Simulation Spotlight: ABCDE Assessments Q&A

In this edition of Simulation Spotlight, in which leading experts discuss key aspects of healthcare and dental curricula, the challenges involved in effective teaching, and the evolving role of immersive learning technology, we’re speaking with Olivia Bradbury and Hilary Gupte. 

Olivia is a registered nurse with a BSc (Hons) in Adult Nursing and holds eight years of experience in healthcare, including roles focusing on palliative and end of life care, alongside acute cardiology and public health immunisation. Olivia is studying for a Master’s degree in Clinical Nutrition, building on her clinical background with a growing academic foundation. Olivia is Immersify’s Healthcare Content Lead, and her key responsibilities involve developing clinically informed and evidence-based educational content to support the ongoing professional development of nurses and allied health professionals. 

Hilary graduated as a registered nurse in 2004 and has since specialized in cardiac, critical care, and emergency settings across both clinical and educational roles. Since earning her Postgraduate Certificate in Education (PGCE) in 2013, she has spent almost a decade in healthcare and medical education, with a strong emphasis on simulation-based learning and the integration of educational technology. Her work spans the UK’s National Health Service and the private sector, where she has led initiatives to enhance learner engagement and clinical competence through innovative teaching strategies. As Immersify’s Healthcare Education Lead, Hilary develops and delivers clinically relevant, pedagogically grounded learning resources that align with the evolving needs of the healthcare workforce. 

In this Q&A, Olivia and Hilary share their insights on the high-stakes, foundational, and information-heavy world of ABCDE assessments, and explore how healthcare simulation technology can reconcile theory, practice, and the practical barriers that separate them. 

Could you give us a brief overview of what the ABCDE assessment is and when it’s typically performed? 

ABCDE, also known as A-E, is a systematic, hierarchical assessment method designed to help clinicians manage deteriorating patients. Or, in simpler terms, it ensures practitioners work through potential problems in order of criticality, starting with the airway (as denoted by ‘A’) and only progressing through airway, breathing, circulation, disability, and exposure when any related concerns have been addressed. 

The fundamental idea here is to provide a clear, systematic approach for working through a patient’s condition, ensuring that life-threatening issues are identified and addressed in priority order. 

What kinds of clinical scenarios really underline the value of the ABCDE assessment in nursing? 

The ABCDE assessment, in nursing and in other healthcare disciplines, is most commonly used when patients are acutely unwell. That might mean visible deterioration, unexpected collapse, or even just a sense that something isn’t quite right. 

In many ways, the value of the ABCDE assessment is that it’s applicable across a huge range of scenarios and contexts: it's a common language for assessing patients and making decisions under pressure. 

From a practitioner’s perspective, what makes ABCDE assessments a complex skill to learn? 

Each step in ABCDE nursing assessments is critically important. Skipping one, or mistaking its priority, can have serious consequences as learners work through airway, breathing, and circulation issues. If a patient isn’t breathing properly, omitting the ‘B’ stage of the assessment can lead to misinterpreted circulatory findings (and, of course, unaddressed breathing issues can quickly worsen the patient's condition).  

But novice practitioners sometimes leap ahead or conflate stages, especially when they’re nervous or overwhelmed.

Another challenge is simply remembering what to check at each stage: every step contains multiple assessments, observations, and questions, which can be difficult to recall and apply accurately under pressure. 

There’s also a distinction between how ABCDE assessments are approached depending on your role or experience. For example, a nurse might check respiratory rate and oxygen saturation under “B” (breathing), while a doctor might request or interpret a chest X-ray. As practitioners gain experience or specialization, their assessments become more complex, but the foundational rationale behind ABCDE assessments remains the same. 

What are the main challenges learners face when learning ABCDE assessments? 

The biggest challenge is volume: there’s a huge amount of underpinning theory. But at the same time, opportunities to implement, refine, and practice that theory in simulation suites are very limited.  

For learners, access to traditional simulation can vary greatly by institution or region, with some only benefitting from one or two sessions per semester. And this can be a high-pressure environment: while peer observation has plenty of value, it can also lead to self-consciousness for learners who haven’t had the opportunity to apply the theory in any prior environments. There’s a real fear of ‘getting it wrong’ in front of others (especially for internationally trained or returning nurses, who may face additional confidence barriers). The result of all this pressure is that it can prevent learners from maximizing the value of this essential and irreplaceable activity. 

It’s also difficult to blend theory with practice. Students often learn the framework in lectures and then try to apply it in simulation later, but that disconnect can make it harder to internalize and recall, especially in the unfamiliar environment of a sim lab. What’s needed is a bridge: a way to practice that’s interactive, safe, and repeatable, and with enough portability that learners can engage with it immediately prior to real-time sim lab practice. 

So how can digital simulation tools and interactive 3D assets help bridge that gap? 

Immersive healthcare simulation software, and particularly tools that incorporate nursing simulation games, allow learners to engage with ABCDE assessments in ways that are tailored to their learning preferences. For educators, the real value of these tools is that they support learning by making simulation more accessible, allowing learners to access all the pedagogical value of learning through failure, reflection, and correction, but without the negative consequences of making mistakes.  

Activities centered around interactive 3D assets offer a valuable middle ground between abstract theory and high-stakes clinical placements. 3D environments also support incremental learning: having supporting text embedded within a simulated scenario allows learners to reflect, retry, and truly understand the process. 

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Are there specific mistakes learners commonly make early on? 

Yes! And most of them stem from trying to rush or multitask through the steps. Learners often mix up which elements belong where, or they complete ‘B’ and jump straight to ‘D,’ skipping over key circulation checks.  

In this kind of assessment, ABCDE isn’t so much one activity as it is a hundred mini-considerations in sequence that range from checking blood pressure to ascertaining neurological status, and that’s why practice is really important. Once students have learned the framework, they start to refine which tools or observations to use in each case. The goal isn’t just to get learners thinking about what to do in a given scenario, but challenging them to understand why they’re doing it and what to do next with the information they receive. 

What competencies should educators prioritize when teaching ABCDE assessments? 

It’s essential that learners don’t just check boxes. As we’ve mentioned, they need to be fully aware of why they’re doing what they’re doing. Taking a pulse is only useful if you understand how to respond to the result, even if that simply means recognising an abnormality and escalating care to the relevant person. 

At the same time, it’s worth bearing in mind that digital learning tools (including healthcare simulation technology and augmented reality in healthcare environments) can help educators cultivate learners’ soft skills as well as technical ones.  

When learners can independently rehearse hands-on tasks like the A-E assessment, nursing educator time can be redirected toward more nuanced competencies. Rapport-building, communication, and interprofessional collaboration can take a back seat during traditional sessions, but when repeatable elements are supported by the right tooling, educators can focus on the human side of care. 

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Why is early practice so important before placements? 

ABCDE assessments, in nursing and allied healthcare disciplines, are absolutely foundational. It’s the structure that underpins deterioration response and, just as importantly, interprofessional communication. Practicing early and often means that, when learners encounter real-life scenarios, they have a mental framework to fall back on. It also helps them speak the same language as their colleagues during handovers or emergencies. 

In acute settings, this skill can be critical to timely intervention. It’s no exaggeration to say that it saves lives. But its value isn’t limited to just one environment. ABCDE is a universal tool, and the better nurses know it, it becomes a structured pattern they can recall instinctively. That means higher levels of confidence across the discipline, whether we’re talking about a student approaching their first sim lab to a practitioner starting their fifth nursing position.  

Where do you see technology going in this space? 

There’s no question that immersive digital simulation will become more deeply embedded in clinical education. Pressure on faculty is only growing, as is the understanding that, in an Education 4.0 landscape, learners will expect personalized, self-paced, accessible, and student-driven approaches. In that context, self-directed, tech-supported learning will become a cornerstone of how institutions teach essential procedures. 

With the growth of healthcare simulation technology and interactive tools like nursing simulation games, learners will be able to refresh and rehearse key clinical skills on their own terms. That not only meets learner expectations, but supports continuous development throughout an entire career. 

That’s particularly important for nurses, who often move around across a huge variety of settings. If you return to a setting that’s likely to test your ABCDE knowledge, having access to safe, repeatable practice (and forming those habits early) can make all the difference. 

Looking for More Healthcare-Focused Insight Straight From the Experts? 

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