55 (P = .01). CONCLUSIONS: The designed tool is valid to discriminate between novice and expert participants, presents very high concordance between observers and correlates with the risk of leak

Prebriefing en simulación clínica: análisis del concepto y terminología en castellano / Prebriefing in healthcare simulation: Concept analysis and terminology in Spanish

El entrenamiento basado en simulación clínica consta de introducción, escenario y debriefing, siendo los dos últimos los más estudiados en la literatura. El objetivo fue realizar un análisis y comprensión del concepto de introducción, sesión de información u orientación a la simulación (prebriefing, briefing y orientation en inglés) existente en las publicaciones en español, y proponer una definición ampliada y una terminología para uso en la educación en salud. Se realizó una revisión sistemática en MEDES, IBECS, DOCUMED y MEDLINE usando los términos «orientación, orientation, introducción, introduction, facilitación, facilitation, briefing, prebriefing, metodología y methodology», cruzados con «simulation y simulación». Se hizo un análisis evolutivo y comprensión de los resultados con la metodología de Rodgers. De 286 artículos identificados se incluyeron 69 para revisión. Veinte (34,5%) mencionaron la introducción sin identificar formalmente esta fase, con diversas descripciones generales, o usando definiciones o términos concretos. Se propone la utilización del término introducción seguida del nombre de la fase que se está presentando en una actividad de simulación (curso, entorno de simulación, sesión teórica, caso clínico, debriefing u otra actividad) para mantener al participante orientado a lo largo de toda la sesión de entrenamiento, y apoyar la investigación y desarrollo de la simulación

Simulation based training research has focused on scenario and debriefing, being orientation to simulation less explored. However, effective learning depends on creating and maintaining an engaging learning environment. Simulation educators have to build a psychologically safe context that encourage commitment, reflection and meaningful participation. The objective was to analyse and understand the concept of prebriefing to simulation in the publications in Spanish, and to propose an extended definition and terminology for use in health education. We conducted a systematic literature review in MEDES, IBECS, DOCUMED and MEDLINE using the terms "orientación, orientation, introducción, introduction, facilitación, facilitation, briefing, prebriefing, metodología and methodology", crossed with "simulación and simulation". A concept analysis of the results was done using Rodgers methodology. Sixty nine out of 286 articles identified were included for review. Twenty (34.5%) mentioned the introduction without formally identifying this phase, with various general descriptions, or using specific definitions or terms. The use of the term introducción (introduction) followed by the name of the phase that is being contextualized within a simulation-based learning experience (course, simulation environment, theoretical session, clinical case, analysis or other activity) is proposed to keep the participant oriented throughout the session, and to support research and development of simulation

Anesthesia Simulator-Based Functional Capacity Evaluation of an Anesthesiologist After Radial Fracture: A Case Report.

We used simulation as a job-specific functional capacity evaluation method after a distal radius fracture in an anesthesiologist. Treatment included open reduction followed by an internal fixation with an arthrodesis plate. The patient performed simulated anesthesia inductions to assess her response to endotracheal intubation, bag-mask ventilation, and the manual opening of the airway. Data collected helped to guide the rehabilitation protocol, and to assess pain and the time to safely return to work. The patient began her clinical duties after 7 weeks of therapy and was able to fully perform her daily tasks with confidence, and full functional capacity.

Modalidades de formación de instructores en simulación clínica: el papel de una estancia o pasantía / Training instructors in clinical simulation models: The role of a fellowship program

Durante la última década la simulación clínica se ha extendido de modo exponencial a nivel mundial como método de formación y desarrollo de los profesionales de la salud. Ello es debido a que numerosas investigaciones han mostrado que las habilidades clínicas, de comunicación y trabajo en equipo, así como las actitudes y el profesionalismo aprendidos mediante formación con simulación, se trasladan al entorno de trabajo de modo más eficaz que cuando se comparan con los métodos tradicionales. Asimismo, hay una evidencia creciente de que mejora los resultados clínicos y la seguridad del paciente. Para dar respuesta a esta reforma educativa es necesario promover el desarrollo de educadores especializados en los conceptos, teorías y habilidades en los que se fundamenta la simulación en salud. En el presente artículo se describen y estructuran las competencias para la educación basada en simulación clínica, así como los distintos programas docentes que se ofrecen en la actualidad para la formación de instructores en simulación en salud. Además, se analiza el proceso utilizado para desarrollar una estancia en simulación clínica en el Hospital virtual Valdecilla

During the last decade clinical simulation has expanded exponentially worldwide as a method to train and develop healthcare professionals. There is growing evidence supporting that clinical, communication and teamwork skills, as well as attitudes and professionalism learned through simulation-based training, seem transferable into the work environment more effectively when compared with traditional METHODS: Also, technology-enhanced simulation training is associated with improved outcomes and patient safety in comparison with other instructional modalities. To respond to this educational reform it is necessary to promote and facilitate the development of educators with the knowledge, skills, and abilities desired to deliver quality healthcare simulation activities. In this article we review and organise key competencies for simulation-based healthcare education, and a variety of programs currently offered for faculty development in clinical simulation. An analysis of the blueprint and process to implement a fellowship program in clinical simulation at Valdecilla Virtual Hospital, a simulation centre in Spain, is also made

Simulation as a Tool to Facilitate Practice Changes in Teams Taking Care of Patients Under Investigation for Ebola Virus Disease in Spain.

INTRODUCTION: We analyzed the impact of simulation-based training on clinical practice and work processes on teams caring for patients with possible Ebola virus disease (EVD) in Cantabria, Spain. METHODS: The Government of Spain set up a special committee for the management of EVD, and the Spanish Ministry of Health and foreign health services created an action protocol. Each region is responsible for selecting a reference hospital and an in-house care team to care for patients under investigation. Laboratory-confirmed cases of EVD have to be transferred to the Carlos III Health Institute in Madrid. Predeployment training and follow-up support are required to help personnel work safely and effectively. Simulation-based scenarios were designed to give staff the opportunity to practice before encountering a real-life situation. Lessons learned by each team during debriefings were listed, and a survey administered 3 months later assessed the implementation of practice and system changes. RESULTS: Implemented changes were related to clinical practice (eg, teamwork principles application), protocol implementation (eg, addition of new processes and rewriting of confusing parts), and system and workflow (eg, change of shift schedule and rearrangement of room equipment). CONCLUSIONS: Simulation can be used to detect needed changes in protocol or guidelines or can be adapted to meet the needs of a specific team.

The Principles of Magic Applied to Healthcare Simulation.

STATEMENT: Five principles of magic are described that directly relate to enhancing participant engagement in the healthcare simulation setting. The principles discussed are the following: reality is in the mind of the participant, attention is easily misdirected, perception can be manipulated, various cognitive biases can be exploited, and focus must be captured. Using these principles in a healthcare simulation can help fill gaps in fidelity and bring a participant to a point where the situation and events make sense to them, they feel that they are in an appropriate environment, and they are willing to forgive the natural flaws of the simulation itself. Misuse of illusions beyond the purpose of filling fidelity gaps can break trust with the teacher and lead to disengagement of the participant.

Reflexiones sobre una rotación educativa en simulación médica / Reflections on an educational rotation in medical simulation

Mientras que la enseñanza y el aprendizaje son la clave para avanzar en medicina, se dedica poco tiempo a cómo enseñar. Tradicionalmente, los estudiantes de medicina rotan a través de las especialidades médicas estándares con el objetivo de aprender a diagnosticar y tratar las enfermedades más comunes. Muy pocas facultades de medicina ofrecen una rotación o un currículo formal sobre educación médica. Se reflexiona sobre la experiencia de unos estudiantes de medicina al realizar una rotación educativa electiva en el Hospital virtual Valdecilla, un centro de simulación clínica en España con la misión de mejorar la seguridad del paciente mediante el entrenamiento de los profesionales sanitarios y estudiantes de pregrado a través de la simulación clínica en todas sus aplicaciones. La rotación de los estudiantes se realizó a través del Programa Internacional de Salud de la Facultad de Medicina de la Universidad de Nueva York. Se repasan los objetivos de aprendizaje abordados (creación de entornos de aprendizaje psicológicamente seguros, diseño de las estrategias docentes basadas en la teoría de aprendizaje del adulto de Kolb, exposición a los diferentes tipos de simulaciones, introducción al debriefing y al trabajo en equipo, y participación en un proyecto de investigación educativa) y se compara la experiencia con su participación en las simulaciones como estudiantes durante la facultad

While teaching and learning are key elements to advance medicine, little time is spent educating medical professionals on how to teach. Traditionally, medical students rotate through the standard medical specialties with the goal of learning how to diagnose and treat the most common diseases. Few medical schools offer a teaching rotation or formal curriculum in education. We reflect on the experience of medical students in a one-month educational elective at the Hospital virtual Valdecilla in Santander (Spain), a simulation center with the mission of improving quality of care and patient safety by means of interprofessional team training through clinical simulation. The medical student rotation was made possible by the International Health Program at New York University School of Medicine. Learning objectives for the rotation are reviewed, including development of psychologically safe learning environments, design of learning activities based on principles of the adult experiential learning model described by Kolb, exposure to different types of simulation, introduction to debriefing and teamwork principles, and participation in an educational research project. The students’ experience in this rotation is compared to their previous experience participating in simulations as students during clinical rotations at their medical school

Teorías y estilos de debriefing: el método con buen juicio como herramienta de evaluación formativa en salud / Theories and styles of debriefing: the good judgment method as a tool for formative assessment in healthcare

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La simulación clínica como herramienta para facilitar el cambio de cultura en las organizaciones de salud: aplicación práctica de la teoría avanzada del aprendizaje / Clinical simulation as a tool to facilitate culture change in healthcare: Practical application of advanced learning theory

RESUMEN Introducción: Las organizaciones sanitarias continúan aumentando su complejidad. La mayoría de efectos adversos son causados por problemas inherentes a los procesos utilizados. Objetivo: Comprender el valor del entrenamiento de equipos con simulación para promover un enfoque orientado al sistema, centrado en el paciente y conducido por equipos interprofesionales. Metodología: Reflexión sobre estrategias de simulación para afrontar cambios organizativos. Resultados: Equipos interprofesionales fueron capaces de proporcionar sedación de modo seguro para procedimientos de colonoscopia, y para promover el diagnóstico precoz y el rápido tratamiento de pacientes con sepsis severa. Conclusión: La simulación clínica proporciona un entorno seguro para reorganizar el cuidado en salud y entrenar profesionales a trabajar en equipo.

ABSTRACT Introduction: Healthcare continues to grow in complexity. Numerous publications have confirmed that most adverse events are caused by inherent problems within the processes being used, which implies that reengineering the systems can reduce the incidence of error. Objective: To understand the value of team education with clinical simulation to promote a systems-oriented, multidisciplinary team-driven, patient-centered approach for optimal patient outcomes. Methodology: We present several simulation-based strategies as an example on how to cope with changes at the organizational level. Results: After simulation based training inter-professional teams were able to safely provide sedation for colonoscopy, and to enhance teamwork for early detection and goal-directed treatment of sepsis in the surgical ward. Conclusion: Clinical simulation provides a safe environment to reorganize care and train professionals to work in teams.