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14 “Playing games” – using tactical decision games to enhance non-technical skills*
  1. N Woodier,
  2. M Fores,
  3. P Ehilawa,
  4. T Blanks
  1. Trent Simulation, UK


Background Perceptions of simulation-based education focus on the use of manikins. However, simulation can be any imitation of the real-world. Tactical Decision Games (TDGs) are used by emergency response teams (eg. nuclear) as “table-top” simulations to consider ambiguous, dynamic situations with limited resource. TDGs allow exploration of Team Resource Management (TRM) and individual Non-Technical Skills (NTS). Within healthcare their use has been limited to undergraduate or specific specialties eg. anaesthesia.1

We developed and integrated a TDG into a simulation programme to support development of TRM/NTS.

Method Based on development principles2 we created a healthcare-based TDG around a “night on-call.” It surrounds a team of four medics (varying grades), nurse and pharmacist who have 10 patients to prioritise and see. Each member of the team has limited abilities and resources; limited time is given to undertake the task. After completion the situation changes and the team must adapt.

The TDG was trialled as part of a regular multiprofessional simulation day for F1 Doctors, Nurses and Pharmacists. The roles allocated to participants did not necessarily reflect their real-world role.

Results At the time of writing the TDG has been trialled with 73 participants and reactional responses obtained. Using a 5-point Likert scale (5 Strongly Agree, 1 Strongly Disagree) average scores were obtained. Participants found the TDG enjoyable (4.6) and useful (4.5), with a positive opinion that it increased knowledge surrounding NTS (4.2). Participants agreed that it would likely lead to improved NTS in practice (4.0).

Potential impact TDGs offer a novel approach to developing individual NTS and TRM. They are simple to create and easy to administer. To make an effective TDG developers must create dynamic, ambiguous scenarios with limited resource. Our next steps are to research whether TDGs support the development of appropriate team behaviours in simulated environments.


  1. Patey R, Fioratou E, Flin R. (in preparation) Tactical decision games for anaesthetists.

  2. Schmitt J. Designing good TDGs. Mar Corps Gaz 1996;80:96–98.

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