Columns, Training

Using Simulation to Teach Effective Communication

Issue 8 and Volume 42.

EMS educators often think of simulation as a tool used for enhancing patient assessment techniques, teaching skills before performing them on actual patients (e.g., IVs or airways), or performing patient care simulation experiences (i.e., full scenarios). These are easy ways to enhance what’s taught in the classroom and are great examples of education that can be bridged into practice.

How often are communication concepts considered and deliberately integrated into a patient assessment or skills activity? And how often do they become the sole focus of the simulation activity?

There’s little doubt that communication is an important skill for healthcare providers, either between the caregiver and the patient or caregiver to caregiver, yet it’s often minimal or performed poorly.1

Poor communication and patient handoff has been identified as a contributing cause of medical errors.2 How healthcare providers communicate with each other and to their patients is as important as what they’re communicating.

Consideration must be given when designing and delivering simulation activities for including, evaluating and enhancing communication. The considerations for inclusion can be construed in two frameworks: meta objectives and specific objectives.

Meta Objectives

Meta objectives are objectives that always exist no matter what the simulation activity is. They aren’t specifically written down, but are generally understood principles that exist within a profession or professional setting. For instance, one meta objective is that individuals should communicate effectively and professionally during all simulation activities. Meta objectives.

Meta objectives can be continuously embedded behaviors and expectations that serve to build the appropriate culture of care and ethical behavior. For communication, there are some common examples to draw from.

Advanced Cardiac Life Support (ACLS) communication techniques: Readers should be familiar with the effective team communication techniques that are highlighted for use in ACLS courses conducted through the American Heart Association. Clear messages, closed-loop communication, knowledge sharing, and mutual respect are just some of the concepts addressed in the course.3

CUS methodology in TeamSTEPPS: These communication techniques are designed as the consistent terminology used to alert the team to an issue that the individual believes exists, and to escalate as needed until a satisfactory resolution is obtained. CUS is an acronym from the assertive statements used in the technique: I am Concerned; I am Uncomfortable; this is a Safety issue.4

These two examples demonstrate common communication techniques or principles that should be embedded in normal appropriate communications in the healthcare setting. There are certainly other courses, options and techniques that are routinely used. Your agency should have guidelines that can be included in any activity as a background objective to support development and maintenance of effective communication.

Specific Objectives

Specific objectives are defined as objectives that are explicitly stated as a part of the simulation activity. Specific objectives typically start with verbiage such as, “On completion of this activity, the learner shall be able to …” They’re supposed to be specific, measurable, achievable, relevant and time-oriented.5

Specific objectives support the idea that communication is a deliberate and desired outcome of the simulation activity. Here are some examples of simulation activities for which specific objectives can be written.

Introduction of crews: Patients have a right to know who is treating them. This introduction serves to calm patients and reduce tension at the EMS scene. Introduction of the crew allows the EMS crew to connect with the patient and families which improves communication.6

Explanation of procedures throughout treatment: Patients have a right to know what’s being done to them and why. In EMS, we often glaze over this step out of fear of being told not to proceed. There’s a way to inform and empower patients to understand the importance of our treatments and interventions.

Breaking the bad news: There’s nothing worse than having to tell a family or friends that a patient has died. Many healthcare providers avoid this important step of family interaction. The moment treatment is no longer being rendered to the patient; the family/friends become our patients. The only way to become better at saying a patient has died is to practice it.

Preparing the family for a negative outcome: In EMS we know that the patient has a tough road ahead. Encouraging the family through effective communication techniques can allow them to mentally prepare for complicated news that will be delivered either in the field or at the hospital.

Interprofessional activities: Integration of two or more professions, where handoff of care can be measured and assessed to offer improvement in technique.

Public health education: The back to sleep campaign for infants, fall risk assessment for the elderly and medication compliance for all patients are three examples of how EMS can greatly reduce healthcare expenditures by identifying public health risk in the homes of our patients. Non-judgmental communication can mean the difference between an infant surviving, avoiding a broken hip or preventing hospital readmission.


Incorporating communication and utilizing various communication techniques/tools in a simulation activity can help prepare providers with the necessary skills to improve communication between patients, their families and EMS providers.

Poor behaviors can be identified and corrected before they affect a patient or their family. Good communication behaviors can be embedded and strengthened, supporting a culture of communication and care that serves to minimize errors and support our patients and providers safety. jems


1. Van Dulmen S. (2016). Person centered communication in healthcare: a matter of reaching out. The International Journal of Person Centered Medicine. 2016;6(1):18-21.

2. Meisel ZF, Smith RJ. Talking back: A review of handoffs in pediatric emergency care. Clinical Pediatric Emergency Medicine. 2015;16(2):76-82.

3. Advanced cardiac life support. (n.d.) American Heart Association. Retrieved June 22, 2017, from

4. TeamSTEPPS 2.0. (September 2016.) Agency for Healthcare Research and Quality. Retrieved June 22, 2017, from

5. National Association of EMS Educators: Foundations of education: An EMS approach, 2nd edition. Delmar, Cengage Learning: Clifton Park, N.Y., 2013.

6. Henriksen K, Battles JB, Keyes MA, et al., editors: Advances in patient safety: New directions and alternative approaches (Vol. 3: Performance and tools). Agency for Healthcare Research and Quality: Rockville, Md., 2008.