James Lipshaw

Dan Raemer & Janice Palaganas Present the Big Dilemmas of IPE


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Dan Raemer and Janice Palaganas will be presenting the closing keynote speech at the Spring Simulation User Network (SUN) Conference in San Diego, California. The SUN Conference takes place from April 18 through April 20. Dan and Janice’s presentation is entitled, “Dueling Synapses: Dilemmas in Simulation-Enhanced Interprofessional Education.”


If you enjoy the dynamic duo of Dr. Raemer and Dr. Palaganas, be on the lookout for their coming podcast, DJ Simulationistas… ‘sup?, which will be available on the CMS Virtual Campus as well as iTunes and wherever podcasts are found.01_DJSim

In addition to their keynote, Dan, Janice, Roy Phitayakorn, and Denise Gee will also present the Interprofessional Debriefing Workshop at the Association for Surgical Education (ASE) 2017 Surgical Education. This event is the annual meeting of the Association for Surgical Education, and takes place from April 18 to April 22 in San Diego, California.

CMS Simulation Apprentice is the New Simulation Operations Manager at Maine Medical

IMG_4702 (003)The Center for Medical Simulation (CMS)  congratulates Mike Shepherd, former Operations Director at HealthSim United in Wichita, Kansas on becoming the new Simulation Operations Manager at Maine Medical Center. Mike started his new role this past Monday. Everyone here at CMS has fond memories of Mike from the time he spent a week here in September of 2012 as a Technical Apprentice. Since then we’ve kept in touch with Mike and were very excited to learn about his recent career move. Mike stopped to visit Tony Dancel, CMS’ Technical Director, during his recent move to Maine and shared with him the impact that Tony and the week he spent at CMS had on his career. Here’s what Mike wrote to Tony.

“When I began my simulation journey more than five years ago, I didn’t know anything or anyone in the simulation world. Tony was the first simulation professional from outside my region to recognize and acknowledge my potential. After a weeklong apprenticeship working alongside Tony and his staff, I returned home with new knowledge and more confidence. That allowed me to help successfully lead the creation of simulation programming and activities that had never before existed in my community. Fast-forward five years and I’m beginning a new position as the Simulation Operations Manager at Maine Medical Center in Portland. I do not believe this opportunity would have been possible if not for the foundation that was formed during my week at CMS. Tony is not only a wonderful colleague but an even better friend. I am grateful everyday to have had the opportunity to learn from Tony at CMS. I am even more grateful now to be his neighbor, just a few short miles up the road.”

Thanks for the kind words Mike and best of luck with your new position.

Founded in 1993, The Center for Medical Simulation (CMS) was one of the world’s first healthcare simulation centers and continues to be a global leader in the field. At CMS the focus is on communication, collaboration, and crisis management training in order to develop skills and teamwork behaviors that are best learned actively under realistic conditions. Since it first opened in 1993, CMS has trained thousands of participants in its innovative and challenging programs.

To learn more about CMS and its programs contact CMS at info@harvardmedsim.org



Dan Raemer shares ideas on interprofessional massive transfusion protocol simulation

Raemer,Dan_SimTecT2010Raemer Shares Ideas

In response to a  recent post to the Society of Simulation in Healthcare’s Open Forum by Jill Mackey-Feist, Simulation Educator at Samaritan Health Services, asking to hear from others who had experience providing Massive Transfusion Simulations within a multidisciplinary team approach, CMS’ Dan Raemer responded:

We have been conducting massive transfusion cases in our simulations at the Center for Medical Simulation and Mass General Hospital for several years now.  The important components are (1) finding or making an appropriate surgical or OB model that simulates massive hemorrhage in a plausible manner, (2) involving everyone in the situation, and (3) insuring psychological and simulation safety.  We have mostly made our own models such as tumors that rapidly bleed with simulated blood as regulated from the control room.  The model must include several sources of bleeding that are difficult to reach surgically.  There are a number of “tricks” that can be used to ensure that the quantity of blood that appears in suction canisters and on lap-pads and drapes is enough to impress surgeons or obstetricians used to dealing with hemorrhage.  Sometimes this requires an enormous amount of blood!!  Having all of the typical resources (electrosurgery, balloon devices, hemostatic agents, blood warmers, etc.) to deal with blood loss readily available is important so as not to frustrate the participants.  We try to create cases where everyone is involved.  For example, having frequent phone calls with the blood bank about delays in providing blood, minor antibody issues, verification of ID can ensure that team communication issues will arise during the case and be discussed during a debriefing.  Third, we think it is important for psychological safety not to put the team into a situation where they feel that the massive hemorrhage  is a result of their incompetence.  We usually bring the team into a situation where someone (an actor), another surgeon or a trainee has gotten into trouble and has asked the team for help.  We almost always have the patient survive even if they have gone into PEA arrest from the hemorrhage.  As will all simulations, making sure that everything used, including the blood, is labeled “Not for Human Use, Simulation Only” is critically important.  Standardized waterproof labels can be obtained at Foundation for Healthcare Simulation Safety. I would be happy to discuss further if you would like to contact me directly.

Dan Raemer is the Chief Curiosity Officer at the Center for Medical Simulation, Boston, MA 02129 www.harvardmedsim.org .
Dan can be reached at dreamer@harvardmedsim.org or (617) 726-3193.

Founded in 1993, The Center for Medical Simulation (CMS) was one of the world’s first healthcare simulation centers and continues to be a global leader in the field. At CMS the focus is on communication, collaboration, and crisis management training in order to develop skills and teamwork behaviors that are best learned actively under realistic conditions. Since it first opened in 1993, CMS has trained thousands of participants in its innovative and challenging programs. Contact CMS at info@harvardmedsim.org



How to develop a dopamine addiction in feedback and debriefing? Astonishing answers are the drug!

JWR-Headshotsmile copyAstonishing responses from colleagues or learners in feedback conversations or debriefings are like crack cocaine for me… addictive.   Okay, I’ve never tried crack, but the “zing” of an unexpected response can also be quite a high.  The more often I hear things I did not know and could not foresee, the more addicted I get the little dopamine squirt of surprise.  I let myself depend on other people to teach me about themselves and what they are trying to accomplish. 

I start to crave the unique story behind each person’s actions.

So, when I heard the paradoxical phrase, “No was the yes I needed,” while listening to a podcast on Sunday, I pricked up my ears.  Boston chef/entrepreneur Barbara Lynch was explaining how she found her voice and path in the hard-driving kitchen of a mentor who yelled and ranted things like, “No! not like that!”   In an unexpected reversal, Lynch said, “because of the attention deficit disorder and the dyslexia, I couldn’t follow anyone’s formula at all. So “no” to me was the “yes” I needed to hear.”  “No” became the affirmation she needed to find her “Yes!” and do things her own way.

Check out her interview:


Jenny Rudolph is the Executive Director of the Center for Medical Simulation, Boston MA 02129, www.harvardmedsim.org
Founded in 1993, the Center for Medical Simulation (CMS) was one of the world’s first healthcare simulation centers and continues to be a global leader in the field. At CMS the focus is on communication, collaboration, and crisis management training in order to develop skills and teamwork behaviors that are best learned actively under realistic conditions. Since it first opened in 1993, CMS has trained thousands of participants in its innovative and challenging programs.



James Lipshaw

Amanda Gelineau: Transformative Learning at CMS

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Amanda Gelineau is a resident in Anesthesia at the Massachusetts General Hospital in Boston, MA. She spent the month of March at the Center for Medical Simulation on an elective rotation. The goal of the rotation program is to expose residents to the potential and operational use of simulation for education, clinical training and research. Over the course of the month, residents develop simulation scenarios including patient records, plot, setup, debriefing notes, and references.

“I had heard from colleagues who have come to the Center for Medical Simulation before me that the month-long simulation experience offered to MGH anesthesia residents was one of the most transformative experiences in their residency.  Now, having just completed the month myself, I could not agree more.  I saw early on in residency the need for effective interdisciplinary communication in the operating room and how it often falls short.  I sought to learn how we can improve our communication by speaking with mentors who excel in it and reading about effective communication techniques.  It wasn’t until I completed the CMS Comprehensive Instructor Workshop, though, that I finally found what I had been looking for.  Throughout the intensive week long course, I watched as our instructors masterfully handled a large group with strong opinions.  Each day felt as though they were opening a new door with an array of techniques and tools to use in education and debriefing.  I learned not only how to speak my mind more clearly, but also how to listen more openly and empower others to share their thoughts.  The skills I learned in the course can be easily applied to my professional interactions, but I believe that applying them outside of work will help improve my personal interactions as well.  I am so grateful to all the staff at CMS for such an outstanding learning experience and know that I will continue to practice the skills I’ve learned here throughout my career and life.”

–Amanda Gelineau, MD

James Lipshaw

Healthcare Adventures in Australia!


CMS held two of its Healthcare Adventures (HCA) workshops at Mater Education in Brisbane, Queensland, Australia last month. Mater is a CMS Affiliate, though the HCA workshop is available to all organizations, not just those in the affiliate program. Each workshop lasted two days, with the first running February 28th to March 1st, and the second running March 8th to March 9th.

The CMS team involved in these HCA workshops was made up of Robert Simon, Kate Morse, Mary Fey, Demian Szyld, and Jenny Rudolph.

One of the HCA workshops was attended by Mater “Stream Leaders,” and the second by their “Executive Council.” The Healthcare Adventures workshop creates simulations which are intended to open participants to transformational changes in their organizations and in their work life. Participants use these simulations to experience and debrief on how they react as a team, how leadership is determined in crisis situations, how to create an environment and culture where speaking up is encouraged and cultivated, and where staff feel safe speaking up and being transparent with each other.

The Mater team was interested in creating cultural change and embedding “Speaking Up” as a culture, hospital-wide. The workshop was also a jumping off point for having Mater leadership experience the concepts of simulation and “Debriefing with Good Judgment,” and showing how simulations can help people change the way they think.

The reaction from the Mater team was very positive. The faculty said their goal was to create the right balance of comfort and discomfort in the simulation experience in order to to foment change, and to get participants to reflect honestly on their interactions. When the team returned to Mater a week later, the Mater leadership team was excited to show us how they had implemented one of the systems from the HCA workshop, the “Learning Pathways Grid,” which they had printed up on a large board in their office space.

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The Healthcare Adventures workshop aims to move organizations from conventional to transformational modes.

Overall, the two workshops held at Mater Education were a great success, and we are very excited to continue bringing Healthcare Adventures to other hospital leaders and teams around the world!




Healthcare Adventures (HCA) are customized, intensive team-training workshops for leadership and management teams across the healthcare spectrum. Designed to improve individual and team performance by developing collaboration and communication, the HCA workshops use a simulated patient experience in a highly realistic clinical environment to highlight a team’s dynamics in a powerful, but non-threatening fashion. Non-clinicians actually get the chance to care for a patient and experience real-life issues first hand, and clinicians are challenged to think like healthcare administrators and executives!

CMS faculty and professional facilitators work with the team before the simulation, discussing objectives and expectations, and again after the simulation, identifying important interactions, key learnings and actionable strategies. This allows the group to turn learning into action immediately, by working on a real-world project with the help and support of the CMS facilitators. Depending on their needs, teams can draw variety of follow up support mechanisms and training to advance their learning and performance. Topics include teamwork, effective communication, resource management, performance enhancement and patient safety.

Workshops include:

  • Consultation between the team leader and a CMS facilitator prior to the workshop
  • Team pre-briefing on simulation objectives and strategies
  • Customized team challenge in the simulated clinical environment
  • Debriefing and discussion to identify important interactions and to develop actionable strategies for implementation
  • Facilitated work session to apply new strategies to an existing project (i.e., budget negotiations, product development, and pipeline strategy)
  • Report from CMS facilitator
  • Follow-up between the CMS facilitator and the team leader

For more information about Healthcare Adventures click here, or contact Gary Rossi, COO, at grossi@harvardmedsim.org



James Lipshaw

A Letter to Jenny Rudolph from Our Colleagues in Edmonton, Alberta

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Mary Fey with the CMS team and Albertan sim educators at MacEwan University in Edmonton.

Colette Foisy-Doll is a Registered Nurse (RN) and a Certified Healthcare Simulation Educator who has been on the faculty at MacEwan University in Edmonton, Alberta, where she now serves as Director of the Clinical Simulation Centre, since 1994. She was one of the first pioneers of simulation-based undergraduate nursing education in Canada and has served as a consultant for the development of more than 20 simulation programs in Canada and around the world, including programs in Jordan, Qatar, Saudi Arabia, and most recently in Turkey and Ukraine. She is also an alumna of the Center for Medical Simulation Comprehensive Instructor Workshop. MacEwan University has offered the Comprehensive Instructor Workshop twice, and most recently hosted the CMS Gateway Debriefing Workshop.

We recently received a touching letter from Colette Foisy-Doll, Director of the Clinical Simulation Centre at MacEwan University in Edmonton, Alberta. MacEwan had just hosted the CMS Gateway Debriefing Workshop, a one-day course which introduces healthcare education faculty to the foundational principles of “Debriefing with Good Judgement.”

Here’s what Colette had to say about the workshop:

Dear Jenny,

I trust that life is bringing heaps of goodness your way and I hope all is well in your world.

I am writing to send good news by letting you know what an amazing and transformational learning event Mary [Fey] and the CMS graduate facilitators provided for MacEwan University and our Interdisciplinary Healthcare Education Partnership community of practice. I was so very proud to be hosting this session and since last Thursday, have been barraged with wonderful remarks and positive feedback.

In keeping with the Center for Medical Simulation tradition of excellence through teaching Debriefing with Good Judgment, Mary provided us with a powerful and stimulating learning experience that was enhanced by the many gifts she so openly shares. She is amazing, and you already know that. It was especially meaningful to have Mary stay for our premier Sim-IPE HELP! Save Stan event where she got right in there, modeling debriefing and providing valued feedback for our facilitators.

She is a kindred spirit to all, not unlike other members of the CMS team. To me, this is one of the defining characteristics of your team and your collective work – you genuinely care about and for others and your commitment to empowering people fosters instant connections and life-long bonds that reach far beyond the outcomes of simple training sessions. Education is most valuable when it is emancipatory….

It is absolutely essential to spread the CMS word and to continue to transform our healthcare teams and environments one voice at a time while building capacity in our education/healthcare community. The Gateway course is very important because it brings the CMS experience to vast numbers of educators/HCPs that otherwise could not afford to partake. I hope many go on to taking the full course, but if they do not have access to funds, this is a huge opportunity to learn.

I am watching and noticing as CMS continues to expand and develop its programming and am excited to feel that I can play a small part of it!

All the very best to you and the team.

Cheers, Colette


And here is what Jenny Rudolph, Executive Director of CMS, had to say in response:

Dear Colette,

Thanks for this very touching and heartfelt message. It sounds like the Gateway course had a wonderful impact and that Mary Fey’s work was as magical as I know it to be.

You, of course, seeded the ground for this marvelous work with your long-standing commitment to excellence in debriefing, your skill, and of course heart!

What you describe below is the kind of impact and feeling that I think helps us all know why we are doing this work and inspires us to work hard to do more.

Thank you so much for taking the time to write.




James Lipshaw

Jeff Cooper’s Letter to the Editor Provides Important Addendum to CRICO History

Jeffrey Cooper, PhD

On December 9, 2016, the journal Patient Safety & Quality in Healthcare published an article by Susan Carr, reflecting on the 40 years CRICO has served as malpractice insurance provider for Harvard medical institutions and their affiliate programs. (Full article: https://www.rmf.harvard.edu/About-CRICO/Media/In-the-News/News/2016/December/CRICO-Celebrates-40-Years-in-Patient-Safety)

On February 27, 2017, Jeff Cooper, Executive Director Emeritus of the Center for Medical Simulation, submitted a letter to the editors of Patient Safety & Quality in Healthcare, to address some critical pieces of the history of CRICO’s leadership in patient safety, which he felt were missing from the original article.

Thank you for giving visibility to the story of CRICO’s story of leadership in patient safety. It is worthy of praise and emulation. Yet, I think there are critical pieces of the story that perhaps space didn’t permit telling, although I think they are among the most important. Then again, I have a bias because I was there . . .

The other aspects of the CRICO patient safety story are important examples of how a forward-thinking insurance company can achieve a win-win-win-win (patient, provider, hospital, insurer). But, I believe it was the leadership of the HMS anesthesia Executive Committee that led to one of CRICO’s earliest and greatest successes, and that enabled the continued concentration on patient safety.

Dr. Cooper’s full letter, along with references, can be found at the Patient Safety & Quality in Healthcare website: http://www.psqh.com/analysis/letter-to-the-editor-cricos-patient-safety-leadership-a-missing-piece/

James Lipshaw

Participate in a Systematic Review of In Situ Simulation Debriefing

Are you an experienced simulation debriefer?

Victoria Brazil, Walter Eppich, and Margaret Bearman are looking for volunteers to participate in a systematic review of debriefing strategies for in situ simulations.

Please read their note below, and contact them at ISSdebriefing@gmail.com if you are interested in participating.


The optimal debriefing strategies for in situ simulations (ISS) are unclear. The current practice of expert and experienced in situ debriefers has not been reviewed systematically. Most published reports of ISS programs lack detail as to how debriefing is conducted.

We’re conducting a study which aims to review the current practice of experienced in situ simulation debriefers – their context and approach, and the basis on which debriefing approach is determined. We’d like your help!

If you are interested in finding out more – please email ISSdebriefing@gmail.com


Many thanks

Victoria Brazil, Walter Eppich and Margaret Bearman

James Lipshaw

Behind the 2-Way Mirror with Dr. Crystal Tan

Dr Crystal Tan

Crystal Tan is a resident in Anesthesia at the Massachusetts General Hospital in Boston, MA. She spent the month of February at the Center for Medical Simulation on an elective rotation. The goal of the rotation program is to expose residents to the potential and operational use of simulation for education, clinical training and research. Over the course of the month, residents develop simulation scenarios including patient records, plot, setup, debriefing notes, and references.

“Have you ever wondered what happens behind the two-way mirror at a simulation center?

After spending a month at CMS, I can answer that question: wigs and fake blood, occasional burning smells, wonderful people dedicated to the art and theory of simulation, a willingness to roll with the punches and improvise, a philosophical approach to andragogy (a word I learned with Tony Dancel that means “adult education”), and a comically improbable amount of orange Tang.

I had a remarkable experience during my rotation. I learned about the technical ins and outs of staging simulations including setting up realistic scenarios, playing different operating room characters, and programming mannequins to have plummeting bradycardia or STEMIs. Through this supporting role, I watched (and sometimes helped) different groups of participants code a patient three times a day, three times a week. If repetition is the key to success, then I can’t think of a better way to practice ACLS protocols (not to mention the group dynamics intrinsic to crisis management).

A major component of the simulation experience is debriefing. After a simulation is completed, the team is given a chance to breathe, release their emotions, discuss the gritty details of the case, and perhaps learn something new. These sessions are run by debriefers trained to probe a participant’s thoughts with sincere interest and without judgment. I learned to set aside my preconceived notions as I observed and occasionally participated in these sessions. After each debriefing, I never doubted that each participant gave their full effort, and I believe each one walked away with at least one clinical or behavioral lesson they could incorporate into their practice.

The world of simulation is much larger than I realized; the depth of research, international collaboration, and even safety within simulation is incredible. Moreover, lessons from simulation are relevant not just in clinical practice but also in day-to-day life; if we could all set aside our assumptions and listen without judging, then we might all accomplish more.”

–Crystal Tan, MD