What Matters in Simulation Facilitation? Lessons from a Patient with Laryngospasm

One of the most common questions we hear about VEMS is whether participants can really become immersed when the patient is just a laminated picture. Recently, we watched a team manage a patient with laryngospasm using VEMS. The answer seemed pretty obvious.

They weren't casually discussing a case. They were leaning forward. Speaking urgently. Repositioning. Troubleshooting. Reassessing. The room was buzzing with the kind of focused energy that anyone who has managed a difficult airway would immediately recognize.

Paying attention to the facilitator is helpful in understanding what supported immersion.

The Cues That Matter

Laryngospasm is a great example to think about immersion because the clues clinicians rely on are subtle and dynamic.

• What does the airway sound like?
• Is there chest rise?
• How much resistance is there when bagging?
• Is the stridor improving or worsening?

These are exactly the cues that airway clinicians use to make decisions in real life. They are also some of the hardest things for a mannequin to represent accurately. A facilitator, however, can provide these cues instantly and reliably.

As participants adjusted their airway manoeuvres, applied positive pressure, or deepened anaesthesia, the facilitator continuously updated what they were seeing, hearing, and feeling.

"you can't bag anything through that"

"that's not working"

"you're still not getting any air entry"

These small updates allowed the team to remain completely engaged in the problem they were trying to solve. Nobody was wondering what they were supposed to be seeing or feeling or if the simulator was working...instead they were doing what clinicians do every day: receiving cues, making decisions, and adapting their actions.

Anticipatory Cueing

We've written before about anticipatory cueing—the practice of providing the information participants are naturally seeking before they have to ask for it. This case reinforces just how important that skill is.

An experienced airway clinician doesn't consciously think, "I should now ask the facilitator whether chest rise is present."

They simply look.

In simulation, facilitators can preserve that natural workflow by proactively providing the cues participants would normally perceive. Done well, this keeps cognitive effort focused on reasoning and action rather than extracting information from the simulation.

The facilitator isn't giving answers. They're simply making sure participants have access to the same information they would have in real life.

Perhaps the Facilitator Is the Fidelity?

Simulation discussions often focus on equipment, technology, and physical realism.

But watching this scenario unfold reminded us that what matters most is often much simpler. Participants became immersed not because the patient looked real. They became immersed because the clinical information felt real. The facilitator was able to provide accurate, timely, clinically meaningful cues that evolved in response to the team's actions.

In that moment, the facilitator wasn't operating the simulation. They were the physiology.

And perhaps that's one of the most important lessons from VEMS: fidelity isn't always about what participants see or feel. It's about whether we give them the right cues at the right time.