Simulated death can be an appropriate training tool for medical students



PubMed - indexed for MEDLINE


Rogers G1, de Rooy NJ1, Bowe P1,2


1School of Medicine, Griffith University, Queensland, Australia
2Gold Coast Hospital, Southport, Queensland, Australia


Simulated death can be an appropriate training tool for medical students


Med Educ.2011 Oct;45(10):1061. doi: 10.1111/j.1365-2923.2011.04027.x.

Letter to the Editor

Editor – In their recent letter, Bruppacher, Chen and Lachapelle1 expressed concern about the potential dangers of using simulated death in scenario-based teaching for health professionals in training, suggesting that such a strategy ‘would be best directed towards senior trainees whose scope of practice and responsibilities are commensurate with managing such complex scenarios’. Given that the death of the patient is by far the most common outcome in the resuscitation of real patients who experience cardiac arrest in hospitals2 and that such emergencies are managed by teams that often include practitioners at all levels of experience, this seems a surprising assertion.

In 2010, we included a resuscitation scenario in which the patient died in an extended immersion simulation programme delivered to 143 final-year medical students. Immediately after the simulation, student teams underwent debriefing with experienced practitioners who had observed their resuscitation performance. The same evening, they wrote about the events of the day, including this session, in reflective journals. Our reviewof the journals and videorecordings of the debriefing sessions revealed no evidence of undue distress or the formation of undesirable attitudes among our participants, who were at the time very junior members of clinical teams. Rather, it highlighted a recognition among our students that patient death will be a common outcome of real resuscitation experiences, despite the best efforts of those involved, and that they need to prepare themselves to respond appropriately to this outcome. Indeed, several students commented on the usefulness of having a simulated experience of the death of a patient, despite resuscitation, because it afforded them the opportunity to reflect on how such a death might feel in a real-life clinical context. We agree with Bruppacher and colleagues that the educational use of simulated death ‘must be grounded in sound ethical principles that respect the teaching modality, promote a non-punitive culture around patient safety and interprofessional collaboration, and consider the well-being of learners’.1 However, we would argue that none of these concerns preclude the careful and considered use of simulated death in integrated simulation experiences for medical and other health care students.



1 Bruppacher HR, Chen RP, Lachapelle K. First, do no harm: using simulated patient death to enhance learning? Med Educ 2011;45:317–8.

2 Nadkarni VM, Larkin GL, Peberdy MA et al. First documented rhythm and clinical outcome from in-hospital cardiac arrest among children and adults. JAMA 2005;295:50–7.


Correspondence: A/Prof. Gary Rogers, GH1- Gold Coast campus, Griffith University, Queensland 4222, Australia.

Tel: 00 61 75678 0326; Fax: 00 61 75678 0303
doi: 10.1111/j.1365-2923.2011.04027.x

Comment on:

Med Educ. 2011 Mar;45(3):317-8