Turn Right Here: Driving Healthcare Quality Improvements Through Car Simulator Training

Situational Awareness (SA) is critical in healthcare. Although SA is a term that most in healthcare are familiar with - some even having an intuitive definition of it (i.e., “to know what is going on”), the full understanding of it is often quite limited and it is generally silently understood. This tacit characteristic is in part due to the lack of an operational definition and difficulty in becoming more explicit during training. Furthermore, SA translates poorly into daily practice. We introduce here an innovative approach to teach and train SA to healthcare quality and risk managers using a driving simulator. Driving is a daily activity familiar to most people. In addition, effective and safe driving requires a surprising high level of situational awareness. The rationale of our approach is to leverage everyone’s close familiarity with driving, and through structured and guided personal experience in a driving simulator, facilitate translation and transfer of the acquired experience and understanding to their daily practice in healthcare.

 We use a full-scale mockup for a car, including fully functioning seat (including personal adjustment and a seat belt, gear, pedals, and a steering wheel. The trainee is seated in front of three wide screens providing a full field of view (including rear and side mirrors). We designed 14 driving scenarios that focus on various situational elements (e.g., weather influence, reading instruments, noticing other road users, etc.), and mapped each to an equivalent medical scenario (e.g., influence of ambient conditions, reading vital signs monitor, teamwork, etc.). In addition to the basic situational elements, we identified in each scenario the facts a person should gather, the required understanding, and the relevant thinking ahead.

 The overall procedure of the simulation session consists of each trainee experiencing at least one driving scenario, while the rest of the participants observe. Each scenario is followed by a full playback of the scenario, and then a group debriefing which focuses first on the experience and SA elements of the driving, and then a discussion on translating the experience and understanding of the concept to a medical scenario. This approach is easily scalable to an online and remote training, with the pervasiveness of driving games and simulations, and online technologies that support virtual group work.