Table 2 Toolkit part 1—sustainable changes to the delivery of SBE
From: Simulation-based education and sustainability: creating a bridge to action
Area of resource use (environmental aspect) | Suggested changes | Supporting frameworks | Potential impacts and how to measure these | Potential risks and mitigation |
|---|---|---|---|---|
Supports ISO 14001 clause 6: planning [36] | Supports ISO 14001 clause 8: operations | Â | Supports ISO 14001 clause 9: performance and clause 10: improvement | Â |
Energy consumption | • Turn off simulators and other equipment when not in use • Use energy efficient lighting/products • Use renewable energy sources where possible • Ensure efficient booking so that sessions are not run multiple times with low participant numbers | • The Paris Agreement (2016) • The Planetary Boundaries Framework (2009) • UNSDG 7–Affordable clean energy–requires increased energy efficiency and growth of modern renewable energy sources (2015) • The Circular Economy System (2017) • Standardised Carbon Emissions Reporting for Higher and Further Education (SCEF) (2024) | • Reduces unnecessary energy consumption and associated GHG emissions • Reduced pollution from burning fossil fuels • Financial savings • Energy consumption can be measured using meters or energy-monitoring smart plugs. Reduction in GHG emissions and financial spend can be extrapolated from this • More efficient use of simulation team time • Simulation sessions delivered, participant numbers and faculty numbers can be monitored | • The financial cost of different energy providers must be monitored • Quality of learning should be evaluated if changes are made to simulation programme delivery |
Water consumption | • Reduce water consumption where possible. This could be through actions such as minimising linen use | • The Planetary Boundaries Framework (2009) • UNSDG 6–Clean water and sanitation–requires acceleration of the implementation of integrated water resources management (2015) • The Lancet Commission on Planetary Health (2015) | • Preservation of water as a natural resource • Reduced GHG emissions associated with water treatment • It may be possible to monitor water usage using meters • The use of products that require laundering can be monitored and reduction in GHG emissions extrapolated from this | • Cleanliness and sterility must be monitored (where relevant) |
Material use (presented in accordance with the 9r framework) | • Refuse-consider materials/products procured—are they all necessary? • Rethink-pool equipment with neighbouring simulation centres • Reduce-consider how simulation is delivered-can intended learning outcomes be met with lower fidelity simulation? Could virtual reality or augmented reality simulation support your simulation centre to improve environmental impact? - If possible, use out of date equipment that might otherwise be thrown away • Re-use-encourage participants to bring reusable cups/water bottles for personal use - Reuse equipment when possible—create posters to explain which items should be kept and which disposed of • Repair-repair items when possible • Refurbish, remanufacture and repurpose-opt for suppliers that demonstrate robust environmental credentials; e.g. use of non-oil derived polymers, willingness to take back used simulators for refurbishing/re-purposing and have a clear commitment to zero waste operations - Procure previously used/repurposed equipment when possible • Recycle-ensure used materials are recycled where possible • Recover-opt for biodegradable or recyclable materials where possible | • The Circular Economy System (2017) • The 9R Framework (2017) • UNSDG 12 – Ensure sustainable consumption and production patterns (2015) | • Fewer natural resources required to create new products • Reduced GHG emissions from production of new products • Reduced waste • Financial savings from both procurement and waste disposal • Number of a particular item used by the simulation centre can be monitored. From this changes in associated GHG emission can be calculated • It might be practical to focus on one or two items initially and gradually build on this work | • GHG emissions and financial cost associated with transport must be balanced against those associated with procurement of equipment for individual centres • Financial cost must be monitored if opting for different suppliers • Consider the potential unintended consequences to learning and the future clinical practice of learners when changing to lower fidelity simulation methods or virtual or augmented reality-based simulation. Consider regular evaluation of changes made to scenario design and delivery to ensure it is still meeting the needs of learners |
Food consumption | • Opt for foods with a lower carbon footprint—these will generally be vegetarian/plant based food options | • The Lancet Commission on Planetary Health (2015) | • Reduced GHG emissions • Potential health benefits of a vegetarian/plant based diet • Reduced cost • Food purchased and any food waste generated can be monitored. From this information associated GHG emissions and financial spend can be calculated | • Food options might be less appealing therefore generating more food waste • Financial cost needs to be monitored |
Waste disposal | • Reuse items when possible to minimise waste • Re-home unwanted items, if this is not possible consider if the item could be repurposed • Segregate waste appropriately and recycle where possible | • The 9R Framework (2017) • The Circular Economy System (2017) • SCEF (2024) | • Reduced GHG emissions • Financial savings • Amount of waste in each ‘stream’ can be measured and changes in GHG emissions and financial spend extrapolated from this | • Waste should be checked to ensure any hazardous waste, such as clinical waste/sharps, is appropriately disposed of |
Transport | • Explore virtual simulation options • Consider work from home options for staff if appropriate • Promote the use of active travel, public transport and carpooling • Consider the location of your simulation sessions in relation to location of participants-could the session be delivered outside of the simulation centre by adjusting scenarios/equipment? | • The Paris Agreement (2016) • The Planetary Boundaries Framework (2009) • SCEF (2024) | • Decreases travel-related emissions, particularly for geographically dispersed simulation team/learners • Mode and distance travelled by participants and faculty can be measured • Varying locations and increased working from home may be seen as positive changes by staff and could improve recruitment and retention | • Ensure accessibility is maintained for learners and staff. Consider surveying staff and learners after changes to location of simulation sessions/place of work are made • Potential impacts on recruitment and retention of staff could be positive or negative. Risks could include impacts on ability to balance the delivery of simulation sessions alongside clinical roles if sessions are moved away from central clinical sites |