From Crisis to Confidence: Tackling Worst-Case Scenarios with Simulation

Lauren E. Schlegel, MD, Ernest D. Gomez, MD, MTR, Amy S. Whigham, MD, MS-HPEd, Gene Liu, MD, MMM, Richard Goldman, MD, and Katherine R. Kavanagh, MD, on behalf of the Simulation Education Committee

Since 2018, the Simulation Education Committee (SIMEC) has hosted a "Worst-Case Scenarios" simulation day at the AAO-HNSF Annual Meeting & OTO EXPO, offering healthcare professionals a hands-on opportunity to navigate high-stakes, low-frequency clinical situations. Participants of diverse training levels and backgrounds gather at a simulation center in the host city, where they are divided into small groups and engage in six challenging, realistic simulations. 

These scenarios are designed to challenge participants’ decision-making, communication, and crisis management skills. Learning occurs through immersive participation and comprehensive debriefing sessions led by expert facilitators who guide participants to evaluate their own performance and reinforce key clinical principles. This interactive and collaborative environment fosters valuable learning and equips participants with the confidence and expertise needed to manage rare, high-risk situations in real-world clinical settings, with the goal of improving patient safety and care outcomes.

Simulation plays a growing role in modern medical education, offering a unique opportunity for healthcare professionals to hone their technical and non-technical skills in a safe, controlled environment. By providing a platform for repeated practice without the possibility of harming real patients, simulation-based training (SBT) enhances clinical competency, improves patient safety, and leads to better clinical outcomes.¹ Key advantages of SBT include faster skill acquisition, reduced error rates, and the provision of immediate feedback and structured debriefing, all of which are essential components for cementing learning.^1,2 In surgical education, simulation is invaluable for mastering complex procedures and developing crucial non-technical skills such as communication and decision-making.³

One of the most impactful applications of SBT for rare or high-risk clinical scenarios. Research has shown that SBT significantly enhances crisis resource management skills, including effective team communication, leadership, decision-making, and situational awareness.⁴ Simulation plays a pivotal role in preparing healthcare professionals for real-world challenges, ultimately improving patient care outcomes. Among the many initiatives provided by the SIMEC, the Worst-Case Scenarios at the Annual Meeting serves as an example of high-quality implementation of a simulation-based course to a high volume of learners using a high volume of course faculty.

Worst-Case Scenarios Preparation

The SIMEC collaborates annually to refresh the curriculum of the Worst-Case Scenarios. This dynamic process involves brainstorming new, high-impact scenarios that address emerging clinical challenges, while also retiring or modifying older scenarios that may have become outdated or logistically complex for the next course site. The final schedule includes six carefully selected scenarios, each representing a critical and high-risk situation in otolaryngology. For each scenario, approximately three faculty members are recruited to serve as facilitators or actors, guiding participants through the simulation and debriefing processes. Faculty receive comprehensive materials, including learning objectives, relevant clinical guidelines, and recent landmark studies, ensuring they are fully prepared to deliver an effective session.  

Worst-Case Scenarios Simulation

Participants gather at a state-of-the-art simulation center to engage in these high-stakes training modules. Divided into small groups, they experience each scenario in a hands-on, interactive manner (see two photos below). By simulating lifelike situations—such as palpating subcutaneous emphysema in a patient with a pneumothorax or managing a carotid blowout while under pressure—participants gain practical experience in handling stressful situations they may encounter. Faculty play a vital role in guiding participants through these challenges, ensuring that key learning objectives are met while providing valuable insights into effective decision-making and crisis management.

Two team members at AM24 coordinate a flexible bronchoscopy under pressure.

Video laryngoscopy is utilized for urgent intubation in this difficult airway case.

Worst-Case Scenarios Debrief

The debriefing session is a critical component of education and real-life learning. In small groups, participants reflect on their performance and discuss key learning points with the faculty. This collaborative discussion begins with open-ended questions, encouraging participants to self-evaluate and share their insights. Faculty members facilitate the debrief by reviewing relevant guidelines, highlighting evidence-based practices, and discussing the latest high-quality research in the field. After completing the simulation, all participants and faculty reconvene as a large group to provide constructive feedback and suggestions for future improvements. This feedback loop ensures continuous refinement of the curriculum and the overall participant experience.

Looking Forward

The Worst-Case Scenarios bootcamp offers a dynamic, immersive learning experience for otolaryngologists, allowing them to navigate some of the most challenging clinical scenarios in otolaryngology. By integrating this training into the Annual Meeting, we create a unique opportunity for otolaryngologists around the world to collaborate and learn from one another, fostering global best practices in patient safety and clinical management. Additionally, the diverse setting of the simulation encourages cross-disciplinary dialogue on resource management in both high- and low-resource environments. These discussions not only deepen participants' understanding of crisis management but also enhance their preparedness for rare, worst-case scenarios.

The informal feedback from participants is overwhelmingly positive, with many expressing a desire to revisit the course to further refine their skills. The course directors and SIMEC are committed to continuous innovation, constantly seeking new ways to expand and diversify the scenarios offered. As we look forward, we aim to introduce additional cutting-edge scenarios that reflect emerging trends in medical practice, ensuring that otolaryngologists are equipped with the tools and knowledge needed to face all challenges, no matter how unexpected.

Acknowledgement

The course directors thank the Worst-Case Scenarios faculty members for their commitment to simulation education and give credit to the faculty for the success of the course.

References

1. Elendu C, Amaechi DC, Okatta AU, et al. The impact of simulation-based training in medical education: A review. Medicine (Baltimore). Jul 5 2024;103(27):e38813. doi:10.1097/md.0000000000038813
2. Motola I, Devine LA, Chung HS, et al. Simulation in healthcare education: a best evidence practical guide. AMEE Guide No. 82. Med Teach. Oct 2013;35(10):e1511-30. doi:10.3109/0142159x.2013.818632
3. Abahuje E, Tuyishime E, Alayande BT. Global surgical simulation education, current practices, and future directions. Surgery. Apr 2025;180:109050. doi:10.1016/j.surg.2024.109050
4. Saeed S, Hegazy NN, Malik MGR, et al. Transforming the delivery of care from "I" to "We" by developing the crisis resource management skills in pediatric interprofessional teams to handle common emergencies through simulation. BMC Med Educ. Jun 11 2024;24(1):649. doi:10.1186/s12909-024-05459-2