Step 1: Watch the Overview Video

Step 2: Familiarize Yourself with the SUGAR and Debriefing Literature

In order to best understand the framework for SUGAR and the importance of skilled debriefing, we recommend you read at least the following two articles:

Butteris SM, Gladding SP, Eppich W, Hagen SA, Pitt MB, Investigators S. Simulation Use for Global Away Rotations (SUGAR): Preparing Residents for Emotional Challenges Abroad-A Multicenter Study. Academic pediatrics 2014; 14(5): 533-41.

Eppich W, Cheng A. Promoting Excellence and Reflective Learning in Simulation (PEARLS): Development and Rationale for a Blended Approach to Health Care Simulation Debriefing. Simulation in healthcare : journal of the Society for Simulation in Healthcare 2015.

Additional recommended reading is located in the Resources Section

Step 3: Download Case Example

Download this sample case to follow along in the facilitator training videos.

Step 4: Understand how to use the SUGAR Case Handouts

These three short tutorials (3-4 minutes each) provide an overview of how to use the SUGAR Case Handouts and Debriefing Script.

SUGAR Case Handout Overview

SUGAR Paradigm Overview

SUGAR Debriefing Script Overview

Step 5: Prepare Your SUGAR Supplies

SUGAR Supply Video

Step 6: See SUGAR in Action

Because SUGAR differs in many ways from traditional simulation sessions, in order to understand how to facilitate the sessions successfully, it is imperative that you have seen them play out in real time. The videos below provide a look at residents encountering obstacles in managing diabetic ketoacidosis and debriefing the session afterwards. Be sure to follow along with your case handouts.

Keep in mind, these cases are not meant to be perfect examples of how to lead SUGAR sessions, but rather to highlight key aspects of facilitating SUGAR using the handouts as guides. You’ll note, for example, that on occasion during the debriefings, we fall back to the common format of asking “what am I thinking questions?”  When you notice these types of questions, practice reframing the question using the advocacy/inquiry model on the handout where you pair your observation with your point of view. 

DKA

Step 7: Understand the Emotional Power of SUGAR

One of the primary goals of SUGAR is to elicit complex emotions that mimic those often encountered in resource-limited settings in the safety of a simulated environment. This allows participants to experience and process these emotions in a controlled and supported environment BEFORE they experience them thousands of miles away, potentially without access to immediate support. The DKA case demonstrates the frustration providers can feel when faced with managing a patient without the resources they are used to having, and the empowerment that comes from the dynamic problem solving needed to overcome these limitations. Other cases in the curriculum, however, address more challenging emotional triggers such as perceived futility, death and long-term disability, and delays in care.

The following case deals with a neonate who requires advanced resuscitation, yet there is no access to a ventilator. Whereas the DKA case required intellectual problem solving, this case illustrates how SUGAR can be used to elicit and debrief powerful emotions and challenges less likely to be addressed in a traditional preparatory curriculum.

Keep in mind, these cases are not meant to be perfect examples of how to lead SUGAR sessions, but rather to highlight key aspects of facilitating SUGAR using the handouts as guides. You may notice how much of the rich discussion in the debriefing has nothing to do with medical management but rather cultural differences. Even so, it is quite tempting to fall back to our role as teachers to fill in knowledge gaps, often by asking what am I thinking questions. When you notice this, attempt to reframe the question using the advocacy/inquiry model on the handout where you pair your observation with your point of view.

Neonatal Resuscitation Video

Step 8: Download All Cases

Download All Cases

Step 9: Learn About Performing Procedures with Limited Resources

Watch the Videos