Little Things Make Big Differences

Self-Study Online


This game-based learning activity puts you in the shoes of a patient, resident or physician depending on how you choose to see the events unfold. Help Dr. Staples determine what went wrong while gaining the skills and knowledge to manage disruptive behaviour in teams.


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Learning Outcomes

By the end of this simulation-based learning activity, you will be able to:

  • Recognize the environmental stimuli that can precipitate disruptive behaviour.
  • Identify strategies for mitigating disruptive behaviour in the clinical environment.
  • Describe the impact disruptive behaviour has on the clinical environment.
  • Apply prescribed techniques that promote a “just culture” in the clinical environment.
  • Reflect on experiences with disruptive behaviour in the clinical environment.

Intended Audience

Powerful tool for a wide range of health care professionals who work or manage team-based patient care.

Authors and Disclosures

Peter Blair, MD, FRCS, FRCSC Nothing to disclose.
Bonnie McLeod, RN, BScN, MSN CPN(C)

Membership on advisory boards:

  • Conquer Experience – PeriopSim
  • International Council on Smoke Plume Inc. ICSP
  • Operating Room Nurses Association of Canada ORNAC
Glenn Barton, RN, MSN(Ed) Staff of the Royal College of Physicians and Surgeons of Canada
Anne Matlow, MD, FRCPC Nothing to disclose.
Susan Brien, MEd, CSPQ, FRCSC, CPE Staff of the Royal College of Physicians and Surgeons of Canada
Board member of Can Health
Michelle Chiu, MD, FRCPC Nothing to disclose.
Sherissa Microys, BMedSci, MD, FRCPC Honorarium for teaching from Canadian Patient Safety Institute
Principal investigator on funded study by Convance
Craig Ceppetelli Staff of the Royal College of Physicians and Surgeons of Canada
Michael Kaufmann, MD, FCFP Nothing to disclose.
Gregory Nelson, MD, PhD, FRCSC Nothing to disclose.

CME Accreditation

This activity is an Accredited Self-Assessment Program (Section 3) as defined by the Maintenance of Certification (MOC) Program of the Royal College of Physicians and Surgeons of Canada, and approved by Royal College Continuing Professional Development Unit. You may claim a maximum of 2 hours (credits are automatically calculated).

Time Commitment

1-2 hours to complete. Save progress & re-start anytime

System Requirements

We have tested the learning environment and cases to function properly on the most up to date version of Chrome, Firefox, Safari and Edge on  desktop  and tablet devices. Tablet devices should have a minimum resolution of 2048 x 1536. While the activity may work properly on other systems not described above we cannot guarantee full functionality.

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