Clinical simulation in Spanish hospitals: an account of a meeting

Clinical simulation in Spanish hospitals continues to advance, albeit unevenly. At the 11th SESSEP Congress, three key pillars for its consolidation were identified: institutional regulations, functional structure, and adequate resources. This article summarizes the findings of the meeting and calls for action to integrate simulation as a training standard, essential for improving patient safety and quality of care.

Clinical simulation is a recognized tool for improving professional training and patient safety. However, although there are studies on the consolidation of teaching with clinical simulation in universities, we are still far from really knowing the actual level of development of this tool, and even further when it comes to simulation in hospitals. Simulation in clinical settings is not advancing at the desired pace despite its proven effectiveness in patient safety and in the training of professionals in the process of specialization and clinical and interdisciplinary teams, and despite strong ministerial recommendations in favor of the use of clinical simulation.

At the 11th Congress of the Spanish Society for Clinical Simulation and Patient Safety (SESSEP), held in Oviedo in April 2024, clinical care experts were invited to analyze the current state of simulation in hospitals and the challenges to be overcome.

Analysis of the conference

Prior to the congress, a survey was distributed to SESSEP members to obtain data on simulation in their centers. During the session, moderated by two experts, the double diamond principles were used to organize the discussions. Participants were grouped according to the level of simulation development in their hospitals: novice, intermediate, and advanced. The discussion was recorded, with the consent of the attendees, and the challenges were grouped according to the experience of each group.

Of the 38 respondents, 65% used simulation in various hospital services. Seventy-three point six percent used simulation for resident training and 78.9% for continuing education. Twenty-eight professionals participated in the session, of whom 42.9% represented hospitals with a novice level of simulation, 28.56% with an intermediate level, and 28.56% with an advanced level.

Identifying needs in hospitals

Hospitals with a novice level of simulation identified the need for adequate resources and space, as well as defining the place of simulation within the organizational structure. At the intermediate level, the lack of consistent training programs and the need for a dedicated manager were highlighted. Advanced centers emphasized the importance of simulation research and collaboration with other hospitals and technology industries, as well as supporting clinical simulation under a structure based on quality standards such as INACLS or ASPIH.

Identifying needs to move forward:

After consolidating the challenges, they were organized into three pillars for the development of simulation in hospitals:

1. Ministerial regulations and institutional support: Despite its recognized effectiveness, simulation still lacks consistent institutional support. It is crucial that health authorities establish clear regulations that promote the integration of simulation into training programs and provide the necessary resources for its development. Hospitals need support to create functional and sustainable simulation units.
2. Defined functional structure: Simulation programs must have a functional structure within hospitals, either as independent units or as part of the organizational chart, such as working groups, etc., that allows them to carry out their activities in a coordinated manner, facilitating sustainable and cross-cutting programs for all professionals in the institution.
3. Resources: The lack of trained personnel, specialized technicians, and dedicated spaces remains a major obstacle. Hospitals must have the necessary means to make simulation an effective and accessible tool.

Conclusions and transfer to our reality. Call to action.

All participants, although aware of the long road ahead for clinical simulation in hospitals, expressed the need to create a hospital simulation working group to grow together in its consolidation and advance patient safety. This document serves as a guide to position the level of simulation in each hospital and the future challenges that lie ahead.

However, this is not an isolated case in Spain. SESSEP was present at the recent signing of the Global Consensus on Healthcare Simulation led by SSH and SESAM, which brought together widespread support for clinical simulation from different societies and highlighted the need for global support from political parties. This consensus embodies a major political effort to promote collaboration in the field of simulation in healthcare and patient safety.

In addition to continuing to work and improve the quality of clinical simulation, the Spanish Ministry of Health, as is already the case in other countries and at the level of various autonomous communities in Spain, must be aware that

simulation is not an option but a training requirement whose benefits for patient safety extend to healthcare personnel and the general population.

Final considerations

We can conclude that the implementation of clinical simulation in hospitals is uneven but advancing inexorably, and that the main axes for the development of simulation at the hospital level rest on three fundamental pillars: (1) ministerial regulations and institutional support, (2) a defined functional structure, and (3) investment in human and material resources. Only through robust and coordinated support can we ensure that simulation becomes a standard for healthcare training, thereby contributing to improved patient safety and quality of care.

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