Much of advanced practice involves clinical reasoning,critical thinking and clinical decision making. These are often practiced in busy clinical environments which abound with handovers, interruptions, uncertainties and pressures of time and task. In order to replicate some of these environmental factors in real time clinical scenarios, but incorporating the opportunity of detailed debriefing supported by a video recording of the action, high fidelity patient simulation has been used. This article describes how these elements have been synthesised into a variety of courses for advanced practitioners delivered at the Scottish Clinical Simulation Centre.

Background

A sophisticated, life-size manikin which breathes,blinks, moves and talks is the centrepiece of the Scottish

Clinical Simulation Centre (SCSC). It is a state-of the-art multi-professional training facility and the sole high

fidelity simulation centre in Scotland. The centre provides training for over 1000 healthcare professionals each year through a variety of courses. The centre utilises both METI and Laerdal simulators including adults, children and babies and the simulation suite can be transformed into a ward area, maternity unit, emergency department, intensive care unit, operating theatre, dental surgery or general practice environment to allow great flexibility in the scope of simulation provided. The simulator provides

the closest situation to the real thing without any risk to patients or learners, so that healthcare professionals can rehearse management of both routine and less common, life-threatening, events.

Using advanced technology and a one-way mirrored control room, as well as a radio link with the instructor, the simulators can be utilised to mimic different clinical conditions. The appropriate physiological response to particular interventions and drugs can be reproduced. Real monitors display the 'patient's' vital signs so that participants can assess the patient's progress and response to support and treatment - as they would in a real-life situation. Audiovisual equipment allows all training scenarios to be recorded with the ability to playback the recordings to help reflection during debriefing by a faculty of experienced centre staff.

Supporting safe, effective, person centred care, through the use of care pathways hosted by the Scottish Pathways Association (SPA) and the European Pathway Association (E-P-A).