Funded by Health Education North West London (HENWL)

Project summary

Members of the ICCESS team have developed four pioneering simulation tools for use in education and engagement, representing a diverse range of approaches to Simulation-based Education:

  • Sequential simulation of care pathways
  • Haptics-based unsighted clinical examination training
  • Complex Interventional Procedures on Conscious Patients
  • Stroke e-learning

These simulation tools have been developed iteratively alongside experienced clinicians, clinical educators and learners from multi-professional backgrounds, and in consultation with patients and patient advocates.

Project aims

Sequential Simulation of Care Pathways

Sequential Simulation (SqS) is the physical re-enactment of the chronology of care. SqS provides a model for collaborative co-design of a simulation of a care pathway, using scenarios based upon real patient experiences. The scenarios incorporate real clinicians, alongside trained actors, in simulated clinical settings relevant to the issue addressed. The aim is to realistically portray current health systems, in order to aid healthcare professionals to visualise their role within the bigger picture; help patients to understand current health system processes and to provide an opportunity to voice their opinions of proposed or existing systems; enable a critical evaluation of current or proposed systems, and to test changes and new interventions in a safe environment; and open a dialogue between patients and healthcare staff outside of the healthcare setting.

Haptics-based Unsighted Clinical Examination

This examination tool was developed using expertise gained through understanding and quantifying performance of specialist experts. It comprises an examination model which allows learners to practice undertaking digital rectal examination (DRE), using haptic technology to provide physical feedback to the learner during the examination. It also uses pioneering interactive anatomy software to allow “see-through visualisation” of the examination by learner and educator. The tool is now being expanded using distributed simulation equipment to support a holistic approach to learning DRE in the clinical setting, using an embedded simulated patient.

Complex Interventional Procedures on Conscious Patients

This immersive team-based training programme was initially created to support trainee cardiologists in learning technical and team skills for cardiac catheterisation. It has since been further developed for multidisciplinary team training, and, utilising an embedded simulated patient, to support learning relating to communication skills and consent.

 Stroke e-learning

This e-learning tool supports healthcare professionals to learn about assessment, diagnosis and management of stroke patients. The suite consists of several scenarios following real patients through the stroke pathway, breaking  down each patient journey into twelve multi-media pages. This provides a virtual clinical experience which is combined with an educational package to support learning against clear learning outcomes. The tool has been used for small group teaching and e-learning.


Collaborative Implementation

The simulation tools have been implemented in various clinical education settings, in collaboration with clinical educators. We take an iterative, flexible approach to collaboration and this has been key in ensuring that the tools are used in a way which is relevant to improving healthcare. We have achieved this by collaborating with health care professionals to implement the tools for specific groups of learners, with use of the simulation tool supported by an educational component, in line with specific learning outcomes relevant to the clinical learners and the service need.

In addition to applications in clinical education, the simulation tools also have a role in engagement of patients, clinical and non-clinical staff, in service reconfiguration and quality improvement. They have been employed in these settings in collaboration with patients, primary and secondary care teams, commissioners, administrative and managerial staff.

Implementation in Community Healthcare Setting

We have now entered a new phase of the Collaborative Clinical Education initiative, involving broadening our implementation of the tools to the community and primary care settings.

Several collaborations are currently in progress and we are looking to broaden our collaboration with doctors, nurses and clinical educators from a variety of community settings.

For further information please contact Miranda Kronfli:


Progress to date and outputs


The SqS tool has been implemented in a wide variety of clinical education and engagement settings. These include co-design of new models of care in North West London; training for nurses in acute care; and engagement of service users in the development of point of care diagnostic tools.

The Complex Interventional Procedures on Conscious Patients tool was implemented in 2014 as the Imperial Cardiovascular Training Programme (iCAST) for cardiology specialty trainees at Imperial College NHS Trust. It has also been showcased at the ACI and BCS Conferences, with excellent feedback from external examiners and trainees.

The stroke e-learning tool has been implemented for both doctor and nurse and therapy learners at two London Hyper-acute Stroke Units (HASU) for small group and individual training sessions. Evaluation has demonstrated a positive impact on learners’ perceptions of their knowledge in stroke assessment and treatment.


Weldon, S-M., Kneebone, R., Bello, F. (2016). Collaborative Healthcare Remodelling through Sequential Simulation (SqS): A Patient and Front-line Staff Perspective. BMJ Simulation & Technology Enhanced Learning. [In-print]

Weldon, S-M., Ralhan, S., Paice, E., Kneebone, R., & Bello, F. (2016). Sequential simulation of a Patient Pathway. The Clinical Teacher. [In-print]

Weldon, S-M., Ralhan, S., Paice, E., Kneebone, R., & Bello, F. (2015). Sequential simulation (SqS): an innovative approach to educating GP receptionists about integrated care via a patient journey – A mixed methods approach. BioMed Central Journal Family Practice. 16. pp. 108

Brenton H, Woodward P, Gillies M, Birns J, Ames D, Bello F, 2015, Linking Aetiology with Social Communication in a Virtual Stroke Patient, 15th International Conference on Intelligent Virtual Agents (IVA), Publisher: SPRINGER-VERLAG BERLIN, Pages: 270-274.

Costopoulos C, Kelay T, Ako E, Yasin M, Chan KL, Gold M, Kneebone R, Bello F, Malik IS (2015). Novel Simulation-based Training in Cardiology: Trainee Feedback and Evaluation of a Pilot Study, CARDIOLOGY, Vol: 131, Pages:70-70.

Coates L, Weldon S-M, Rodrigues A, Bello F, Kneebone R (2015). Simulation as a public engagement: Engaging children in medicine and science in some surprising places, International Pediatric Simulation Symposia and Workshops, British Columbia, Canada.

Coates L, Woodward P, Granados A, Weldon S-M, Kelay T, Kneebone R, Bello F (2015). Educational Technology and Innovations to Training and Patient Care Using Simulation, HENWL Primary Care Educator Conference, London, UK.

Paice E, Weldon S-M, Ralhan S, Bello F, Kneebone R (2015). Sequential simulation (SqS) of a patient journey: an intervention to engage GP receptionists in integrated care, 15th International Conference for Integrated Care, London, UK.

Paice E, Weldon S-M, Ralhan S, Bello F, Kneebone R (2015). Patient produced simulation for education and training, International Forum on Quality and Safety in Healthcare, London, UK.

Weldon S, Bello F, Kneebone R (2015). Sequential Simulation (SqS) Concept & Applications., UK Simulation in Nursing Education Conference. Imperial College Centre for Engagement and Simulation Science, December 2015

Weldon S, Woodward P, Granados A, Coates L, Kelay T, Kneebone R, Bello F (2015). Future of Technology: The latest in simulation technology, RCGP – City Health Safeguarding the Future, London, UK.

Huddy J, Weldon S-M, Ralhan S, Bello F, Kneebone R, Hanna G (2015). Sequential simulation of clinical pathways: a tool for public and patient involvement in diagnostic research, UK Diagnostic Forum.

Weldon S, Coates L, Granados A, Woodward P, Kelay T, Kneebone R, Bello F (2014). Collaborative Clinical Education, Health Education North West London - Simulation: Is a New Approach Needed?, London, UK.

Coates L, Malik N, Granados A, Kelay T, Weldon S-M, Woodward P, Kneebone R, Bello F (2014). Collaborative Clinical Education: Our experience of moving simulation training from secondary care to the primary care environment, Health Education North West London - Simulation: Is a New Approach Needed?, London, UK.


8th annual London Specialty School of Obstetrics and Gynaecology conference, March 2016: Oral Poster Presentation 2nd prize. Standardising the bimanual vaginal examination: creating a cognitive task analysis. Plumptre B, Mulki O, Granados A, Ahmed S, Low-Beer N, Higham J, Bello F.

Royal College of Obstetricians and Gynaecologists world congress, June 2016: Conference top 500 abstracts. Bimanual vaginal examination: using innovation through cognitive task analysis to standardise practise and enhance teaching. Mulki O, Plumptre B, Granados A, Ahmed S, Low-Beer N, Higham J, Bello F.

Simulation: Is a New Approach Needed? Health Education North West London, December 2014: Oral Poster Presentations 1st  Prize. Hounslow Whole System Integrated Model of Care Sequential Simulation (SqS) Workshops. Weldon S-M, Coates L, Kneebone R, Bello F.

Project Team

Dr Miranda Kronfli

Dr Miranda Kronfli

Dr Miranda Kronfli
Implementation Lead

Peter Woodward

Peter Woodward

Peter Woodward
Stroke e-learning