Healthcare simulation has evolved dramatically over the years, transforming how medical professionals are trained and educated. In the fourth episode of SIM Moove, the French-language podcast by SIMZINE, host Fouad Mahrar chats with a key figure in the world of healthcare simulation, Pierre Rostini, to discuss his career, challenges, and vision for the future of simulation. Rostini, who has been involved in simulation in Marseille for over two decades, shares insights that are both practical and philosophical, offering listeners a detailed look into the past, present, and future of healthcare simulation in France.
A SIMZINE exclusive based on SIM Moove podcast interview with Pierre Rostini
In this episode of SIM Moove, Fouad Marhar had a chat with Pierre Rostini, a veteran in the field whose career spans over decades of medical practice and educational innovation. As Dr Rostini approaches his 70th birthday, he shared insights from his remarkable journey and his latest project: a groundbreaking simulation center in Marseille that promises to contribute to healthcare education in France.
Introduction to the World of Simulation
Dr Rostini’s route to becoming a simulation pioneer was anything but traditional. Beginning as a mathematics and physics student, he worked as a nursing assistant for several years before pursuing medical studies. Although initially aimed at anesthesiology, a reform in medical studies redirected his path toward intensive care and emergency medicine. His work in the field of emergency response provided him with a unique perspective on the importance of quick, effective decision-making in stressful situations—an ideal foundation for embracing simulation-based training.
“We quickly realized that learning by doing, learning from errors, aligned perfectly with high-fidelity simulation,” Rostini explained. In 2009, he acquired his first Laerdal simulator, marking the beginning of a transformation in healthcare education at Marseille’s CESU (Centre d’Enseignement des Soins d’Urgence). The hospital directors, recognizing the potential impact, supported his vision, leading to the creation of a dedicated simulation room and eventually a full-fledged simulation center within CESU.
He recounts the early days with humor: “We started with one of the first high-fidelity manikins, and we had to teach ourselves how to use it. For the first few months, it was like a comedy show—we’d laugh at ourselves because we didn’t always know what we were doing. But we learned.” Despite the initial learning curve, Dr Rostini and his team pushed forward, fully integrating simulation into the training programs at CESU, which eventually evolved into a fully established center for high-fidelity healthcare simulation.
Beyond Emergency Training
While simulation in France initially focused on emergency procedures and stress management, Dr Rostini’s vision evolved beyond these constraints. “Today, we’re no longer in this mindset,” he emphasized, highlighting how simulation has become integrated into all aspects of medical and paramedical studies, focusing on comprehensive competency development rather than just acute situations.
This approach stands in stark contrast to the Anglo-Saxon model, which Dr Rostini describes as more vertically structured due to hyper-specialization. The French system, he explains, emphasizes interdisciplinary training, reflecting the reality of modern healthcare where professionals must master multiple skills simultaneously. In an intensive care unit, for instance, nurses must be proficient in ventilation, dialysis, and ECLS (ExtraCorporeal Life Support) simultaneously.
Dr Rostini mentions how his exposure to Canadian and Swiss models of simulation training heavily influenced the development of Marseille’s simulation center. “I’ve always been impressed by the Canadians and the Swiss—they’ve been real pioneers in simulation. I’ve learned a lot from their methods, particularly around the integration of simulation into routine education.”
The Art of Debriefing
At the heart of Dr Rostini’s methodology lies a unique approach to debriefing, developed through years of experience and continuous refinement. His team adheres to what he calls “the rule of eight” – limiting groups to eight or nine learners per session – and dedicates approximately 90 minutes of debriefing time for every 15 minutes of simulation. This comprehensive approach follows the SBAR framework (Situation, Background, Assessment, Recommendation), creating a structured environment for reflection and learning.
“Benevolence is crucial,” Rostini insisted, describing a three-tiered approach to kindness: in theoretical training, scenario design, and debriefing. This philosophy has proven successful, with over 1,500 nurses trained through their five-day adaptation programs over the past decade. The program has been particularly valuable for professionals seeking to deepen their understanding after their first year of practice, helping them bridge the gap between theoretical knowledge and practical expertise.
“The hardest part of simulation isn’t the technical side—it’s learning how to debrief properly,” he explains. “Debriefing is about guiding the participants to reflect on their actions without judgment. It’s not about pointing out mistakes but about understanding why they made certain decisions and how they can improve in the future.” Learning to avoid judgment while facilitating debriefing was a challenge that took Dr Rostini several years to master. He uses the metaphor of a spinning dancer optical illusion to illustrate the importance of perspective in observation: “When you see someone, you don’t know which side they’re looking at. If you don’t see the same thing, if you don’t hear the same thing, you can’t have the same attitude.”
A New Chapter: The Marseille Simulation Center
Perhaps Dr Rostini’s most ambitious project is the new simulation center being developed through a scientific interest group (GIS) involving Aix-Marseille University and AP-HM (Assistance Publique – Hôpitaux de Marseille). The project’s inception came from an unexpected source: the university president, Ivan Berlin, who had authored a report on skill transfer. After a concerning experience on an unfamiliar airline, Mr Berlin recognized the vital importance of simulation in professional training.
The center, which took three years of planning and one year of construction, represents an innovative approach to simulation facility design. It features a unique three-floor layout:
- A 750-square-meter procedural space accommodating up to 250 students
- A clinical confrontation floor with specialized rooms for various medical disciplines
- A ground floor dedicated to high-fidelity simulation, featuring five simulation rooms paired with ten debriefing rooms
This distinctive design, inspired by Canadian practices but adapted to local needs, allows for optimal resource utilization and can accommodate large student cohorts efficiently. “When you start with two groups alternating between simulation and debriefing, it becomes financially viable,” Dr Rostini explained, demonstrating how practical considerations shaped the center’s architecture.
The facility’s modular design allows for remarkable flexibility – large spaces can be subdivided as needed, and clinical examination rooms can be converted into emergency triage centers. The sophisticated audio-visual system, though initially challenging to fund, enables comprehensive tracking of student progress from their second year through advanced studies.
A Legacy in the Making
As Dr Rostini prepares for retirement, his legacy includes pioneering work in simulation-based assessment. Under his leadership, the center has successfully integrated simulation into formal evaluations, including ultrasound training and nursing qualifications. This approach allows for comprehensive assessment of not just technical skills, but also clinical reasoning, communication, and professional behavior.
The center has even validated practical examinations through simulation during the COVID-19 pandemic, with students conducting self-debriefing to demonstrate their clinical reasoning and practical skills. This approach to assessment represents a significant step forward in medical education, integrating theoretical knowledge, practical skills, and professional comportment into a single evaluation framework.
“The most challenging aspects are learning to debrief effectively and writing scenarios with precise objectives,” Dr Rostini advised those looking to follow in his footsteps. “You need to avoid overloading scenarios with complications, and above all, you need to build a team that evolves together and finds joy in the work.”
As healthcare simulation continues to evolve, Dr Rostini’s contributions – from his emphasis on benevolent education to his innovative facility design – will undoubtedly influence the field for years to come. His journey from emergency physician to simulation pioneer demonstrates how vision, persistence, and adaptability can transform medical education for the better.
The new Marseille simulation center stands as a testament to this transformation, ready to train the next generation of healthcare professionals in an environment that prioritizes learning through experience, reflection, and collaboration. As Dr Rostini puts it, “It’s so rich in terms of discussions and discoveries that it’s a whole world to discover and create.”
Full conversation available in French on SIM Moove
READ ALSO
