A group of NHS Highland trainers have been applying Dynamis’ scenario-driven approach to their PMVA training since 2022 and have reported striking results: one cohort recorded a 72% uplift in confidence about safely breaking away from violent contact.
The NHS Highland team shared their experiences at an update to the GSA membership’s annual conference in Newcastle, alongside Dynamis’ Director of Training Gerard O’Dea and Professor Chris Cushion from Loughborough University. Here, we reflect on the merits of the scenario-driven approach and offer insights to teams striving for more efficient, engaging and effective PMVA training for their people.
Why integrate the scenario-driven approach?
The NHS Highland team had noticed that much training in conflict and physical interventions was de-contextualised, linear and skill-based, as well as being low-pressure and predictable. Real life on wards and in communities was a different proposition — pressured, chaotic, intense and surprising.
They needed training that resulted in more effective transfer of desired behaviours into the workplace, and increased staff confidence.
There was also a wider problem. Their people were becoming jaded with trainer development: the “same old thing, year-on-year”, with dry legal updates and the practice of static training as per the classroom model. They needed an approach that engaged learners and ensured efficient transfer of knowledge and skills.
To build better PMVA training, the team hosted SCENA Instructor Development CPD courses in 2020 and 2022 with Dynamis Training and have been building effective programme designs with the scenario-driven approach ever since.
How do training teams integrate the approach?
Leveraging the evidence base around “performance versus learning” — and understanding that high repetitions are required to properly embed target skills — the NHS Highland team transformed the way they delivered PMVA training.
Here is a closer look at how they did it.
1. Ask the right questions and engage from every angle
To shape an efficient, effective pathway towards scenario-driven training, the team spent time engaging with questions such as:
- What are the ‘core’ conflict and intervention scenarios experienced in our services?
- What changes will we need to make to our training plans?
- What considerations need to be made for our training environment and rooms to enable scenario-based training (SBT)?
- How will our trainers upskill to deliver in a scenario-driven way?
- What adaptations will we need to make to our course paperwork?
- How will we, at all stages, consider the learning needs of our people and articulate the benefit of the changes we are making?
Through discussion, debate and a shared route-map, everyone was invested in the transformation.
2. Invest time and resources in design
The planning stage took considerable time, but was worth the investment. The team made a number of important changes:
- Reviewing the ordering and sequencing of practice activities, re-engineering the training plan along research-informed and evidence-based lines, and capitalising on the prior experience and professional ability of learners.
- Increasing the complexity and risk level in the planned scenarios through a continuum of behavioural, environmental, staffing and task changes, progressing on a gradient of intensity.
- Creating a series of ‘patient role player briefings’ which gave life to the scenarios and specific direction to the role players — surfacing the need for specific skills, understanding or decision-making.
- Careful placement of the appropriate GSA breakaway and GSA holding skills needed in different situations, with differently presenting patients in a variety of operational contexts to reflect real life.
3. Make assessment reflect the model
The team embraced ‘assessment for learning’ by creating a new format for assessments. Most practice now occurs and is observed (and therefore assessed) in-scenario, throughout a training session — not at a single end-point test.
The assessments documented specific actions during practice activities, predicted common pitfalls in technique, decision-making or lawful use of force, and were explicit about how the instructor would coach learners through those moments.
4. Build prompts into the training environment
To support in-scenario training, practice activities and feedback delivery, the team selected a number of core curriculum components to present on printed materials (posters and cards). Those materials created a persistent presence in the training room, underlining their importance throughout the session.
5. Roll out in phases: refreshers first, then longer courses
The NHS Highland team started the rollout with their Mental Health Refresher programme — an annual update for learners who had already completed a multi-day PMVA course specific to mental health units.
Transforming a shorter-duration course with the new skills and structure gave them the confidence and the impetus to quickly spread the rollout to other programmes, including a 4-day Mental Health PMVA programme.
What were the results?
Initial feedback on the question “What impressed you or interested you the most?” from participants across the programmes came back loud and clear:
“Scenarios have been very helpful.” “Training is so much better.” “Realistic.” “More interactive.” “Specific to our needs.”
Course evaluations measured self-reported pre- and post-course confidence across three areas: safely de-escalating situations, using breakaway techniques, and applying restraint holds as a last resort. The results spoke for themselves.
📊 Confidence uplift after scenario-driven training:
- 46% — safely de-escalate situations
- 72% — safely break away from violent contact
- 48% — safely apply restraint as a last resort (Mental Health cohort)
Feedback and evaluations like these are a significant message of hope for trainers in NHS trusts around the country who may feel the impact of their own programmes is suffering because of a stagnant or rigid delivery medium.
If your organisation wants to experience the benefits of a scenario-driven approach and the specific evidence-based, research-informed methodology taught on the SCENA Instructor CPD course, contact Dynamis today. We will work with you to create efficient, effective and engaging PMVA training which benefits your people and looks after your service users.
Note: SCENA as a trainer CPD/upskill programme is technique and system-agnostic. Trainers continue to use the techniques and tactics which their risk-assessments and certification allows for.
This guide is part of our ongoing work with NHS trusts, schools, and the wider community of organisations that need practical, evidence-informed conflict-management training.