Part-task simulation training is the breaking down of a large, multicomponent task into simpler individualised elements. This type of training focuses on the specific fundamentals of a task and the development of ‘automated skills’, which would otherwise be challenging to achieve in the context of a complex task. They are specifically designed to replicate only part of an actual clinical scenario [4]. Some simple examples include venupuncture, cannulation and suture pads. This type of training is now familiar to most healthcare professionals.

More complex part-task trainers are now commonplace in surgical training. There is substantial evidence available on how to incorporate these trainers into a wider training programme [5]. In particular, it is important that trainees experience part-task training at an appropriate point in their learning curve. Once a trainee has mastered the technical skill required, the part-task can be incorporated into a wider clinical scenario where other non-technical skills will be needed (Fig. 1.1).

There are now realistic part-task trainers for almost every practical procedure that occurs in Intensive Care. Realistic, airway and tracheostomy trainers are widely available [6]. The use of chest drain and central venous access trainers is now well established. The developing trend is to incorporate these trainers into specific learning modules that form part of a wider curriculum [7].

A typical modular approach to teaching chest drain insertion would begin with some screen-based material, outlining the anatomical, technical and equipment issues. The students would then progress to working through the procedure on a part-task trainer facilitated by an experienced practitioner. Once the students have reached an acceptable level, the part-task trainer can be inserted into a more complex simulated scenario. The students are then required to carry out the same technical task, but under time pressure and a certain level of stress. This stepwise fashion allows the skills learned to be gradually reinforced. At each stage, a formal feedback session is essential.

The uniformity of part-task trainers to some degree allows a level of comparative assessment. This may be useful in monitoring the students’ progress and detecting problems at an early stage.

High-fidelity or ‘immersion’ simulation incorporates knowledge, technical and procedural skills alongside non-technical skills such as communication and teamwork within realistic scenarios. The high-fidelity manikins give immediate, real-time feedback on the patients’ condition and response to interventions. This dynamic component encourages the participants to become immersed in the scenario; so, their responses and behaviours become closely related to a ‘real’ situation. This dynamic component of high-fidelity simulation training has been shown to lead to increased confidence and decreased anxiety amongst the trainees. However, the key element is the debriefing session where participants partake in a detailed discussion of their experiences as a part of an experiential learning process. This process is most effective if carried out as a team exercise, with all those involved taking part. The validity of high-fidelity simulation training lies in careful planning, authenticity, close clinical resemblance and high clinical relevance (Fig. 1.2).

An example of high-fidelity simulation training in the Intensive Care Unit (ICU) setting was conducted in the University of Toronto where a new protocol for cardiac arrest in patients with severe acute respiratory syndrome (SARS) was evaluated. The simulation training raised issues that had previously not been considered, in particular the time taken to don the personal protection system (PPS) in an acute situation, techniques of defibrillation, and ergonomic factors such as minimising stethoscope use to avoid dislodging the PPS helmet. Effective changes were then made to improve the protocol [7]. High-fidelity simulation has been used effectively to familiarise ICU staff with new complex treatments, such as extracorporeal membrane oxygenation [8].

All ICUs will have critical incidents. High-fidelity simulation is an effective way of examining these incidents in a safe and positive environment leading to improvements in patient outcomes.