Reflections on Simulation

With this issue of Simulation in Healthcare, I am delighted to serve as section editor and launch our new narrative feature, Reflections on Simulation.

Narrative features in medical and healthcare publications typically showcase writers' humanism, storytelling, and personal experiences as a means to share valuable insights and lessons learned.^1,2 Narrative writing may be thought of as meaningful human interest stories that have universal appeal and applicability. Narratives typically focus on personal, emotionally grounded, memorable experiences that indelibly change one's perspective and, sometimes, one's life course.³ The pieces might be authored by anyone with an interesting simulation-related viewpoint to offer, regardless of professional discipline or role. A narrative feature holds the promise of engaging those within our diverse simulation community who may not be academics, researchers, or published authors. We want to hear from those within the community who might not typically use publication outlets to voice their opinions, to reveal their truths, or to share their stories.

The simulation world naturally lends itself to narrative expression. Our field is rapidly growing and transforming, and many of us come to simulation “on a mission” because we are passionate about our work, our patients, our teaching. We are often clinical, educational, and healthcare policy change agents who are not satisfied with the status quo. We represent a diverse, creative, interprofessional group that takes pride in being inclusive and innovative, thinking outside of the box, and optimizing learning. For many, simulation serves as a bridge to fulfilling, unexpected collaborations that otherwise might not be possible. Simulation brings us together across many disciplines: nursing, medicine, respiratory therapy, pharmacy, chaplaincy, psychology, engineering, standardized patients, performing arts, moulage artists, among others, and across roles as clinicians, researchers, educators, inventors, authors, administrators, and entrepreneurs. Intellectual stimulation and creative learning potential are amplified within the field of simulation because we can learn more from people who are different from us, across boundaries, than from those who are similar to us.⁴ As simulationists, we take on challenges, solve problems, stand up for reform, and make healthcare better and safer through our simulation endeavors. In addition, shared stories bind people with similar experiences and solidify relationships.

Beyond cross-pollination within the simulation community, narratives might also help others, less familiar with simulation, to understand better what simulation has to offer, to depict instances of patient safety achievements, and to strengthen the educational and business cases for healthcare simulation. Good stories animate and enrich the learning and, some might say, are necessary to contextualize and memorialize the learning. As human beings, with oral traditions that long predate our scientific inquiry and method, we are hard-wired to listen, tell, and learn from stories. Gathering a careful history from a patient, for example, can be considered storytelling. Good case scenarios, the bedrock of the simulation enterprise, depict realistic patient stories, and their healthcare trajectories. In addition, debriefing, in its many forms, might be considered as the process of better understanding and elaborating upon the stories that unfold in the actual simulation scenarios. In my experience as a simulation educator and founder of an institute devoted to communication and relational learning, the empirical studies necessarily legitimize and validate our efforts and work. However, personal stories about the simulation experience move clinicians to enroll in our courses, department chairs to vouch for the worth and require attendance at our courses, administrators to commit financial resources and space, and funders to get on board.⁵

A growing number of healthcare specialty journals offer narrative essay publication forums. Within the simulation world, in recent years, the International Meeting on Simulation in Healthcare has increasingly featured speakers' personal stories related to simulation. IGNITE presentations, for example, are brief, popular, well-attended, and coveted storytelling opportunities that build community. At the International Meeting on Simulation in Healthcare 2017, the conference included a joint session with simulation educators and learners who shared their stories to a rapt, attentive audience. Witnessing the power of the storytelling and the personal nature of the sharing convinced us that it is time for Simulation in Healthcare to host its own narrative feature, and the seed of Reflections on Simulation took root and we expect that it will flourish.

Perhaps the most celebrated, long-running healthcare narrative essay series, and a worthy role model, is A Piece of My Mind published in the Journal of the American Medical Association (JAMA) (http://www.jamanetwork.com).⁶ The series is simply and broadly described as personal vignettes exploring the dynamics of the patient-physician relationship. The clinical and educational epiphanies and insights published in the series are often shared among colleagues. The stories characteristically offer a window into wisdom and comprise a vast array of topics ranging from stressful bungled communication, troubled teamwork, strong identifications with patients, grief and attending funerals, to coping with and revealing one's own health issues as care providers. The stories go deep to reveal the authors' personal vulnerabilities and often spring from vivid moments-in-time to shed light on one's personhood, as well as “the soul” of medicine. In this spirit, we hope that Reflections on Simulation evolves to become a valued source of multiple perspectives, advice, and wisdom, as it knits together our diverse simulation community.

Reflections on Simulation encourages submissions from a diverse, representative group of authors devoted to telling first-person, descriptive stories and sharing perspectives about the joys, challenges, learning epiphanies, clinical and educational insights, and wisdom related to simulation in healthcare. We want to hear not only what brings people to simulation and why but also what keeps people engaged in simulation, and how. Efforts will be made to publish a balance of articles ranging from simulation learning, teamwork, challenges, obstacles, novel solutions, and teaching, with representation from all disciplines, learner and teacher alike, who contribute to the simulation enterprise.

Reflections on Simulation articles are intended to be brief with a word count set at 750 to 1000 words. It is anticipated that most submissions will be sole authored, but submissions may include up to 3 authors. Furthermore, given the narrative nature of these submissions, citing references is not expected, unless deemed necessary. Specific details for submissions will soon be added to the instructions for authors section of the article web page (http://edmgr.ovid.com/sih/accounts/ifauth.htm#15).

We all have simulation stories and we hope to publish as many as possible, but not all narrative pieces will merit publication. Reflection on Simulation manuscripts will be read by the Section Editor and Editor-in-Chief and, if promising, evaluated through a careful process by a panel of reviewers. Submissions will be evaluated according to several quality indicators including originality, relevance to simulation, representation across simulation, educational value, first-person storytelling, quality of writing, diversity of learning, and the “inspiration factor.” However, specific feedback on acceptance/rejection decisions will not be possible.

Initially, the narrative pieces will be published occasionally. The frequency of narrative pieces will ultimately reflect the quality of submissions and the popularity of the feature. We anticipate eventually publishing one narrative manuscript per issue. As we undertake this exciting new initiative, we welcome your ideas, thoughts, and submissions and hope to make the simulation community proud.

For our inaugural narrative publication, we gratefully acknowledge Ignacio del Moral, PhD, MD, of the Hospital Virtual Valdecilla in Spain, who authored My Simulation Journey: Making the Impossible, Possible. He generously shares his unforgettable, personal moment-of-truth that committed him on the path to an international career and leadership in simulation. Please join me in reading his story and imagining his experience, and to reflect on your own simulation journey.