High-fidelity simulation programs in ICU-related ethical non-technical skills training: A narrative review.

Objective: Is there a place for non-technical skills training in the ICU? And what teaching strategy should we implement in this process? This narrative review analyzes the benefits of teaching ethics in the ICU environment by applying high-fidelity simulation scenarios to real-life situations, thereby improving communication, moral reasoning, self-reliance, cooperation, and perceptual skills. Methods: In the literature, there are few publications on the training of ICU residents in non-technical skills and ethical dilemmas using high-fidelity simulations. After searching and scoping the database, we have identified 8 publications relevant to this narrative review. Results: In the reviewed studies, the main topics discussed and rehearsed using simulations were as follows: communicating an adverse event during anesthesia in one study, delivering bad news in two studies, the ethics of end-of-life care, and the do-not-resuscitate order in three studies, and ethical non-technical skills such as communications, teamwork and confidence in emergent real-life situations in four studies. Conclusions: Developing a more structured approach to teaching ethics-related events is important, particularly in critical care settings. All reviewed studies reached the same conclusion: high-fidelity simulation training is an educational strategy for ICU residents to develop a foundation in ethical considerations and moral reasoning by improving ethical non-technical skills, such as confidence, communication, teamwork, delivering bad news, and end-of-life care.