About 

Dr. Shailesh Shetty is the Chief of Emergency for Aster Hospitals Bangalore in India with 25+ years of experience in managing emergencies. He has an extensive experience from the Emergency Department at Bahrain Defense Force Military Hospital. He has held leadership positions in the Emergency Department and has taught nursing students and medical professionals as well as organized conferences and workshops in emergency medicine.  

What are some challenges to ensure quality of healthcare in India?  

It's a multifaceted issue, really. One of the most pressing challenges is the high turnover rate in hospitals. This makes it difficult to retain and retrain healthcare professionals. Training and continuous education are critical to keep staff motivated. Unfortunately, there's a lack of consistent training standards across various institutions, which can lead to outdated practices. The National Medical Commission has made progress in addressing this, there are still gaps.  

How were you first introduced to simulation-based training?  

You know, I think back to when simulation-based training first started making waves in India. I believe it was around 2005 with the AHA courses, but things really kicked off at a simulation conference where we got to dive deeper into the concept. My first big experience came during a critical care conference where I teamed up with Laerdal to create a scenario-based teaching workshop. It was such a hit that we were invited back for another international conference in India. From there, we expanded into airway management, pediatric emergency medicine, and faculty development workshops, all centered around simulation methodologies. That’s when I really got introduced to the exciting world of simulation. 

Is simulation-based education a well-known methodology in India? 

As for the awareness of simulation in India, it’s definitely on the rise. More people are starting to recognize the value of simulation-based training, but it’s still not as widespread as it could – and should - be. Some leading medical colleges and nursing schools have embraced it, proving how effective it can be in preparing students for real-world clinical situations. Plus, it’s now become mandatory by our medical governing body, which is a big step forward. 

But there are still some hurdles to overcome. Awareness and access really vary between urban and rural areas. Urban centers tend to have better resources, while many rural institutions face challenges like limited funding and facilities and a lack of trained faculty to teach. 

During my undergraduate days of medical training, the concept of simulation-based learning was not known. However, during my postgraduate years, we did have a skills lab with some simulation-based teaching, but there was not much importance to debriefing. I was introduced to what simulation really can be, through a program called SimBegin, which focuses on integrating simulation into healthcare education for beginners, but also really focuses on the debriefing part.

What was your experience with the SimBegin program?

My experience with the SimBegin program was highly positive. The program had a well-structured curriculum that gradually introduced more complex scenarios. Each session had clinical scenarios, from basic procedures to emergencies, and we also created our own simulations. This kept things interesting and challenged us in different ways. We used high-fidelity simulators that mirrored real clinical situations. It allowed us to practice essential skills like intubation, CPR, and patient assessments in a safe space. Plus, after learning the theory, we could apply it right away in the simulations. Many of the exercises were team-based, which helped us improve our communication skills. It was invaluable for grasping how healthcare teams function in real life. The debriefing sessions after each simulation were crucial. They provided a space for reflection and to give and receive constructive feedback.

How has it been used at your hospital and with your team?

In our hospital, simulation training has been integrated into our Emergency Medical team’s routine, through a low-dose, high-frequency training approach. We conduct regular simulation drills, often on a weekly or bi-weekly basis. Each session targets skill like IV cannulation, endotracheal intubation or communication related to specific emergencies, such as cardiac arrest, trauma management, or respiratory distress. This focused approach helps reinforce specific skills and knowledge, ensuring that each team member can master individual components of emergency care. 

Simulations often involve not just doctors but also nurses, paramedics, and other healthcare professionals to improve communication within the team, which is critical in emergency situations.  
Instructors provide immediate feedback during and after simulations, allowing team members to adjust their techniques and approaches on the spot. After each session we have debriefing discussions to reflect on what went well and what could be improved. This reflective practice encourages a culture of continuous improvement and accountability.

Overall, the use of simulation in our hospital, particularly within the Emergency Medical team, has really improved our ability to respond to emergencies. The low-dose, high-frequency training model allows us to continuously refine our skills and improve teamwork. 

Can you share an example of a time where simulation training has resulted in a life being saved? 

Yes! It was a busy evening in the emergency department when a paramedic team rushed in with a young man in his late thirties who had a cardiac arrest. From our extensive practice, my colleagues and I knew exactly what to do. It was instinctive. Just weeks earlier, we had practiced this exact scenario during our simulation training, focusing on high-quality CPR, defibrillator use, and clear communication. 

Even during the stress of an emergency, our team communicated effectively. Everyone knew their role, calling out vital signs and interventions. It was a perfect example of what we had practiced. 
After a lot of effort, we delivered shocks with the defibrillator when we detected ventricular tachycardia. After a few attempts, we detected a faint pulse. Such a relief. Once the patient stabilized, we moved him to the Cath lab. I reflected on how our simulation training had prepared us for this moment. That night, we saved a life because of the skills and teamwork from our training.

What is the most important aspect of simulation training?  

I’d say the debriefing part. It really improves the learning experience and helps us apply what we learn in simulations to real life. 

First, it allows everyone to reflect on their performance and team dynamics, which deepens understanding. Debriefing helps us connect the dots between simulations and real-life scenarios. I’d say debriefing is the cornerstone of simulation training, turning a practical exercise into a rich learning experience.  

What advice would you give about the process of debriefing and how to do it well?

Here are some tips for effective debriefing:

• The most important part is to create a safe, non-judgmental environment.
• Mistakes are part of learning, so you need to focus on improvement rather than blame.
• Using a structured approach like the CORE structure in SimBegin can help guide discussions.
• Ask open-ended questions like “What went well?” or “What challenges did you face?”
• Keep the conversation tied to the simulation's goals to help participants connect their experiences to the skills we want to emphasize.
• Have participants assess their own performance first.
• Balance emotional and technical aspects by acknowledging participants' feelings while also covering technical skills and decision-making.
• Understanding participants' perspectives can help refine future sessions, so be flexible and ready to adjust based on feedback. 

How are you using simulation to train basic emergency care now? And what would you like to see in the future?  

Right now, we’re using simulation to train Basic Emergency Care (BEC) with structured scenarios, hands-on practice, and team exercises. Our training focuses on emergencies like cardiac arrest, respiratory distress, and trauma management. 

Teamwork is a big part of our approach, too. We involve different healthcare disciplines, which helps everyone understand their roles. We use a low-dose, high-frequency training, with brief, focused sessions often, and we always end with a debriefing to talk about what went well and what could be better. 

I’d love to see the BEC course standardized across healthcare settings with simulation training. There’s a new portable Emergency Care Learning Lab developed by Laerdal together with the World Health Organization that could be really beneficial for hands-on practice, especially for rural areas. 

How has your perspective changed towards simulation over time? 

My view on simulation has changed a lot over time. I went from being a bit skeptical to really appreciating its value. Seeing how simulation training has boosted our team’s performance in critical moments made a huge impact, especially when we successfully resuscitated a patient just after a drill. 

Eventually, I started pushing for more simulation training in our department. I realized it’s not just a learning tool; it’s essential for patient safety. Now, I can’t imagine healthcare without it.