Playmobil, pressure and prioritisation:

a simulation for stepping up to ST4

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Event: Anaesthetic updates – Trainee focused
Event: Anaesthetic updates – Trainee focused

Authors:

Transitioning to ST4 represents a pivotal step in anaesthetic training. Anaesthetists in training must advance their own clinical skills while learning to manage emergency workloads, prioritise limited resources, and coordinate theatre teams under pressure as a more senior resident anaesthetist.

While technical skills are well covered in training, structured education on non-technical decision-making and prioritisation remains limited. To address this, we developed a low-cost, tabletop simulation workshop using Playmobil figures and printed theatre schematics to recreate the pressures of an emergency on-call shift. 

The exercise is aligned with multiple Stage 2 learning outcomes, including Team Working and Professional Behaviours and Communication, with a key focus on decision-making, delegation, leadership, and the real-world complexities of senior responsibility.

Our workshop

The ‘Management of the Emergency List’ workshop immerses anaesthetists in training in a typical 12-hour consultant-on-call shift (08:00–20:00) at a major trauma centre. Using Playmobil figures to represent anaesthetic and theatre staff, and a printed map of two theatre complexes, residents work in groups to manage emergency surgical cases as they arise. Participants begin with a handover sheet listing emergency cases. As the day unfolds, facilitators inject new events such as a Code Red trauma, sick laparotomy, anaphylaxis, ward MET (Medical Emergency Team) calls, or ITU transfer requests, each designed to test prioritisation, delegation, and escalation. A vintage kitchen clock (an intentionally analogue touch) is used to advance time and simulate real-world pacing. The learning objectives are listed below with a selection of scenarios.

Learning objectives

  • Prepare for real-world handover and team leadership at ST4.
  • Experience real-life registrar responsibilities and handover challenges.
  • Prioritise cases based on urgency, patient safety, and surgical complexity.
  • Enhance decision-making under pressure.
  • Delegate appropriately to junior staff and escalate when needed.
  • Develop a ‘bird’s-eye view’ of theatre resource allocation and situational awareness across multiple operating theatres.
  • Strategic workforce use to safely allocate limited human and physical resources.

Other simulation scenarios in addition to the emergency list

Area covered: 

  • managing complex dynamic situations
  • responds professionally in emergencies
  • seeks assistance appropriately
  • coordination in theatre (team, blood products, communication and updates.)

Area covered: 

  • delegation and prioritisation of resources
  • knows when to escalate as other lists will be affected (management and clinical staff)
  • process for arranging an additional emergency theatre and the wider implications of this
  • reflects on safety implications
  • communication with other teams (eg, ICM).

Area covered: 

  • provides leadership to junior colleague
  • remote supervision and maintaining professional behaviour in absence.

Area covered: 

  • MDT collaboration
  • professionalism under pressure, role modelling and providing backup.

Area covered: 

  • recognising team dynamics and adjusting approach
  • reflects on impact of behaviours on patient safety
  • difficult conversations with colleagues.

Area covered: 

  • reflective leadership and workload sharing
  • acknowledges and mitigates impact of working patterns on wellbeing
  • coordination of workload.

Area covered: 

  • responding to acute dynamic challenge
  • acts appropriately in emergency, maintaining judgement
  • appreciation of skill-mix required and decision-making on timing and location of intubation.

Area covered: 

  • leading or delegating in critical events
  • maintains professionalism under pressure
  • coordination within the MDT and support of junior residents.
     

Area covered: 

  • MDT coordination across systems
  • formulates plan and reflects on system safety
  • discussion of resources (who is the best person to go on the transfer and the service implications of this).

Area covered: 

  • prioritising and communicating with specialists
  • communicates clinical boundaries; handles competing demands with sensitivity and clarity.

The simulated team includes a CT2 (pre-primary exam), an ST6 (post-final FRCA), and a consultant. Theatre staff and their distribution must be managed realistically. Our workshop mirrors day-to-day challenges, including delayed theatres, overbooked lists, fatigued staff, and the competing needs of patient safety, urgency, and resource availability. Facilitated debriefs after each phase allow residents to explore their own clinical reasoning, assertiveness, human factors, and systems-level thinking. Residents are encouraged to reflect on the 'step-up' in autonomy, leadership, and workload pressures that ST4 demands.

Evaluating performance

The pilot workshop was delivered to two groups of CT3 anaesthetists (n=18).

All participants rated the workshop as ‘Excellent’ or ‘Good’ for format, content, relevance to training, and personal development. Feedback included:

  • ‘Very useful to explore the management side of an anaesthetic on-call shift’.
  • ‘Really engaging and relevant – helped frame the step-up to ST4’.

The exercise was also positively received by faculty, who noted the ease of delivery, low cost, reproducibility and high fidelity of the simulation scenarios. The workshop mapped directly to Stage 2 learning outcomes for Team Working  and Professional Behaviours and Communication. 


Workshop mapping

Team Work – Workshop mapping. Stage Learning Outcome: applies teamworking skills to effectively manage complex dynamic situations.
Workshop element Domain(s)
CT3s must lead a team that includes a CT2 and ST6 in a high-pressure environment. (A, D)
Delegating tasks during emergencies (eg, MET call, Code Red trauma) simulates realtime leadership under pressure. (A, E)
Scenario-based debrief encourages reflection on leadership style and decision-making. (B, C)
Managing operating theatres across multiple specialties requires multidisciplinary coordination and liaison with surgeons, OPDs and nurses across multiple lists. (D)
Scenario layering (multiple overlapping or sequential challenges during a simulation): Code Red, difficult airway, MET call, ITU transfer. (E)
Professional Behaviours and Communication – Workshop mapping.
Stage learning outcome: demonstrates the professional values and behaviours required of senior anaesthetists in training.
Workshop element Domain(s)
CT3s must decide when to escalate to a second on-call consultant vs. manage independently. (B)
Several scenarios (eg, difficult airway, sick laparotomy, intra-op anaphylaxis) require professional decision-making under stress. (E)
Realistic senior-facing decision-making. (D)
Group analysis of potential delays and errors. (C)
Responding to requests from ITU, wards, and theatre teams challenges participants to balance workload, communicate clearly, and prioritise safely. (C, F)
The debrief allows reflection on professional behaviours, acting as a role model, and coping with workload impact, exploring burnout, overcommitment, prioritisation of safe breaks. (D, G

 

Using a playful but effective medium, the exercise recreates the experience of managing a real emergency list and its daily challenges as a senior anaesthetist. The format encourages personal reflection on workload, team dynamics, escalation thresholds, and leadership style throughout the workshop, and an appreciation that these skills are critical at ST4 level and beyond.

This simulation fills a recognised gap in anaesthetic training: the development of non-technical skills such as prioritisation, leadership, and resource management under pressure. It aligns well with ARCP portfolio evidence and training-the-trainers initiatives. Anaesthetists in training consistently report increased confidence, greater awareness of systems complexity, and improved ability to delegate and prioritise. This simple, scalable model can be easily replicated locally, regionally, or adapted for faculty development.

The use of Playmobil figures may appear light-hearted, but the educational value is substantial.