Volume 8 no 3

NEWS: Learning to lead – a simulation exercise

Pat Rich

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NEWS: Learning to lead – a simulation exercise

Pat Rich


Being a physician leader at whatever level is no game, and being a true leader cannot be simulated. But that doesn’t mean learning to be an effective leader cannot be presented in a simulated format as an online game. That is exactly what the Canadian Society of Physician Leaders (CSPL) and the Royal College of Physicians and Surgeons of Canada in collaboration with Global LEADs have developed.


An interactive online module, called SimuLEADerShip, is available to CSPL members and Royal College fellows and resident affiliates. It helps participants develop leadership capabilities by working to improve patient and family-centred care in a fictious hospital setting of the future. As the skills learned can be applied in various settings, participating in the online simulation can be of value to family physicians as well as specialists.


Although this learning activity has been available only since the beginning of December, its development took two years and the involvement of several experts in simulation, gaming, and leadership. Dr. Johny Van Aerde, executive director of CSPL, who was directly involved in this process, described the genesis of SimuLEADerShip and the aims of the initiative in a recent interview.


The CSPL had been investigating easier ways for its members to develop leadership skills, because they are often working in environments where they face a number of pressures and have little time for personal skills development. At the same time, Dr. Van Aerde had been taking online courses and coming to appreciate commonalities between gamification and simulation theory. He noted that simulation is already used extensively in the health care system to teach many medical skills.


In 2019, the Royal College released an online video game as a learning module for quality improvement. According to Dr. Van Aerde, it used video clips to provide the participant with the perspectives of various stakeholders, such as the patient, resident, and physicians holding various positions. The initiative demonstrated the value of taking this approach to teaching fundamental organizational skills to physicians.


In January 2020, senior leadership at CSPL and the Royal College met and agreed to work together to develop a leadership training simulation module. To provide an evidence-based framework for the approach, Dr. Van Aerde said LEADS Global and Dr. Graham Dickson were engaged to participate in the project. Created with Dr. Dickson as principle investigator in 2006, the LEADS framework is a comprehensive approach to leadership development in health care.1 It describes five core domains: Lead self, Engage others, Achieve results, Develop coalitions, and Systems transformation, which are each supported by four capabilities. It has been widely endorsed both in Canada and internationally.


SimuLEADerShip was developed around this framework, with a team under the direction of Dr. Anne Matlow, who had also led the development of the quality improvement simulation for the Royal College. The aim was to use the latest thinking in simulation theory to create an evidence-based experience that was both educational and fun.


  • As stated by the Royal College, the learning outcomes of SimuLEADerShip are to:
  • Integrate the domains and capabilities of the LEADS in a Caring Environment capabilities framework into your leadership activities
  • Reflect on the challenges of taking on a formal leadership role in a health care environment
  • Assess and develop your personal leadership capabilities using the LEADS framework


A note in the module itself is more specific:


The overall goal of the game is to successfully navigate change at Pondview Hospital. Ideally, the choices you make are aligned with the principles of effective leadership embodied by the LEADS framework and act to increase or decrease your Lead self, Engage others and Achieve results capabilities. Playing the game is intended to give a practical example of how the LEADS framework can be used to approach various leadership challenges. As a Royal College Section 3 simulation learning activity, it gives you some direct feedback on capabilities in the first 3 domains of LEADS while providing an opportunity for you to identify areas for improvement and plan for future learning about leadership.


Set in the children’s hospital of Pondview in the near future (to allow the game designers to incorporate robotic elements that might not seem feasible at the current time), the scenario on which the module is based involves a young physician who is “tapped on the shoulder” to apply to lead the neonatal intensive care unit (NICU). The challenge is presented as follows:

It’s 2032 and guess what? Society and the environment haven’t collapsed, humankind isn’t at the cusp of extinction and we live in a time of equity, harmony and sustainable growth. The world truly is a magical place. Our story takes place at Pondview Hospital, where you have worked as a neonatologist for the last 11 years. Even though society has advanced tremendously, there are still challenges in your facility. Challenges that require the strength of a leader and you, Dr. X have always wanted to take on a formal leadership role. One day while on break you notice an internal job posting for an opening...


Starting with the interview process to apply for the position, the module works through a number of scenarios. The module allows the participant to share their thoughts and reflections and listen to advice from online “coaches”. Dr. Van Aerde said the initial plan had been to have video clips of various stakeholders in the scenarios, but this was not possible because of the isolation requirements at the start of the COVID-19 pandemic when the game was in development.


“It becomes obvious very fast that you have to engage others to improve the NICU,” said Dr. Van Aerde. The simulation also extends outside the hospital environment as the participant engages with the community to find appropriate supports for patients as well as dealing with broader system issues, such as health equity.


Two CSPL members who are family physicians were also involved in the module’s development to help make sure it was relevant to family physicians as well as specialists. “Leadership skills are leadership skills,” said Dr. Van Aerde, and while the scenario in the game may not involve many elements common to family practice, the module focuses on learning skills that can be applied in a variety of settings.


As stated in the module itself: “While the game does try to reflect what it might be like to take on a leadership role in a neonatal intensive care unit at a community hospital, we consider most aspects of the story to be highly generalizable. We have made every effort possible to ensure the game is inclusive and can be enjoyed by physicians from any background.”

Although it may seem that a module involving an online game and simulation might naturally attract younger physicians who grew up in a gaming culture, Dr. Van Aerde said the approach also appeals to older physicians. “Do you want to sit down with yet another book or another long course after a long day at work? Or do you want to have something where you can learn for 20 minutes, and then go back again and see if you can improve your score? In today’s busy world, and being alone and not being able to learn in a team environment, I think [the module] serves all of us.”


Check it out. Exclusive access to CSPL members with Access code CSPL001



By early April 2022, 520 physicians had registered for the game. A small number who were involved in evaluating the simulation before its release said they found the experience positive and noted the creativity in taking such an innovative approach to leadership training. The module does not always take itself too seriously; for example, the folder where you can store resources is called “dossier” because “we thought the word ‘dossier’ sounded more like something in an Ian Fleming novel and, therefore, much cooler.” Another funny example is one of the possible answers, whether you should choose to rely on social media, “like the Kardashians,” for seeking information on the posted position. The game quickly ends with the note that “communicating effectively is centre to your ability to influence others and express your authentic self. In this case using social media was not very effective. Live conversations are preferred for deep information.” The module has been certified by the Royal College and the College of Family Physicians of Canada for up to 9 Mainpro+ credits as a 3-credit/h self-learning program.


The SimuLEADerShip development team


Anne Matlow, MD – patient safety and system educator, RCPSC

Graham Dickson, PhD – CEO of LEADS Global

John Van Aerde, MD – executive medical director, CSPL

Kirk DeRosier – instructional designer/evaluator, Royal College

Glenn Barton – curriculum designer, Royal College

Kevin McCarragher – new media design specialist, Royal College

Dietrich Furstenburg, MD – Board of Directors, CSPL

Constance LeBlanc, MD – Board of Directors, CSPL

Martin Vogel, MD – Board of Directors, CSPL

Carol Rochefort – executive director, CSPL

Susan Brien, MD – former director, Practice and System Innovation (Royal College)



1.Purser R. McMildfulness: how mindfulness became the new capitalist spirituality. London: Repeater Books; 2019.

2.Winerman L. The mind’s mirror. Monitor Psychol 2005;36(9):48. Available: https://www.apa.org/monitor/oct05/mirror



Pat Rich is an Ottawa-based writer and editor.



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