There is increased availability and development of the advanced clinical practitioner (ACP) course to upskill allied health professionals in clinical, leadership and supervision areas [1]. Locally, ACPs and ACPs in training have not previously had simulation integrated into their training for this role despite this being considered an effective learning method for communication skills [2]. The simulation department was approached with funding to develop a course to add variation to their development programme and enhance learning in areas better targeted through simulation.

Activity:

A survey was sent to the ACP cohort to ascertain their desired learning objectives from simulation training. Then the team met a focus group of ACP trainees to further explore their varied roles and the expected changes moving to the ACP role. From this research, a 1-day course was developed to include scenarios with themes felt to be widely applicable across the umbrella of ‘advanced clinical practice’. Examples included; managing patient expectations, challenging hierarchy, safeguarding, learning disability, mental capacity assessment, difficult supervision. Two courses have been completed with a mix of ACP roles, and scenarios adapted to apply to the specific participants. The debriefs explored how the scenario theme could be applied cross discipline and gave an opportunity for these senior healthcare professionals to share experiences and their individual management strategies.

Findings:

This was a stimulating but challenging course to develop given the seniority and multidisciplinary background of the target group. This required significant creativity and adaptability from the organizing team and multiple scenarios to be designed for participants. The courses generated valuable discussion and all candidates reported the day to be a useful experience with specific learning and development taken from the day. Limitations included some allocated scenarios were felt to be outside the usual job remit of the allocated participant, which could impact on the authenticity and psychological safety of the scenario for that candidate. Despite this, useful discussion of the intended themes was still possible, and this was reinforced by the experience brought from the candidates present.

Conclusion:

Even though ACPs may have similar more complex learning needs in line with their required capabilities, this is challenging to translate into a transferable and valuable simulation course when targeting multiple disciplines with varying amounts of senior experience. We reflect on ways to approach this in the future and would be open to opinions from our esteemed education colleagues.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

In a number of medical schools, students often feel unprepared to manage acutely unwell trauma patients, with a majority of students reporting they had received less than five hours of trauma-based teaching and clinical skills exposure [1]. Despite the lack of previous training, newly graduated doctors are often one of the first professionals to initiate assessment and management of trauma patients on arrival to hospital [2].

Our scenario design aims to help both medical and nursing students gain experience of multiple trauma patients in a simulated environment. We wished to incorporate the skills of prioritization, leadership, role allocation and delegation whilst also covering some technical skills of trauma management. This scenario aims to simulate a high-pressure, busy clinical environment where students can practise the management of patients requiring immediate care in a resuscitation room setting.

Activity:

The students were briefed collectively for the multiple trauma simulation, as if there were a ‘stand-by call’ as a pre-alert from the ambulance crew. The students were informed that there was a nearby road traffic accident and there would be three casualties arriving: a patient with a head injury who was on an anticoagulant, a patient who had a chest wall injury and a patient who had suffered burns at the scene. They were allocated 5-10 minutes to assist with assigning roles and identifying how they planned to divide up tasks before starting the simulation. The initial assessment and management plans were commenced by the students, and a member of the faculty team would come in around half-way through as a ‘senior emergency physician’, who could offer advice and guidance.

Findings:

Verbal and written feedback collected from both medical and nursing students was positive, with many stating that they felt their teamwork and leadership abilities had been enhanced. Multiple people commented on the impact of clear communication, task delegation and leadership on the outcome of the scenario. Several students also commented on the positive impact of multidisciplinary working by combining both medical and nursing students for simulation training, and felt they had a greater appreciation and understanding of each other’s roles.

Conclusion:

Students felt that their confidence in both technical and non-technical skills had improved as a result of participating in the scenario, and many felt they had learnt valuable leadership and teamwork abilities.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

It is recognized that clinical placements are sometimes limited for allied health professionals (AHPs) [1]. This, coupled with the ‘People Plan’ [2], which highlights the need for increasing numbers of AHPs in the workforce, has led to considerations of alternatives to traditional clinical placements. We were approached by a podiatry undergraduate programme to assist with delivering a podiatry simulated placement, for BSc and separately for MSc podiatry students, each for three days, for the academic year 2022/2023.

Activity:

Development of the simulated placement took five weeks; it was collaborative, with input from HEI academics, subject specialists, and simulation-based educationalists. Six scenarios were created which aligned with the HCPC Standards of Proficiency for Podiatrists [3]. These reflected the breadth of experiences students might have experienced in a clinical placement; they focused on communication and behaviours. Actors were involved in playing the roles of simulated colleagues, patients, and relatives, with experienced facilitators setting up a safe, non-threatening, immersive learning environment, covering triggers and time outs in the pre-brief. The following were areas covered:

Scope of practice and autonomous practice

Professional judgement

Culture, equality, diversity and non-discriminatory practice

Confidentiality and professionalism

Team working

Communication skills, face to face and telephone

Safe practice environments

The learning was underpinned by a communication skills framework enabling students to structure their conversations and behaviours appropriately. Reflection was used post debrief and explored the subsequent day. All scenarios were presented as either forum theatre or fishbowl simulation, with all students being present in the same space as the simulation.

Findings:

Evaluation was positive from both BSc and MSc groups. Students highly rated the structured approach provided by the communication framework stating it helped them converse effectively and build rapport with patients, relatives and colleagues. The inclusion of actors, although daunting for some initially, added hugely to their learning experience. Students commented on how they felt more prepared for real-world situations and how they hadn’t appreciated the breadth and impact of their practice.

Conclusion:

Simulated placements can offer a safe and controlled environment for podiatry students to develop their skills and engage in vital conversations with patients, relatives and colleagues. Facilitators should adapt to different confidence levels and learning styles of the students and actors fully briefed and in line with these adaptations. These simulated real-life placements are replicable and can help in preparing a workforce fit for purpose.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

To address the existing workforce deficit within Physiotherapy an extra 500 Physiotherapists need to be trained every year - an additional 15% of current student numbers. The biggest barrier to expansion of student numbers is placement capacity. Novel and innovative models of placement are being trialled, with a strong emphasis on the four pillars of clinical practice. Simulation, and virtual based placements offer alternative models of placement provision [1]. Current literature has detailed successful simulated clinical placement within Physiotherapy using full or partial substitution of clinical placement. It has been shown that switching up to 25% of practice learning to a simulated model does not compromise student attainment or competency [2]. However, these studies tend to involve small student numbers. For simulated placements to be a practical alternative they need to be delivered at scale.

The aim of this pilot project was to develop, deliver and evaluate an on campus simulated placement experience for 140 first year Physiotherapy students at a large UK university.

Activity:

A four-week program of activities was designed to simulate the core learning that occurs on a typical physiotherapy clinical placement. Including case scenarios with standardized patients, virtual case discussions with clinicians, expert patient panel, day in the life of videos, note writing workshops and live streaming of patient sessions. Students attended two observational days in practice with structured debriefing on campus. Themes for the placement included communication, risk assessment, patient journeys, wellness and effective learning on placement. The development of the learning activities was research and stakeholder informed. Clinical scenarios were co-designed with level 5 Physiotherapy students.

Findings:

Placement evaluation was collected via a questionnaire including open ended questions and Likert scales (0-5). Students agreed that that placement was engaging and interesting (mean score of 3.45), with the greatest agreement that the placement had improved note writing, communication and understanding of professionalism. Students ranked simulated clinical scenarios and observation as their preference for activity, with peer learning to support these activities to be ranked the lowest.

A review of placement attainment data noted a correlation with previous clinical placement data. There was an increase in a student’s perception of their preparedness to go on a clinical placement pre and post simulated placement.

Conclusion:

Large scale, simulated on campus placements are workable and a useful learning experience for first year Physiotherapy students.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Gamification of learning is becoming increasingly popular within higher education [1]. Student activities described as ‘gameful training’, including Escape Rooms, have reported additional learner benefits including improved teamwork, creative thinking and communication skills compared to traditional session designs [2]. There is a small number of existing case studies demonstrating their utilization within healthcare professional education and the reported additional benefits included pertinent skills such as task delegation and leadership, as well as being an engaging teaching strategy that promotes active learning [3].

Activity:

A trial simulation escape room was created and implemented for level 5 adult and mental health branch nursing students within a Higher Education Institution. 12 different teams of students entered the escape room and worked together to ‘treat Arthur’, a patient presenting with acute anxiety and chest pain. Students were required to assess, escalate and manage Arthur effectively and would ‘escape the ward’, once he had received all of the required treatment.

The learning outcomes for the scenario and subsequent puzzles and tasks were created based on recent curriculum teaching allowing students to apply prior learning within the escape room environment. Puzzles included coded locked boxes and students were required to apply relevant knowledge, such as answering pharmacology questions, to generate codes and progress throughout the scenario. Simulation equipment was utilized and students unlocked clinical treatments and medical devices which in turn had to be delivered to Arthur. The facilitator maintained an active role within the scenario and allowed students to practise communication skills such as escalating their concerns about Arthur via the telephone.

It must be noted that the design time was significant for one scenario and required several pilots to ensure that all components were cohesive. Full support and creative input was required from the simulation technicians to ensure the activity’s success.

Findings:

Students fed back that they enjoyed the activity and were observed to work effectively together and prioritize and delegate throughout the task with minimal supervision. Students also stated the scenario context was helpful to apply their prior learning and were pleased that they had been able to manage this patient presentation together. Feedback from facilitators was also positive and both staff and students found it to be an engaging experience.

Conclusion:

Simulation escape rooms offer an innovative and engaging way for students to apply learning and vital practice technical and non-technical skills. For educators, clear learning outcomes and allowing sufficient design time is a necessity.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Simulation training sessions were designed at the University Hospital of Wales in order to implement the new national guidelines for the management of suspected haematoma following thyroid surgery [1].

Opportunities included on site portable training with a part task trainer and high-fidelity scenarios simulating patient deterioration following thyroid surgery in an immersive environment.

Our initial design for the high-fidelity set-up included a simulated neck haematoma achieved by using a second generation supraglottic airway device (SAD) with an inflatable cuff placed in the manikin’s neck with the laryngeal opening outwards and tubing inside the chest. The opening was filled with red jelly, covered by simulated strap muscles (made from simulated small bowel with interrupted sutures) and simulated neck skin (which presented a sutured incision complete with steri-strips). Ongoing bleeding was simulated by injecting liquid jelly through the SAD’s gastric port via a long connecting tube in the manikin’s thorax.

This simulation training increased confidence and familiarity with the steps required to manage post thyroid surgery haematomas in 100% (15/15) of candidates, with 73% grading the mannikin ≥4/5 for realism. However, it was costly to provide and time-consuming to set up.

It was decided to try to make the set-up cheaper and easier to reproduce without impairing quality.

Activity:

Equipment costs were reviewed and alternative options identified. Expensive components included the SAD and bowel material, which were replaced with a cheaper SAD and a disposable tourniquet fashioned as shown in Figure 1-A100. Participants used both devices and were asked for feedback.

Figure 1-A100:

Making the simulation larynx and strap muscles. A step by step guide

Findings:

The cost of disposable props used in each session was reduced from £133.04 to £8.52 with the new equipment. The designers also felt it was significantly more robust and easier to reproduce. This approach could also be easily adapted for mobile part-task training, improving multi-disciplinary access to training.

Feedback showed 47% of candidates felt the new set-up to be better, and 47% reported non-inferiority.

Conclusion:

Changing to new equipment resulted in a design that was significantly cheaper, easier to source and set-up, while being at least as realistic and offering training opportunities outside the high-fidelity environment.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Due to the nature of simulation-based education, large amounts of blank paperwork are used and disposed of in any given scenario. As many trusts are now moving towards e-noting, including e-obs and e-prescribing, the use of these in simulation can be extremely beneficial for the learners. These were highlighted by the author as areas for sustainability and increased realism throughout the simulation sessions run by the team at Dartford and Gravesham NHS Trust [1].

Activity:

This initiative was developed to cut down on the amount of paper waste used during scenarios and increase the realism for the learners taking part. E-obs, e-prescribing and e-noting templates were created using Microsoft Excel and Microsoft Word that mirrored the programmes used throughout the trust, and were made readily available for the learners taking part in the simulation scenarios. These were then saved as templates, and a new version created for each existing patient throughout the scenarios. On top of this, each new scenario created also required a new set of e-noting, including a NEWS, prescription and the relevant paperwork. ‘Patients’ who had progressed through ED, for example, had a completed CAS card, and their NEWS chart reflected the several sets of observations already taken. The NEWS chart template was also adapted for patients with COPD, and PEWS charts for each paediatric age group were also created, alongside separate e-prescribing to mirror the paediatric version of the drug charts throughout the trust.

Findings:

Learners who participated in the scenarios using e-noting provided positive feedback, highlighting the realism and relevance to practice. 43 learners were asked to complete a short survey after taking part in 1 or more scenarios using the new e-noting system. 79% of learners reported that they found the system easy to use, 90% reported the relevance to clinical practice, 81% reported that it was realistic and 95% were happy that this is a feasible and sustainable way to utilize prescribing, observations measurement and note writing/history taking throughout the simulation sessions. 4% reported not using the e-noting system during their scenario.

Conclusion:

Although the creation of the e-noting system required additional time and resources at the start, they quickly became easy to implement and adapt to each new patient or scenario. The use of this system leads to much less paperwork being destroyed and increased the realism for the participants who use e-noting throughout the trust.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Simulation Based Education (SBE) is well established across healthcare disciplines. However, the benefits can only be obtained in their entirety if simulation is embedded routinely in the healthcare system [1].

Aim: To create and embed SBE sessions targeted at Nursing and Allied Health Profession students within their placement learning.

Activity:

We collaborated with clinicians to create training sessions covering clinical and transferable skills alongside scenarios that are not covered in university teaching. Attendance of the sessions was voluntary, allocating places on a first come, first served basis.

The session format consisted of an initial teaching presentation followed by a simulated scenario, debrief, topic specific activities and a final group discussion.

We collated data from students immediately after the session via anonymous, online feedback forms. We have since sent follow up questionnaires to all students we had contact details for who attended a session in 2022.

Findings:

We created and delivered 18 simulation training sessions covering 13 topics, totalling 70 hours of training delivery. A total of 103 students from 6 professional groups participated. The students were in varying stages of their education, belonging to 8 HEIs. We received 74 responses out of the 103 students.

Our results showed 99% of students felt the training session met their learning needs and 62.7% found the simulation and debrief the most beneficial part. Additionally, 87.5% found it beneficial working alongside other students and 81.3% reported the session allowed them to gain better understanding of differing professional roles.

Students’ confidence levels relating to their ability to manage the clinical scenario significantly increased post simulation with 64.7% rating ‘Somewhat Confident’ and 27.5% rating ‘Extremely Confident’.

We received 26 responses to the follow up questionnaire. In total 94% reported they have since applied the skills they learnt in practice. Furthermore, 42.9% stated their experience in our sessions had been influential in considering applying for posts in Trust.

Conclusion:

Simulation allows NHS students to learn essential clinical skills and collaborative working [2]. Our data proves our sessions are successful in increasing confidence scores, insight into other roles and provided invaluable networking time and peer support.

We have created a catalogue of simulations that are sustainable and can be utilized in future student placements. We can also conclude we are not only developing our student NHS population but directly influencing our future workforce in Somerset.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

The Acute Care Unit (ACU) is the busy admissions ward at the trust. Many junior doctors rotate through the ACU for their acute medicine training and the department frequently welcomes newly-qualified nurses or nurses new to the NHS. All staff are involved in managing acutely unwell admissions with a range of presentations.

In this dynamic environment, ensuring time is dedicated to teaching is an important part of staff development. In addition, it is important to create opportunities for team-building between disciplines, and evidence shows that this improves outcomes for patients [1].

Teaching for different professional disciplines is often delivered separately. Whilst sometimes preferable, we recognized the department could benefit from simulation sessions involving all members of the clinical team to represent realistic clinical practice. The aims were to:

Address recent clinical incidents

Practice managing common medical emergencies as a multidisciplinary team

Build a greater sense of team between the ACU staff.

Activity:

We designed and implemented a programme of weekly multidisciplinary in-situ simulation on ACU. Sessions involve a range of nursing and medical staff and students and are delivered in an empty bed space on the ACU. Simulations focus on clinical scenarios that might reasonably arise in the department. We use iSimulate technology and re-use the simulation suite’s equipment to reduce resource burden and maintain sustainability.

Feedback is collected after each session to quality assure and improve the sessions, and 2 further quality improvement reviews completed to explore how to maximize engagement and learning. This has led to coordination of scenarios with the established weekly seminar-based departmental teaching, to consolidate learning across settings and this is reinforced with a ‘learning point of the week’.

Findings:

Sessions have been successfully delivered on a near-weekly basis throughout the year, despite significant clinical pressures. This has been achieved through coordinated efforts from the simulation team, ACU fellows and registrars, charge nurses and Practice Development Nurse.

We estimate to have reached more than 50 colleagues, with typically 4-8 attendees per session. We have rotated through 15 different scenarios and counting, covering key topics including various medical emergencies, violence and aggression, and ‘soft signs’ of deterioration.

The programme has been well received, and feedback has specifically commented on the benefit of simulation in a multidisciplinary and in-situ setting.

Conclusion:

We demonstrate it is possible to maintain an effective regular simulation programme in the department to support patient safety initiatives and team working.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Simulated placements for paramedics are increasing, with some organizations approaching these placements innovatively, focussing on combining undergraduate paramedic facilitation skills with peer reviewing skills [1]. Other HEIs focus on clinical skills with manikin scenario-simulations and on virtual reality driven learning. Effective communication skills are crucial for paramedics and simulated placements provide an opportunity to practice these skills. There is a heavy focus on communication skills in the HCPC Standards of Proficiency for Paramedics [2]; this, combined with our responsibilities to patients and their relatives means that rehearsal of these skills, are not overlooked in preference to technical skill acquisition.

Activity:

A simulation-based education provider and an HEI, co-created a two-day simulated placement for 60 paramedic undergraduates. The scenario content was developed to reflect the broad client base paramedics interact with: patients, relatives, by-standers, other healthcare, and emergency service professionals, all from across the life span and from different cultural and social backgrounds. The scenario focus was: care, kindness and compassion, confidentiality and candour, supporting colleagues, de-escalation, safeguarding, inclusivity, and transgender and gender diversity. Scenario development was undertaken by a range of healthcare professionals, and co-produced with lay developers, people who had experienced paramedic intervention. Actors were coached in role depiction and escalation, briefed regarding the learning outcomes, and had the pre-requisite experience in debriefing and feedback skills.

Findings:

Each learning outcome was scored by the students, for confidence and ability, in a pre-post evaluation. Overall students evaluated the placement as a meaningful learning opportunity. They felt able to consider their existing knowledge, then practice their skills and reflect on their attitudes. They described feeling better prepared for ‘real’ situations. Students reported the usefulness of being able to stop, discuss and restart/resume the simulation. Feedback from actors, peers and facilitators was described as an enhancement, and crucially, the co-production of the scenarios with lay developers, translating their ‘real’ experiences resonated with the students creating genuine, authentic learning opportunities.

Conclusion:

Communicating is a vital paramedic skill; evidence demonstrates that these vital skills, done well, lead to improved patient outcomes and satisfaction, and a reduction of medical errors [3]. Simulated placements are an essential ingredient in developing these skills and the involvement of actors and experienced facilitators provides a safe environment for students to practice. This initiative provides valuable insights into the co-production of scenarios (with users) and partnerships between HEIs and external simulation-based education providers.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

In 2008 the National Patient Safety Agency reported 12 patient deaths directly related to chest drain insertion over a 3-year period. Since then there have been calls from publications highlighting the need for better education for clinicians [1]. Simulation has been shown to improve chest drain insertion technique [2], and multi-disciplinary simulation can encourage teamwork and communication skills [3]. Given that this procedure is an essential requirement for anaesthetic, intensive care, emergency medicine and internal medicine trainees, we decided to introduce a multi-disciplinary simulation course for the insertion of chest drains.

Activity:

A basic needs analysis was carried out with stakeholders. Initially the course was designed to run for half a day, with a maximum of 12 candidates and a minimum of 3 faculty. A course timetable, course manual, equipment list and pre- and post-course feedback questionnaires were created. The course begins with a lecture, followed by three simulation-based workshops, which the candidates rotate between. These cover seldinger and surgical chest drain insertion, and the basics of chest ultrasound, using ultrasoundable chest drain manikins.

Findings:

Feedback from the first course in July 2022 suggested that there should be a designated faculty team leader and healthy volunteers for the ultrasound workshop. We implemented this feedback and ran the course again in December 2022. Candidates were asked to rate their post course confidence at performing the procedure, with a score ranging between 1 and 7 (each number was assigned a qualitative value with 1 being unable to perform the procedure and 7 being extremely confident in performing the procedure). After the first course, the average score was 5 points. After the second, the average increased to 5.5. The course ran for a third time in April 2023, during which the duration of the workshops was increased and a lecture on aftercare was added. The average post course confidence score was 5.7. All candidates felt that the session fully met the learning objectives and would recommend the course to others.

Conclusion:

After implementing changes to our course including assigning a faculty team leader, recruiting healthy volunteers, increasing the time spent in workshops and adding a session on aftercare, there has been an improvement in the candidates’ average post course confidence at performing chest drains and qualitative candidate feedback was positive. We would recommend our course structure to others designing a chest drain course.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Medical escape rooms have risen in popularity for their ability to teach various skills to medical students in a gamified context [1]. We designed two simulation-based medical escape rooms in which students could enhance their clinical and non-clinical skills, and learn about human factors. The escape room mimicked the complexity of a real patient with multiple pathologies, unlike traditional simulation, which usually focuses on one. This created a fun, realistic approach to experiential learning whilst enhancing psychological safety, collaboration, teamwork and communication.

Learning outcomes for the escape room incorporated clinical reasoning, prescribing, data interpretation, synthesis of management plans, practicing effective communication, teamworking, leadership and situational awareness skills. These were mapped to the General Medical Council’s outcomes for graduates.

The aim of creating the escape room was to create a realistic complex scenario, incorporate teamworking and clinical and non-clinical aspects of patient care, whilst maximizing engagement and easing the stress of traditional simulation.

Activity:

The escape room simulations were themed for Christmas and Valentine’s day with an underlying non-medical mission. The simulation was designed to ensure students practiced their A-E assessments. When students made the correct assessments and requested the correct investigations and management, clues would reveal answers to complete a puzzle or unlock a box that would slowly allow them to solve their non-medical mission.

Findings:

Feedback was collected from all 40 students who participated in the two escape rooms, using Likert scales and open answer text. 97% of students agreed or strongly agreed that the Escape Room enhanced their clinical reasoning skills. 98% agreed or strongly agreed that the session addressed nonclinical skills e.g. leadership, communication and teamworking and that the session will benefit patient care in future clinical practice. 95% agreed or strongly agreed that the debrief enhanced their clinical knowledge. Students enjoyed treating realistic multiple pathologies and completing several tasks, allowing for prolonged, in depth simulated practice. Students appreciated the teamworking opportunities, quizzes, puzzles and lateral thinking opportunities. They found the Escape Room simulation more fun and relaxing than traditional simulation, yet just as relevant.

Conclusion:

The positive feedback validates the potential of medical escape rooms as a unique teaching modality, and the scope to promote teamworking within a complex simulation scenario beyond that of traditional simulation. There is the potential to diversify and use escape rooms to promote interprofessional learning.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Surveying University of Nottingham (UoN) medical students in their final year with regards to applying an A-E approach in a medical emergency context, we found that they lacked confidence. In order to address this curriculum gap, we designed a low-fidelity simulation-based workshop which has been shown to improve confidence in developing key skills relating to medical emergencies [1].

This consists of a 2-hour session for groups of 6, for all students undertaking their medical placements at Nottingham University Hospitals (NUH).

After successfully implementing this workshop for students in their final year, we asked ourselves ‘when is it too early for medical students to cover A-E assessments in medical training?’

Considering this is an essential skill to develop and part of their intended learning outcomes (ILOs) that is also tested in their 3rd year examinations, we introduced an adapted version of this workshop for the more junior cohort.

Activity:

We constructed this workshop with alignment to both the final and third year UoN curriculum ILOs. Google forms were used to survey students’ confidence pre and post-session.

We used a low-fidelity simulation mannequin, focusing on an otherwise realistic clinical environment using medical notes, a portfolio of investigations and props. This included an observation monitor, a real-time display with altering vital parameters and a fully equipped emergency trolley.

Pre‐reading handouts on A-E assessment by the Resuscitation Council UK [2] were provided. We watched a pre‐recorded demonstration video of the management of hypoglycaemia prior to students working in pairs on three scenarios.

During the simulation scenarios, faculty members acted as either the patient or team members, including as a nurse and medical registrar.

Results:

We showed that participation in our workshop significantly improved student confidence in the specific domains (see Table 1-A82).

Table 1-A82:

Summary of the student questionnaire results

	Pre-session confidence	Post-session confidence	Improvement in confidence
FFP (3rd year medical students)
Recognizing when to perform an A-E assessment (n=31)	36.6%	100%	+63.3%
Confidence in applying an A-E assessment on an unwell medical patient (n = 31)	6.7%	90.3%	+83.6%
Confidence in managing chest sepsis (n = 31)	3.2%	70.9%	+67.7%
Confidence in managing a STEMI (n = 31)	9.5%	83.9%	+74.4%
Confidence in managing DKA (n = 31)	13%	70.9%	+57.9%
CP3 (5th year medical students)
Recognizing when to perform an A-E assessment (n=54)	87.3%	100%	+12.7%
Confidence in applying an A-E assessment on an unwell medical patient (n = 54)	29.1%	94.4%	+65.3%
Confidence in managing acute asthma exacerbation (n=36)	13.9%	97.2%	+83.3%
Confidence in managing hyperkalaemia with ECG changes (n=36)	11.1%	88.9%	+77.8%
Confidence in managing SVT (n = 36)	0.0%	83.4%	+83.4%

Written feedback from students suggested active participation in a simulated learning environment together with a detailed debrief and facilitated discussion was a powerful learning experience.

Conclusion:

This workshop has now been embedded into the teaching timetable at NUH. A-E assessment is a key template doctors of all grades use when facing the most critical situations.

Considering the feedback, introducing more junior students to the structure of an A-E assessment early is essential for creating a scaffold in their long-term memory, ingraining this into their professional practice. This will prepare them for their OSCEs and the new GMC mandated MLA examinations [3] and, more importantly, for when they start their roles as foundation doctors.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

International medical graduates (IMGs) are doctors that have graduated from a medical university outside of the UK and subsequently employed by the NHS. The transition to working within the NHS presents them with many new challenges including communication, cultural differences, healthcare system differences, NHS policies and UK legal frameworks, and the expectations attributed to a doctor practicing in the UK. They often commence work with little training about these practical challenges and as a result encounter a steep learning curve. IMGs are significantly more likely to receive complaints and face fitness to practice investigation [1]. Therefore, developing educational opportunities to help them adapt to working in the NHS is a necessity.

Simulation has been shown to improve the confidence, knowledge and provides an ethically and educationally safe setting for doctors to develop their practice [2,3]. We therefore created an IMG oriented simulation programme that focussed on some of the key challenges they face.

Activity:

We delivered simulation sessions on four separate days with 6-8 IMG candidates at each. Sessions consisted of two clinical scenarios divided into sections, approximately 20 minutes long, each targeting a key educational outcome. We used a combination of a computerized simulation manikin (SimMan Essential) and live actors. Key educational outcomes included managing an acutely deteriorating patient, escalating to a senior, obtaining a collateral history, breaking bad news and duty of candour. Each candidate had the opportunity to participate in a part of the simulation whilst the others observed. The candidates were then debriefed and learning objectives explored by a trained faculty member. The candidates were asked to complete pre-simulation, immediate post-simulation and 3-month post-simulation feedback forms using a nominal Likert scale. They scored 1-10 (10 being ‘strongly agree’) on their confidence around each component of the educational outcomes.

Findings:

We had 21 candidates complete the simulation day, with 19 responses to the immediate post simulation survey and 9 responses to the 3-month post simulation survey. The results showed a significant increase in the confidence of the candidates for each educational outcome, with mean scores increasing from 6-7 to >9. We also demonstrated that the candidate’s confidence remained and they were still using the skills they had learned 3 months later.

Conclusion:

We have demonstrated that IMG oriented simulation is a valuable educational tool for doctors transitioning into working within the NHS. Confidence around a variety of difficult topics increases and the lessons learned have a lasting impact.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

An NHS provider had no established simulation education opportunities for community based allied health professionals (AHP). Urgent Community Response (UCR) teams are interdisciplinary teams, comprised of nurses, paramedics, physiotherapists and occupational therapists, who provide care to adults in their home to avoid hospital admission [1]. Older people experience effective high-quality care when a multi-skilled clinician, working across the usual professional boundaries, can effectively address their needs rather than requiring numerous other professionals to visit them at home.

In this NHS Trust, intermediate care teams were required to include UCR referrals as part of their usual work. The physiotherapists and occupational therapists from these teams required upskilling to be able to safely support patients requiring this more acute and urgent level of care.

Clinicians working in the community have limited opportunity to observe and learn from each other. Simulation is an evidenced based educational activity to support the development of new knowledge and skills required in interdisciplinary teams working in clinical settings [2]. It was hypothesized that interprofessional simulation would be an effective educational intervention to support this upskilling.

Activity:

A faculty was established which included a simulation educator; simulation technician; a practice development AHP; and a physiotherapist with clinical experience of working within this setting.

Simulation scenarios were developed to reflect common referral presentations; the Skills for Health UCR Capability Framework [3]; and learning outcomes identified as priorities by the clinicians and service managers. The learning outcomes included applying an A to E assessment; the use of NEWS2 and the SBAR escalation tool when assessing an adult patient in their own home.

A modified Kirkpatrick evaluation form was used to evaluate the training.

Findings:

Three simulation training events were offered. There were 26 participants overall with representation from physiotherapy, occupational therapy, nursing and healthcare support workers. There were fourteen evaluation responses to a modified Kirkpatrick evaluation form. The evaluation identified that simulation provided an opportunity to learn from other professions; supported the practical application of learning; debriefing provided a safe learning environment; and that the learning would lead to changes in their current practice (see Table 1-A74).

Table 1-A74:

Evaluation themes with supporting examples

Theme	Verbatim comments
Pre-scenario teaching	The training at the start was great, really informative…was really important
Practical application of the learning	remaining calm in a crisis situation and providing accurate handoversenjoyed the practical nature of learninginteractive training is more effectiveExcellent way to learn
Relatable to clinical work	Case studies useful and relatable to day-to-day workWill incorporate SBAR and NEWS2 into our assessment documentation
Opportunity to observe and learn from others	Interesting to see our other teams approach situations
Debriefing provided a safe learning environment	…great discussion facilitation…very reassuring environment which I think a lot of staff found helped cement how much they did knowfacilitators created a supportive learning environment to make you feel comfortable

Conclusion:

Simulation training events were evaluated by participants from an interprofessional community team as a safe, practical and effective way to support their upskilling to provide an UCR service. Simulation should be considered as part of an education package to support interprofessional teams upskilling to provide new services in a community setting.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Acknowledgements:

This work forms part of a fellowship project funded by NHS England (South East) Workforce, Training and Education; with the Florence Nightingale Foundation and Canterbury Christ Church University.

The past three years during Covid19 have brought significant changes to our simulation service, including a change of specialist extended faculty. As we began to resume our standard service, and new faculty members joined the team, it became apparent that we had been heavily reliant on individual faculty memory and had lost some organizational memory. This impacted the efficiency and quality of the service, as well as the experience for the new staff members. Therefore, we decided to evaluate all our courses to identify opportunities that would improve the overall service and help integrate new faculty.

Activity:

We initially used a scoping exercise based on the System Engineering Initiative in Patient Safety (SEIPS) framework [1] to evaluate all our courses looking at course design, scenario design, evaluation tools and course delivery to highlight themes for service improvement. Potential service improvement ideas were prioritized taking into consideration the Hierarchy of Intervention Effectiveness to ensure improvements were mixed across the person and system-focused levels [2].

Findings:

The SEIPS scoping exercise highlighted inconsistency in course design, delivery and evaluation. As a team we set about designing a standardized approach that could be applied to both established and new courses, aiming to enable course resilience and retain valuable knowledge and documentation.

We have designed and embedded standardization in all aspects of course design, delivery and evaluation:

SEIPS based scenario design proforma

Course introduction with a human factors workshop

Incivility workshop

Technical teaching aid for debriefing

Human factors teaching tools

Pre- and post-course evaluation

Anonymized feedback from faculty was used to assess the impact of the standardized course design. This standardized approach has supported existing and new faculty to develop and run high quality courses; created a shared understanding of teaching content and delivery, and has had a positive impact on the consistency of course quality.

Conclusion:

By scoping and exploring our service we illuminated gaps within our organizational memory and were able to strengthen these by designing a series of innovative documents, proformas, teaching aides and evaluation. This standardized approach helps to enable consistent high quality, support new faculty, whilst still allowing for flexibility and adaptations when delivering courses.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

There is a large backlog in surgery due to covid as well as surgical training [1]. We explored the feasibility of a dry lab simulation environment to teach advanced surgical specialty skills to learners with different levels of experience.

Activity:

Session description: We ran 5 cardiothoracic surgical simulation courses over 2021-2022 with a total of 61 delegates. We covered coronary anastomosis, aortic valve replacement, video-assisted-thoracoscopic-surgery (VATS) lung wedge resection and pulmonary vessel dissection. Each skill station ran for 40 minutes including a 15-minute description and real-time demo.

Target audience: Participants included 36 medical students, 14 specialty doctors and 11 foundation doctors.

Resources:

We used synthetic plastinated and resin printed models with modular metal frames to help with retraction and suspension of the area of interest for the cardiac models. For the VATS models a laptop with connected angled endoscopic camera was utilized. The lung models were 3D printed.

Findings:

88% of all participants were able to complete all procedures successfully under supervision. 96% of all participants increased in confidence with the procedure following simulation compared to before. Interestingly only 44% of specialty trainees described themselves as confident in some procedures prior to simulation. Of the medical student cohort 95% had not had any previous simulation or surgical experience prior.

Conclusion:

We have demonstrated the feasibility of a dry lab simulation programme for candidates of all experiences in cardiothoracic surgery. Confidence in surgical technique is low during the COVID era. Simulation improved confidence in surgical technique and must be offered more widely to enhance training experiences. No experience is necessary for successful simulation.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Simulations can be important for wider learning and patient safety [1]. However, the delivery of traditional simulations is not always feasible [2]. We developed an alternative ‘Mini-Sim’ to deliver high quality teaching with a sustainable approach, aimed to save time and resources.

Activity:

The simulation team delivered traditional ward-based simulations every Wednesday. Where this was not possible, due to timing or staffing constraints, we delivered ‘Mini-Sims’. This involved participant verbalizing their assessments to a pre-written scenario with a facilitator asking follow-up questions as opposed to physically acting out. Data collected over 5 months included the type and duration of simulation, how many participants were involved, and resources required.

Findings:

Across the 5 months, between 0 to 16 participants were reached monthly using traditional simulations, whereas ‘Mini-Sims’ reached 4 to 14, Figure 1-A62. Except in February, ‘Mini-Sims’ demonstrated greater monthly participation. The average ‘Mini-Sim’ took 15 minutes, a considerable difference to traditional simulations, which took 60 minutes to comprehensively implement. The delivery of one traditional simulation can be complex, requiring: minimum 3 staff members to facilitate and act; space and time on a clinical ward; and props. We were unable to deliver a traditional simulation if there were no technicians to manage the props or if there was insufficient ward space. Conversely, ‘Mini-Sims’ required only a script and a facilitator. In October and December, where no traditional simulations could be delivered, historically the wards would have received no simulation teaching those months. However, ‘Mini-Sims’ provided an alternative opportunity to reach 6 and 4 participants respectively. This is due to its simplicity resulting in less impact from ward and time pressures, or staff absence within the simulation team.

Figure 1-A62:

Comparing participant numbers from ‘Traditional Sims’ with ‘Mini-Sims’ delivered between October 2022 to February 2023

Conclusion:

Where resources and time are limited, the minimalistic approach of ‘Mini-Sims’ provide consistent teaching opportunities and promotes sustainability in man-power, time, and costs. Whilst humble in appearance, ‘Mini-Sims’ show sizeable potential for sustainable learning.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

The Medical Support Worker (MSW) programme enables International Medical Graduates (IMG) and refugee doctors to support clinical teams, whilst General Medical Council registration is gained [1]. North Bristol NHS Trust, a large teaching hospital in South-West England, has designed and implemented a novel training programme for a second cohort of 30 MSWs. A comprehensive learning needs assessment informed the content of the programme.

Methods:

Learning needs were identified from two probing questionnaires and reflective pieces, completed by 22, 27 and 29 MSWs respectively; alongside Health Education England and General Medical Council guidance [2, 3].

Four principal areas were identified- (1) Communication, (2) Portfolio Development, (3) Career Development, (4) Preparation for work in the NHS.

A subsequent teaching programme consisted of simulation, human factors, communication and ethics training, alongside community theatre delivered communication skills, interview preparation practice, portfolio training sessions and a specifically tailored lecture series. The programme was evaluated using two delayed surveys, formed largely of Likert scale questions, completed by 25 and 17 MSWs.

Results:

Pre-intervention: Communication, social skills or cultural change were highlighted as the biggest challenges by 64% MSWs. Only 48% of MSWs felt confident working in the NHS. Confidence in managing emergencies, sensitive discussions, presenting cases, and updating relatives was low (0-35%). 75% requested teaching in assessing acutely unwell patients and decision-making. 60% wanted to improve teamworking skills.

Post-intervention: Confidence working within the NHS rose from 48% to 92%. 100% of MSWs reported that the teaching programme helped them prepare for work as doctors in the NHS. There was a greater understanding of the structure and function of the NHS, the role of allied healthcare professionals, plus the portfolio and professional development requirements of doctors (92%).

100% of MSWs felt their communication skills had improved. 87.5% reported increased confidence with informal conversation and 100% reported increased confidence in voicing opinions and raising concerns.

Additionally, 100% of MSWs reported increased confidence recognizing and assessing acutely unwell patients. Confidence in managing emergencies, sensitive discussions, presenting cases, and updating relatives improved (60-88%).

Conclusion:

This well-received, novel programme addresses some of the unique learning needs of MSWs and helps them prepare for work as doctors in the NHS. Collaborations with other trusts are taking place to establish whether the programme could be adapted for IMGs more broadly.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Simulated sessions are widely used within medical education. Despite the potential benefits of simulated learning, it suffers from a narrow scope of practice; acute, emergency presentations and procedural skills. There is less research for its utility in sub-acute and chronic disease management.

To develop expertise in medical practice, learners require sufficient foundational knowledge to facilitate more complex behaviours [1]. Within ward environments, lack of foundational knowledge in both ‘hard’ (knowledge) skills, and ‘soft’ (organizational) skills can limit learners’ potential for development. Considering legitimate peripheral participation theory, learners require ‘enculturing’ into an institution to develop ‘soft’ skills. Examples of ‘soft’ skills include understanding problem solving approaches, language, values and norms of the profession [2].

Aim:

To design and assess the educational impact of simulated ward round teaching sessions on medical students in semi-acute settings, focussing on ‘enculturing’ skills.

Methods:

This was a prospective study. We created a ward round-based simulation session, with six simulated patient scenarios, designed for clinical placement level medical students. Ten students were included in the study.

We utilized an induction exercise to familiarize students with medical documentation, a simulated ward round, and a consolidation exercise reviewing discharge paperwork and prescriptions. A simulated patient was present in each scenario, with a member of faculty facilitating. Simulated ward round entries, nursing handover queries and investigations were provided to students. Scenarios were 20 minutes; with objectives to produce ward round documentation and generate holistic clinical management decisions. Students participated in a ‘board round’, which served as a forum for station specific feedback.

Enculturing values were assessed via a 40-point, knowledge based formative assessment, covering the main themes of the session: appropriate documentation, medical abbreviations, and clinical decision-making. Assessment was administered both pre- and post-session. Qualitative feedback of the session was obtained from learners to identify themes for further development.

Results:

There was a significant improvement in knowledge following the session (see Table 1-A57). The results were analysed with a two tailed paired t test, with statistical significance reached (p = 0.0018). Positive qualitative feedback was given. The main themes of student feedback indicated improved confidence in the ward environment, with medical documentation and clinical decision-making.

Table 1-A57:

Results of pre- and post-intervention knowledge assessment

Student	Scores
	Pre test raw score (/40)	Pre test standardized score	Post test raw score (/40)	Post test standardized score	Absolute difference
1	16	0.40	36	0.90	+0.50
2	17	0.43	37	0.93	+0.50
3	28.5	0.71	37	0.93	+0.22
4	24.5	0.61	36	0.90	+0.29
5	16	0.40	29	0.73	+0.33
6	29	0.73	38	0.95	+0.22
7	30.5	0.76	36	0.90	+0.14
8	28	0.70	36	0.90	+0.20
9	33	0.83	36	0.90	+0.07
10	26	0.65	35	0.88	+0.23
			Mean Raw score Difference		10.75
			Mean Standardized Score change		+0.27
			p value (at 95% CI)		0.00018

Conclusion:

Our results demonstrate an increased sense of empowerment in the study population.

Simulated practice can be used effectively to enhance learning in sub-acute medical situations. Enculturing skills were particularly enhanced; promoting future learning through orientation within zones of legitimate peripheral participation.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Stress, anxiety and depression affect one-fifth of the working age population and are a leading cause of staff attrition and loss of productivity [1]. Conversations between colleagues can help reduce stress, increase job satisfaction and productivity, build stronger relationships, and create a more positive work environment [2]. In spite of numerous policy initiatives in large organizations and fewer in small [3], it is reported, by colleagues, that hands on ‘practice’ in having conversations would be beneficial. We were approached to create a remote live four-hour workshop with authentic simulated scenarios, appropriate for a cross cultural global reach, aiming to enable staff to feel ‘at ease’ with having proactive conversations with their colleagues on a daily basis.

Activity:

In 2021-2022, 120 hours were spent developing a live module for managers working in non-healthcare environments. This module was preceded by three online eLearning modules, ‘being aware, being proactive and being responsive’. After eight pilots, content and delivery was scrutinized, analysing feedback from participating managers, facilitators, and actors. In 2023, a further 24 workshops are underway, using the refined content and delivery structure; 144 actors, 24 facilitators and 24 simulation advisers are involved. Participants are global managers, clustered into geographical regions; module timings are amended to suit time zones and in total 192 participants are able to take part in small groups of eight. A 90 minute follow up a month later enables participants to discuss the personal areas of identified focus.

Findings:

Creating a safe space has been essential, with ongoing facilitator alertness. Participants have immersed themselves in the six scenarios covering loneliness, disillusion, over-work, depression, crisis and acute anxiety. Participants key areas of focus have included: being sensitive to situations, being a better observer, sharing values with staff, spending time with colleagues, scheduling time to look after oneself.

Timekeeping to ensure equity of discussion and involvement, and arrival and integration of the six actors have both been challenging, although mitigated by the pilot experience.

Conclusion:

This programme, incorporates online eLearning modules, a remote ‘live’ simulated module, and follow-up group sessions. By practising through simulated scenarios, there is significant potential to improve the support, retention and wellbeing of employees within this non-healthcare organization. The programme’s global scope, with five regions, highlights its relevance and applicability to a diverse range of workplaces. There is potential for replication in other organizations facing similar challenges, ultimately impacting on our society as a whole.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

The ‘Standards Framework for Nursing and Midwifery Education’ set out by the Nursing and Midwifery Council states that nurses are expected to develop ‘supervision and leadership skills’ [1]. However, band 5 nurses at a NHS Trust indicated their reticence about taking on ‘nurse in charge’ roles and wanted to build their confidence in engaging in challenging conversations with an assertive approach. As an education provider, we worked alongside the Trust nursing practice development team to develop and deliver a simulation-based workshop to help improve band 5 nurses leadership skills through simulated scenarios. The workshop was integrated into a leadership development day.

Activity:

To encourage all nursing staff to ‘embrace their inner leader’, The Royal College of Nursing described five ways to do so – be a role model, show emotional intelligence, motivate others, create shared goals and display courage [2]. Scenarios, with actors, were developed to allow practice of these strategies whilst having difficult conversations from within a leadership role and included: listening to a colleague with personal difficulties, dealing with angry relatives, supporting a patient after unwelcome news and discussing with a clinician concerns about professionalism and kindness. Participants were provided a communication framework (STEPS: start, time, empathy, provision of support, sense check)) to assist their preparation, pacing, framing and summarizing.

Findings:

Of the 12 sessions completed (n = 180 participants) the feedback thus far has been overwhelmingly positive. Comments from attendees to date include:

Everyone was so brilliant! I was so nervous about the simulation but (the facilitator) has been wonderful. Actors were amazing.

Facilitators have been so kind and knowledgeable.

Attending this study day has given me better confidence in my own ability to be in charge and deal with challenging situations.

STEPS has given me a very good guide in dealing with professional communication as a nurse in charge.

Live actors are very beneficial for us as it gives us real life actions to follow and deal with daily situations in the ward.

Immersive and interactive.

Conclusion:

This simulation-based workshop developed with RCN leadership values in mind, has supported 180 band 5 nurses with their leadership roles. It has been immensely well received and has assisted these nurses in their workplaces. Based on the success of the first 12 sessions, 12 additional sessions are planned with pre and post feedback data from attendees being collated for analysis.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

In July 2018 the government launched the national LGBT action plan to advance the rights of LGBT people to improve the way that public services work for them, regardless of their sexual orientation, gender identity or sex characteristics [1]. Transgender and gender diverse (TGD) [2], individuals continue to experience discrimination and disadvantages in accessing healthcare whilst often having complex health needs, furthermore, there is a gap in undergraduate curriculums on TGD patient care [3].

Activity:

A workshop was co-produced with members of the TGD community; scenario content was translated from their own experiences of prejudice and disrespect. In order to maximize participation, the scenario is delivered through forum theatre. It centres on an individual from the TGD community (played by a trans-actor) and the assumptions of a health professional (played by an actor). Audience members watch the scenario unfold; at closure of the first run through, the audience have a facilitated discussion. During the second run through, audiences are invited to change the behaviour of the health professional, leading to preferable, respectful and safe care. The actors have been trained to amend their actions as instructed by the audience members via the facilitator. After the simulation, the trans-actor de-roles and then describes the journey of transitioning their gender identity and presentation. The simulation and the lived experience are separated and treated as two separate elements of the training.

Results:

The co-produced scenario-based simulation has been successful in promoting respect and understanding of those from the TGD community. Audiences have been a broad range of professional groups: vocational, undergraduate and registrants. This session has been repeated over fifty times, with changes made to suit the audience background. Health professionals have had the opportunity to learn and practice appropriate communication skills. The lived experience component post-simulation was impactful in providing a personal insight into the challenges faced by TGD individuals. Participants reported an increase in knowledge of the needs of, and confidence in communicating with, members of the TGD community.

Conclusion:

The co-produced, replicable, scenario-based simulation, featuring forum theatre and lived experience, is an effective method of promoting respect and understanding of those from the TGD community. The simulation provides healthcare professionals with the opportunity to learn and practice appropriate communication skills. Separating the simulation with lived experience is an essential component, due to ethical and safety issues, although linking the two, strengthens the authenticity of the session.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Repeated attempts at peripheral intravenous (PIV) access cause increased discomfort and delays in treatment for patients in hospital. The use of ultrasound can improve success in PIV access, benefitting patient experience. Medical professionals are increasingly expected to use ultrasound when landmark techniques fail [1]. We sought to improve confidence using ultrasound for PIV cannulation with low-cost simulation models made from ADAMgel [2] or tofu in multiple teaching sessions.

Activity:

We organized teaching sessions with multiple specialties at St Richard’s Hospital. A total of 48 members of staff have been taught over four sessions. Prior to the teaching session learners were asked to complete a survey identifying previous ultrasound experience and rating confidence using ultrasound for PIV access. The teaching session consisted of an introductory multimedia presentation with a video demonstration, then practical experience. Models consisted of water-filled balloons placed in ADAMgel (Aqueous Dietary Fibre Antifreeze Mix gel) or tofu to simulate human tissue and veins, Figure 1-A52. Red dye added to the water in the balloons produced ‘flashback’ in the intravenous cannula. Modification of difficulty was achieved by changing the balloon depth. We then conducted questionnaires immediately after the sessions for feedback.

Figure 1-A52:

Models used to deliver teaching sessions. After ADAMgel became available this has been used exclusively due to it being more reusable compared to the tofu modelsA: tofu model with ultrasound image underneath.B: ADAMgel model with ultrasound image underneath

Findings:

The initial survey identified only 29% of staff had previously used ultrasound for PIV access, and half of these (15% overall) had only used it once or twice a year. Using a five-point Likert scale, 74% of respondents rated their confidence in using ultrasound as one or two out of five. All respondents thought they would benefit from further teaching in PIV access. Feedback after teaching sessions was favourable, with 95% of respondents finding the session very useful and 95% also believing it would increase their use of ultrasound in clinical practice. After the session, more than half rated their confidence in ultrasound cannulation as four or five out of five.

Conclusion:

We have demonstrated that there is a desire from medical staff to increase their competency in ultrasound-guided PIV cannulation. Using low-cost, high-fidelity simulation models with a blended learning method, we can deliver teaching sessions to a large number of medical staff. We hope to continue this teaching in collaboration with our sister sites throughout Sussex to increase confidence with ultrasound-guided PIV cannulation in this region.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Clinical placements are an essential part of physiotherapy education, providing students with the opportunity to gain practical experience in clinical settings. Due to the limited number of available placements [1], and the fact that simulated placements have emerged as an innovative approach to placement experience [2], we co-produced (HEI and simulation-based education provider) a placement programme for 80 BSc and 30 MSc undergraduate physiotherapy students. We describe the structure of the well evaluated and replicable large-scale simulated placement.

Activity:

Each student was provided with 40 simulated placement hours over one week, this was divided between hands on facilitated simulation, with follow-up synthesis and reflection of the learning outcomes. The facilitated sessions with actor role players centred around authentic scenarios which were level-matched and closely aligned with the HCPC Physiotherapy Standards of Proficiency [3]. The scenarios reflected the diverse society in which we live, with actors taking on roles of patients/relatives and colleagues, from a range of backgrounds, with differing demographics and characteristics, presenting in a broad range of situations. Students were able to reflect on their interactions, before, during and after the simulation; they received objective feedback from the actor, from the unique perspective of patient/relative or colleague, they received feedback from their peers and from the facilitator.

Findings:

The simulated placement, for both sets of students, was a resounding success. Both groups (BSc and MSc) worked through 10 scenarios. The larger BSc group required 20 separate facilitated sessions and 40 actors. For the MSc group, there were 5 facilitated sessions and 10 actors. As always, sustainability of programmes is linked to budget. Although a quantified analysis is yet to be completed, the time taken to organize the placement, write matched scenarios with clear learning outcomes, deliver the placement and evaluate, is time consuming. Continued co-production with shared facilitation (HEI and education provider) is a potential way forward, with re-use of scenarios and rotations; it is highly replicable, with a team of experienced facilitators and actors.

Conclusion:

Simulated clinical placements provide physiotherapy MSc and BSc students with a valuable, realistic learning experience, in a safe and supportive, facilitator-led environment. The placement was found to be effective in enhancing students’ communication skills, professionalism, empathy, and compassion. Involving actors was found to be an effective way of immersing students in realistic clinical scenarios. This is a reusable resource, so considering ‘return on investment’ would suggest repeating for future students.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Between April and September 2022, 11,496 internationally educated nurses (IENs) registered with the NMC for the first time, which is 606 less than those domestically educated within the same timeframe [1]. To register, IENs must pass OSCEs and although globally assessed, there is no specific communication skills assessment [2]. A literature review identified challenges associated with integration into culturally different healthcare systems, most notably communication barriers; however, it found that with good support it is possible for IENs to achieve their full career potential [3].

Methods:

To support local healthcare trusts and IENs, our organization designed a simulation-based educational programme to address the aforementioned barriers. To ensure a non-paternalistic approach, IENs lived experiences allowed the development of authentic, co-produced simulated scenarios. Actors were trained for the roles, and learning outcomes and debriefing processes were shared in advance. To assist participants with their skills, a model of communication was introduced, enabling them reference to a framework whilst participating and observing. Eight groups of six IENs have participated over eight months.

Results:

Thematic analysis identified themes in which IENs wanted to be upskilled, these were integrated into multi-faceted simulated scenarios:

Distressed relatives – IENs reported struggling setting appropriate boundaries and dealing with conflict with emotive relatives.

Difficult conversations with patients – IENs felt ill equipped to communicate with challenging patients due to anxiety through language and cultural barriers leading to avoidance of engagement, further exacerbating the issues.

Differing patient agenda – IENs struggled to manage patients who were not engaging with recommended multi-disciplinary interventions, due to a poor understanding of the MDT agenda.

Hierarchical adjustment – IENs typically came from countries with a more established hierarchy and did not feel confident clarifying doctor’s decisions even if concerned.

Evaluation linked to the learning outcomes; a rating scale from 1 (no ability/confidence) to 5 (excellent ability/confidence). 48 IENs have undertaken this training and all report progression in ability and confidence, with ongoing applicability of their learning within the workplace.

Conclusion:

The number of IENs is increasing within the NHS with recent records indicating NMC registrations being equal between domestic and internationally educated nursing staff. A repeatable simulation-based communication skills workshop has been developed based upon the lived experiences reported by IENs. Further deliveries are planned with subsequent quantitative and qualitative analysis.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

There is a well-recognized tension between clinical service provision and participation in learning events for junior doctors (JDs) in the UK [1]. JDs frequently report that they are unable to attend regular teaching due to departmental clinical pressures, representing lost opportunities for their training and development. Therefore, there is need for development of training methods which minimize impact on clinical service delivery.

Aims:

To develop a simulation training model for Emergency Department (ED) JDs which would a) deliver tailored learning objectives according to the participants’ level of training and b) have minimal impact upon ED service provision.

Methods:

The ‘Simulation and Personalised Education in the Emergency Department’ (SPEED) model was developed. On SPEED days, JDs and advanced clinical practitioners (ACPs) who were undertaking clinical duties in ED on that day were invited on an individual basis to participate in a twenty-minute clinical simulation. Upon completion, the participant underwent a ten-minute debrief to reinforce predetermined learning objectives and supply feedback to simulation tutors before returning to their clinical duties in ED. Pre- and post-session questionnaires were conducted to assess acquisition of learning objectives. Training days were conducted in EDs of a UK Major Trauma Centre (MTC) and an associated small teaching hospital (TH). Departmental data on time to be seen by an ED clinician were collected retrospectively for SPEED days and comparable non-SPEED days, with differentiation between the majors and urgent care (UC) MTC sub-departments.

Results:

A total of 7 SPEED days were conducted over 6 months between September 2022 and March 2023 – 5 in the MTC ED and 2 in the TH ED. 65 JDs and ACPs participated across the seven days. On asking about the usefulness of the SPEED session for day-to-day practice, 41 participants responded ‘strongly agree’ and 18 participants responded ‘agree’. 6 of the 7 SPEED days demonstrated a positive mean difference in post-session questionnaire score when compared to pre-test questionnaire. There was no statistically significant difference in time to see clinician between SPEED days and comparable non-SPEED days in MTC majors (1h11m vs. 48m), MTC UC (2h41m vs. 2h25m), or TH (1h15m vs. 1h8m) (Kruskal-Wallis test, p > 0.05).

Conclusion:

The SPEED model demonstrates acquisition of learning objectives which are relevant to day-to-day practice. There is no evidence that delivery of this model significantly affects waiting times in either a small or large ED. Adoption of this training strategy may improve training opportunities for other ED clinicians.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Practice based learning (PBL) remains a universal mandatory experience for physiotherapy students. Challenges of placement capacity were heightened by the impact of COVID 19 as well as growing demand in response to the NHS long term plan/interim people plan for growth in AHP workforce. These challenges provided opportunity to rapidly progress sustainable PBL capacity utilizing simulation as replacement and enhancement of PBL.

Having established simulation as placement replacement within the Faculty of Health & Wellbeing at University of Winchester [1], the simulated placement preparation (SPP) project aimed to explore the acceptability of simulation as preparatory enhancement of PBL, delivering a week of multilevel peer assisted simulated PBL; two primary objectives of reducing demand on capacity and optimizing students’ success in PBL through preparatory simulated activities.

Activity:

Simulation and learning focused on the development of digital capabilities in recognition of the Topol review that reflected the requirements of NHS workforce to be digitally capable [2]. Additionally, the KNOWSBEST study [3] recommended digital capability and simulation within PBL, thus simulated activities were designed to promote core digital capabilities including training and simulation in remote consultations and presenting simulated scenarios accessed via electronic patient records.

Collaborative learning in practice (CLiP) model of supervision was used to promote peer assisted learning with learning outcomes focused on communication and MDT domains of the common placement assessment form (CPAF), familiarization with digital technologies and orientation and management of scenarios in high acuity environments and enhancement of digital capabilities. The SPP week utilized mixed modality and fidelity simulated activities including ‘real play’ remote consultations, simulated patients, manikins/ventilators and virtual simulations.

Students completed faculty developed questionnaires pre and post SPP relating to self-assessed communication and telehealth capability and specific clinical competence in musculoskeletal and cardiorespiratory physiotherapy. A convenience sample of students participated in focus group interviews following subsequent completion of PBL to explore their perceived impact of SPP on subsequent PBL. Thematic analysis was used to analyse focus group interviews and pre-post anaylsis conducted using repeated measures ANOVA.

Findings:

Results demonstrated increased capabilities in teleconsultation and appreciation of digital technologies potential. Students reported enhancement of in person and remote communication as well as clinical capabilities in high acuity environments.

Conclusion:

Students reported the SPP week as an acceptable means of replacing one week of PBL, enhancing the preparedness for clinical environments and sustainably increasing placement capacity by providing 4440 hours of simulated PBL.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

The new Speciality Training curriculum for Palliative Medicine from August 2022 identifies key procedural skills that, for the first time, can be performed in a simulation (SIM) skills lab to demonstrate proficiency [1]. These include tracheostomy care, managing non-invasive ventilation (NIV) and the management of indwelling ascitic drains. These skills can be difficult to acquire in non-hospital settings like hospices and in the community. A bespoke, pilot palliative care skills day was organized to assess the suitability for theory, skills training and subsequent opportunity to demonstrate proficiency by sign off against curriculum competencies.

Methods:

A total of 11 palliative care trainees from the Northern Deanery attended a pilot SIM study day in March 2023. Three parallel workshops were planned – tracheostomy care, the insertion and management of ascitic drains and managing NIV. Each workshop was delivered by local experts in the area (non- palliative care professionals) with experience of teaching and training other professionals. assessing internal medicine trainees. Trainers were briefed on learning outcomes prior to the session by two palliative care consultants, and the clinical context of each session was set within relevant palliative care environments for e.g. the care of a patient in a hospice, in the community or in a hospital.

Trainee confidence was assessed before and after SIM training with the use of 10-point Likert scales and free text comments.

Results:

Overall self-reported trainee confidence and competence scores increased for all three workshops (Paracentesis 7 to 8.8 out of 10, NIV 4.5 to 8.6, tracheostomy care 3.8 to 8.9). All trainees agreed it was an effective and educational way of addressing curriculum objectives; and agreed it should be a rolling programme offered regionally. Trainees commented on the positive learning environment, the small group sizes, the benefit of being taught by experts and having the opportunity to be assessed for curriculum requirements. Trainees who had previously achieved competencies commented on the benefit of refreshing skills. One area for development identified was the lack of standardization on DOPs forms about the level of proficiency required. This will be fed back to the regional training committee for the future. Trainees identified further clinical skills that could be addressed in a skills lab and hence, a second skills day will be organized.

Conclusion:

SIM training is an effective tool for delivering training around procedural skills for palliative care registrars. It also brings opportunity to demonstrate proficiency in specific practical skills.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Transitions from CAMHS services to adult mental health care present a challenge to patients, carers, and professionals alike and are often managed poorly by services, leading to avoidable anxiety and adverse experiences for service users [1]. For patients with autism, transitions can be extremely distressing and require careful consideration and planning to ensure continuity of care. There is a lack of clarity for professionals and services users about what resources are available and appropriate for people with autism. This course is designed to provide professionals working in both CAMHS and adult mental health with a better understanding of autism and introduce strategies to improve the management of transitions and care of individuals with autism.

Methods:

Maudsley Learning, in collaboration with the ESTIA Centre, offered an online simulation training program on two occasions. The course aimed to provide participants with a clinical understanding of autism and autistic persons’ lived experiences, to equip participants with person-centred strategies to support individuals with autism, address the challenges faced by autistic individuals during child-to-adult transitions, and implement strategies to improve the care of individuals with autism who have co-morbid mental and physical illnesses.

The training began with group icebreakers and a didactic introduction to simulation training to establish psychological safety followed by five scenarios covering different aspects of ASD and the challenges faced by individuals with ASD during transition. To add higher fidelity and better learning experience, we involved actors with autism and intellectual disability. The Maudsley debrief model was used to provide constructive feedback to participants on their contributions and facilitate positive learning experiences.

Participants completed a questionnaire before and after the course assessing their confidence in skills related to the course. They also provided qualitative feedback on their experience and their willingness to apply their learning.

Results:

Paired samples t-tests did not find a significant difference in scores for course-specific questions between pre-course (M =16.75 SD = 2.50) and post-course (M = 20.25, SD =.50), t(2.64)=3 p >.0.05, 95% CI [-7.70,.70]. 100% of the participants reported that they would recommend the course.

Conclusion:

This course was co-produced and involved actors with autism and intellectual disability for better learning. The score improved slightly, but not significantly due to a small number of participants. All participants found the course helpful for their clinical practice and would recommend it. The course is best conducted in-person for optimal learning experiences.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Simulation based learning is becoming an increasingly important focus across medical curricula internationally [1]. The need for medical students to be both theoretically and practically competent is essential in the transition to becoming a successful junior doctor. High technology driven manikin simulations are useful, however access is limited by lack of equipment, finance, and training. In district general hospitals this restricts junior doctors’ exposure to teaching and students’ access to a diversity of cases. Utilizing junior doctors as Near Peer Tutors (NPTs) provides a real life equivalent to the simulation experience that comes closer to exposing trainees to the realities of hospital life as an on-call doctor [2].

Methods:

A 6-week programme originally designed in a separate NHS Trust was adapted and streamlined with improvements made to data collection, labour division and content delivery. Ten simulation sessions across two district general hospitals ran from 18/10/22 to 21/04/23 with 37 medical students and 8 NPTs. Each week focused on typical, in-hospital scenarios commonly faced by junior doctors. A self-assessment confidence survey and digital knowledge quiz was undertaken on the weekly topic followed by a 10-minute, high yield, interactive lecture delivered by a NPT. Students were split into groups of two and each group assessed the ‘acutely unwell patient’ with an ‘ABCDE’ styled approach to diagnosis and management. The NPT actor simulated improvement or decline based on the management decisions of the students. A STOP5 hot debrief ran at the end to give constructive feedback and promote discussion [3].

Results:

Self-assessment confidence scores by medical students were quantified against a 4-point Likert confidence scale. The students’ confidence rating improved by an average of 0.65 units (average pre-teaching = 2.40, average post-teaching = 3.05) (p<0.00001). Following the session, 35/37 students described themselves as ‘quite confident’ managing an emergency scenario compared with 13/37 prior to the session. Thematic analysis of the perceived benefit by students highlighted 3 main areas; an opportunity to engage in practical scenarios, utilization of A-E assessments, and the benefits of real-life actors. Students enjoyed the ‘informal setting’, ‘life like’ encounters, and expressed they would like to attend additional specialty specific sessions.

Conclusion:

NPT centred medical simulation in a low-cost environment is a compelling method of engaging junior doctors as teachers and equipping medical students with the skills to become future on-call doctors. We encourage the implementation of similar programmes alongside medical school curricula to supplement preparation for practice.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Training nurses to improve their ability and confidence to communicate effectively in difficult situations is beneficial [1]. Simulation is an effective method to replicate difficult communication situations with colleagues, family or patients and improves communication skills [2]. Iyasere et al., (2022) [2] determined improving perceived confidence to communicate increased team-performance specifically amongst nurses. The main purpose was to evaluate the effectiveness of using simulation-based communication scenarios to improve critical care nurses’ perceived confidence to communicate in difficult situations.

Methods:

Fourteen (Band 5 and Band 6) critical care nurses attended three sessions of communication simulation. Participants were invited based on manager feedback either requiring improved communication or demonstrating excellent communication skills, an equal number from both spectrums attended each session. A diamond debriefing model was used after each scenario as the debriefing model provides reflection resulting in improved practice [3]. Debriefing was conducted by training simulation faculty. A survey was used to measure perceived confidence and ability to communicate in three difficult situations: escalating concern, next-of-kin communication (NOK) and colleague interaction. The survey was presented pre-, post-simulation and at six-weeks post.

Results:

Results showed an increase in confidence and ability to communicate in all three communication situations, as shown in Figure 1-A37. The largest improvement was within NOK communication, increasing from 6.73 to 8.77 (1-10 scale), the smallest change was ‘ability to escalate a concern’, however pre-simulation it achieved the highest level of confidence. Six-week post scores remained higher than pre-session ratings in all situations, but did drop slightly from post-session. Difficult communication with a colleague had the lowest score at each measurement interval.

Figure 1-A37:

The average rating (1-10) of perceived confidence in each simulation element, at each interval

Conclusion:

Simulation-based training is an effective method to increase Critical Care nurses perceived confidence to communicate in demanding situations. Communication situations involving colleagues remains the most challenging communication scenario for nurses. Improving confidence to communicate is essential to effective team working and patient-centred nursing practice. Further study is needed but initial results suggest the method is beneficial to improve critical care nursing practice.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Whether clinical or non-clinical, patient facing or not, staff working in a healthcare environment will need to initiate or manage challenging conversations in the workplace, with colleagues, patients or relatives/carers. How well and how compassionately these more difficult interactions are handled is critical to whether the conversation is effective, and leaves all parties feel respected and heard, even if the issue itself cannot be resolved. If there is negative escalation of the situation, trust is undermined, leading to further complications, distress and potential error. This can have a significant impact on team working, and ultimately on the patient or their relative’s experience [1].

Activity:

Evidence was gathered from a large NHS Trust during the two-month long design of the workshop. The aim was to enable participants to learn communication strategies and techniques helping them to effectively manage challenging conversations with kindness and compassion. In 2020, five standalone sessions were delivered online (a result of the geographical size of the Trust rather than a result of the pandemic); there has been a further six online deliveries per year to date, with constant review and revision. Content includes: Active listening, empathy, communication strategies, appreciative enquiry, an exploration of values, and opportunities for reflection. The scenarios cover colleague to colleague interactions (Teams meeting), frustrated relatives (phone call), isolated patient (video consultation) and unsafe colleague (face to face). All are effective in an online environment, and are authentic and relatable.

Findings:

Over 300 NHS staff have participated over three years. Evaluation shows they agree or strongly agree that their skills and knowledge has improved, the scenarios were relevant and authentic, and the mode of participation provided a valuable opportunity to practice new skills in a safe environment. All felt more confident to hold challenging conversations that would be more mutually positive and avoid escalation. Consistently, participants have commented on the positivity of receiving feedback from each other and the involvement of actors was found to be highly beneficial, with feedback from them, from their perspective, uniquely insightful.

Conclusion:

For the last three years, staff from a large NHS Trust have been able to learn and practice challenging conversations, through online, live simulation, with ‘real’ patients, relatives/carers and colleagues. They have explored why conflict occurs and practised strategies, stopping and restarting, rehearsing and debriefing. Participants have requested further sessions and stated they would highly recommend all colleagues to undertake this training.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Research suggests that interprofessional training wards (ITW) enhance student learning and patient satisfaction [1] but are resource intensive from governance and faculty training points of view. Given NHS pressures, we developed a simulated ITW to meet training needs of healthcare undergraduates and improve attitudes and confidence regarding interprofessional working prior to qualification.

Methods:

The session simulated a typical ward day, with nursing handover, ward-round, board-round, communication scenarios, and an acutely deteriorating patient. Final year medical, nursing and physiotherapy students attended, and formed interprofessional teams. After each scenario an interprofessional debrief took place. Students completed the readiness for interprofessional learning scale (RIPLS) [2] pre and post, also providing feedback using Likert scales and qualitative comments.

Results:

35 students participated, all completing RIPLS, and 32 completing Likert and qualitative feedback. Despite the small dataset, we demonstrated significant change (p<0.05) in 9 of the RIPLS statements, indicating a positive change in attitudes toward interprofessional learning.

All students felt the session met their learning requirements. Likert feedback across professions demonstrated increased understanding and valuing of multi-disciplinary teams (MDT) (97%); appreciation of the relevance of multi-disciplinary working to their training (91%); belief that it would change their approach to MDT work (84%); and increased confidence prior to transitioning to a working role (81%). Profession-specific breakdown demonstrated highest confidence and increased understanding for physiotherapists, however they (alongside nurses) found the content more challenging.

Figure 1-A35:

Summary of infographic for SUIT ward

Thematic analysis highlighted several key themes: Interprofessional teamworking, patient-centred care, communication, professional readiness, technical skills, and satisfaction with session format and delivery. Interprofessional teamworking, patient-centred care, and communication bridged the categories of ‘valued aspects’ and ‘take-home messages’, demonstrating uptake of key learning points, and reinforcing the changes in the RIPLS data. While the feedback regarding the ‘suggested improvements’ category reiterated the challenges of catering to all learners, this category’s comments were overwhelmingly positive, with appreciation and importance of this learning event appearing frequently. One wrote, ‘I feel incredibly lucky to have had the opportunity to take part… and strongly believe every single healthcare student should have the chance to attend a similar session’.

Conclusion:

Our pilot program suggests that using simulated ITWs offers multiple benefits to students. The simulated ITW environment improved confidence and understanding of interprofessional roles in clinical practice; and was valuable and relevant to learners with early signs of improving attitudes towards interprofessional learning. A full study is needed to fully assess the learning benefits and cost-effectiveness of simulated ITW environments.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

The Medical Support Worker (MSW) Programme, funded by NHSEI, enables International Medical Graduates (IMG) and refugee doctors to work in the NHS, whilst acquiring General Medical Council (GMC) registration [1]. MSWs and IMGs have a recognized set of learning needs, with communication difficulties the most reported challenge amongst IMGs [2]. North Bristol Trust (NBT) employed a second cohort of 30 MSWs in July 2022, all of whom previously practiced medicine in Myanmar. NBT enlisted the assistance of a local Community Theatre to create and deliver a novel training programme with an emphasis on improving confidence in communication.

Methods:

Reflective pieces completed by MSWs one month in to post, alongside two probing questionnaires, highlighted the demand for communication training. A local Community Theatre, with prior experience of working with migrants, refugees, and vulnerable groups, was contacted. The Community Theatre met with both current and former MSWs to further identify development needs. Subsequently four two-hour workshops, with specific focuses, were designed:

Session 1: Informal conversation, talking about yourself

Session 2: Voicing opinions and interpretations, acknowledging mistakes

Session 3: Talk about yourself, interview practice, body language

Session 4: Public speaking, dealing with conflict

Workshops consisted mostly of games and small group activities with an element of performance. The programme was evaluated using a feedback form, consisting largely of Likert scale questions, completed after the 4th session.

Results:

Communication, social skills or cultural change were highlighted as the biggest challenges by MSWs (64%). Confidence in tasks that involved speaking in front of groups, dealing with conflict, or speaking to relatives was low (13.6-22%). Only 52% of MSWs felt confident speaking to colleagues.

The sessions were well received with 100% of respondents reporting both to have enjoyed the sessions and that they would recommend the sessions to other MSWs.

Results showed improvements in confidence, specifically with regards to: conversing with colleagues (94%), informal conversation (87.5%), public speaking (88%), raising concerns (100%) and offering opinions (100%).

Conclusion:

This novel locally developed communication training addresses some of the unique learning needs of MSWs and improves communication skills in a range of areas. The programme is being considered for expansion to international nurses and IMGs at NBT.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Delayed airway management was identified in 70% (9 of 13) of Insitu simulation (ISS) with an average time of 3.42 minutes from identification of the problem to management. The resuscitation council UK suggest that in most patients presenting with a compromised airway, simple actions are sufficient to stabilize them, failing to do so increases the risk of hypoxia and multi-organ failure [1]. To address this trust wide training was initiated through the ‘skills2u’ programme, where toolbox teaching was taken to the wards.

Methods:

Across a two-week period, a multiprofessional team comprising of the simulation faculty, anaesthetists, and advanced clinical practitioners, visited all clinical areas and delivered a short 10–15-minute practical ward-based interactive session to the interprofessional team. The session covered airway assessment, airway opening manoeuvres and opportunity to practice inserting basic airway adjuncts.

Results:

412 clinical staff, of all grades and disciplines, were taught in basic airway management of the deteriorating and arrested patient. Evaluation of the teaching revealed 95.5% of staff agreed it was relevant to their role and 98% agreed they now felt better prepared to respond to changes in a patient’s condition. In the subsequent three months, technical skills performance errors for airway management were identified in 15% of 10 ISS completed. In these simulations the average time taken to manage the airway from identification of the problem reduced to 1.39 minutes.

Conclusion:

Using ISS to identify technical skills performance errors followed by a trust wide ward-based education programme is an effective way to enhance patient safety.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Registered healthcare professionals undertake a wide range of mental health work, sometimes with little preparation and training [1]. Increasingly non-registered staff take on mental health call-handler roles, having conversations with vulnerable individuals over the phone; these staff often lack the training to effectively communicate with callers. The aim of this initiative was to design and deliver a telephone skills training program for non-registered NHS mental health call-handlers, with the hypothesis that such training would improve their communication skills and overall job performance. Studies have shown that receiving training in having supportive mental health conversations over the phone increases staff confidence and changes their attitudes [2] and has the potential to benefit staff retention.

Methods:

A mixed-methods approach was used in the design, incorporating both qualitative and quantitative data collection and based on the needs and feedback of the call-handlers themselves. Evidence shows that involving simulated patients (SPs) can be effective in telephone studies [3]; leading us to train experienced SPs in their roles as members of the community phoning the help line. All was face to face, although conducted over the phone with the SP hidden. Active participants, the SP and the observing participants all became involved in the debrief. The content covered active listening, empathy, signposting and options in handling the challenging situations. Developed over a month, the programme was delivered as part of an overall training for their roles.

Results:

The evaluation of the session indicated significant self-rated confidence in having calls with members of the public. The scenarios increased in intensity, covering topics ranging from bullying, domestic violence, gambling addiction and intent to take life. Qualitative feedback from the call-handlers showed that they felt more confident and prepared in their roles, and were better equipped to handle challenging situations. The involvement of SPs was also found to be authentic and highly beneficial by the call-handlers. Participants requested frequent practice sessions, face to face or online.

Conclusion:

Investing in providing targeted training and support for non-registered NHS mental health call-handlers, can have a positive impact on their communication skills, overall job performance and likely staff retention. This can ultimately lead to improved quality of care and patient outcomes in the mental health sector. The involvement of SPs can provide a valuable learning experience, both in role and in the debrief, for call-handlers, and help to prepare them for real-life scenarios.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

It is well established that simulation is a powerful tool for developing empathy in healthcare students [1]. Previous simulation designs surrounding the ‘patient experience’ have focused on putting the learner into the patient’s position and mimicking health conditions [2]. Empathic Simulation (ES) is a novel simulation design which focuses on healthcare students thinking of ways to improve the patient experience whilst a simulated patient (SP) wears an audio-visual headset recording device. This allows for an immersive video-assisted debrief session where students see how they are perceived through the eyes of the patient, promoting self-reflection and behavioural awareness to a higher degree compared to previous techniques [3].

Methods:

In March 2023, ES was trialled by 36 3rd year medical students during a ‘Patient Experience Week’ whilst on placement at a District General Hospital. The simulation focused on an SP wanting to self-discharge due to an accumulation of poor experiences during their hospital stay. Students were encouraged to determine and resolve these issues using the resources available to them in a simulation suite. Throughout the simulation, the SP wore a Microsoft HoloLens to record the scenario from their viewpoint. Afterwards, the recording was used to stimulate discussion during an immersive debrief session.

Students provided pre and post-simulation feedback using an online polling software. This included rating their confidence with various scenarios, e.g. discussing with patients who wish to self-discharge the reasoning behind their thoughts. Further feedback was also collected via a follow-up survey.

Results:

28/36 students provided feedback at the end of their ‘Patient Experience Week’. There was an average of 24% increase in confidence across all scenarios (average rating of 3.1 vs 4.3) and a 16% increase in confidence in the ability to empathize with patients experiencing long-term health conditions (see Figure 1-A26). In a follow-up survey, 9/10 students believed that they were more empathetic towards patients because of the ES session and learnt more about themselves compared to usual simulation debriefs. Moreover, 10/10 students felt their communication skills had improved following the session.

Figure 1-A26:

Average confidence ratings reflecting various scenarios were gathered from students before and after the ‘Patient Experience Week’ in March 2023. This figure demonstrates the average confidence ratings for scenarios related to Empathic Simulation before vs after the session.

Conclusion:

Empathic Simulation may be an effective simulation design to improve empathy and insight into the patient experience as well as situational and self-awareness in healthcare students. Research into the effectiveness of this novel simulation will be explored in the future.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

As international migration continues to shape the healthcare workforce globally, the United Kingdom (UK) has seen a significant increase in internationally educated (IE) nurses, midwives and allied health professionals (AHPs) [1]. These healthcare workers are vital to maintaining healthcare services, yet they face multiple challenges including language pronunciation, culture shock, and lack of social support [2]. The aim of this NHSE funded project was to identify the experiences of IE registrants, then develop and deliver a sustainable set of simulation-based workshops equipping established nurses, midwives and AHPs with the necessary skills to be allies [3].

Activity:

The project design involved a mixed-method approach. Qualitative data was collected from across the region through focus group discussions and semi-structured interviews with IE registrants and with Trust leads for inclusivity and diversity. The findings were analysed and authentic story boards and scripts for scenarios were developed, cross checking back to source. These then became the core of a ‘re-usable’ workshop with skilled actor role players and facilitators. Allyship is introduced, advantage and privilege discussed, pre-recorded films analysed, and simulation is through live face to face encounters and forum theatre. The workshop centres on cultural allyship and the four pillars of allyship, which include awareness, empathy, action, and sustainability.

Findings:

Face to face simulation-based experiential learning has enabled participants to explore different scenarios and gain insights into the challenges faced by IE registrants. Workshops have been delivered on 20 occasions to groups of around 20, predominantly UK educated, nurses, midwives and AHPs. The impact has been significant; over 400 participants have benefitted, with evaluations of the workshop comprehensively positive. The participants reported increased awareness of their own biases and privilege, improved empathy towards IE registrants, and increased confidence in taking action to support them. The workshop ends with each participant making a pledge, showing their commitment to being an ally to IE registrants.

Conclusion:

Equipping UK educated nurses, midwives and AHPs with the skills to be allies to IE registrants is essential, not least because this is about being respectful and compassionate to one another, but also retaining our recruited workforce helps us all deliver safe healthcare. These repeated workshops, adaptable for different professional groups, are an effective way to achieve the goal of being active as an ally. The workshops have the potential to be replicated in other healthcare settings to promote cultural allyship, and improve healthcare outcomes for all.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Collaborative learning is recognized as essential in ensuring the delivery of safe and effective healthcare. It is fundamental to creating the healthcare teams of the future [1,3]. Central to this, is the early exposure of healthcare students to multiple, healthcare professions to begin the process of thinking and practising in a more interprofessional way. Importantly, how the interprofessional experience is assessed is crucial to the success of collaborative learning. This was the background to the development of an interprofessional module within the School of Nursing & Midwifery at Queens’ University Belfast.

Aims:

(1) To collaborate on the development of additional IPE workshops to supplement an established interprofessional simulation model. (2) To develop an assessment component for the interprofessional activities, including interprofessional simulation. (3) To evaluate the process.

Methods:

Drawing upon the expertise associated with the implementation of a highly successful interprofessional simulation programme, an interprofessional education (IPE) group was established with representation across the Faculty. From the outset, there was a need to have a shared understanding of the module and its complexities, and to work together to collectively support the pedagogy, shaping student learning and assessment, and providing the best educational experience [2]. The team collaborated on sourcing and establishing IPE workshops, developing reflective questions, as well as working on designing and integrating an online video within a digital platform, and streaming all students to one interprofessional workshop. An evaluation questionnaire was created using Microsoft Forms. The 17-item questionnaire incorporated three Likert scales, plus two either/or answers and two questions on digital device/browser. The questionnaire had 10 qualitative ‘free response’ questions to allow candidates to elaborate, expand, clarify or illustrate their answers.

Results:

The collaboration with staff across the Faculty of Medicine Health & Life Sciences resulted in the establishment of four additional IPE workshops to complement an established six. Total number of IPE workshops, n = 10. These workshops were positively evaluated by both students and staff and one workshop contributed to a national IPE award. Importantly, the video-based, reflective, summative assessments submitted following participation in the IPE workshops were of a high standard with students reflecting on the importance and value of having the opportunity to engage with other professions and on how the IPE simulated workshops adding to their learning.

Conclusion:

Interprofessional opportunities that utilize a reflective video-based assessment contribute positively to the student experience and are a welcome addition to the undergraduate nursing curriculum.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

In 2021, a diverse international and inter-professional team designed and implemented an intensive in-person simulation week and an interactive online learning programme to enhance student preparation for clinical placement (the Clinical Placement Enhancement Project) supported with funding from Health Education England. The simulation programme aimed for students to develop their patient-centred communication skills, assessment and therapeutic management by attending three simulation scenarios and inter-professional understanding through participation in a multi-disciplinary team (MDT) meeting. The bespoke online programme was designed with similar learning outcomes and utilized various learning materials, including 360° images of clinical environments linked to case studies.

Methods:

The study design was an integrative mixed-methods feasibility study, with 29 AHP students participating in the simulation and 24 students taking part in the online arm of the study. Students from physiotherapy, occupational therapy and podiatry self-selected their preferred delivery mode for placement preparation. The evaluation explored the experiences of both domestic and international students attending the simulation and using the online learning. In addition, perspectives of the clinical educators and actor role players were explored. Data were inductively analysed using a reflexive thematic approach and integrated with the quantitative data.

Results:

The key findings from the pilot study showed the value of the simulation programme in allowing students to apply their learning, particularly helping them to develop their confidence in communication, rapport building and interventions. By contrast, the online learning programme was most effective at developing students’ clinical reasoning and proficiency with documentation [1]. We have built on these findings this year, to upscale the simulation programme to include all first-year AHP students (n = 130). We have reduced the number of scenarios from three to one, choosing the frailty scenario as this meets the generic outcomes for the programme and the profession-specific learning outcomes. We have retained the MDT simulation as an inter-professional simulation but modified the delivery from a ‘fishbowl style’ to a theatre forum to increase capacity. We have updated the online learning programme to be used as a supplementary learning resource before and during the simulation week. The content has been organized into inter-professional and profession-specific learning materials so that the site is easily navigated and accessible.

Conclusion:

By combining the immersive simulation with the online learning, we have created a sustainable and achievable approach to better prepare AHP students for clinical placement, and this combined approach may help to reduce the burden for our clinical educators.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

Over the last decade, there has been increasing awareness of the prevalence of gender-based violence with increasing recognition of its disproportionate impact on vulnerable adults and children [1]. When these vulnerable adults and children may present to services, healthcare professionals have an opportune position to recognize this and act as an agent to signpost these individuals to relevant services. Individuals suffering from gender-based violence prefer practitioners to ask about the possibility of violence as it is easier for them to disclose this in response to the question than to offer the information unprompted [2]. While communication skills are taught to various degrees in medical schools around the country, the authors of this project recognized that many medical schools did not address these issues in these sessions. Consequently, a communication-based skills day was developed that addressed this and offered an opportunity for training and simulation of scenarios.

Aims:

These sessions aimed to improve students’ confidence in recognizing indicators of abuse and asking individuals if they were subject to forms of violence or abuse.

Methods:

A half-day teaching programme was produced for final year medical students. This comprised of a talk on the indicators of gender-based violence, suggestions on how to approach enquiring about gender-based violence and simulation scenarios incorporating gender-based violence. The scenarios were designed to include indicators of violence aforementioned in the talk to enable students to practise question asking.

Pre- and post-session questionnaires were used, and students were to rate their confidence on a scale of 1–5 of how confident they felt asking these questions and recognizing indicators of violence.

Results:

Twenty-three students partook in the two sessions delivered. Pre-session data suggested that students had received minimal teaching on the indicators of violence. After completion of the sessions, there was a 57% increase in the students’ confidence in recognizing a victim of violence and a 51% increase in confidence in asking whether an individual had been subject to violence. Qualitative data suggested that students valued simulation incorporating indicators of violence and opportunity to sensitively enquire if someone had experienced violence. Overall, students felt better equipped to address future scenarios where an individual may have been subject to violence.

Conclusion:

Our teaching session increased the confidence of final-year medical students in recognizing the indicators of violence and their ability to sensitively enquire about any violence that an individual may be subject to.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.