To do what we usually do : An ethnomethodological investigation of intensive care simulations

Sammanfattning: Simulators provide great promises of pedagogical utility in a wide array of practices. This study focuses on the use of a full-scale mannequin simulator in training of personnel at an intensive care unit at a Swedish hospital. In medicine, simulators are a means of doing realistic training without risks for the patient. Simulators for use in intensive care medicine are built to resemble as closely as possible the human physiology. In the studied sessions the simulator (a Laerdal SimMan) is set up to be an as-authentic-as-possible replication of the nurses regular, day-to-day practice. In examining the training-sessions, it was found that the participants often did other things than “proper” simulation, such as joking or making comments about the simulation. These “transgressional activities” were studied from a perspective of ethnomethodology, using video-recordings of the session. These were transcribed and analyzed in detail using ethnomethodologically informed interaction analysis. Several themes were developed from the recordings and transcripts. These have in common that they demonstrate the participants’ own achievement and maintenance of the simulation as a distinct activity. The analysis provides an account of how the local order of the simulation is upheld, how it is breached and how the participants find their way back into doing “proper” simulation. It is an overview of the interactional methods that participants utilize to accomplish the simulation as a simulation. This study concludes with a discussion of how this study can provide a more nuanced view of simulations, in particular the relation between simulated and “real” practices. Notions of realism, authenticity and fidelity in simulations can all be seen to be the participants’ own concern, which informs their activities in the simulation.