Simulating the Consequences in 'High Stakes' Training

In high-stakes training, one powerful technique to make training stick is to simulate the consequences as much as possible.

The idea comes from anesthesiology training: In simulated surgical environments operating on a test dummy, the patient dies. The team has to give the bad news actors posing as the patient’s family.

“Despite the fact that they realize that the relative of the simulated patient is just an actor ...,” researchers found, “the requirement to explain to the ‘family’ what has just transpired is a major challenge. These sessions are often highly emotional and are moving to observe.”

How it works

When you conduct high-stakes training, you can apply this same idea by making the simulated consequences as similar as possible to the actual consequences. Examples:

  • During a simulated sale (say, a videotaped role play), if trainees don’t get the sale, they have to go tell your boss what happened. The boss can then review the tape and counsel the person. But doing it can heighten awareness of the importance of the training and motivate people during training.
  • During employment law training, have the company lawyer cross-examine managers about the actions they took after a worker complained.
  • In safety training, sit participants in front of a video camera and have them record a “last message” to their families. (Or have them write a letter to their families on why they died for not tying off when using fall protection.)


It sounds brutal, and it can be, but in high-stakes environments, these simulated exercises will hammer home the actual consequences. Two immediate benefits:

  • Motivation. “Heck, yeah, I am going to listen to you now that I’ve acted out what can happen.”
  • Reassurance. You empower people when they “face the fear” in simulations. If the boss offers helpful suggestions and reassurance, they will be less afraid knowing someone has their back.


Sometimes, simulations will show people they’re in the wrong job. In mine-rescue simulations, some participants got lost in the (non-toxic) smoke. They got confused, had to be helped, and decided mine rescue work wasn’t for them.

Steps to consider

How can you make it work? Consider the following steps:

  1. Videotape the simulations, if possible. That allows you to debrief them and offer suggestions.
  2. Use group simulations. Bad things happen frequently because of the interaction of people. In an anesthesiology case, a technician swapped out a machine that only seemed to be compatible with connecting hoses. The result was overheated air that couldn’t easily be noticed.
  3. Continue a simulation all the way through to the end. Consequences are part of the scenario and involve what follow up behaviors trainees will in after the fact. In employment law, how do they handle a follow-up investigation and cross-examination?
  4. Add in real-life type experienced in the simulation. In anesthesia, they have a straight-out death scenario, where the patient dies from an allergic reaction to a drug he’s never received before.


There’s nothing that can be done about it. Make it clear that you’re concerned with mistakes that are under their control, but the simulation can remind them that not everything is.

Learning the difference helps humanize the training and will strengthen them in the field.

Source: Gaba, et al., “Simulated-based training in anesthesia crisis resource management (ACRM): A decade of experience.” Simulation & Gaming, Vol. 32, No. 2, June 2001, Pp. 175-193.

Stephen J. Meyer is CEO and Director of Learning and Development at the Rapid Learning Institute. Prior to starting the Rapid Learning Institute and its parent company Business 21 in 2002, Steve was the Director of Publishing at The Hay Group, a leading HR, benefits and compensation consulting firm. Meyer received his MBA from The Wharton School at the University of Pennsylvania and has a Masters degree from the University of California, San Diego. Follow him on Twitter.

Image used under Creative Commons by Flickr user Army Medicine.



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