Simulation as an extreme environment to train elite providers A talk by Luca Carenzo at TBS23

1. SIMULATION
AS AN EXTREME ENVIRONMENT
TO TRAIN ELITE PROVIDERS
LUCA CARENZO
@carenzmd

4. Stressors
• NO PREDETERMINED STORYBOARD
• LOSS OF REFERENCE POINTS
• SENSORY ALTERATION / DEPRIVATION
• TEMPORAL DISORIENTATION
• CONFINEMENT
• LIMITED / RESTRICTED COMMUNICATION
• REQUIRED AUTONOMY ON LOCAL / MECHANICAL
TASKS

5. Stressors
during
COVID
• NOVEL / ALIEN ENVIRONMENT
• ISOLATION / REMOTENESS
• CONFINEMENT
• LIMITED PRIVACY
• REQUIRES ADAPTATION TO THE ENVIRONMENT,
CONTINUOUS SITUATION AWARENESS AND
MANAGEMENT OF STRESS

6. Preparedness OVERCOMES Fear

7. Crucial Analogies
Environmental / Exploration / Risk
Technical Progression /
Safety
Mission / Operations
Scientific / Documentation Crew Interaction / Behavioural Skills

11. Non technical skills for long duration spaceflight

12. The team MUST FEEL SAFE TO TAKE INTERPERSONAL RISKS and be vulnerable in front of one
another.
Fundamental in maintaining this facilitative culture is the PRESUMPTION OF POSITIVE INTENT.
This means a presumption that EVERYONE WORKING IN THE SERVICE IS STRIVING TO DO THEIR
BEST for every patient

13. SIMULATE TO…

15. DISPATCH

16. DISPATCH
• Male

17. DISPATCH
• Male
• Fall from height

18. HOW DEMANDING DO YOU EXPECT THE TASK TO BE?

19. HOW ABLE ARE YOU TO COPE WITH THE DEMANDS
OF THE TASK?

20. DISPATCH

21. DISPATCH
• Male

22. DISPATCH
• Male
• Fall from height

23. DISPATCH
• Male
• Fall from height
• 3 yrs old

24. DISPATCH
• Male
• Fall from height
• 3 yrs old
• CPR in progress

26. BIOPSYCHOSOCIAL MODEL OF
CHALLENGE AND THREAT

27. CONSISTENT LINK BETWEEN HOW OUR BODY RESPONDS AND
PERFORMANCE IN ELITE SPORT PROFESSIONALS
Turner, M. J., Jones, M. V., Sheffield, D., & Cross, S. L.
(2012). Cardiovascular indices of challenge and
threat states predict performance under stress in
cognitive and motor tasks. International Journal of
Psychophysiology, 86, (1), 48-57.
Turner, M. J., Jones, M. V., Sheffield, D., Slater, M. J.,
Barker, J. B., Bell, J. B. (2013). Who Thrives
Under Pressure? Predicting the Performance of
Elite Academy Cricketers using the
Cardiovascular Indicators of Challenge and
Threat States. Journal of Sport and Exercise
Psychology, 35, 387-397
Dixon, J., Jones, M. V., & Turner, M. J. (in
press). The benefits of a challenge approach
on match day: Investigating cardiovascular
reactivity in professional academy soccer
players. European Journal of Sport Science,

28. TWO GROUPS OF PEOPLE 1 MINUTE OF INSTRUCTIONS PRIOR TO
CLIMBING A WALL BUT CHANGED THREE SENTENCES
“you can feel confident that you will be
able to climb effectively”
“you obviously can't be sure that you
will climb the wall effectively”
“you have control over the skills
required to climb well”
“how well you do on the task may be
related to factors outside of your
control”
“try your best to stay on the wall and
get as high as you can”
“try your best not to fall off the wall at
any point”.

29. BY CHANGING THREE SENTENCES RESEARCHERS COULD MAKE PEOPLE
APPROACH A DEMANDING SITUATION AS A CHALLENGE.
Turner, M. J., Jones, M. V., Sheffield, D., Barker, J. B., & Coffee. (2014). Manipulating
cardiovascular indices of challenge and threat using resource appraisals. International Journal
of Psychophysiology, 94, 9–18

30. Appraisals

31. Share behavioral tools and models with teams in risky
environments simulating mission operations
Be FOR e DEC ision
Facts
Options
Risks & Benefits
Decision
Execution plan
Check
Feedback
Subject
Observation
Impact
Suggestion
Impact
BRIEF 3i
introduce
inform
include
DeBRIEF

32. LESSONS FROM BEYOND THE SURFACE

33. TRAIN YOUR TEAM CRITICAL SKILLS IN REALISTIC
CONDITIONS

34. Ensure your team uses reminders & checklists
Atul Gawande
Checklist Manifesto
(35% reduction
in complication and death)

35. BUILD TRUST & RESPECT IN YOUR TEAM

36. GET READY
FOR THE
WORST

37. BRIEF YOUR TEAM – CREATE A SHARED MENTAL
MODEL
Leadership
Communication
Exchange of
Information
Shared
Knowledge
Motivation
Team Mental
Model
Cooperation
Coordination
Safe and
Efficient
Performance
[Badke-Schaub, 2008]

38. LEAD BY DELEGATION, MAINTAIN TEAM
SITUATIONAL AWARENESS, ASK & LISTEN TO YOUR
TEAM TO BE ABLE TO TAKE INFORMED DECISIONS

39. DEBRIEF EVERY EVENT WITH YOUR TEAM TO LEARN
FROM MISTAKES AND REPEAT SUCCESSES