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Nathan Oliver, Immersive Medical Training

Simulation Training at a Fraction of the Cost

I was only eleven when I decided that a career in healthcare was for me. I really wanted to be part of the team that exists primarily to help people feel better, live better, and—where possible—to get better as well.

Today, as a nurse, an educator, and a manager within the Medical Education Directorate at NHS Lothian, I can honestly say that I work in a team that exists primarily for that purpose. What I couldn’t have conceived of at 11, however, is how complex, busy, and demanding the healthcare environment truly is. I still can’t—not really.

The necessary technical skills are varied and complicated, and are required to be repeated—without space for error—all day every day. But non-technical skills such as decision making, communication, and prioritisation are required just as often and are arguably more complex still. Simulation training has emerged as a powerful method to help train and rehearse all of these skills safely.

Simulation helps develop great clinicians and teams. The impact simulation training can have on students and clinical teams is well known and its use is growing. But did I mention we work within a complex, busy, and demanding sector? Training and rehearsal are essential, and time and resources are finite. There are rotas to fill, clinics to attend, theatres to run, plates to spin, and budgets to meet. This requires my team within the Medical Education Directorate at NHS Lothian to look for innovative ways to provide our quality clinical teams with a quality training environment to match.

Better Training Through Simulation

As the Clinical Simulation Manager for the Medical Education Directorate at NHS Lothian, my role helps to create effective simulation programmes and experiences for both students and clinical teams. I work across Edinburgh and the Lothians to support simulation from its development, through to its delivery, and to try to measure the positive impact it has on the team.To this end, NHS Lothian has developed four dedicated simulation suites across our acute hospitals in the area. These suites look and feel like authentic clinical environments with bed spaces, hospital furniture, clinical trolleys, and equipment. It is in such rooms that simulated patients or manikins play out prewritten clinical 'storylines' for incoming clinical teams to engage with whilst others view from a dedicated viewing and debriefing room. The whole ‘story’ unfolds in a deliberate manner from a hidden control room where trained faculty move the scenario forward reactively or proactively by inputting different variables into the simulation through voice, phone call, or ‘patient’ reaction.

To support busy environments, we also need to ensure our simulations are mobile, and can be transported to the ward or department for live simulation in the actual clinical environment, and the clinician’s ‘natural habitat.’

As simulation activity grew in popularity and demand across Lothian, so too did the requirement to create more simulation space. The remit was clear: We needed a fifth simulation suite in Lothian to continue delivering the amount of work expected of us. However, therein lay two challenges. The first was space—we had none. Well, not none exactly, we had two large storerooms. The second was cost. In my enthusiasm to create a high-quality simulation room, I found myself at the sharp end of a large quote, fully priced in excess of several hundred thousand pounds. I’ll be honest with you—I didn’t (and still don’t) have that kind of funding available to me. I needed to be innovative.

My job was to create a simulation suite out of a starchy white storage room and make it feel like an authentic clinical space. We had to transform the space to help participants suspend reality when they entered and allow themselves to be immersed in the experience. It needed to feel like a clinician’s ‘natural habitat’ as much as possible, complete with bed spaces, hospital furniture, clinical trolleys, and equipment—but it needed to be achieved at a fraction of the cost.

A Simple Solution to the Rescue

With finite resources, we couldn't build a bespoke solution, complete with hospital gases, bleeping machines, and background furniture. It wouldn’t be perfectly tailored with all the hardware I had envisioned. I just didn’t have the resources. That's when we considered KwickScreen, which I first discovered at a conference. Their retractable screens would make it possible to display high-resolution images and lay out the room any way I needed.

With KwickScreen, we were able to partition off the entire room to transform it from a starchy-looking storage room into a clinical-feeling space. We were able to create an Emergency Department for one scenario and a surgical ward the next. We could be in an operating theatre for one simulation session and then be in the community visiting a home, all without leaving the room. The photos for the screens came from actual rooms in our hospital—complete with machines in the background.

A sense of immersion is important in simulation. We could have put all of our funding into the latest manikin or a new piece of technology (which I love by the way!), but without an environment that seems relatively realistic, the engagement level of the participant is liable to be impacted. Simulation without a sense of immersion doesn’t translate. The beauty of what we’ve accomplished with KwickScreen is that it provides a more clinical-feeling experience in a very non-clinical-feeling environment.

Here is where it gets interesting. When I look at the post-course evaluations from clinicians and healthcare workers across all of the sites I manage, there is no difference in feedback between our most expensive suite and the one I've built out of a storage room with KwickScreen. Engagement appears the same and learning appears the same. It’s fascinating to see our clinical teams engaging in simulation in a setup that didn’t cost us three times the price.

One of the unforeseen benefits of the KwickScreen-backed simulation room has been its mobility. The limits of a simulation suite are physical ones. There are physical installations along walls—large monitors, furniture, trolleys, and other equipment—you can't easily pick it all up and move it. However, with KwickScreen, it’s possible to pack everything up and take it wherever the situation warrants. We’ve often delivered in situ simulation in storerooms, cupboards, and bathrooms because bed spaces are full, but training is required. With KwickScreen ,we have a new opportunity to create clinical-feeling areas in a ward treatment room or a storeroom, adding a new sense of immersion to a room otherwise full of intravenous fluids and catheter equipment.

The Advantages of a Finite Budget

If you were to ask me one thing I’ve learned through this experience, it would be this: Working in a complex, busy, and demanding environment forces you to respond innovatively. You have to adjust and shift what you do, but that can bring out new, exciting ideas. Necessity really does seem to be the mother of invention.

And I know it’s not just me. Every healthcare setting I’ve ever worked at are complex and dynamic; resource and time restricted. If I had one piece of advice for anyone in a similar situation, it would be this: It's possible to deliver lots of quality simulation for less than you’ve probably had quoted to you.

I've discovered that delivering the most effective simulation isn't about having the biggest budget. Instead, it's about having enough to create an adequate sense of immersion—a context that feels authentic. Not that participants don’t know it's a simulator—of course they do. I would be concerned if they didn’t. It is just about building a level of real-feel that supports learning in context and helps them reproduce it in their real life.

With credit to the team at KwickScreen, we’ve built a Simulation Suite that works and is actively in use almost every week. KwickScreen’s solution has made it possible to take a simple storage room and turn it into a successful simulation training space.


  • Perivale, Greenford UB6 7DZ, UK
  • Nathan Oliver