In Situ Simulation (ISS)
In situ simulation is a simulation activity that takes place in the actual patient care setting, with team members working in their own environment rather than in a dedicated simulation facility. The Healthcare Simulation Dictionary notes that it can be announced or unannounced, that the unannounced form is also called a drill, and that it suits workplaces a sim lab cannot reproduce, such as an ambulance, a catheterization lab, or a dentist's chair. Programs use it both to train teams and to find latent safety threats in the system.
The defining gain is environmental and system fidelity. A code run on the actual unit uses the actual crash cart, the actual overhead page, and the actual elevator, so the failures it exposes are the ones that will occur during a real event: a missing airway blade, a badge that does not open the medication room, an escalation pathway nobody can name. Patterson and colleagues, cited in the Healthcare Simulation Dictionary, describe exactly this use for detecting safety threats in high risk areas.
The cost is clinical disruption and added risk. Running a scenario on a live unit means occupying a room, pulling staff who still have patients, and keeping simulated medications and equipment strictly separated from real supplies, which is a documented source of harm when it goes wrong. Programs that do this well have a written abort procedure and a pharmacy-approved labeling scheme before they run their first session.
Psychological safety needs more attention in situ than it does in the lab, not less. Staff are on their own ground, often in front of colleagues and sometimes within earshot of patients and families, so a prebrief that states the purpose and the confidentiality rules, and a debrief that holds to them, is what keeps an unannounced drill from being received as an inspection.
In situ work also reaches people a simulation center never sees. Night float, transport teams, and units that cannot release staff for half a day at a central facility get practice when the practice comes to them, which is often the strongest argument a GME leader can make for funding the program.
What this looks like in a program
- A pediatric program runs unannounced in situ sessions on inpatient units on a monthly cadence and tracks the latent safety threats found per session alongside its education outcomes.
- Simulation staff bring simulated medications in visibly distinct packaging and reconcile the kit before leaving the unit, since a simulated vial left in a real drawer is the classic in situ near miss.
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Last updated August 2026