Exceptional healthcare requires experience that only comes with repeated opportunities to put skills to work. Cedars-Sinai Guerin Children’s offers a Pediatric Simulation Program aimed at improving outcomes for the medical center’s youngest patients by enabling care providers to hone their craft through dedicated, hands-on practice.
“Over the past two decades, simulation has emerged as a professional field that can help navigate the complexities of healthcare in a safe learning environment that yields measurable results,” said Pooja Nawathe, MD, medical director of the Pediatric Simulation Program. “There is a growing body of evidence showing simulation leads to success: helping patients do better, increasing care providers’ confidence, streamlining communications and strengthening team dynamics.”
Those dynamics are at the heart of complex medical interventions, and the Pediatric Simulation Program involves all members of the pediatric care team in its trainings. From physicians, nurses and pharmacists to respiratory therapists, child-life specialists and social workers, the program engages participants in exercises that enhance their individual abilities and foster group cohesion.
Nawathe notes that having a dedicated simulation program affirms Guerin Children’s commitment to prioritizing both patient safety and systems improvement. “Simulation is a robust methodology for streamlining processes and assessing performance,” she said. “The more we do, the more we can establish best practices and elevate our level of care.”
Practicing in Place
The Pediatric Simulation Program collaborates closely with the Women’s Guild Simulation Center for Advanced Clinical Skills, an immersive environment equipped with the latest patient simulators and medical devices. But much of its emphasis is on leading simulations in situ.
“There are some aspects of a real clinical environment—whether it’s the ergonomics or the human factors—that cannot be created in a simulation center, so we bring the simulation directly to the clinic,” Nawathe said. “We have mobile simulation equipment. As part of the program, our nurse educators and I have led in situ pediatric simulations in the pediatric intensive care unit, the neonatal intensive care unit, the Guerin Children’s inpatient unit, the Guerin Children’s outpatient clinic, and the emergency room, and we are now collaborating with the Beverly Hills Fire Department to organize in situ simulations.”
Nawathe’s team conducted three surgical simulations for extracorporeal membrane oxygenation that involved developing a congenital cardiac arrest activation tree.
“We did multitier simulations over a period of three months that brought together our blood bank, cardiac surgeons, perfusionists and other members of the operating room team,” she recalled. “The educational objective was to identify, in a strategic manner with a systematic human factors approach, which members of the team needed to be activated at different parts of the process to ensure we had the right people in place to care for the patient in the best way possible.”
This highlights what Nawathe points to as an essential element of the Pediatric Simulation Program: its relevance to diverse care providers at every stage of their career. “It doesn’t matter if you’re a seasoned healthcare worker or a new trainee; simulations are about lifelong learning that leads to exemplary patient care.”
Recipe for Impact
The simulations grow out of needs assessments conducted across Guerin Children’s. Once a need is established, Nawathe and her team design the simulation, which is built out in three parts: the pre-brief, the simulation session and the debrief.
“Simulations put participants in a vulnerable position: They’re being evaluated, and that can raise all sorts of uncomfortable feelings,” Nawathe said. “In the pre-brief, we work hard to create a psychologically safe environment in which people feel seen and heard. The basic assumption is that everyone participating in the simulation is intelligent and capable of doing their best. We make clear that’s our starting point, and that we’re all in it together.”
The simulation itself lasts for a maximum of 15 minutes and leads to the debrief, where the bulk of the learning and self-reflection happens.
“The first thing we do in the debrief is to ask for people’s reactions, giving them a chance to talk about what happened during the simulation,” Nawathe said. “Then we move on to analysis and what we call the ‘delta method’: looking at what went well and what could have gone better. We close with a summary, in which we identify key takeaways that stem from participants’ self-reflection.”
In addition to pioneering innovative simulations at Guerin Children’s, the program continues to build partnerships across Cedars-Sinai and beyond, playing a pivotal role in multicenter research projects to help advance the field. In recognition of the program’s growing reach, Nawathe was recently invited to become a fellow of the Society for Simulation in Healthcare Academy.
“Cedars-Sinai’s program has established itself as an interprofessional center of excellence for pediatric simulation education and research, and I look forward to increasing our impact locally, regionally and globally,” Nawathe said.