Clinical simulation in intensive care training: evidence, European models and opportunities for Portugal.

Authors

  • Jaime Miguel Abreu UCIP-ULSCB, Polivalent Intensive Care Unit of the Local Health Unit of Castelo Branco, PORTUGAL; FCS-UBI, Faculty of Health Sciences - University of Beira Interior, PORTUGAL; CACB - Clinical Academic Center of Beiras, PORTUGAL https://orcid.org/0000-0002-2618-4149
  • Miguel Castelo-Branco UCI-ULSCBeira, Intensive Care Unit of the Local Health Unit of Cova da Beira, PORTUGAL; FCS-UBI, Faculty of Health Sciences - University of Beira Interior, PORTUGAL; CACB - Clinical Academic Center of Beiras, PORTUGAL; RISE-Health, PORTUGAL https://orcid.org/0000-0002-6191-5912
DOI: https://doi.org/10.6018/edumed.657461
Keywords: Clinical Simulation, Intensive Care Medicine, Patient Safety, Medical Education, EPAs, Competency-based Training

Abstract

Clinical simulation has become established as a fundamental pedagogical tool in medical training, with solid evidence of its impact on knowledge, technical skills, and clinical behaviors, as well as on patient outcomes. This article reviews the literature on simulation in Intensive Care Medicine, highlighting effective strategies such as deliberate practice, repeated training, structured debriefing, and in situ simulation. The situation in Portugal is analyzed, where the Intensive Care Medicine residency program lacks formal integration of simulation, in contrast to the Spanish model led by SEMICYUC and the European CoBaTrICE program, which is competency-based and assessed through the OSCE. National examples (Anesthesiology), a mapping of simulation centers, and a SWOT analysis identifying strengths, weaknesses, opportunities, and threats for its implementation are also presented. Finally, the role of Entrustable Professional Activities (EPAs) as a tool for objective and progressive evaluation is discussed. The structured integration of simulation into Portuguese training represents a strategic opportunity to improve educational quality, reduce inequalities, and strengthen the safety of critically ill patients.

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References

1. Cook DA, Hatala R, Brydges R, et al. Technology-enhanced simulation for health professions education: a systematic review and meta-analysis. JAMA. 2011, 306(9), 978–88. https://doi.org/10.1001/jama.2011.1234

2. McGaghie WC, Issenberg SB, Cohen ER, et al. Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? Acad Med. 2011, 86(6) ,706–11. https://doi.org/10.1097/acm.0b013e318217e119

3. Issenberg SB, McGaghie WC, Petrusa ER, et al. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach. 2005, 27(1), 10–28. https://doi.org/10.1080/01421590500046924

4. Zendejas B, Brydges R, Wang AT, Cook DA. Patient outcomes in simulation-based medical education: a systematic review. J Gen Intern Med. 2013, 28(8), 1078–89. https://doi.org/10.1007/s11606-012-2264-5

5. Kiessling A, Amiri C, Arhammar J, Lundbäck M, Wallingstam C, Wikner J, Svensson R, Henriksson P, Kuhl J. Interprofessional simulation-based team-training and self-efficacy in emergency medicine situations. J Interprof Care. 2022, 36(6), 873-881. https://doi.org/10.1080/13561820.2022.2038103

6. Wu G, Podlinski L, Wang C, Chang C, Arriaga AF. Intraoperative code blue: improving teamwork and code response through interprofessional, in situ simulation. Jt Comm J Qual Patient Saf. 2022, 48(12), 665-673. https://doi.org/10.1016/j.jcjq.2022.08.011

7. Zhao L, Wu C, Li T, et al. Integration of mind mapping and in-situ simulation training to enhance the implementation of sepsis Hour-1 bundle treatment. BMC Med Educ. 2025, 25, 331. https://doi.org/10.1186/s12909-025-06918-0

8. Ippolito M, Simone B, Safadi S, Einav S, Cortegiani A. Effectiveness of a remote simulation training in mechanical ventilation among trainees. Pulmonology. 2023, 29(4), 332-334. https://doi.org/10.1016/j.pulmoe.2022.05.007

9. Spadaro S, Karbing DS, Fogagnolo A, Ragazzi R, Mojoli F, Waldmann AD, et al. Simulation training for residents focused on mechanical ventilation: a randomized trial using mannequin-based versus computer-based simulation. Simul Healthc. 2017, 12(6), 349-355. https://doi.org/10.1097/SIH.0000000000000249

10. SEMICYUC. Programa de formación en Medicina Intensiva basado en competencias [Internet]. [cited 2025 Oct 20]. Available from: https://semicyuc.org/cobatrice/

11. Castellanos-Ortega A, et al. Competency assessment of residents through simulation-based OSCE. Med Intensiva. 2022, 46(9): 491-500. https://www.medintensiva.org/es-competency-assessment-residents-intensive-care-articulo-S2173572722001722

12. Sociedad Portuguesa de Anestesiología. Secção de Simulação Médica: plano de ação 2023–2025 [Internet]. https://spanestesiologia.pt/wp-content/uploads/2023/05/seccao_simulacao_2023_plano_accao.pdf

13. Centro de Simulação Biomédica de Coimbra. Plano pedagógico para o internato de Anestesiologia. 2024.https://www.simcoimbra.org/files/cursos/10_07_15_08_newsletter_ppn_modulo_4_jan_2015.pdf

14. Silva J, et al. Mapeamento dos centros de simulação em Portugal. Acta Med Port. 2024, 37(5), 345–53.

15. SIMUCI: Formación en Medicina Intensiva. Hospital Vall d’Hebron [Internet]. Available from: https://www.vallhebron.com/es/docencia/vall-dhebron-centro-de-simulacion-clinica-avanzada/programas/simuci-formacion-en-medicina-intensiva

16. Royal College of Physicians and Surgeons of Canada. EPAs in Critical Care Medicine. 2024. https://www.royalcollege.ca/content/dam/documents/ibd/critical-care-medicine/epa-guide-critical-care-medicine-adult-v2-e.pdf

17. American Board of Surgery. Entrustable Professional Activities for Surgical Critical Care. 2025. https://www.absurgery.org/get-certified/epas/

Published
03-12-2025
How to Cite
Abreu, J. M., & Castelo-Branco, M. (2025). Clinical simulation in intensive care training: evidence, European models and opportunities for Portugal. Spanish Journal of Medical Education, 6(6). https://doi.org/10.6018/edumed.657461
Issue
Vol. 6 No. 6 (2025): Revista Española de Educación Médica
Section
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