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Reality check: the Clinical Skills and Simulation Centre

Clinical staff need to gain experience of emergency situations to improve outcomes for patients. This is where our simulation faculty comes into play

Clinical Skills and Simulation training at The Royal Marsden

Imagine you're a doctor arriving for your shift at The Royal Marsden. You have three patients that require your immediate attention: one needs a multidisciplinary team meeting set up to decide the next steps in clinical care; the next requires urgent radiotherapy; and the third has just been admitted with signs of overwhelming infection.

How do you juggle everyone’s needs? To ensure clinical staff can deal with common predicaments like these, similar scenarios can be set up using actors and mannequins to stand in for real-life patients.

The Clinical Skills and Simulation Centre (CSSC) is a state-of-the-art medical education and training facility, where healthcare professionals can work through emergency situations and clinical procedures in a safe, simulated environment.

Thanks to a collaboration between The Royal Marsden and Royal Brompton, The Royal Marsden School uses the CSSC to provide personal and professional development for doctors and nurses, allied health professional and healthcare support workers.

Lara Roskelly, Matron on Horder Ward, was one of the first nurses at The Royal Marsden to be trained using simulation in 2009. She now helps design courses and trains others using simulation.

She says: “We use basic mannequins for practising everyday clinical procedures, such as setting up life support and applying sutures, and we insert olives into chicken breasts to practise fine-needle aspiration under ultrasound.

"But much of the simulation training we do recreates challenging clinical scenarios using sophisticated mannequins and actors.”

According to the National Confidential Enquiry into Patient Outcome and Death, poor communication contributes to bad outcomes in more than 40% of clinical cases.

Simulation training gives trainees the opportunity to refine their communications skills, from breaking bad news to patients and their families to discussing treatment plans with colleagues, delegating to their team and improving confidence in speaking up and handling difficult situations.


number of people involved in a simulation scenario

Emergency room dummies

The latest model of mannequin available in the CSSC is capable of sweating, crying and speaking. It is operated remotely from a control room separated by a glass partition, where the doctors directing the scenario can speak through the mannequin; for example, to say that they are in pain.

They can raise or drop the model’s blood pressure, heart rate and respiration rate. 

A scenario is likely to include a mannequin and two members of the faculty playing the role of patients or their relatives. In total, there are usually 12 candidates involved, including a mixture of junior and senior staff from a variety of disciplines. 

Following each scenario, which lasts an average of 15 minutes, the group spends half an hour or more debriefing, discussing what went well and what they could have done differently. They then watch scenes back on video and observe their body language and their interaction with the patient and their colleagues.

Core medical trainees, who are on a two-year programme covering generic medicine disciplines before becoming registrars, are required to train using simulation as part of their qualification.

The CSSC is also open to all Royal Marsden staff who want a refresher for clinical skills, or who have faced a difficult situation that they would like to work through.

Lara says: “Simulation is an incredibly valuable learning process. Trainees might go into a scenario feeling apprehensive, but by the end of the session they want to do it all over again."