The simulation community has been keen to share their reflections and strategies on how sustainability can support and enhance the quality and impact of health and care simulation activities. Many of the abstracts received demonstrate that our community is aware, concerned and actively developing sustainable solutions [4–15].

One of the primary aspects of sustainable simulation is resource efficiency. Health, care and educational institutions are often limited by budget constraints and environmental concerns. Sustainable simulation strategies help them make the most of their investments in simulation technology and facilities. By maximizing the utilization of their human resources, material, equipment and space, institutions can reduce costs and minimize their environmental footprint [4,5].

Moreover, sustainability in health and care simulation promotes the development of accessible, environmentally and economically responsible technological solutions. Low-cost solutions often involve finding affordable, non-disposable alternatives to expensive simulation tools and props. Durable, reusable materials, for example, drive both eco-friendly and cost-effectiveness goals simultaneously [6,7]. On the other hand, the use of cutting-edge technologies, such as virtual reality, provides immersive learning experiences while reducing the use of disposables, associated waste and travel [8,9].

Sustainable simulation also encourages collaborative partnerships among health, care and educational institutions, and industry stakeholders. These partnerships can facilitate the sharing of resources, expertise, best practices, and the development of standardized or innovative solutions. This collaborative approach ensures that health and care simulation activities maintain a high level of quality and relevance while conserving resources [10–12].

Furthermore, sustainable simulation aligns with the broader goals of health and care education and practice. By promoting resource efficiency and responsible use of technology, it prepares health and care professionals to be mindful of resource allocation at work. This is especially relevant in a world where sustainability and health and care outcomes are interconnected [13].

Sustainable simulation practices are inherently scalable. They can be adapted to accommodate growing student populations without a proportional increase in costs or environmental impact. This scalability is essential as health and care education strives to meet the rising demand for skilled professionals [14,15].

In conclusion, sustainable simulation is a pragmatic approach to improving health and care education and practice. By adopting sustainable practices in health and care simulation-based activities, we can ensure that these invaluable training tools remain accessible, effective and aligned with the evolving needs of health and care. As we move forward, let us embrace our evolving principles of sustainable simulation as means to elevate the quality and impact of health and care education, ultimately leading to better care and a more responsible use of resources.

We invite you to continue this reflection and call to action during the 2023 ASPiH Conference in Brighton, 6–8 November 2023, which has a vibrant and rich scientific programme, as illustrated by the abstracts selected for publication in this special issue of the International Journal of Healthcare Simulation.

Acknowledgements:

Thank you to everyone who responded to the call for abstracts for this year’s ASPiH conference and to the scientific committee members involved in the reviewing process.

A 2-year Multisector Pharmacist (MSP) Foundation to Advanced programme was devised providing structured supervised learning, progressing to clinically enhanced independent prescribing (CEPIP). MSPs identified the need for additional physical assessment skills (PAS) training to support achieving the CEPIP. A secondary care Trust has an established simulation suite which could be utilised to support CEPIP learners and Health Education England vision that simulation can improve the quality of health and care by providing equity of opportunities for learners and improving patient safety through gaining vital skills [1]. We aimed to design simulation-based scenarios to support MSPs PAS required to complete the CEPIP, measure the relevance of the simulation events held against individual learning needs, identify key learning points from each event through evaluation, and make recommendations for future events

Methods:

MSP trainee representative, Pharmacy Education leads and simulation practitioners working group scoped suitable scenarios designed for MSP. Simulation practitioners delivered the scenarios on two separate events during 2022 with experience pharmacist facilitation support for feedback. The target audience was MSPs and event opened up to pharmacists from other sectors undertaking the CEPIP course to maximise simulation suite use.

Data was collected through a Likert scale learner evaluation form completed immediately after each event, this encompassed relevance for the individuals learning needs, key learning points gained and recommendations for future sessions. Comments were thematically analysed. Ethical approval for the study was not required.

Results:

5 MSPs and 2 CEPIP learners from other sectors attended the PAS sessions.

100 % responses (n=7). All agreed sessions were relevant for individual learning needs and appropriately pitched. The key learning points were: •

Benefits of practising PAS within a safe environment

Structured feedback on PAS by simulation facilitator supported individual development

Future recommendations were for more cases and simulation sessions.

A limitation of the study was that it included a small number of learners however key themes could still be identified.

Conclusion:

Collaboration with the simulation suite and pharmacy has demonstrated the value of simulation to support PAS within a safe and structured environment. Future events to support PAS will be scheduled with the aim for these to become multi-professional and to further develop local networking.

Reference

1. Health Education England. Enhancing education, clinical practice and staff wellbeing. A national vision for the role of simulation and immersive learning technologies in health and care. November 2020. https://www.hee.nhs.uk/sites/default/files/documents/National%20Strategic%20Vision%20of%20Sim%20in%20Health%20and%20Care.pdf [Accessed on 30/06/2022]

Student midwives frequently encounter bereaved parents as part of their experience in clinical practice. Yet many students report feeling unprepared and anxious when caring for them during this difficult time [1]. Consequently, midwifery students often lack the necessary skills in communicating with bereaved parents and providing emotional support which can impact on the quality of care that parents receive [2]. The evidence on how best to educate and train students in this aspect of care is limited both in scope and quality [3]. Therefore, this study explored student midwives lived experience of participating in an immersive, unfolding bereavement scenario based on a real clinical situation using standardised patients.

Methods:

Interpretative Phenomenology was employed to collect and analyse data from semi-structured interviews conducted with a sample of nine student midwives. Mezirow’s Transformative Learning Theory was also used as a lens to analyse the data.

Findings:

Three key super-ordinate themes emerged from analysis of the data. Firstly, ‘a rollercoaster of emotions’ captured the complexity of feelings and emotions the students experienced as they encountered the bereaved parents for the first time. Secondly, ‘trying to console and making things easier’ depicted the deep sense of powerlessness and the professional dilemmas experienced as the students struggled to emotionally console and communicate the right words to say to the grieving parents. Thirdly, ‘a unique learning experience’ conceptualised the students’ transformational journey as they critically reflected on significant aspects of their learning, identifying the professional and personal insights that would enable them to provide effective care.

Conclusion:

The findings of the study highlight the powerful role of simulation as an experiential model of teaching bereavement care within undergraduate midwifery education that can transform student midwives’ ability to provide compassionate care to bereaved parents during this traumatic time.

References

1. McKenna L, Rolls C. Undergraduate midwifery students’ first experiences with stillbirth and neonatal death. Contemporary nurse. 2011;38(1–2):76–83.

2. Ockenden D. Ockenden report. Emerging findings and recommendations from the Independent Review of maternity services at the Shrewsbury and Telford Hospital NHS Trust. APS group on behalf of the Controller of Her Majesty Stationery Office. 2020 Dec 10.

3. Alghamdi R, Jarrett P. Experiences of student midwives in the care of women with perinatal loss: a qualitative descriptive study. British Journal of Midwifery. 2016;24(10):715–22.

A recurrent theme from child safeguarding practice reviews at a local and national level where a child has died or suffered significant harm has been the failure of practitioners to exhibit professional curiosity, challenge and have difficult conversations with children and their families about their concerns [1]. In 2015 the local safeguarding children partnership developed multi-agency/professional classroom training on ‘difficult conversations’. What was missing was practitioners having the opportunity practise theory/strategies for having difficult conversations in a safe learning environment. Although there is a history of Simulation education being integral to experiential learning of hospital-based staff this is not the case for community practitioners [2].

Activity:

The aim of the training was to enable senior health visitors (HVs)` to understand why having difficult conversations is key to keeping children safe, reflect on practice build confidence, knowledge, and competence. The scenarios were based safeguarding concerns identified from clinical practice. The training was held in the Education Centre Simulation Suite which was set up for one clinic scenario and four home visits. The use of visual and audio equipment enabled all participants to watch the simulation in another room. Actors were used to play the roles of an older and young mother. This added to the realism of the scenarios

Results:

Feedback was collected pre- and post-simulation. Prior to the session all seven participants said they felt confident having a difficult conversation. Nevertheless, post-training all said they enjoyed the session and would like simulation to be part of their ongoing professional development because it provided an opportunity to identify communication blind spots, reflect on practice, tips, and tricks to move conversation forward and future practice changes.

‘Improving (our) communications skills. Regular feedback to improve service.’

‘Having feedback from the actors provided honest feedback and advice’

Conclusion:

This was the first simulation training, areas for improvement were identified during and after the session. For example, the debriefing after the third scenario was altered as the facilitator felt some participants were defensive. As a result, participants were less defensive when feedback was given. The HVs found simulation provided a safe learning environment to develop and hone their skills on holding difficult conversations which keep` children safe. The intention is to develop a proposal to have simulation training as part of the multi-agency/professional difficult conversations training offer and to create a Simulation Facilitator role for community staff.

References

1. National Society for the Prevention of Cruelty to Children (NSPCC) 2022 Recently Published Case Reviews: Case Reviews published in 2022. https://learning.nspcc.org.uk/case-reviews/recently-published-case-reviews [Accessed on 21/06/2022]

2. NHS Health Education England. Simulation. 2016. https://www.hee.nhs.uk/our-work/simulation [Accessed on 21/06/2022]

Doctors within the NHS from black, Asian, and minority ethnic (BAME), and International Graduate backgrounds face differential attainment in their progression in the NHS and share differing experiences. It has been reported by the GMC that higher rates of complains against International Graduates may reflect the lack of induction and social integration within the NHS culture [1]. Virtual Reality (VR) provides an immersive platform, with viewers able to involve themselves in realistic scenarios remotely. We utilised 360-degree VR to produce a realistic scenario on the differing experience of a BAME, International Graduated Doctor on their first day in the NHS.

Methods:

We created a 360-degree VR scenario reflecting a realistic situation of a new International Graduated Doctor and the impact on the behaviours in the professional and social aspects of the NHS. The scenario whilst fictional was informed by real experiences faced by Trainees in our Trust from BAME and other minority groups. The scenario was presented through VR headsets and post-video feedback was gained with anonymous surveys to Trainers (n=16) and Trainees (n=27) from differing ethnic backgrounds.

Results:

100% of participants found the video helpful, would recommend it to colleagues, felt immersed in the scenario due to the use of VR, and would be interested in similar Virtual Reality scenarios on different diversity topics. Within ethnicities, the majority of Caucasian participants felt able to talk and raise issues regarding diversity and inclusivity whilst ethnic minorities did not (Table 1). Comments gave insight to participants and their own experiences – with a British participant reflecting ‘Felt ashamed that I have never thought of what happens to my colleagues new to the system’ and ethnic minority participants feeling that the scenario ‘resonated with their experiences’

Table 1:

Differing opinions based on ethnicity on comfort in talking about and raising issues regarding diversity and inclusivity in the workplace

Conclusion:

VR and 360-degree platforms allow an extremely immersive and realistic resource for sharing difficult experiences faced by healthcare workers from various backgrounds within the NHS. Importantly viewers are able to experience and be involved in difficult scenarios within a safe and non-threatening space, allowing reflection and the empowerment for speaking up. By utilising this immersive educational tool, we were able to share the differing experiences faced within the NHS by BAME and International Graduate groups, allowing reflection for change. We hope to further utilise this platform to share the many experiences faced by healthcare workers thus providing insight into the diverse community and improving diversity and inclusion within the NHS.

Reference

1. NHS Medical Workforce Race Equality Standard (MWRES); 2020 data analysis report for the NHS

medical workforce. July 2021.https://www.england.nhs.uk/wp-content/uploads/2021/07/MWRES-DIGITAL-2020_FINAL.pdf [Accessed on 21/06/2022]

Effective communication in the healthcare setting is essential for safe clinical practice and providing good patient care. Doctors frequently request and receive clinical tasks and information over the telephone, a skill which became even more important during the COVID-19 pandemic [1]. However, these skills are rarely incorporated into the medical school curriculum and new Foundation Year 1 (FY1) doctors lack the confidence and ability to effectively communicate over the telephone [2]. The aim of this project was to improve the confidence of medical students in communicating over the telephone in a clinical context using scenarios.

Methods:

A team of post-foundation doctors created seven telephone-based scenarios representative of what a FY1 doctor could commonly experience on a ward. Each patient scenario involved two telephone calls to healthcare professionals (e.g.: doctors, nurses, pharmacists, allied health professionals) and/or patient relatives who were role-played by clinical teaching fellows (CTFs). Tasks included making requests and referrals, taking collateral histories, asking for specialist advice, and updating the next of kin. Students entered the simulation suite individually and received a short verbal handover along with patient notes, then used their clinical judgement to decide who to call. The remaining students observed the live video stream with audio from a different room and also had access to the patient notes and results. A tutorial was given before the simulation session on confidentiality, how to use a hospital telephone, and how to use the ‘Situation, Background, Assessment, Recommendation’ (SBAR) referral tool. All students completed questionnaires before and after the simulation and confidence was measured on a 10-point Likert scale. Student-led debriefings after each scenario were facilitated by CTFs.

Results:

A total of twenty-two fourth-year medical students participated. 73% had never received any formal teaching on telephone communication. 40% had never used the telephone during their clinical placements. 41% were not aware of the SBAR tool prior to the session. The questionnaire results from pre-simulation (M=4.24, SD=1.30) and post-simulation (M=6.57, SD=1.47) indicate that there was a statistically significant increase of students’ confidence in communicating over the telephone, t(22)=4.1, p<0.001. Free-text feedback demonstrated an improved understanding of the most appropriate person to call in different situations.

Conclusion:

Our results demonstrate the benefit of simulation in increasing the confidence of medical students in telephone communication. Formally incorporating this training into medical school curriculums may improve patient care involving FY1 doctors and ensure safer communication in clinical practice.

References

1. Schrager SB. Managing a Telephone Encounter: Five Tips for Effective Communication. Fam Pract Manag. 2020;27(3):4.

2. Marshall SD, Harrison JC, Flanagan B. Telephone referral education, and evidence of retention and transfer after six-months. BMC Medical Education. 2012;12(1):38.

The Curriculum for Internal Medicine Training [IMT] outlines that simulation should be used as a teaching tool during the three years of training to consolidate clinical knowledge and incorporate the importance of human factors in the clinical workplace [1]. Although simulation is used as the mainstay of teaching procedural skills for IMT trainees, we identified that there was no immersive simulation beyond this offered to these trainees at our Trust. This inspired us to design an immersive one-day simulation course, which we called MEDICS [Managing Emergency Decisions and Interventions in Critical Situations]. This course, aimed at IMT year 2 and 3 trainees, gives them the opportunity to lead in common medical emergencies, practise task prioritisation, and prepare for the role of medical registrar, with human factors integrated into these immersive scenarios.

Methods:

We used the IMT curriculum and our discussions with IMT trainees to design seven scenarios with emergencies from each core speciality, which were highlighted as areas where IMT trainees felt less confident. Following each scenario, we held a 30-minute debriefing to highlight key clinical learning points and discuss the impact of human factors in the delivery of care.

Results:

Post-course feedback for both pilot courses were overwhelmingly positive, with all candidates feeling that the course improved their confidence in dealing with these medical emergencies and enhanced their preparation for the role of medical registrar.

Conclusion:

Immersive simulation is an effective means of giving IMT trainees the opportunity to practise leadership, delegation, and task prioritisation to improve their preparation for the step up to medical registrar.

Reference

1. Joint Royal Colleges of Physicians Training Board, Curriculum for Internal Medicine Training Stage 1 Training, Federation of Royal College of Physicians 2019. https://www.jrcptb.org.uk/sites/default/files/IM_Curriculum_Sept2519.pdf [Accessed on 24/06/2022]

Hospitals are dynamic healthcare environments, adapting to challenges including increasing demand through the design and construction of new clinical areas. In-situ simulation has been used effectively in clinical settings to assess the strength and suitability of these clinical environments prior to their use [1]. Additionally, simulation has been more recently used in critical care settings to evaluate adaptations required in response to new challenges, including the COVID-19 pandemic [2]. We ran a one day in-situ simulation-based session called Simulation for Stress Testing and Operational Readiness in Critical Care (SSTORCC) to evaluate the operational readiness of a new twenty-four bedded critical care unit built at our hospital prior to its official opening to patients and staff. The aim was to assess the operational readiness of the new critical care unit and evaluate its safety for patients, with the objective being to identify problems that would affect this. The attendees were key members of the team and stakeholders so that issues that arose from the session were addressed in a timely fashion.

Methods:

This in-situ simulation session followed a patient’s journey from admittance to the new critical care unit and incorporated all aspects of patient care, including accessing the unit, the ergonomics of the bed space, and equipment availability. We simulated several emergency situations including emergency intubation and cardiac arrest, and a transfer from the unit to another area of the hospital.

Results:

The session identified key areas of development and modifications required prior to the move of patients and staff to the new critical care unit. These included ensuring access to the unit for relevant staff at the hospital, clear labelling on each equipment trolley, assembly of emergency drug boxes for each of the four areas of the unit, and raising awareness about the location and opening of the new unit to the wider hospital.

Conclusion:

In-situ simulation is a constructive tool to use in stress testing a new critical care unit and allows for efficient recognition of areas which require immediate action prior to being considered ready for operational use.

References

1. Frommelt J, Noeller T. In situ Simulation to Evaluate the Readiness of a New Clinical Space. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2022.

2. Fregene TE, Nadarajah P, Buckley JF, Bigham S, Nangalia V. Use of in situ simulation to evaluate the operational readiness of a high-consequence infectious disease intensive care unit. Anaesthesia. 2020;75(6):733–738.

The success of the biannual ‘QMC Craniotomy Simulator Course’ [1] led to the development of the permanent Nottingham Neurosurgical Simulator and teaching programme, to provide regular in-house simulation opportunities for neurosurgical trainees and rotational junior doctors. The intention was to emulate training in the aviation industry by providing early exposure to basic neurosurgical procedures in a safe and controlled environment, in preparation for the transition to performing these on patients. The simulator comprises the ROWENA (Realistic Operative Workstation for Educating Neurosurgical Apprentices) simulation model [2] alongside surgical equipment identical to that used within the department. We have evaluated the impact of delivering monthly teaching sessions over the course of 3 years and will also present the anticipated future direction for this programme.

Methods:

35 teaching sessions have been delivered since 2019, totalling 75 hours of teaching, and 260 training man-hours. 16 sessions have been attended by trainee or registrar grade doctors, and 24 by junior doctors. The simulator can also be used for independent practice, of which 5 hours have been formally logged. The most popular and commonly delivered teaching topics have been patient positioning and 3-point headrest use (n=9) and insertion of intracranial pressure monitors (n=12) in addition to creation of burr holes (n=15) and craniotomies (n=7) using a variety of different drills. A dedicated session on ward-based procedures for incoming junior doctors has recently been implemented as part of the mandatory induction training.

Results:

Feedback collected has consistently demonstrated an increase in self-reported confidence in performing a procedure following simulation teaching. 23 clinicians have achieved formal accreditation in safe use of the 3-point headrest as assessed by a senior consultant and accreditation in ultrasound-guided insertion of external ventricular drains will soon be offered. Assessment using the MOSATS (Modified Objective Structured Assessment of Technical Skills) tool [3] is currently being introduced to objectively track progress of attendees over time.

Conclusion:

We have shown that regular neurosurgical simulation teaching improves the confidence of trainees and is suitable for accreditation of key procedural elements. We hope to further show that this is also reflected by objective improvement in skill as assessed using the MOSATS tool. We intend to develop the programme further by designing a prescribed curriculum and formative assessment process for both early years trainees and junior doctors.

Conflict of interest:

Mr Ashpole is the inventor of the ROWENA simulation system.

References

1. Kumaria A, Chan H, Javed S, Dapaah A, Mitoko C, Glancz L, D’Aquino D, Ashpole R. Training on a craniotomy simulator improves neurosurgical operative performance. BMJ Simulation and Technology Enhanced Learning. 2019; 5 Supplement 2: A13.

2. Ashpole RD. Introducing ROWENA: a simulator for surgical training. Royal College of Surgeons Bulletin. 2015;97(7):299–301.

3. Gough M, Solomou G, Khan DZ, Kamel M, Fountain D, Kumaria A, Ashpole R, Sinha S, Mendoza N. The evolution of an SBNS-accredited NANSIG simulated skills workshop for aspiring neurosurgical trainees: an analysis of qualitative and quantitative data. Acta Neurochirurgica. 2020;162(10): 2323–2334.

COVID-19 has reduced training opportunities for surgical trainees, foundation doctors, and medical students [1]. With elective surgery cancelled, millions of patients on waiting lists, strict requirements on physical distancing, and trainees looking to meet numbers for competencies, it is difficult to achieve the necessary exposure and experience required as per the GMC’s ‘Outcome for Graduates’, the Royal College of Surgeons of England, and the UK medical undergraduate curricula [2,3]. Thus, a hybrid, one day surgical simulation course, aligned to the curricula was designed for attendees to assess, resuscitate, and manage unwell surgical patients.

Methods:

Candidates were chosen from the region on a first-come, first-serve basis, amongst medical students, foundation doctors, and core surgical trainees. Interactive workshops in the morning were based around theatre etiquette, surgical instruments, suturing, as well as assessing unwell surgical patients. These were followed by high-fidelity surgical scenarios, whereby the candidates were expected to reach a diagnosis, devise an initial management plan, and prepare their patient for theatre. The afternoon consisted of the same candidates carrying out the procedure required for their patient in a theatre setting with senior support available. Medical meat was used for the practical skills component and props, such as a Boyle’s machine were used to simulate the theatre environment. The faculty also played the roles of theatre staff, including an anaesthetist, a scrub-nurse, a floater, and a runner. A high-definition audio-visual system streamed the simulation to the other candidates in the debriefing room. Each scenario was followed by a structured debriefing discussing technical and non-technical objectives, facilitated by surgical consultants. Pre- and post-course questionnaires were completed.

Results:

Post-course, all candidates (n=8) provided scores for specific questions. An average of their response for each question, marked out of 10, is presented in Table1.

Conclusion:

It is vital to ensure that early exposure to surgical specialities is not disrupted as that is significantly detrimental for tomorrows’ surgeons. Based off evaluation, our course was highly successful in achieving the goals described previously. The variety of candidates at different stages in their surgical career, sharing similar positive opinions about this course further highlights its suitability for all. We endeavour to run more of these courses in the United Kingdom and abroad to ensure that medical undergraduates, as well as surgically inclined junior doctors can develop key surgical competencies and thus are well equipped when caring for surgical patients.

Table 1:

Survey results from 8 participants out of 10 points

References

1. Munro C, Burke J, Allum W, Mortensen N. COVID-19 leaves surgical training in crisis. BMJ 2021;n372.

2. Carr A, Smith J, Camaradou J, Prieto-Alhambra D. Growing backlog of planned surgery due to COVID-19. BMJ. 2021;372:n339.

3. General Medical Council. Practical skills and procedures. 2019. https://www.gmc-uk.org/-/media/documents/practical-skills-and-procedures-a4_pdf-78058950.pdf?la=en&hash=9585CB5CA3DA386B768F70DAD3F62170C2E987E5 [Accessed on 18/07/2022]

Simulation followed by debriefing has been acknowledged as a fundamental training approach in healthcare education as it can provide safe experiential learning opportunities. Although many institutions adopt full-scale simulation (FSS), it is very costly (e.g. specialised training facilities, simulators, …). Facilitated mental simulation which is supported by simple visual representations to involve several learners together can be used for cognitive skills rehearsal face-to-face or remotely via an online video conferencing platform. We call this approach Visual-Enhanced Mental Simulation (VEMS) [1].

This study aims to explore the perspectives of nursing students and lecturers concerning VEMS as a simulation modality.

Methods:

This IRB-approved study (aHSK/PGR/UH/03692) used a mix method approach targeting 150 adult nursing students exposed on at least one occasion to either or both FSS and VEMS followed by debriefing and all healthcare lecturers from a UK-based higher education institution. For further exploration of students and lecturers’ perspectives about VEMS and its effectiveness, they were invited to take part in a telephone interview. The lecturers were from nursing, midwifery, and physiotherapy. All of them received a VEMS guide to get a better idea of what it is and so they could think about its application in their programme. Participating students had previous exposure to VEMS.

Preliminary Result:

Qualitative data of the study were analysed using thematic analysis with NVivo 12. 10 students and 10 healthcare lecturers agreed to participate in a telephone interview. Both students and lecturers positively perceived VEMS. As the facilitation method of VEMS is very similar to full-scale simulation [1,2], students indicated that they were able to practise their non-technical skills. The identified downside of VEMS is that students find it difficult to communicate with a poster while the facilitator vocalises the patient’s voice. Nevertheless, students agreed that this method was helpful to practise decision-making skills and should be more integrated into the curriculum. Lecturers found it was a cost-effective and easy to set up classroom-based activity which could be used as a learning activity. They also found various ways of remotely facilitating VEMS to overcome the challenges of delivering training while maintaining learners’ physical distancing.

Conclusion:

VEMS provides lecturers and nursing students a cost-effective low-technology and a practice-based activity [3]. Followed by debriefing, it can be used in a nursing curriculum to mentally practise nursing skills in a safe and engaging environment. Obtaining feedback from lecturers from other disciplines can promote its use in different settings.

References

1. Dogan B, Pattison N, Alinier G. A form of mental simulation with significant enhancements enabling teamwork training. Int J Healthc Simul 2021;1:56–61.

2. Alinier G, Meyer J, Naidoo V, Campbell C. Simplifying simulated practice for healthcare professionals and educators. Journal of Emergency Medicine, Trauma and Acute Care. 2016 (2-International Conference in Emergency Medicine and Public Health-Qatar Proceedings):79.

3. Alinier G, Tuffnell C, Dogan B. Simulation on a Low Budget. In Clinical Simulation 2019 Jan 1 (pp. 667–689). Academic Press.

Whilst simulated patient (SP) inclusion in Medicine communication training is well established [1]^, a review of parallel literature for undergraduate Pharmacy programmes showed such research as extremely limited. The novel nature of a Pharmacy communication course (UK university) required a more detailed appraisal than existing module evaluations offered, so a study of student attitudes towards the course was undertaken. On commencement of a new MPharm programme in 2013, pharmacy and specialist clinical communication staff collaborated to develop an ambitious communication and professionalism course utilising a longitudinal 4-year complex simulation. The course is designed to meet the General Pharmaceutical Council (GPhC) standards and address the need for pharmacists to, ‘understand the complexities of patients’ circumstances insofar as they are relevant to their medicines use or other behaviours relevant to personal health and wellbeing’ [2]. During the course, SPs present a series of fictitious patient/family journeys lasting years enabling students to contemplate the role of pharmacists in the provision of continuity of care. Students are encouraged to consider appropriate professional identity development and acquisition of clinical communication abilities, while also investigating the perspectives of family members and healthcare team members involved in cases. The feasibility of sustaining an effective longitudinal SP programme has been questioned [3], but the current four-year programme has been successfully maintained since the 2016–2017 academic year. Student cohorts range from 59–164 and participate in two simulation sessions per year. Logistical challenges, in addition to significant cost and time resources, have included retention of SPs to present consistent characters over years, integration of curricula revisions, and continuous updating of an extensive longitudinal simulation handbook. We aimed to explore students’ attitudes towards MPharm communication and professionalism training and to understand how its elements impact on student perceptions.

Methods:

In 2020, shortly before the coronavirus 2019 pandemic, 3 focus groups and one in-depth interview were conducted with undergraduate students from each year of the MPharm programme. A framework analysis method is being used to identify main and sub-themes from the data.

Results:

Preliminary thematic analysis findings indicate a student focus on fear of exposure, recognition of professional values, confidence building in the application of knowledge, and the importance of integration of teaching and placement activity.

Conclusion:

There is limited research in the use of SPs in undergraduate Pharmacy education with regards to how it helps them to develop in the domain of communication skills and professionalism and we hope our study will contribute to filling this gap.

References

1. Aspegren K. BEME Guide No. 2: Teaching and learning communication skills in medicine-a review with quality grading of articles. Med Teach. 1999 Jan 1;21(6):563–70. doi:10.1080/01421599978979

2. General Pharmaceutical Council (GPhC), Future pharmacists: standards for the initial education and training of pharmacists. London: GPhC; 2011.

3. Bokken L, Linssen T, Scherpbier A, van der Vleuten C, Rethans J-J. The longitudinal simulated patient program: evaluations by teachers and students and feasibility. Med Teach. 2009;31(7):613–620.

International Medical Graduates (IMGs) are making up an increasing proportion of the medical workforce in secondary care [1,2]. One of the most popular routes to enter clinical practice in the United Kingdom is through Trust-based Clinical Fellow posts, particularly for those not yet working at Consultant level [2]. At the Royal Wolverhampton NHS Trust (RWT), Clinical Fellows now make up almost half of non-Consultant doctor positions, working alongside, and equivalent to, colleagues that are in traditional training positions. Doctors employed by Health Education England, have specific training pathways that are funded centrally [2]. Conversely, doctors in non-training positions, including Clinical Fellows, do not have access to the same level of structure and funding. This also applies to educational opportunities, including Simulation-Based Education. IMGs often join the National Health Service with a wealth of clinical knowledge, skills, and experience. However, a local learning needs analysis revealed that their biggest challenges lie around differences in healthcare systems and culture. These skills are essential components of non-technical skills, which, we would argue, are ideal to be addressed using a simulation-based approach.

Methods:

The results of the learning needs analysis informed the development of a bespoke simulation-based course for Clinical Fellows at RWT. We discuss the challenges of developing and organising such a course, as well as the successes and learning points gained from a pilot course.

Results:

A pilot course was delivered to three cohorts of Clinical Fellows. All 23 of the participating Clinical Fellows had undergone medical training outside of the United Kingdom. The course comprised a variety of workshops and simulation-based scenarios covering a range of non-technical skills. Pre- and post-course surveys demonstrated significant positive outcomes in all areas, including communication, respectful challenge, breaking bad news, and medical handover.

Conclusion:

Simulation-based education provides a beneficial learning environment for Clinical Fellows. For a group whose biggest learning gap lies with non-technical skills, it can be argued that this cohort of doctors is likely to have a greater benefit from simulation-based education than colleagues that have worked and trained within the United Kingdom. It is envisaged that this data can enable the Clinical Fellow Programme Team to obtain funding for further simulation-based courses aimed at Clinical Fellows in all medical specialties, hence having a positive impact on patient care and safety across the Trust.

References

1. Baker C. NHS staff from overseas: statistics. House of Commons Library; 2021

2. Jalal M, Bardhan KD, Sanders D, Illing J. Overseas doctors of the NHS: migration, transition, challenges and towards resolution. Future healthcare journal. 2019;6(1):76–81.

There is international agreement that undergraduate healthcare students should be prepared for practice by experiencing Interprofessional Education (IPE) [1]. As a result, in the last decade IPE has become established in the curriculum of undergraduate health and social care education. Simulation-Based Education (SBE) provides an immersive, authentic experience to explore teamwork for undergraduate healthcare students.

Methods:

A paediatric SBE course was developed for undergraduate physiotherapy (PT), medical (M), and children specialty nursing students (CN) with intended learning outcomes focussed on teamwork. During the course, three participants (one from each discipline) worked collaboratively to address the needs of a simulated patient. One scenario focussed on recognition and management of an unwell child and the other scenario was discharge planning. Following the scenario, interprofessional faculty co-facilitated a structured debriefing using the Plus/Delta model. The course was evaluated using the ‘Readiness for Interprofessional Learning Scale’ (RIPLS) [2]. The RIPLS scale measures attitudes to learning with other professionals on a five-point Likert scale. In order to gather additional qualitative data, the RIPLS was adapted to include free text questions. Statistical analysis of the pre- and post-course RIPLS was conducted using SSPS and thematic analysis was used to analyse the free text comments. The qualitative analysis is reported here.

Findings:

Thirty-three students have participated to date (12 PT, 13 M, 8 CN). The four subscales of RIPLS were used as a framework for the thematic analysis. Most of the students described valuing the collaboration and teamwork during the course that enabled delivery of patient care ‘practice working as a team in a safe environment’. Almost all student feedback suggested they benefited from the opportunity to work together to deepen their understanding of roles and responsibilities ‘becoming aware of other professionals’ assessments and job roles’. Many of the participants’ feedback suggested they had positive professional identity, valuing sharing knowledge between the members of the interprofessional team to enable effective decision-making, ‘working with other professions, sharing knowledge to make clinical decisions’. Students also described benefiting from working with an interprofessional peer group ‘working with colleagues of the same level of other professions’.

Conclusion:

Students developed their interprofessional working relationships and attitudes during this SBE course which was viewed as a positive learning experience. The literature often discusses challenges to implement interprofessional simulation [3]. This course has shown it is feasible to deliver interprofessional SBE to enhance team working.

References

1. World Health Organisation. Framework for Action on Interprofessional Education and Collaborative Practice. Geneva: World Health Organisation; 2010

2. Parsells G, Bligh J. The Development of a Questionnaire to Assess the Readiness for Healthcare Students for Interprofessional Learning (RIPLS). Medical Education. 1999;33:95–100

3. Gough S, Hellaby M, Jones N, MacKinnon R. A review of Undergraduate Interprofessional Simulation-Based Education. Collegian. 2012;19(3):153–170.

Fibreoptic intubation training has traditionally been performed using real fibreoptic scopes and manikins or improvised airway ‘boxes’, recently progressing to virtual reality training devices [1]. The latter are populated with computer generated images, represented 2 dimensionally on screens without depth perception and fail to reproduce the natural variation. We aimed to address these issues by producing a simulator that utilises a real patient’s anatomy, in a mixed reality platform, without the need for additional hardware.

Methods:

Health Research Authority Ethics approval was obtained. A digital imaging and communications in medicine (DICOM) file from an anonymised CT scan of a patient’s head and neck, was processed in Avizo data visualisation software. It was segmented into anatomical structures and 2 tissue densities (bone/cartilage and soft tissue). This was imported into the Unity game engine as a 3D model. A fibreoptic scope with functional eye piece, monitor (to display the virtual fibreoptic scope image) and reference plane were also modelled. These objects were placed into a scene using the Windows Mixed Reality Toolkit to allow component interaction and support the application to a Hololens 2 mixed reality headset. Azure anchors were used to site the simulation in a real-world location and allow consistent position between use sessions (Figure 1). The gesture recognition function of Hololens was used to enable grasping and manipulation of the fibreoptic scope controller and voice commands were also enable for key actions. Its use was piloted by the developing team.

Figure 1:

Mixed reality fibreoptic intubation simulator, Hololens views.

Results:

Using a DICOM file creates a detailed an anatomically accurate image, though it lacks surface characteristics (texture/colour variation) that make features appear natural. The virtual monitor is an interesting psychological construct, being a virtual view from within a virtual world. However, this performed well, with sufficient frame rate and resolution to feel natural. The physics of a flexible scope proved challenging, so we modelled this as a rigid structure for proof of concept. We also noted that the inclusion of collision avoidance would increase usability and realism.

Conclusion:

There is a deliverable workflow from CT scan to mixed reality training. If refined this could be used to prepare for airway management in specific patients e.g. airway cancer [2]. Automating the DICOM import process would give access to the wealth of clinical variation available through existing CT databases and support a broader/higher level training experience.

References

1. Baker PA, Weller JM, Baker MJ, Hounsell GL, Scott J, Gardiner PJ, Thompson JM. Evaluating the ORSIM® simulator for assessment of anaesthetists’ skills in flexible bronchoscopy: aspects of validity and reliability. Br J Anaesth. 2016;117 Suppl 1:i87-i91.

2. Ormandy D, Kolb B, Jayaram S, Burley O, Kyzas P, Vallance H, Vassiliou L. Difficult airways: a 3D printing study with virtual fibreoptic endoscopy. British Journal of Oral and Maxillofacial Surgery. 2021;59(2):e65–71.

Recent events have resulted in widespread migration to technology-enhanced learning (TEL) including virtual reality (VR). Simulation remains essential [1] for foundation year doctor (FYD) training but access is dependent on significant resource and faculty requirements. VR allows FYDs to interact safely with virtual patients/healthcare professionals in 3D with a headset. This could complement existing simulation-based training. Over 200 FYDs work across the sites of Oxford University Hospitals NHS foundation Trust (OUHT). They already receive high-fidelity simulation and online teaching. We aimed to identify the best way to add VR to this teaching programme and assess its value in the context of anticipated challenges such as cohort/faculty sizes, space/equipment limitations, and available teaching time.

Methods:

The Oxford Medical Simulation (OMS) VR platform was used [2] as we already have extensive experience with this system in undergraduate education. FYDs were consulted in the design of teaching models with varying faculty and equipment requirements (Figure 1). Sessions involving faculty were offered on a voluntary sign-up basis. Feedback was requested from FYDs and educators.

Figure 1:

Virtual Reality (VR) teaching models for the Foundation Year Doctors (FYD). Virtual Reality Simulation for the Foundation Programme.

Results:

Initial reaction was encouraging. An FYD consulted at the design stage remarked: ‘…the scenarios were all really useful and enjoyable to work through. I think they are pitched at exactly the right level for FY1/FY2 … I also found it straightforward to access any of the investigations and resources that I needed in the scenarios and found the guided feedback really helpful too.’ Despite this, participation was surprisingly low, thereby limiting model evaluation. Early qualitative feedback suggested a preference for 3D over 2D this is supported by only 39/208 FYDs requesting home access. In response 3D sessions were increased but attendance remained low. Ongoing efforts are being made to maximise exposure and evaluate the programme as well as investigating the low participation level. Availability of dedicated teaching time and proximity to the end of the academic year could be important contributors.

Conclusion:

The negative impact of the pandemic on trainees’ wellbeing and burnout risk has been nationally recognised alongside the reduced ability of trainers to protect training time [3]. Although the limited initial response was positive, technology and novelty alone cannot be relied upon to support training recovery. Learning from this project is being used directly to improve models for the next cohort and feedback to those involved in organising FYD education at the Trust.

References

1. United Kingdom Foundation Programme Office (UKFPO). UK Foundation Programme Curriculum 2021. 2021. https://foundationprogramme.nhs.uk/curriculum/ [Accessed on 29/06/2022]

2. Oxford Medical Simulation (OMS). Oxford Medical Simulation – VR training for optimal patient care. https://oxfordmedicalsimulation.com/ [Accessed on 29/06/2022]

3. General Medical Council. The state of medical education and practice in the UK. 2021. https://www.gmc-uk.org/about/what-we-do-and-why/data-and-research/the-state-of-medical-education-and-practice-in-the-uk [Accessed on 30/06/2022]

A hybrid course was designed utilising areas of the Specific Learning Objectives (SLOs) within the new Royal College of Emergency Medicine (RCEM) curriculum launched in August 2021 [1]. Emergency Medicine (EM) trainees must develop a wide range of clinical knowledge, practical skills, as well as critical thinking and rapid decision-making ability to assess, resuscitate, and manage critically ill and injured patients. The low occurrence of these situations within the clinical arena results in significant challenges with regards to providing experience and training.

Methods:

The new RCEM curriculum was reviewed with a focus on SLO 6 (Proficiently deliver key procedural skills in Emergency Medicine) and SLO 7 (Deal with complex or challenging situations in the workplace), and a one-day ST4 course was developed. Half of the course featured interactive presentations and hands-on procedural workshops with medical meat, models, and part-task trainers. The other half provided immersive simulation-based scenarios covering additional presentations and skills. Each session was facilitated by senior faculty who are experts in their respective domains. A high-definition audio-visual system streamed the simulation to the other candidates viewing it from the debriefing room. Each scenario was followed by a structured debriefing discussing technical and non-technical objectives. Pre- and post-course questionnaires were completed. The course ran in November 2021, March, and April 2022.

Results:

All trainees (n=29) provided scores on how useful they found the day, with an average score of 9.8 out of 10. The pre-course questionnaire highlighted that the trainees were looking to be more confident in approaching high acuity, low occurrence (HALO) procedures. In the post-course questionnaire, majority of the trainees described increased confidence and safe techniques learnt from being able to practise skills and drills on appropriate models and medical meat.

Conclusion:

The post-course questionnaires were reflective of our course meeting SLO 6 and 7 of the new RCEM curriculum. The majority of trainees commented on feeling a lot more confident in approaching HALO procedures after having had the opportunity to practise during the course. Our plans are for all ED ST3/4s to attend in the next few months, with a view to this becoming a regular part of their training programme. Furthermore, we plan to develop advanced courses for higher speciality trainees, as these would be beneficial in meeting the RCEM curriculum outcomes but also ensuring trainee satisfaction and encourage confident and safe practice.

Reference

1. Royal College of Emergency Medicine, RCEM CURRICULUM. 2021. https://rcemcurriculum.co.uk/ [Accessed on 29/06/2022]

3D printing allows for the rapid production of novel 3 dimensional (3D) models. Its use, both for medical [1] and non-medical purposes, has seen exponential growth in recent years. Including the 3D printing of airways as part of the preassessment process [2]. Within medical education it has already been used for a variety of purposes [3]. Here we explore how it is being used for simulation-based training in airway management and how its use could be further developed.

Methods:

Pubmed was searched using the terms; 3 dimensional (or 3D) and printing and airway or anaesthesia/anaesthetic and teaching (or training or education). Papers were excluded if their focus was not on airway training, if they were not written in English or did not contain original research. The themes of model creation process and their role for teaching was reviewed.

Results:

20 results were returned. However, 13 did not focus on airway management, leaving only 7 results. Models design was created via, de novo design, from pre-existing electronic 3D renders or from cross sectional imaging and then using a computer processing to extract a 3D render which is then optimised before being printed. These cross-sectional images came from either patient specific datasets or from open-source image libraries. Of the papers reviewed the majority were regarding designs for front of neck airway trainers with other uses being for bronchoscopy as well as one paper that was looking at recreating patient specific pathology both for preoperative simulation but also helps in discussions with patients.

Conclusion:

These methods provide an interesting opportunity for training. The ease of creating one off components with 3D printing, allowing for the creation of a variety of pathology, seems to be poorly exploited. Instead, most of the work so far has been on 3D printing ‘normal’ airways. There is a significant technical skill required to convert patient anatomy into specific models, which slows adoption of such techniques. Work will also need to be done to assess if these models have greater educational value compared to more traditional models, especially when considering patient specific models for use for pre-procedure practice.

References

1. Aimar A, Palermo A, Innocenti B. The Role of 3D Printing in Medical Applications: A State of the Art. J Healthc Eng. 2019;2019:5340616.

2. Ormandy D, Kolb B, Jayaram S, Burley O, Kyzas P, Vallance H, Vassiliou L. Difficult airways: a 3D printing study with virtual fibreoptic endoscopy. Br J Oral Maxillofac Surg. 2021;59(2):e65-e71.

3. Garcia J, Yang Z, Mongrain R, Leask RL, Lachapelle K. 3D printing materials and their use in medical education: a review of current technology and trends for the future. BMJ Simul Technol Enhanc Learn. 2018;4(1):27–40.

The mortality gap experienced by individuals with severe mental illness (SMI) remains high, with SMI patients having a life expectancy of 10–20 years lower than the general population, suggesting that these patients are benefiting less from advances in healthcare [1]. The past decade has seen an increased focus on policy and guidance to reduce restrictive interventions in mental health settings [2]. A large teaching hospital in South London identified a need to improve the care of patients with mental health needs in the acute Trust. This study presents the findings of a simulation-based training focused on reducing restrictive practices in acute settings with the aim of improving skills and knowledge in caring for mental health patients.

Methods:

The simulation courses were interprofessional and delivered online over 2 days. Day one involved didactic teaching around common mental health presentations, de-escalation skills, the public health approach to reducing restrictive practices when working with mental health patients in the Acute Trust, legal frameworks, referral pathways, and personal wellbeing. Day two comprised of 4–5 scenarios covering a range of common mental health presentations in the acute Trust, including Delirium/agitation/psychosis; Emotionally Unstable Personality Disorder, Angry Relative scenario, Hypoxia and craving meds/cigarettes, Bipolar. The simulations involved specially trained actors as simulated patients to ensure consistency and to allow for improvisation in their responses to participants. Actors represented the diverse communities of South London, and Equality, Diversity, and Inclusion was considered from the development stages discussed in debriefings. Participants (n=65) completed a pre- and post-course questionnaire measuring their confidence in course specific skills and human factors skills, as well as collecting qualitative feedback on their experience of the course and intention to apply the learning.

Results:

Participants (n=65) showed a statistically significant difference between their pre- (M=90.40, SD=19.96) and post- (M=100.03, SD=21.01) course human factors scores, t(64)=5.06, p<.001, CI[0.359, 0.891], with a moderate effect size of d=0.63. There was also a statistically significant difference between their pre- (M=33.11, SD=6.18) and post- (M=38.83, SD=4.59) course specific skills scores, t(64)=8.78, p<.001, CI[0.778, 1.393], with a large effect size of d=1.09.

Conclusion:

The course was effective at improving participants’ self-efficacy in working with mental health patients. Improving knowledge, skills, and confidence across disciplines and professions in Acute Trusts will enhance the quality of care that mental health patients from diverse backgrounds receive when requiring hospital care.

References

1. De Mooij LD, Kikkert M, Theunissen J, Beekman AT, De Haan L, Duurkoop PW, Van HL, Dekker JJ. Dying too soon: Excess mortality in severe mental illness. Frontiers in Psychiatry. 2019;10:855.

2. The Stationary Office. Mental Health Act 1983: Code of Practice. (2015). Norwich. 3: 98–338.

The role of the Advanced Nurse Practitioner (ANP) within Scotland continues to expand and with the introduction of the transforming roles programme [1], this expansion is expected to continue exponentially. Within the USA it is commonplace for ANP to perform diagnostic lumbar punctures (DLP) however, this is a new development within the UK. Simulation-Based Mastery Learning (SBML) supports skill acquisition [2] and so within a Scottish District General hospital, a core group of ANPs took part in a SBML programme to perform DLPs. This programme was adapted and delivered by an ANP across all grades of Doctors. While literature exists around the role of the ANP and perceptions of the role in facilitating learning, there is little evidence exploring the role of ANPs as a facilitator of advanced clinical skills, traditionally taught by medical staff. Therefore, this study aimed to explore nursing and medical staff’s perceptions of ANPS performing and teaching DLPs.

Methods:

This study utilised an exploratory qualitative approach to conduct semi-structured interviews with eight participants (medical staff n=4, nursing staff n=4), within Acute Medical Services. Ethical approval was granted by an approved Further Education Institution, School of Health and Life Sciences Ethics Committee. Data was analysed using thematic analysis as described by Braun and Clarke [3].

Findings:

Three themes were developed through the thematic analysis. The themes were: improve the patient journey, ANPs integration and support within the multidisciplinary team, and ANPs as expert practitioners performing and teaching skills. The participants discussed a perceived reduction in patient anxiety leading to an increase in patient satisfaction. Participants discussed feeling that ANPs bridged the gap between nursing and medical staff which enhanced team working. All participants felt ANPs were best placed to perform DLP as ANPs had greater availability facilitating timely procedures for the patient. All participants discussed a potential for deskilling of medical staff. However, the medical staff participants felt that their skill acquisition could be enhanced by having access to an expert practitioner who can deliver mastery teaching and learning.

Conclusion:

This study suggests that ANPs have expertise to perform and teach clinical skills using a mastery skills programme. Further research should explore the benefits of using ANPs to deliver mastery skills to enhance skill acquisition across all professions. In addition, research to explore the patients’ perspective would be beneficial.

References

1. NES.scot.nhs.uk. 2022. Transforming NMAHP roles. NHS Education for Scotland. https://www.nes.scot.nhs.uk/our-work/transforming-nmahp-roles/ [Accessed on 29/06/2022].

2. Mehdipour–Rabori R, Bagherian B, Nematollahi M. Simulation-based mastery improves nursing skills in BSc nursing students: a quasi-experimental study. BMC Nursing. 2021;20(1):1–7.

3. Clarke V, Braun V. Thematic Analysis. In: Lyons E, Coyle A (eds.). Analysing Qualitative Data in Psychology, 2nd Edn., Sage Publications, London. 2016. pp. 84–103.

The Registrar Ready days have been running within the Paediatrics speciality in our Deanery for several years. They are aimed at trainees at ST2-3 who are stepping up to the second on-call rota. It is a simulation-based course which aims to help trainees learn in a constructive and safe environment what being the ‘Paediatric Registrar on-call’ may feel like. The scenarios cover a variety of aspects of the Paediatric on-call including critical thinking and decision-making, dealing with difficult patients, communication, and leadership skills. Each candidate will experience the opportunity to lead a scenario with sufficient time for debriefing and self-reflection with a supportive faculty. The aim of the day is to build self-confidence and ability, whilst allowing the trainees to experience decision-making/team management skills in an encouraging environment. Studies have shown that simulation-based medical education can improve both clinical knowledge, but also increase awareness of the importance of human factors in managing a medical emergency [1]. Studies from other regions have highlighted the importance of continuing education in paediatrics in the form of Registrar Ready days comparing trainee satisfaction pre- and post-COVID-19 [2].

Methods:

Previous Registrar Ready days had been uncoordinated, meaning trainees’ experiences were different depending on where they attended. We wanted to ensure that no matter where the course was delivered, and who the faculty were, the trainees would have an equitable experience. The previous and prospective trainees were surveyed to ensure that we delivered scenarios that were relevant to their level and of topics that were interesting and based on real-life situations. As part of the process, the simulations were re-written with sufficient information, so that the days could be run even without the organisers.

Findings:

Feedback from the 10 ‘registrar-ready’ paediatric trainees and the faculty from the course was excellent. Self-ratings for trainee confidence relating to different situations showed an improvement following the day. Trainees commented on a very supportive atmosphere, useful scenarios, and detailed feedback discussion as being the best aspects of the course.

Conclusion:

Standardising the simulation day has meant that paediatric trainees in our region have an equitable experience when attending the course. The new scenarios are relevant to trainees and have proven to improve their confidence when they must take responsibility for different scenarios. We aim to re-assess confidence once they have stepped-up to being a Registrar to ensure that the learning is still relevant.

References

1. Buazon A, Eneje O, Hare A, Spurr L, Kashyup M, Carby M. The use of a high-fidelity simulation-based course to prepare for the transition to a medical registrar. 2 Future Healthc J. 2017;4(Suppl 2):s31.

2. Wilson G, Lucas SF, Salam H. 1751 Is there still a place for face-to-face simulation courses during the pandemic? A comparison of trainee satisfaction of simulation courses pre- and post-COVID. Archives of Disease in Childhood 2021;106:A477.

The role of the nurse associate, despite being a relatively new one [1], faces several challenges regarding hands-on clinical care. The Clinical Simulation Course for Nurse Associates (NA) was developed as a new one-day simulation course aimed at Nurse associates delivering clinical care to provide them an opportunity to enhance their skills. The course’s main goals are to increase knowledge and confidence in applying a range of skills including assessment and management of risk, teamwork and professional collaboration, effective communication and de-escalation skills, and most importantly the role of human factors in delivering effective patient care in a range of clinical settings. Participants were involved in a series of four scenarios using professional actors, followed by debriefing and a didactic presentation on scenario-specific topics.

Methods:

The participants were asked to complete two scales, pre- and post-course: (1) the Human Factor Skills for Healthcare Instrument (HFSHI) [2], measuring self-efficacy in human factors skills, and (2) a scale developed for this study, the Course Specific Question Scale (CSQ), to measure changes in knowledge, skills, and confidence on course-specific learning objectives.

Results:

Paired samples t-tests were conducted to analyze the difference in ratings between the pre- and post-course questionnaires. Scores on the HFSHI showed a significant increase (M=92.23) and post-course (M=108.81), t(12)=4.50, p<.001, 95% CI [0.500, 1.968], with an effect size of d=1.25.

Scores on the CSQ did show statically significant increase between the pre- (M=37.92) and post-course (M=42.25) t(11)=3.096, p=.01, 95% CI [0.204, 1.555], with an effect size of d=0.89.

Conclusion:

The innovative Clinical Simulation Course for Nurse Associates course is effective in improving knowledge and confidence to help Nurse Associates deal with patients in clinical settings. These results demonstrate benefit in widespread areas such as improving interpersonal and de-escalation skills, recognition of and response to domestic abuse victims and escalation of safeguarding concerns, collaborating across the multidisciplinary teams, being aware of the role of the confidentiality policies in patient safety, using effective communications skills to engage with patients regarding improvement of physical and mental health, and understanding the role of human factors in delivery effective care to patients. Hence, this course can complement future placements and other educational settings to provide valuable clinical experience and prepare NA for their role.

Reference

1. King R, Ryan T, Wood E, Tod A, Robertson S. Motivations, experiences and aspirations of trainee nursing associates in England: a qualitative study. BMC Health Services Research. 2020;20(1):1–0.

2. Reedy GB, Lavelle M, Simpson T, Anderson JE. Development of the Human Factors Skills for Healthcare Instrument: a valid and reliable tool for assessing interprofessional learning across healthcare practice settings. BMJ Simulation and Technology Enhanced Learning. 2017;3(4):135–141

There are more than 600 refugee doctors living in the UK, who face many obstacles on the path to the General Medical Council (GMC) registration [1]. Assisting this group to pass the GMC required examinations, the Professional and Linguistics Assessment Board (PLAB), not only helps displaced individuals find fulfilling and dependable employment, it would also contribute to alleviating the shortage of doctors in the UK. In Wales, refugee doctors receive classroom teaching of English language and some UK medical concepts, but practical training and clinical opportunities remain limited. Simulation-based training is long established in providing practical medical education [2]. Our goal was to set up a simulation programme to help refugee doctors in Wales to pass the practical examinations required for GMC registration and to prepare them for practice in the UK.

Activity:

We have held a pilot simulation day open to refugee doctors in Wales, using existing simulation facilities used for NHS and medical school teaching. The day consists of a combination of practical procedure practice (e.g. cannulation or basic airway management) and simulation-based scenarios (e.g. anaphylaxis or the acutely unwell patient). Scenarios are designed to reflect likely examination topics in their examination and situations that a Foundation doctor might likely encounter. Scenarios were run using a high-fidelity simulation environment. Practical procedure workshops used low fidelity part-task trainers, allowing opportunity for the group to familiarise themselves with common procedures. The day was open to all refugee doctors in Wales, not just those about to sit the Objective Structured Clinical Examination part of the PLAB examination.

Findings:

Feedback from the doctors has been extremely positive, with requests for more regular teaching. Feedback shows that attendees feel more confident not only working towards their examinations, but of being able to practise in UK hospitals. Additionally, they feel simulation-based training improves English language skills as well as practical skills.

Discussion:

This course provides for a previous gap in the support given to refugee doctors in Wales, allowing theoretical concepts to be put into practice. Feedback suggests that simulation also has a role to play in consolidating and expanding medical English. We are thus designing a simulation programme open to Welsh refugee doctors with clinical practice and language development as learning objectives.

References

1. Refugee Council UK. Building Bridges Impact Report 2016–19. 2020. https://www.refugeecouncil.org.uk/information/resources/building-bridges-impact-report-2016-2019/ [Accessed on 29/06/2022]

2. Aggarwal R, Mytton OT, Derbrew M, Hananel D, Heydenburg M, Issenberg B, MacAulay C, Mancini ME, Morimoto T, Soper N, Ziv A. Training and simulation for patient safety. BMJ Quality & Safety. 2010;19(Suppl 2):i34–43.

Maudsley Simulation has successfully pivoted to digital delivery of mental health simulation-based education (SBE) and developed a growing portfolio of digital courses, having trained over 2,000 participants online since 2020. During this time, the team have identified new training needs for faculty and technicians, to successfully adapt to online delivery of SBE. The Moderator-Technician role has emerged as essential in managing the many challenges relating to participant engagement, which is crucial to success and long-term knowledge retention [1]. These challenges include infrastructure availability, online comfort, and creating a psychologically safe space.

Methods:

To reduce the technical burden during courses, there was a front-loading of responsibility to participants by specifying the technical requirements by email in advance. This pre-course intervention also ensured specialist access needs could be met, such as implementing live captioning for a hearing-impaired participant. Moderator-Technicians played an active and assertive role during digital deliveries and were responsible for welcoming participants and delivering a platform orientation and troubleshooting session. Participants were supported with Audio-Visual connectivity, which helped to ensure that technical issues did not derail the fluency of the delivery. The process of building psychological safety and creating online comfort was also an important component of the introductory session, which included talking participants through online etiquette, the importance of visibility, recording of the session, and use of direct message functionality within the Zoom platform. The limitations of online training were also acknowledged. Course participants were asked to complete pre- and post-course evaluation forms which included quantitative feedback on the technical components of online simulation courses.

Results:

The end of day participant feedback was overwhelmingly positive about the online experience. Out of 332 participants, 95% reported benefits of having a Moderator-Technician, with emerging qualitative themes around finding it easier to engage due to clear guidance from the Moderator. A total of 94% reported a good experience in terms of platform accessibility.

Conclusion:

Online simulation has emerged as a valuable modality for mental health simulation-based education (SBE) and the Moderator-Technician role has proven to be indispensable in maximising engagement and reducing cognitive load for facilitators. Further research is needed to assess the value of the Moderator-Technician role in online simulation. Moderator-Technicians should continue to harness new technologies to further enhance engagement and support sustainability. For example, trialling the use of mixed modality simulation through hybrid learning delivery.

Reference

1. Liu Q, Mo S. Is Social Distancing Law the New Normal? Forced Shift to Media Online Learning and Its Effectiveness: A Moderating Role of Student Engagement During the Pandemic of COVID-19. Frontiers in Psychology. 2022. 13; 923996.

Diagnostic radiography students find working with patients that have suffered trauma or are severely ill, particularly challenging [1]. There is potential for vicarious trauma and poor reactions or behaviours to have a lasting negative impact on the patient. The practice of emotional labour is used to display an organisationally acceptable demeanour; however, this is associated with burnout [2]. This research aimed to evaluate the use of a simulation using moulage in preparing students for these encounters in advance of clinical placement.

Methods:

This research used a longitudinal quasi-experimental design and mixed methods approach. Data collection involved two consecutive first-year cohorts starting in 2018 and 2019. Students (n=97) were randomised into a control and simulation group. The simulation group supported the imaging of a patient who had suffered an open fracture. Quantitative data was collected before and during placement using Visual Analogue Scales (VAS) to measure students’ feelings. Qualitative data was collected at two stages. Firstly, twenty-four small focus groups (n=5) were conducted at the debriefing stage of the simulation and were thematically analysed. Secondly, semi-structured interviews were conducted with students (n=7) following their experience of seeing an open wound in clinical practice. These were analysed using Interpretative Phenomenological Analysis (IPA). All three stems of data collection were triangulated to identify new meta-inferences.

Results:

Statistically significant changes were identified following the simulation, with improved emotional preparedness and a reduction in negatively valenced emotions. Six themes were identified following the simulation: emotion, realistic simulation, pain, difficulty communicating, developing teamwork and patient-centred care. Five superordinate themes emerged from the IPA interviews: experiencing a new environment, navigating new relationships, preparation, engagement with wound, and emotional management. Three meta-inferences were established: simulation to reality, knowledge is power, and emotional support.

Conclusion:

The simulation provided a safe space to encounter an open wound ahead of clinical practice, reducing students’ anxiety and improving their emotional preparedness. The use of moulage enhanced the authenticity of the simulation promoting a similar emotional reaction to those experienced in a real situation. Students gained a better understanding of their role in providing quality patient-centred care, allowing them to consider adjustments to their practice and behaviours before working with real patients. Peer support and teamwork were developed through the simulation, and this was sustained into clinical practice. Evidence indicates the implementation of a simulation using moulage, would have a positive impact on emotional labour, improving the student and patient experience.

References

1. Hyde E, Strudwick R. How prepared are students for the workplace? Imaging Therapy Practice. 2017 September:5–11.

2. Jeung DY, Kim C, Chang SJ. Emotional labor and burnout: A review of the literature. Yonsei medical journal. 2018;59(2):187–193.

Fourth-year medical students undertook five weeks of clinical placement in healthcare of later life (HCOLL: Geriatric and Stroke Medicine, and Old Age Psychiatry). These specialities manage older patients with complex medical and psychosocial needs, often resulting in challenging ethical dilemmas [1]. Hence, effective multidisciplinary teamwork and communication with patients and their next-of-kin (NOK) become essential in delivering person-centred care. We aimed to provide a safe environment for the participants to have in-depth discussions on some of these ethical issues, develop relevant communication skills, and better understand the roles of the Multidisciplinary Team (MDT) members in HCOLL.

Methods:

We conducted fourteen half-day sessions between August 2021 and May 2022. Each session involved small-group discussions facilitated by educators/specialists from HCOLL background. The participants were presented with four scenarios relating to the hospital admission of an older patient following an acute stroke. Their tasks included:

- Obtaining a collateral history from the NOK, which was role-played by a simulated participant. Initially the simulated participant would join the sessions via MS Teams due to COVID-19 physical distancing rules. However, since April 2022 the sessions transitioned to face-to-face encounters.

- Discussing capacity assessment and communicating Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) decision to NOK.

- Discussing Advance Decision to Refuse Treatment (ADRT).

- Discussing the ethical/medico-legal issues surrounding artificial feeding including discussing feeding at risk with NOK.

- Discussing the role of the MDT in the discharge planning process and communicating discharge plans with NOK.

Results:

143 participants completed the pre- and post-workshop questionnaires. An overwhelming majority (93.5%) reported increased understanding of ethical issues and the roles of the MDT within HCOLL after the workshop and improved confidence in having difficult discussions with patients and their NOK. The DNACPR and risk-feeding scenarios stood out the most for the participants, with the majority describing it as ‘very challenging but useful.’

Conclusion:

The joint simulation workshop is an effective method of improving medical students’ understanding of the MDT and common ethical dilemmas within HCOLL as well as their confidence when addressing these issues.

Reference

1. Mueller PS, Hook CC, Fleming KC. Ethical issues in geriatrics: a guide for clinicians. Mayo Clin Proc. 2004 Apr;79(4):554–62. doi: 10.4065/79.4.554. PMID: 15065621.

Historically, simulation-based education (SBE) has been delivered to uniprofessional groups by uniprofessional faculty. This does not reflect the way we work in delivering patient care. There is international agreement that pre-registration healthcare students should experience interprofessional education (IPE) to prepare them for practice [1]. Within the United Kingdom, Higher Education Institutions (HEI) are embedding IPE as part of pre-registration curriculums. The aim of this project was to develop and evaluate an interprofessional clinical simulation course to explore the concepts of teamwork. The course was delivered to pre-registration medical, nursing, and pharmacy students.

Methods:

A group of interprofessional simulation educators from three HEIs in the West of Scotland worked collaboratively to develop the intended learning outcomes (ILO) and design the simulation-based course. During the course, up to six students (three medical, two nursing, and one pharmacy) worked in a simulated medical ward scenario to prioritise and deliver care to patients. Following the session, interprofessional faculty co-facilitated a structured debriefing. The ‘Plus/Delta’ model of debriefing [2] was used and output analysed using qualitative content analysis. Ethical approval was granted by University of Glasgow medical school ethics committee to evaluate the learning experience utilising a mixed methods approach.

Results:

A total of 65 courses were delivered over eight days with 232 student participants (178 medical, 33 nursing, and 21 pharmacy students). A framework for content analysis was developed using the ILOs which was used to code the take-home messages (THM) recorded as part of each debriefing. There were 148 THM that related to teamwork and collaboration. A further 51 THM were related to understanding what each team member brings to patient care. Finally, 53 THM related to factors that may influence teamwork such as feeling afraid, resulting in a lack of confidence.

Conclusion:

Evaluation of the THM suggests that the ILOs were met. It is recognised that to enable healthcare professionals to work together to deliver safe, effective patient care, they should learn together. Delivering IPE to pre-registration healthcare students builds a foundation for life-long interprofessional learning.

References

1. World Health Organisation. Framework for Action on Interprofessional Education and Collaborative Practice. Geneva: World Health Organisation; 2010

2. Dismukes RK, Smith GM. Facilitation and debriefing in aviation training and operations. Routledge; 2017.

Between 2016–2018, 375,400 people were diagnosed with cancer and between 2017–2019 167,142 people died from cancer in the United Kingdom [1]. 64% of patients with a cancer diagnosis express a wish to die at home although currently only 30% manage to do so [2]. The Primary Care team who look after a person with cancer remains the same unless they move or change practice. Their household will also, in most circumstances, be looked after by the same team. It is therefore vital for healthcare practitioners (HCP) in primary care to be able to recognise different stages in a patient’s disease trajectory and be able to manage this effectively. Integral to this is a need for exemplary communication with the person and their household, in order that a therapeutic relationship with all is maintained [3].

Methods:

We worked with the local Macmillan team to develop four different scenarios involving the same 44-year-old woman with a diagnosis of breast cancer. The scenarios were: neutropenic sepsis during chemotherapy, agitation caused by metastatic disease, conversations around completing a ReSPECT form and preferred place of death, and lastly end of life care and recognition of dying. Before each scenario participants were told how much time had elapsed since the patient had last been ‘seen.’ The simulation suite was set up as a consulting room for the first two scenarios and the patient’s home for the remaining two. We used an experienced Simulated Patient with the patient’s wife being played by one of the faculty.

The session was delivered to an interprofessional group of eight participants and comprised of four different HCP roles. It was jointly facilitated by the author and a member of the Macmillan team.

Results:

87.5% of attendees felt that their awareness of oncological emergencies and how they can present in primary care had increased because of the training, with 100% feeling it was relevant to their developmental needs and that it met the learning objectives for the day. There was appreciation of the value of being able to simulate breaking bad news and that the sequential nature of the day made it feel realistic to participants.

Conclusion:

Sequential style simulations work well for primary care HCPs who recognise the value of simulation that replicates their own practice. We recommend exploration of further scenarios around end-of-life care and communication.

References

1. Cancer Research UK. Cancer Statistics for the UK. Cancer Research UK. 2015. https://www.cancerresearchuk.org/health-professional/cancer-statistics-for-the-uk [Accessed on 30/06/2022]

2. NICE. Implementation: getting started. Care of dying adults in the last days of life. Guidance. NICE. https://www.nice.org.uk/guidance/ng31/chapter/implementation-getting-started [Accessed on 30/06/2022]

3. UK Government. What’s Important to me. A Review of Choice in End of Life Care. https://www.gov.uk/government/publications/choice-in-end-of-life-care [Accessed on 30/06/2022]

Debriefing is a form of ‘‘reflective practice’’ and provides a means of reflection-on-action in the process of continuous learning [1]. Debriefing and feedback have been recognized as the most important aspects of healthcare simulation [2]. It is necessary for simulation, and educators have reported that debriefing increases learners’ knowledge, skill performance, satisfaction, and self-reflection [3]. The ‘Advancing simulation debriefing’ course was delivered in April 2022. The participants were healthcare professionals who had experience in debriefing.

Methods:

The full-day course included reviewing the facilitators’ experience and knowledge of debriefing frameworks and skills, and how these can be adapted and built upon to facilitate more demanding debriefings. During this engaging and interactive course, the attendees were invited to reflect on their own experiences and challenges, and build on active involvement in practising these skills live via tailored exercises. Participants were asked to complete a pre-course and post-course questionnaire rating their knowledge, confidence, and attitudes towards debriefing skills. The learning objectives covered a range of skills, such as learning different strategies for uncovering biases within debriefings and how to address these, how to maintain core psychological safety through challenging debriefings, and how psychologically informed debriefing principles, can enhance debriefing practice, for scenarios with a mental health focus as well as many others. Ethical approval was given by the Psychiatry Nursing and Midwifery Research Ethics Subcommittee at King’s College London (PNM 13/14–179).

Results:

Paired samples t-tests were conducted to analyze the difference in ratings between the pre-and post-course questionnaires. Of the 18 participants within the course, 11 provided eligible responses. They were healthcare professionals who were regularly involved in simulation-based education and debriefing. Results demonstrated a significant difference in the scores for all course-specific questions between pre- and post-score answers (pre-course MD=70.81, SD=9.24, post-course MD=96.82, SD=6.35) t(10) test=-7.41, p<0.0001, with an average increase of 37% in the total score. Open-text responses reflected improved confidence in the usage of different debriefing models, considering emotional factors, and taking the lead while debriefing.

Conclusion:

The course had an impact on improving debriefing skills, especially by improving the facilitators’ confidence in debriefing skills, ability to debrief, and understanding of how debriefing is related to simulation-based learning. These results demonstrate a profound benefit of the use of advanced debriefing skills as a better way to standardize participant experience across different sites to improve healthcare practice.

References

1. Sawyer T, Eppich W, Brett-Fleegler M, Grant V, Cheng A. More Than One Way to Debrief. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare. 2016;11(3):209–217.

2. Voyer S, Hatala R. Debriefing and Feedback. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare. 2015;10(2):67–68

3. Kim Y, Yoo J. The utilization of debriefing for simulation in healthcare: A literature review. Nurse Education in Practice. 2020;43:102698.

Outcomes for Graduates mandates that newly qualified doctors should be able to recognise and manage their own Implicit Biases and the impact it has on individuals/groups [1]. Implicit bias (IB) refers to attitudes unconsciously affecting our understanding, actions, and decisions. Implicit Bias Recognition and Management (IBRM) strategies have included using online tests, lectures/workshops, and more recently simulation-based education (SBE) [2]. Literature suggests that SBE offers an approach that will lead to a change in perspectives for IB but more evidence is needed to ascertain whether SBE is an acceptable and effective method for medical students [3]. This study aims to firstly compare SBE to workshop-based teaching and secondly to explore medical students’ views and experiences of an SBE session aimed to support their recognition of implicit bias.

Methods:

This mixed method study is a pilot head-to-head trial of the two IBRM strategies followed by qualitative analysis of SBE. Following voluntary recruitment and consent of fourth- and fifth-year medical students (n=18), covariate adaptive randomization is used to assign them to a group. Both the SBE scenario (simulated ward round) and the interactive workshop were designed using learning objectives and constructive alignment theory. During the simulated ward round, a series of events demonstrating escalating IB were witnessed, and student experience and recognition were explored during the debriefing. The 1-hour interactive workshop covered theory (definitions, impact of IB and microaggressions, and challenges to confronting) followed by two case-based discussions. Post-session participant questionnaires (5-point Likert scale and free-text questions) are collected and analysed quantitatively using averages and Mann-Whitney U test. Following interviews, free-text responses and transcripts are coded by independent researchers into transformative learning framework using template analysis via Qualitative software NVivo. Ethical approval has been sought (SERB/2021/12/2236).

Results:

The preliminary results from this pilot (n=6) suggest that the workshop is better than SBE at raising awareness (4.3 Vs 2.7). Qualitative feedback suggests that SBE provided a powerful experience (Table 1).

Table 1:

An extract sample of results to date, exploring medical students’ view on participating in simulation-based education to explore recognition of IB

Conclusion:

At present, participant numbers from the pilot are too small to make meaningful conclusions. Ongoing recruitment and post-session semi-structured interviews with students will help to inform which method is better at short-term awareness raising, however further follow-up will be required to identify longer-term impact. This will guide instruction on IBRM for medical students and whether witnessing IB events can be embedded in their current simulation curriculum.

References

1. General Medical Council. Outcomes for Graduates. 2018. https://www.gmc-uk.org/media/documents/dc11326-outcomes-for-graduates-2018_pdf-75040796.pdf [Accessed on 26/10/2021].

2. Sukhera J, Watling C. A framework for integrating implicit bias recognition into health professions education. Academic Medicine. 2018;93(1):35–40.

3. Vora S, Dahlen B, Adler M, Kessler DO, Jones VF, Kimble S, Calhoun A. Recommendations and guidelines for the use of simulation to address structural racism and implicit bias. Simulation in Healthcare. 2021;16(4):275–284.

During the COVID-19 pandemic, remote consultations have replaced face-to-face appointments in many settings [1]. Over the past few decades simulation-based education (SBE), particularly standardised patients (SP) are being increasingly utilised to assess competency in patient care, especially regarding communication skills [2]. SBE with particular emphasis on human factors is now a mandatory part of medical training as per the new Internal Medicine Training (IMT) stage 1 curriculum which was introduced in 2019 [3]. This regional cardiology simulation and study day was designed with the aim of providing IMT trainees the necessary skill set to manage video consultations using simulated patient-care scenarios using SP as a simulation modality.

Methods:

A one-day cardiology online course was created and delivered via an online platform (Zoom), comprising of a morning study session of frequented cardiology presentations tailored to IMT training curriculum followed by an afternoon session where each trainee got the opportunity to participate in two simulated video consultation scenarios. The theme of the scenarios included commonly encountered cardiology presentations in clinic setting such as heart failure, atrial fibrillation, ischemic heart disease, and syncope with particular emphasis on non-clinical skills surrounding effective communication, medico-legal challenges, and shared decision-making. Scenarios were delivered via SPs who were prebriefed with detailed scripts and guidance on specific areas of challenges to focus. In addition to group debriefing, all participants received individual written feedback from respective SPs after the course.

Results:

After the successful run of a pilot course in palliative care and cardiology during the COVID-19 pandemic, four courses were run during the current academic year, involving a total of 32 participants. Feedback demonstrated that all trainees were satisfied with the overall content of the course (Figure 1). 100% of trainees felt the course content improved their clinical capabilities with over 62% making major improvement in practice. Over 96% of candidates felt more confidence in dealing with the clinical scenarios in future. Mean grading of course satisfaction was 4.9/5.

Conclusion:

The regional online cardiology study day and simulation course has been successfully in improving confidence in IMTs to carry out remote consultations in the post-pandemic era as well as equip them with clinical and non-clinical skills to manage a specialty clinic. Expanding this course design to other specialties will go a long way in improving confidence and skills of IMT trainees in managing online clinics as well as bridge gaps in opportunities to mandatory SBE in the region.

Figure:

Trainee feedback comments

References

1. British Geriatrics Society. Remote consultations during COVID-19 and beyond. 26 February 2021. https://www.bgs.org.uk/resources/remote-consultations-during-covid-19-and-beyond [Accessed on 19/06/2022]

2. Gerzina HA, Stovsky E. Standardized Patient Assessment of Learners in Medical Simulation. Treasure Island (FL). StatPearls Publishing. 2022.

3. Joint Royal Colleges of Physicians Training Board. Curriculum for Internal Medicine Stage 1 Training. 2019. https://www.jrcptb.org.uk/sites/default/files/IM_Curriculum_Sept2019.pdf [Accessed on 19/06/2022]

Conversations regarding deceased organ donation are complex and ideally are held with support from specialist nurses [1]. However, unplanned situations where this topic is raised are encountered in clinical practice. These discussions can involve unexpected elements and views, without immediate support available from specialist teams. Conditional or directed organ donation involves the caveat that an organ is or is not donated to a specific individual or demographic. In 1998 a deceased organ donation was accepted in Sheffield with the condition it only be transplanted into a white patient [2]. This sparked an ethical debate and government review. The subsequent report identified this practice as unacceptable and fundamentally against the altruistic nature of organ donation [3]. We aimed to increase candidate familiarity with the process of deceased organ donation, ensuring future discussions are held at an appropriate time involving essential members of the multidisciplinary team.

Methods:

We simulated a complex discussion regarding organ donation where conditional and directed viewpoints were addressed. This scenario also highlighted elements of inclusivity and discrimination that may be encountered in clinical practice. A scenario was designed following input from senior members of the emergency department, intensive care, and specialist nurses for organ donation. The simulation was discussed at a meeting of our Trust clinical Ethics Committee. Consent was electronically obtained prior to participation, and data regarding candidate familiarity with deceased organ donation was anonymously recorded utilising a Likert scale before and after completion of the simulation. These results were used to assess the effectiveness of the scenario against the desired aims utilising the Kirkpatrick model of learning.

Results:

Ten sessions were held recruiting 30 participants. Following completion of the simulation session, our results demonstrate junior clinicians in the emergency department developed increased familiarity regarding the process and timelines surrounding deceased organ donation, and improved confidence tackling complex conversations containing controversial viewpoints.

Conclusion:

We are intending to utilise data gathered from this scenario to assist in development of a toolkit for the emergency department regarding unanticipated organ donation discussions. We are also hoping to expand the simulation to cover other departments where similar conversations may be encountered.

References

1. Royal College of Emergency Medicine. The RCEM End of Life Care Toolkit: Royal College of Emergency Medicine. 2020. https://rcem.ac.uk/wp-content/uploads/2021/10/RCEM_End_of_Life_Care_Toolkit_December_2020_v2.pdf [Accessed on 19/06/2022]

2. BBC News. Racist organ donation condemned 2000. http://news.bbc.co.uk/1/hi/health/652132.stm [Accessed on 19/06/2022]

3. Department of Health and Social Care. An investigation into conditional organ donation: the report of the panel: Department of Health; 2000.

A 73-year-old patient underwent an anterior cervical discectomy and fusion (ACDF) procedure at our Trust. During the procedure, the patient unfortunately experienced three discreet episodes of accidental awareness under general anaesthesia. The patient subsequently experienced significant psychological morbidity in the form of post-traumatic stress disorder. Accidental awareness under general anaesthesia has an estimated incidence of approximately 1:19,000 anaesthetics. Longer-term psychological effects have been shown to affect approximately half of all patients reporting accidental awareness ^[¹ ^]. In this case, the affected patient felt strongly that they wanted their experience to be utilised to support learning activities for anaesthetic practitioners, with the clear aim of preventing further patient harm. They therefore gave permission for their precise encounter and recollections to inform realistic simulation-based educational exercises, particularly to enable powerful informed debriefing.

Methods:

Using qualitative data gathered during interviews undertaken by the Recovery from Critical Illness team, who include psychological support services, we have developed a dual simulation-based educational session aimed at anaesthetists in training and student operating department practitioners. The first scenario aims to increase practitioner recognition of this potential complication of anaesthesia by realistically simulating intraoperative manifestations of awareness. The second scenario aims to improve immediate follow up and support for an affected patient, informed by our patient’s lived experience and powerful recollections of this disastrous event. We have combined these simulations with structured training on Total Intravenous Anaesthesia (TIVA), with particular focus on the 2019 Association of Anaesthetists guidelines ^[² ^]. In doing so, we aim to ensure participants were equipped with knowledge and skills relating to local equipment and monitoring options, with the intention of minimising the risk of accidental awareness for future patients.

Findings:

The affected patient has endorsed the simulation exercise and has expressed their hopes that their case can be used effectively to improve practitioner cognizance, particularly relating to the psychological impact of accidental awareness. We plan to share details of this simulation exercise with other hospitals within the Deanery via our simulation network, using participant feedback to refine the session content and format of delivery.

Conclusion:

Using a patient’s lived experience to inform simulation exercises can add a powerful dimension to improve realism within simulation-based education, and to optimise informed and accurate debriefing. This is particularly important when reflecting the psychological impact of patient safety incidents on affected individuals.

References

1. Pandit JJ, Andrade J, Bogod DG, Hitchman JM, Jonker WR, Lucas N, Mackay JH, Nimmo AF, O’Connor K, O’Sullivan EP, Paul RG. 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: summary of main findings and risk factors. British journal of anaesthesia. 2014;113(4):549–559.

2. Nimmo AF, Absalom AR, Bagshaw O, Biswas A, Cook TM, Costello A, Grimes S, Mulvey D, Shinde S, Whitehouse T, Wiles MD. Guidelines for the safe practice of total intravenous anaesthesia (TIVA) joint guidelines from the association of anaesthetists and the society for intravenous anaesthesia. Anaesthesia. 2019;74(2):211–224.

COVID-19 continues to impact the availability of student nurse clinical placements and the achievement of necessary clinical hours. The Nursing and Midwifery Council’s COVID-19 recovery standards has permitted approved universities to credit their students with up to 300 hours of practice learning through the use of alternative means, in particular, clinical simulation [1]. There is a growing body of evidence which supports the theory that clinical simulation can be used as an efficient method of teaching [2]. As a result, a small cohort of approximately 43 HNC students articulating into year 2 of their BSc (Hons) Adult and Mental Health nursing degree were required to undertake a week of simulated practice placement accruing 40 clinical hours during July and August 2022. The clinical simulation involved students coming together in small groups undertaking a ‘day in the life’ of a student nurse on a medical, surgical, and community placement. This involved participating in a number of clinical and patient related activities based on practice validated scenarios [3]. We aimed to explore students’ perceptions and experiences of clinical simulation linked to self-confidence, simulation design and educational best practices and to explore stakeholder perceptions and experiences of clinical simulation and its use as a healthcare education tool.

Methods:

A mixed methods approach with questionnaires [Table 1] and focus groups being designed to elicit responses, thoughts, and feelings after participating in the clinical simulation. A pragmatic approach will be applied which will utilise a sequential mixed method of research with an initial phase of quantitative data collection and analysis and a subsequent qualitative phase undertaken thereafter. An additional opportunity for data collection through focus groups has been identified with key stakeholders who have contributed in the clinical simulation experience including, the university simulation team, college partners, practice learning staff and university staff.

Results:

Data collection is underway with early indications from the quantitative data that the simulation was well received by the students. Focus groups are planned to take place in September 2022 followed by analysis and dissemination of synthesised results.

Conclusion:

This is the first time UWS has facilitated the use of clinical simulation in place of practice hours which presents a unique opportunity to research and explore the impact of this method of learning on students’ confidence, self-efficacy, safe practice, and knowledge base. Furthermore, this research will inform the future utilisation of this pedagogical strategy in place of practice learning hours.

References

1. Nursing and Midwifery Council. Council approves continued use of recovery standards to increase flexible use of simulation. Nursing & Midwifery Council; 2021. https://www.nmc.org.uk/news/news-and-updates/council-approves-continued-use-of-recovery-standards-to-increase flexible-use-of-simulation/ [Accessed on 17/06/2022]

2. Padilha JM, Machado PP, Ribeiro A, Ramos J, Costa P. Clinical virtual simulation in nursing education: randomized controlled trial. Journal of medical Internet research. 2019;21(3):e11529.

3. Eyikara E, Baykara ZG. The importance of simulation in nursing education. World Journal on Educational Technology: Current Issues. 2017;9(1):02–7.

The relationship between Trusts and Higher Education Institutions has long been a transactional one. One Trust and one Higher Educational Institution have come together to collaborate on a simulation project that will utilise simulation as a method for improving safety learning through a novel application to simulate incidents that have happened and incorporate them into the incident investigation process training individuals using a systems approach. In safety critical industries such as rail, aviation and marine, simulations are used as part of the incident investigation process, to explore potential causes of accidents, embed learning from investigations amongst the workforce, or to establish the necessary technical and non-technical skills required for effective investigation. A move away from the historically embedded root cause analysis process, which unhelpfully promotes a simplistic incident review often resulting in a single cause outcome, our systems approach is a more holistic method of investigation.

Through a co-production process, the research aims to design and pilot a programme of interventions that will use simulation as an education tool:

1. Training individuals in a systems approach to incident investigation

2. Learning from incidents that have happened applying simulation

3. Training individuals in the delivery of simulation that meets ASPiH standards [1,2]

Methods:

The collaboration between the HEI and the District General Trust allowed for a bid for matched funding to support a project that allows for building academic and research development, leading to a potentially nationally scalable project. Initially delivered as a pilot study, it utilises simulation as method for improving safety learning through its novel application. Scenarios will be based on serious incidents to understand how and why they occurred, generating recommendations that consider systems and human factors. We are collating data and feedback on the interventions and will report these as they emerge.

Results:

This is an ongoing project that is in the implementation phase. To date the training of the simulation faculty has been undertaken in readiness for them to develop the critical incident simulations.

Conclusion:

The use of simulations for incidents will simultaneously form part of the incident investigation process. Running these scenarios later will test whether they are working effectively and allow for feedback to the staff involved in the scenarios or those watching the recordings as well as identify errors that need a system level response.

References

1. Purva M, Nicklin J. ASPiH standards for simulation-based education: process of consultation, design and implementation. BMJ Simulation & Technology Enhanced Learning. 2018;4(3):117.

2. Simulation-Based Education in Healthcare. 2016. Standards Framework and Guidance. Association for simulated practice in healthcare (ASPiH) standards for simulation-based education. https://aspih.org.uk/standards-framework-for-sbe/ [Accessed on 26/06/2022]

Starting a new hospital and university partnership Postgraduate Certificate in Healthcare Education (first cohort 2020) during a global pandemic has proven challenging. With a significant reduction in healthcare education and little face to face learning for students to either observe or participate in, alternative strategies were identified. The validity of observation of pre-recorded teaching material has been shown to be an effective method for education outside of the healthcare sector [1]. Examples within healthcare include the latest edition of the Advanced Trauma Life Support course which uses a facilitated debriefing of a video of a simulated trauma team [2]. In addition to providing examples of how to teach, we also wanted to provide material for students to evaluate the techniques used, engagement with learners, and the extent to which equality, diversity, and inclusivity were considered.

Methods:

Funding was obtained to support filming of a multi-professional simulation, the debriefing, and subsequent interview with participants and faculty. In addition, films were produced of a small group teaching tutorial and an interview with an experienced medical educator. The recordings were used to support programme delivery, either as provocations, teaching points, or as part of assessments.

Results:

The materials proved invaluable to, for example, interrogate with the students, best practice in teaching approaches, unpick the subtly of debriefing skills, hear and understand the lived experiences of different professional groups, and have the opportunity to then revisit this material at ever deeper levels.

Following observations made by students of the education interventions they observed, later sessions in the programme were adapted to specifically address tensions that were identified about interprofessional conflict.

Conclusion:

Use of pre-recorded educational interventions provided stimulating, relevant, and thought-provoking material to initiate conversations about methods of delivering medical education, explore underlying pedagogy, and reflect on the effectiveness from the perspective of the learners. We believe to have achieved maximal benefit from the recorded material. Review with students in the presence of an experienced educator allows more in-depth integration of the material. Whilst provocations can be provided with an online offering, face to face facilitation allows more exploration of the subsequent discussion that ensues.

References

1. Geertshuis S, Liu Q, Rix N, Murdoch O, McConnell M. Learning by watching others learn: the use of videoed tutorials in undergraduate business education. Higher Education Pedagogies. 2021;6(1):156–174.

2. American College of Surgeons. Committee on Trauma. ATLS®: advanced trauma life support student course manual. 2018.

There is increasing recognition of the importance of interprofessional teamwork for enhancing patient care [1]. Undergraduate programmes of education in medicine and nursing are fundamental to developing these skills and interprofessional simulation education (IPSE) has been found to be an effective way of improving decision-making, team cohesiveness, and collaboration [2]. Two Higher Education Institutions in the Northeast of England collaborated on an IPSE event involving 340 final year nursing and medical students. This research aimed to explore the effectiveness of IPSE in improving teamwork and enhancing communication using peer assessment.

Methods:

During a five-day IPSE event in February 2022, each student rotated through four scenarios of acutely deteriorating patients. The students were randomly selected to one of four groups consisting of ~4–6 nursing and 1–2 medical students. Within each scenario 2 nurses and 1 doctor actively participated while the remaining group members observed via live video feed. Across the five days 140 students (41%) completed an amended version of the Performance Assessment for Communication and Teamwork (PACT) novice observer form [3] to rate team functioning on a Likert scale from 1 -5 on five skills domains: Team Structure, Leadership, Situation Monitoring, Mutual Support, and Communication.

Pooled individual ratings and scores between professional groups (nursing and medical) were used to perform repeated measure ANOVAs to explore the impact of repeated scenarios.

Results:

Pooled individual ratings: A statistically significant progressive increase was found in the five teamworking elements: Team Structure (F=9.97, p<.001), Leadership (F=6.71, p=<.001), Situation Monitoring (F=3.56, p=.020), Mutual Support (F=9.67, p<.001), Communication (F=9.85, p<.001).

Professional Group (medical and nursing) ratings: A statistically significant progressive increase was also found: Team Structure (F=9.97, p<.001), Leadership (F=6.71, p<.001), Situation Monitoring (F=9.67, p<.001), Mutual Support (F=9.97, P<.001), Communication (F=9.85, p<.001).

Conclusion:

Using peer assessment to explore team working during IPSE, this study demonstrates a significant increase in scores in the five skills domains. The results suggest that incorporating IPSE into undergraduate medical and nursing curriculums can be an effective way for students to develop and enhance teamworking and communication which is a key component of safe and effective clinical practice and patient care.

References

1. Foronda C, MacWilliams B, McArthur E. Interprofessional communication in healthcare: An integrative review. Nurse education in practice. 2016;19:36–40.

2. Mahmood LS, Mohammed CA, Gilbert JH. Interprofessional simulation education to enhance teamwork and communication skills among medical and nursing undergraduates using the TeamSTEPPS® framework. Medical Journal Armed Forces India. 2021;77:S42–48.

3. Chiu CJ. Development and validation of performance assessment tools for interprofessional communication and teamwork (PACT). Doctoral dissertation. 2014. University of Washington.

The SCOOP protocol [1] for emergency management of post-operative neck haematoma was devised in Oxford in 2019 in response to learning from a critical incident [2]. It has now been nationally recognised [1]. Oxford University Hospitals (OUH) NHS Foundation Trust is an acute tertiary centre providing neck surgery at three distinct sites. In 2019, the Oxford Simulation Training and Research (OxSTAR) group devised an innovative multidisciplinary simulation-based educational programme based on the SCOOP protocol for members of the perioperative team caring for patients receiving neck surgery. It aimed to ensure OUH staff were skilled and equipped to respond to this rare, but life-threatening complication in their own work environments.

Activity:

The course has four major components (Figure 1):

Figure 1:

Illustration of the SCOOP course

1. Lecture: anatomy and clinical context.

2. Group discussion: team members discuss their local experience.

3. Part-task trainer: putting theory into practice using a simple, re-usable and easy to construct tool.

4. High-fidelity simulation: multidisciplinary teamwork and structured debriefing navigating the human factors and decision-making process.

Results:

50 OUH team members across 3 sites attended and provided feedback. Attendees have praised the course for its multidisciplinary nature, attracting staff from nursing, medical, and theatre backgrounds. Feedback has shown that team members have particularly appreciated tackling scenarios in their usual clinical teams. 96% strongly agreed that the course helped them understand the required actions for the management of a neck haematoma – numeric rating scale (NRS) score of 9–10/10. 98% strongly agreed that simulation was helpful in their learning experience – (NRS) score 9–10/10.

Comments demonstrated the strength of the course format:

‘Incredibly useful course and importantly gives use the confidence to make that crucial decision to SCOOP’

‘The practical part of the training was very helpful for me: I feel more confident to do SCOOP and is good to know all the steps and why I have to do it’

Conclusion:

The value of this format is shown in the results above and in the actions of the attendees during/after the course. Group discussions allowed attendees to raise specific departmental or institutional factors impacting SCOOP implementation allowing faculty to raise issues directly to clinical leaders and Trust management. Team leaders attending felt motivated to check their local clinical environments and teach others. The course inspired an attendee to lead tea-trolley for their colleagues who had been unable to attend. This course format could be considered nationally by centres looking to improve patient safety.

References

1. Iliff HA, El‐Boghdadly K, Ahmad I, Davis J, Harris A, Khan S, Lan‐Pak‐Kee V, O’Connor J, Powell L, Rees G, Tatla TS. Management of haematoma after thyroid surgery: systematic review and multidisciplinary consensus guidelines from the Difficult Airway Society, the British Association of Endocrine and Thyroid Surgeons and the British Association of Otorhinolaryngology, Head and Neck Surgery. Anaesthesia. 2022 Jan;77(1):82–95.

2. Oxford University Hospitals NHS Foundation Trust. Learning from Deaths. TB2019.50, 2019. https://www.ouh.nhs.uk/about/trust-board/2019/may/documents/TB2019.50-learning-from-deaths.pdf [Accessed on 20/06/2022]

Neck haematomas are a recognised complication of thyroid surgery. In the most severe events, the haematoma can compromise the airway resulting in hypoxic brain injury or death. While experienced members of the surgical team may be confident in dealing with these complications, others in the multidisciplinary team may require additional training to familiarise themselves with correct emergency procedures. These complications are relatively infrequent, presenting in 1–2% of thyroid surgery patients [1], meaning there are limited opportunities for less experienced staff to learn from real life examples. A simulation-based teaching session was developed by members of the surgical and simulation teams and showed positive results in multidisciplinary training. The teaching was based around a task-training manikin that could be easily transported allowing for training and demonstrations to be delivered away from the simulation centre.

Methods:

The technique for evacuating post-thyroidectomy neck haematomas can be remembered using the mnemonic ‘SCOOP’:

1. Skin exposure

2. Cut sutures

3. Open skin

4. Open muscles

5. Pack Wound.

To simulate this effectively, we created a silicone wound that simulated skin, strap muscles, and a silicone and jelly haematoma, with attached tubing to simulate venous bleeding. This was attached to an old CPR demonstration and practice manikin at the neck (Figure 1). This manikin was supplemented by a laptop and tablet running simulation software, allowing us to simulate patient observations. We also placed a waterproof Bluetooth speaker inside the manikin, linked to a phone used by the simulation operator, to allow for speech and other sounds.

Figure 1:

Image showing the task trainer in use, demonstrating the SCOOP procedure as the candidate cuts the sutures to access the simulated neck haematoma.

Results:

Sessions have taken place in the simulation centre and as an in-situ workstation, reaching 70 participants. Course participants at the simulation centre completed a post-course questionnaire where 21 out of 27 attendees had improved levels of confidence in recognising airway complications and 26 out of 27 had improved confidence managing neck haematoma with compromised airway. Feedback from the in-situ teaching has been very positive.

Conclusion:

The delivery of training around SCOOP and complications post-thyroidectomy surgery is now recommended in guidelines from the Difficult Airway Society [2], the British Association of Endocrine, and Thyroid Surgeons and the British Association of Otorhinolaryngology [3]. This relatively low-cost solution allows for the delivery of training for multidisciplinary surgical ward staff in a safe environment that will improve the confidence of the trainees in dealing with the recognition and management of a life-threatening emergency.

References

1. Doran HE, Wiseman SM, Palazzo FF, Chadwick D, Aspinall S. Post-thyroidectomy bleeding: analysis of risk factors from a national registry. British Journal of Surgery. 2021;108(7):851–857.

2. Iliff HA, El‐Boghdadly K, Ahmad I, Davis J, Harris A, Khan S, Lan‐Pak‐Kee V, O’Connor J, Powell L, Rees G, Tatla TS. Management of haematoma after thyroid surgery: systematic review and multidisciplinary consensus guidelines from the Difficult Airway Society, the British Association of Endocrine and Thyroid Surgeons and the British Association of Otorhinolaryngology, Head and Neck Surgery. Anaesthesia. 2022;77(1):82–95.

3. Management of post-operative haemorrhage in thyroid and parathyroid surgery – British Association of Endocrine and Thyroid Surgeons (BAETS) – https://www.baets.org.uk/management-of-post-operative-haemorrhage-in-thyroid-and-parathyroid-surgery/ [Accessed on 21/06/2022]

The NHS is the largest employer of black and minority ethnic (BAME) people, yet research shows that BAME staff experience greater levels of workplace harassment and discrimination [1]. Phase 2 of the Tackling Inequalities and Discrimination Experiences in Health Services Study (TIDES) focuses on the impact of COVID-19 on inequalities experienced by BAME people working in health and social care. Virtual Reality (VR) training was produced by Maudsley Learning as part of this, and we present the VR champion debriefing train the trainer project.

Methods:

A full-day digital debriefing champion training was developed. This incorporated a session on VR technology, background of the TIDES project, and the importance of debriefing in patient safety and outcomes. This was followed by an introduction of a modified TALK debriefing model [2] and essential debriefing skills training. Participants watched a series of VR videos of 3 characters, focusing on discrimination occurrences for BAME staff occurring during the COVID-19 pandemic (e.g. lack of personal protective equipment availability during night shifts). The champions then participated in a demonstration of a modified TALK debriefing model, after which they practiced leading a debriefing of one of the VR videos themselves. After the course, each VR champion agreed to train at least 10 staff within their clinical teams in-situ, using VR headset kits which were provided to them.

Results:

To date, we have gathered data from 6 participants from various professions. Participants completed a pre- and post-course survey rating their confidence in the skills of focus of the course, including debriefing skills, building psychological safety, using VR, and delivering training. The findings showed an increase in confidence for all participants, with an average increase of 14% from pre-course (M = 29.67) to post-course (M = 35.33) scores. All participants agreed that the course met their learning needs and would be useful for their practice. Preliminary follow-up data shows that the VR videos have been watched 88 times, implying that the champions are actively training staff in their clinical areas. Initial feedback has been very positive and some champions have a waitlist of staff to be trained.

Conclusion:

VR headsets allow viewers to fully immerse themselves in a 360° view of the scene, elicit more emotions, and therefore help to create a richer debriefing discussion. This training has been successful at equipping VR champions with the skills needed to facilitate debriefings in their clinical areas.

References

1. Kline R. Beyond the snowy white peaks of the NHS? Better Health Briefing Paper 39. Race Equality Foundation. 2015. http://raceequalityfoundation.org.uk/wp-content/uploads/2018/02/Health-Briefing-39-_Final.pdf [Accessed on 27/06/2022]

2. TALK foundation. TALK Framework. Talk Debrief. https://www.talkdebrief.org/talkframeworkbackground [Accessed on 27/06/2022]

New General Pharmaceutical Council (GPhC) Initial Education and Training (E&T) Standards for Pharmacists set the ambition from 2026, all pharmacists will be prescribers on registration [1]. There is an increased requirement for simulation-based education (SBE) to support trainees and newly qualified pharmacists to develop key skills required for prescribing, particularly around confidence and tolerance of ambiguity. There is a need to provide this training in a ‘safe space’ without harm to patients. Development of a Pharmacy Faculty for SBE is crucial to creating a safe learning environment and facilitate increased delivery of quality simulation in pharmacy education.

Methods:

In October 2021, NHS Education for Scotland (NES) recruited 3 Regional and 1 National Pharmacy Simulation Leads who were tasked with implementing SBE within pharmacy teams across Scotland and developing faculty. Training is based on the Clinical Skills Management Educational Network (CSMEN) [2] 3-tiered approach.

Tier 1: Awareness to Simulation for Educators: an e-learning and bespoke in person ‘Pharmacy SIMstart’ course was developed and delivered to introduce the concept of SBE to pharmacy teams.

Tier 2: Introductory programme for Simulation-Based Learning Educator: an e-learning and existing 2-day in person ‘Introduction to Simulation – Making it Work’, run by the Scottish Centre for Simulation and Human Factors (SCSHF) was made more widely available to pharmacists.

Tier 3: Advanced programme for Simulation-Based Learning Educator (in development).

E-learning was accessed using the TURAS Learn system (a centralised digital platform developed by NES for products and services). Health boards were asked to identify staff who would be supporting trainees locally to attend the course relevant to their needs. The NES Pharmacy Simulation Leads linked with SBE medical education teams and simulation centres to allow Faculty to develop these newly acquired skills.

Results:

Attendees (Table 1) at these training events were from:

Table 1:

Numbers of pharmacists trained in simulation (Aug 2022)

All pharmacy sectors; Hospital, Primary Care and Community

11 out of the 14 NHS Scotland Health Boards

NES (various pharmacy (E&T) workstreams)

Excellent feedback has been received and captured by post-course questionnaires.

Conclusion:

Interest, enthusiasm, and faculty skills in SBE are growing within Scotland’s Pharmacy services, with a national and regional educational infrastructure to support pharmacy simulation being developed.

Future plans:

Implement a Faculty development framework within Pharmacy

Form specialist working groups to design scenarios to meet requirements in Pharmacy E&T

Ensure research underpins the development of Faculty and simulation delivery to inform future advancement

References

1. General Pharmaceutical Council. Standards for pharmacy education. Pharmacyregulation.org. 2021. https://www.pharmacyregulation.org/education/education-standards#Pharmacist [Accessed on 30/06/2022]

2. Clinical Skills Managed Educational Network (CSMEN). Faculty Development – Becoming a Simulation-Based Educator. Csmen.scot.nhs.uk. 2022. https://www.csmen.scot.nhs.uk/resources/online-resources/faculty-development-becoming-a-simulation-based-educator/ [Accessed on 30/06/2022]

Prior to 2021 within West Hertfordshire Healthcare Trust, mandatory simulation sessions were pre-allocated to foundation trainees. If sessions clashed with trainees’ schedules, trainees would be expected to liaise with simulation faculty to rearrange verbally or via email. This created a significant burden on the faculty as there was no dedicated administrator or time. Moreover, this caused trainee burden on those unable to attend, and a significant proportion did not re-book these sessions. This impacted the efficiency figures for the simulation centre. We aimed to have rigorous adherence to the schedule and wanted the simulation programme to be efficient and work to full capacity. Within this service improvement innovation, the objective was to establish a better method of booking trainees into simulation sessions aiming to alleviate the faculty burden and provide flexibility for the trainees.

Activity:

For the 2021–22 academic year, an online booking system for simulation was established. This was achieved using the Acorn 2 system. Trainees were then permitted to book a date that suited them for their mandatory training, and re-book if their commitments clashed with the booking schedule. This innovation removed the use of faculty as a medium for booking and rescheduling, freeing them to provide more simulation activities by alleviating this administrative burden. Datasets were compared between the 2020–21 and the 2021–22 academic year to determine the extent to which this innovation improved learner attendance within our simulation programme.

Results:

Within this study we found that overall, there was a greater level of attendance from trainees following implementation of the new system than prior to this. We found 6% more simulation sessions were attended (from 87% attendance 2020 – 2021 to 93% attendance 2021 – 2022), and of those not attended, 20% more were rescheduled compared with the previous system (from 41% in 2020 – 2021, to 61% in 2021–2022).

Conclusion:

It is evident from this innovation that a significant impact can be made on learner engagement when we allow trainees flexibility to self-determine their learning timeline. This is echoed within the literature, as adult learning theories emphasise learner led learning and learner driven orientation of their own learning narrative [1, 2]. By placing the onus on trainees, we de-burdened them of the stress of trying to re-allocate their clinical commitments whilst attributing greater accountability to the trainees. Overall, we believe this leads to greater faculty and trainee wellbeing and engagement in simulation-based learning.

References

1. Knowles, M. S. The Adult Learner: A Neglected Species (3rd Ed.). Houston, TX: Gulf Publishing; 1984.

2. Knowles, M. S. Andragogy in Action. San Francisco: Jossey-Bass; (1984).

In a recent survey of 80 final year medical students at The University of Edinburgh, 35% reported being the victim of, while 46% reported witnessing microaggression while on clinical placement. It has been established that microaggressions in the clinical environment have a negative impact on victims as well as patient care ^[¹ ^]. It is therefore vital to educate our future clinicians to identify microaggressions and respond to them appropriately. Active Bystander Training (ABT) is a framework that has been designed for this purpose and has been successfully implemented in the clinical environment [2].

Activity:

We delivered a 90-minute simulation-based session using the ABT framework for final year medical students. In the session, we used two real life examples of microaggressions from our local context. The first example involved racism while the second involved homophobia. We used a combination of shadow-box simulation and immersive simulation to recreate these scenarios. Prior to attending this session, students attended an online teaching session that covered the basic principles of ABT. We began the session with an emphasis on psychological safety and student wellbeing. Participants were then given a short reminder of the principles of ABT. They then watched a video re-enactment of the first scenario. This was followed by a structured debriefing in small groups. Next, in small groups participants were given scripts and assigned roles to take part in an immersive simulation for the second scenario. This was then followed by a second structured debriefing. At the end of the session, there was an opportunity for participants to share their own experiences of microaggressions in the clinical environment. We also signposted students to wellbeing services.

Results:

150 final year medical students participated in the session and gave feedback (Table 1). The session was well received with an average overall score of 4.67/5. 94% of participants reported that the workshop had a positive impact on them. Key themes that emerged from the free text feedback were that participants found the ABT framework useful, they found the session empowering, there was an appetite for more sessions like this during their medical training, and they identified the importance of allyship and victim support.

Table 1:

Reported impact of attending ABT simulation on final year medical students

Conclusion:

This intervention demonstrates that simulation can be used as an effective modality to empower clinicians to identify and respond to microaggressions in the clinical environment.

References

1. Freeman L, Stewart H. Microaggressions in clinical medicine. Kennedy Institute of Ethics Journal. 2018;28(4):411–449.

2. York M, Langford K, Davidson M, Hemingway C, Russell R, Neeley M, Fleming A. Becoming active bystanders and advocates: teaching medical students to respond to bias in the clinical setting. MedEdPORTAL. 2021 Aug 19;17:11175.

The launch of the new Improving Surgical Training (IST) programme in 2020 introduced an exciting opportunity to develop a high-fidelity simulation course designed specifically with surgeons and their training in mind. Surgical simulation is often thought of as task-focussed training, with little emphasis on non-technical skills, especially in junior years of training. This created an opportunity for the formation of a bespoke high-fidelity course immersing IST trainees into surgical scenarios involving an extended surgical team and incorporating elements of technical and non-technical skills.

Methods:

Following a review of the curriculum [1], core training areas were identified. Index procedures and critical conditions appropriate for core-level training were selected to create the scenarios. Furthermore, a surgical simulation faculty was developed whereby consultant surgeons conducted faculty development training, enabling them to support the core simulation faculty. Three scenarios were piloted in a half-day course which was subsequently rolled out to all current IST trainees at the Trust. Key elements incorporated include:

1. Environment – immersion within environments where surgeons work such as theatres, surgical wards, and emergency departments.

2. Surgical issues – each scenario centres around a surgical complaint.

3. Non-technical components – often overlooked in traditional surgical simulation [2] but pertinent to the working life of a surgeon.

4. Multidisciplinary Team – scenarios must incorporate surgeons working within extended teams.

To ensure high-fidelity, a combination of simulation manikins and faculty were used as patients and other characters, with all tasks being carried out in real-time.

Results:

An initial pilot session ran with Deanery and non-Deanery trainees and a mixed simulation faculty including senior surgeons. Three sessions were delivered to a total of twelve trainees attending from a range of different surgical specialties. Feedback demonstrated satisfaction with the course given an average score of 4.67/5 and relevance of course content to current job role average of 4.5/5. 100% of trainees rated session content as either ‘Good’ or ‘Excellent’. Trainees enjoyed how ‘realistic’ the scenarios were and appreciated that they ‘gave a feel of real-life situations and a framework to resort to in difficult day-to-day situations’. Recommendations for improvement included wanting more scenarios and further opportunities to explore human factors.

Conclusion:

Overall feedback was overwhelmingly positive with appreciation of the role of human factors and non-technical skills in surgical training. The results provide a convincing argument for continuing the programme and developing a programme for second year IST trainees to aid transition to registrar training.

References

1. Royal College of Surgeons. Improving Surgical Training. London. October 2015. https://www.rcseng.ac.uk/careers-in-surgery/trainees/ist/ [Accessed on 26/06/2022]

2. Intercollegiate Surgical Curriculum Programme. Simulation training and core surgical training. 2017 https://www.iscp.ac.uk/ [Accessed on 26/06/2022]

Human factors training is the ‘focus on optimising human performance through better understanding the behaviour of individuals and their interactions’ [1]. This is essential within healthcare to improve clinical efficiency and safety. Aviation have long been industry leaders in delivering human factors training with mandated training [2]. Since 2010, emphasis on human factors within the NHS has increased [1] and is often incorporated into clinical simulation training [3], however there remains wide variation in the accessibility, quality, and understanding around human factors. We therefore sought to evaluate the delivery of our human factors teaching within undergraduate medical simulation in our district general hospital.

Methods:

A pre- and post-educational intervention questionnaire was collected from 50 undergraduate medical students following a simulation teaching day. Students were asked to rate on a scale of 1–5 (1 least- 5 most confident) various domains including their understanding of human factors. A questionnaire was collected from the simulation facilitators (10 junior doctors). Facilitators were asked whether they had received any formal training in human factors, as well as how confident they felt in delivering teaching within various domains, including human factors, on a scale of 1–5. A further white spaced questionnaire was completed detailing their understanding of human factors.

Results:

None of the 10 facilitators had formal human factors training and 50% rated their confidence level ≤ 3 when talking about human factors during the debriefing. However 80% rated 4/5 when discussing clinical skills or knowledge. This is reflected in only 50% of students rating a 5 in applying human factors following the simulation course whilst 78% rated a 5 in application of clinical skills/knowledge. Our white spaced questionnaire found a wide discrepancy in facilitators understanding of what human factors were and how to incorporate this into simulation, with the majority placing a heavy bias on non-technical skills.

Conclusion:

There was a lack of awareness of what human factors encompass within our facilitators, likely stemming from a lack of formal training. This in turn resulted in medical students being predominantly taught non-technical skills. As our facilitators come from staff from all areas of the hospital, therefore we propose a human factors module be made available to all hospital staff, as an innovative addition to our hospitals e-Learning platform. This will be mandatory for all future simulation faculty and we hope the ease of access will increase the number of faculty trained in human factors.

References

1. The National Quality Board. Human Factors in Healthcare, A Concordat from the National Quality Board. London: The National Quality Board; 2013. https://www.england.nhs.uk/wp-content/uploads/2013/11/nqb-hum-fact-concord.pdf [Accessed on 26/06/2022]

2. Reynolds R, Blickensderfer E, Martin A, Rossignon K, Maleski V. Human Factors Training in Aviation Maintenance: Impact on Incident Rates. Proceedings of the Human Factors and Ergonomics Society Annual Meeting. 2010;54(19):1518–1520.

3. Reedy G, Lavelle M, Simpson T, Anderson J. Development of the Human Factors Skills for Healthcare Instrument: a valid and reliable tool for assessing interprofessional learning across healthcare practice settings. BMJ Simulation and Technology Enhanced Learning. 2017;3(4):135–141.

When multi-casualty, major incidents occur, an interprofessional response is required [1] and management of these is usually the responsibility of specially trained, experienced staff. Our aim was to pioneer an immersive interprofessional major incident simulation, involving several disciplines and undergraduate paramedic students.

Activity:

Nursing, paramedic, media, journalism, audio technology, and law academics were brought together with Scottish fire and rescue service (SFRS) staff to plan and deliver the simulation. The programme for the day was developed collaboratively and set to achieve a combination of discipline specific and generic interprofessional learning outcomes. As each simulation consisted of multiple casualties, team scenario writing sessions were used to develop storyboards for each casualty. As this exercise had the potential to provoke an emotive response, staff were enlisted to counsel and support anyone who became overwhelmed by the experience, and needed to leave. Journalism students attended the ‘scene’ as television and radio news teams to gain experience of reporting major incidents and conducting press conferences. Media and audio technology students recorded sound and footage of the day, to be used to develop reusable learning objects. SFRS and Scottish Ambulance Service (SAS) personnel were put under scrutiny two weeks later by law students who conducted the post-event legal inquiry.

Findings:

As with every simulation, the success of this exercise was in the planning. From the outset, an interprofessional approach was taken, to ensure the learning objectives of all partners were defined and met. The success of this exercise was founded on the sharing of real-life experiences of the interprofessional team, which enabled the creation of an authentic and safe immersive experience. The opportunity to experience exposure to life changing situations, dealing with bereavement in tragic circumstances, teamwork, and addressing ethical and legal professional issues featured highly in student satisfaction. Learning together was not unique to the students. Experienced professionals reported finding value in developing their skills when under pressure from enthusiastic journalists and giving evidence in a legal setting.

Conclusion:

With careful planning and a team approach, large scale immersive interprofessional simulation is possible. This enhances the student experience while preparing them for the real world and facilitates cross discipline learning from both a student and faculty perspective. Further research is required to measure the long-term impact of such exercises and how these can build resilience in the future workforce.

Reference

1. Joint Emergency Services Interoperability Survey: Executive Summary. UK: Skills for Justice and Joint Emergency Services Interoperability Programme (JESIP); 2013.

Equality, diversity, and inclusion (EDI) are high on the national agenda within healthcare. As an acute Trust based in London, we believe it is important to explore our simulation service provision through this lens, and make appropriate improvements. We have noted EDI interventions typically focused on single or isolated actions that often have minimal impact. The Safety Engineering Initiative for Patient Safety (SEIPS) [1] is a systems-based approach that considers the dual outcomes of system performance and human wellbeing. SEIPS is often described as the ‘Swiss army knife’ of human factors or systems-based models and can be used both retrospectively and prospectively to look at a defined work system, and its related processes. We utilise the SEIPS framework, to evaluate current barriers and enablers to EDI within our simulation service, and use the findings to design appropriate improvements.

Methods:

The SEIPS framework guided our thinking across all stages of the project and we considered the wider context of EDI within our simulation service. Interactions between different work system factors that produce both wanted and unwanted outcomes, and feedback loops were explored. Information gathered from a number of sources allowed for triangulation and a review of emergent themes. Data sources included: Optional online post-course survey, including quantitative and qualitative EDI questions relating to an experience on a recent simulation course. All participants and faculty that attended relevant simulation courses since November 2021 were included. Review of feedback from November 2021 of all relevant simulation courses. Qualitative data themes were mapped to the SEIPS framework. A patient representative shared common EDI experience themes that Trust patients had reported whilst interacting with our hospitals and healthcare services. Relevant scenario and course documentation was reviewed for EDI themes using CORE20PLUS5 [2] as guidance. Frequency of both implied and explicit references were measured.

Findings:

Stage one (evaluation) findings so far, suggest three key themes of accessibility, default gaze, and Work-As-Imagined versus Work-As-Done have emerged. Stage two (improvement) is to design system level improvements and assess them using the Inequality, Feasibility, Acceptability, Cost, Efficiency, and Sustainability (IFACES) criteria. Suitable improvement ideas will then be tested using a Plan/Do/Study/Act (PDSA) cycle.

Conclusion:

We reflect on the utility of SEIPS as a systems-based tool to support an EDI service evaluation and improvement project and share our journey so others may learn from this process.

References

1. Carayon PA, Hundt AS, Karsh BT, Gurses AP, Alvarado CJ, Smith M, Brennan PF. Work system design for patient safety: the SEIPS model. BMJ Quality & Safety. 2006;15(suppl 1):i50–58.

2. NHS England. CORE20PLUS5 – An approach to reducing health inequalities. 2021 Nov. https://www.england.nhs.uk/about/equality/equality-hub/national-healthcare-inequalities-improvement-programme/core20plus5/ [Accessed on 30/06/2022]

Care provision depends as much on the communication skills of care providers as their clinical skills. In 2021, a 420-bedded acute hospital received feedback from a fifth of bereaved families through its ‘Your Views Matter’ bereavement survey (n=145). 80% rated end of life (EOL) care as good/very good. However, 1 in 10 rated it as poor/very poor. In all but two cases, poor communication was identified as a defining factor. Despite communication being a theme in complaints, communication skills training (CST) was not available to ward staff (WS). Using actor role players (ARP) in simulation has been found to be realistic and valuable to learning [1]. The need for development of a standardised CST course for the 637 ward nurses and 273 nursing assistants was paramount. We established a one-day, level 2, accredited Comprehensive CST (CCST) course specifically for ward staff which sits between Basic CST and Advanced CST. We envision that the CCST course becomes highly regarded across the Trust/region and a priority for WS.

Methods:

We translated bereaved relatives’ lived experiences into simulations to inform learning (Table 1). Two ARPs simulate the experiences of a fictional inpatient Bobby Day, as he approaches the EOL and those of his wife Bridgette. Uniquely, throughout the day the course follows Bobby through his final hospital journey allowing participants to become emotionally invested in his and his wife’s experience. Simulations address specific communication skills through both forum theatre and fishbowl. Following each simulation, group activities maximise participation and consolidate learning, whilst sharing service users’ words powerfully demonstrates relevance.

Table 1:

How service users’ liver experiences inform CCST through simulation

Findings:

The initial four courses have received universal praise from participants, ARP, and accreditors:

100% participants reported increased confidence

Content relevant and comprehensive

Key learning: Escalating concerns, Power of silence, Active listening

Self-reflection and peer support positively supported

High energy levels maintained throughout day

Service users’ experiences extremely powerful

Use of ARP provides realism and invaluable insight into user experience

Conclusion:

CST is as important as clinical skills training. Using ARP to simulate situations based on service user feedback, provides powerful learning opportunities through participation and observation. The lived experiences of service users and clinical review findings directly influence course content and impact on future care. Establishing an accredited CCST course with standardised content will ensure quality, deliverability and assurance of training. This has the potential to improve communication skills and consequently user experience of care provision.

Reference

1. Bell SK, Pascucci R, Fancy K, Coleman K, Zurakowski D, Meyer EC. The educational value of improvisational actors to teach communication and relational skills: perspectives of interprofessional learners, faculty, and actors. Patient education and counseling. 2014;96(3):381–388.

‘Human factors’ training is now explicitly referenced in the new Internal Medicine Trainee (IMT) curriculum ^[¹ ^]. The typical IMT scenario is based on deterioration of clinical conditions. The focus is usually the medical management of a certain condition with non-technical skills being discussed incidentally and sometimes superficially during the debriefing. The aim of this course was to see whether a course designed primarily to raise awareness of human factors and the non-technical skills that are part of the arsenal to reduce risk, would be well received by IMT trainees and whether we could truly deliver ‘human factors training’ [2] to this cohort.

Methods:

The course consists of seven scenarios each written with a human factors or non-technical skills focus. For example, the opening forum theatre has the aim of illustrating the effect of stress, emotion, and workload on clinical performance. The format allows different behaviours to be ‘tested’ in the same environment to see the effect choice of behaviour can have. Other non-technical skills explored include workload management, communication of adverse outcomes, and conveying uncertainty. All IMTs within Wessex were invited to attend one of 4 courses, with a maximum number of twelve participants. The scenarios are run in a ‘carousel’ format with a group debriefing after 3 scenarios. The course was delivered using actor role players who were invited to the debriefing allowing direct two-way feedback. Evaluation was completed using a questionnaire based on Kirkpatrick’s model.

Results:

There were 39 attendees across 4 courses. 100% of candidates enjoyed the course and would recommend it to colleagues. 85% said their opinion of SBE was improved by the course with none feeling worse about simulation afterwards. All felt that the course provided a good introduction to human factors.

Only one responder gave a technical skill as their most significant learning. The remainder all gave non-technical skills responses which are exemplified by this direct quote: ‘Really good course. I thought the use of ‘real’ patients made the experience so much more valuable. Was completely different to most other simulation I have done before which is invariably managing a deteriorating manikin patient which usually evolves into an arrest scenario. Found this actually useful for daily life on the job.’

Conclusion:

This course represents a new approach to IMT simulation. It has been well received and adaptations and extensions to the course are already being planned.

References

1. JRCPTB Curriculum for Internal Medicine. Royal College of Physician 2019

2. Jarvis S, Shaw P, Bagshaw M, Cantan C, Skelton S. CAP 737: Flight-crew Human Factors Handbook. 2014. Civil Aviation Authority.

The transition from medical school to foundation practice can be anxiety provoking as the pressure to balance medical and surgical quandaries with the human factors of handovers, task management, and team working can be complex [1]. Often it is the latter human factors that are hard to teach that can make shifts challenging. Students rarely practise skills of prioritisation, handover, and utilisation of team members before starting work. This leads to unsatisfactory practice and increased stress levels among the workforce with a compromise to patient safety [2]. The aims of the Foundation Undergraduate On-Call Simulation (FOCUS) was to increase the students’ confidence and understanding of these tasks which form the basis on an On-Call shift for a foundation doctor.

Methods:

We designed and delivered a one hour simulated on-call shift for 42 medical students during their post-finals assistantship at the Mid Yorkshire NHS Trust. The simulation was modelled on a shift covering medical wards out of hours at Foundation Year 1 level and included the use of a high-fidelity manikin with a review an acutely unwell patient. The sessions ran throughout the day and evening facilitated by three clinical fellows in medical education. We were able to run the session with two students partaking simultaneously on parallel wards which allowed for a joint debriefing.

Results:

We saw an increase in confidence across all areas including handover, task management, and working within a Multidisciplinary Team (MDT). Before FOCUS, only 13 students felt somewhat confident compared to 27 after. Ten students felt no confidence in escalating to seniors before FOCUS. Nine out of these ten students felt somewhat confidence afterwards. We received very positive qualitative data with one student stating FOCUS was the ‘best prep I’ve had for FY1’.

Conclusion:

FOCUS is a new programme created for post-finals medical students that was designed and introduced in 2022. Having received excellent feedback, we have plans to expand the course to more students in the coming year. We also wish to offer adaptations of this course to students in earlier years to promote improvement of the skills required to practise a safe and efficient on-call shift. We would also encourage other Trusts to adopt this programme where possible as the impact on confidence of post-finals students is significant and will lead to reduced stress and anxiety levels in newly qualified junior doctors.

References

1. Bywaters E, Calvert S, Eccles S, Eunson G, Macklin D, McCullough C, Rowland A, Thomson A, Miller P, Hayden J, Leinster S, Rubin P, Simpson J, Lilleyman J, Russell J, Stevenson E. Safe handover: safe patients. 1st ed. London: British Medical Association. 2004.

2. McCullough J H, van Hamel C. Anxiety Among Newly-Qualified Doctors: An Eight-Year Analysis. Medical teacher. 2020;42(1):52–57.

The Southwest Ambulatory Orthopaedic Centre (SWAOC) is a novel, collaborative, regional provision for elective day-case joint arthroplasty, with facilities for exceptional overnight stay. Reorientation of existing infrastructure, combined with the logistics of resource allocation, forced a small window for process assurance prior to the arrival of the first cohort of surgical patients. System testing is usually performed once equipment is finalised and in place [1], however, an early targeted opportunity to deliver simulation was offered to intelligently support the commissioning process within a dynamic timeframe. We aimed to undertake an early prospective assessment of the working environment at a novel orthopaedic centre using high-fidelity simulation.

Methods:

Driven by project timeline requirements, early in-situ high-fidelity simulation was delivered concurrent to infrastructure finalisation. Multidisciplinary team simulation was undertaken in multiple locations including theatres, wards, and ancillary areas. Critical incidents and common clinical scenarios were ‘drilled’ in real time, debriefed, and re-run with real-time evaluation to identify safety concerns and explore quality improvement opportunities. Overseeing the commissioning, SWAOC stakeholders (n=6) consisted of anaesthetic and surgical consultants, clinical theatre managers, and a business manager. Stakeholders were surveyed for feedback throughout this evolution.

Results:

Stakeholders reported preliminary and subsequent simulations as beneficial. It was stated that early simulation supports the discovery of ‘hidden problems’ informing timely modification of pathways and/or site design (Table 1). Identifying problems early during infrastructure delivery allowed for proactive discussion, smoother change management, time for re-simulation, and supported any infrastructure amendments to adhere to target timelines. Successful, rapid ingress through and egress from building entrances, and simulating real-time joint replacement surgery ensured confidence in proposed target timeframes. Directed corporate messaging with invested parties to highlight the success of the system testing reinforced wider assurance in the facility.

Table 1:

Latent threats found at the Southwest Ambulatory Orthopaedic Centre

Conclusion:

High-fidelity in-situ simulation is a powerful, flexible and resource-inexpensive tool within clinical capability development. It permits agile but rigorous testing and analysis of systems within novel sites early in the development process, while changes are still possible. This capability can rapidly expose unrecognised or latent threats such as an inefficient clinical configuration, or a compromise in procedural space without posing risks to patients [2]. In performing targeted simulation ahead of when ‘traditional’ systems testing is usually performed, safety and quality improvements can be understood at more financially viable stages of capability generation and allow operational leaders to achieve timely decision-making.

References

1. Geis G, Pio B, Pendergrass T, Moyer M, Patterson M. Simulation to Assess the Safety of New Healthcare Teams and New Facilities. Simul Healthcare. 2011;6(3):125–133.

2. Kaba A, Barnes S. Commissioning simulations to test new healthcare facilities: a proactive and innovative approach to healthcare system safety. Adv Simul. 2019;4(1).

The benefits of multidisciplinary teamwork in healthcare are well documented [1] and there is growing support for simulation as a vital teaching approach for healthcare professionals [2]. Our aim was to investigate whether a novel multi-professional simulation improves the understanding of nursing and medical students regarding their respective roles, and the role of others, in a multidisciplinary team in community and acute hospital settings. Key learning objectives included understanding of roles within a healthcare team and communication skills, both with the patient and other healthcare professionals.

Methods:

We developed a novel, 4-hour simulation session comprised of three distinct scenarios to run in Summer 2022. A single older person’s patient journey was followed from being found by district nurses after a fall at home, to an acute deterioration within a hospital setting and then the development of delirium in a community rehabilitation hospital. Whilst developing these scenarios, guidance and input was sought from service user focus groups, hospital medical and nursing staff, and community practitioners. 5^th year medical students and 2^nd year nursing students participated in mixed groups, with a maximum of 6 students. A trained actor was used as a simulated patient to maximise the fidelity of the scenarios, with computer-controlled monitoring displaying patient observations relevant to the scenario when necessary. Those not participating in the scenario viewed their colleagues in real-time. Multiple camera angles and microphones meant they could critically appraise and evaluate their colleagues’ simulation to maximise their learning. Following each scenario, there was a student-focused debriefing using the diamond [3] tool facilitated by nursing and medical faculty. The simulated patient also gave non-medical feedback from a patients’ perspective. Students then completed a questionnaire focusing on areas such as understanding their role within the multidisciplinary team and communication with the patient and other healthcare professionals: this was used to quantify the students’ self-reported learning.

Results:

Data analysis focused on the students’ self-reported confidence in understanding the roles of different members of the multidisciplinary team and the effectiveness of their communication in a high-fidelity simulation.

Conclusion:

Interprofessional learning is a valuable tool for teaching medical and nursing students the roles of professionals within a healthcare team. A simulation comprising of community care, acute hospital medicine, and community rehabilitation allows the students to develop an array of skills, from clinical prioritisation and diagnostic medicine to communication skills in a high-fidelity environment.

References

1. Murphy M, Curtis K, McCloughen A. What is the impact of multidisciplinary team simulation training on team performance and efficiency of patient care? An integrative review. Australasian emergency nursing journal. 2016;19(1):44–53.

2. Sanko J, Mckay M, Shekhter I, Motola I, Birnbach DJ. What participants learn, with, from and about each other during inter-professional education encounters: A qualitative analysis. Nurse Education Today. 2020 May 1;88:104386.

3. Jaye P, Thomas L, Reedy G. ‘The Diamond’: a structure for simulation debrief. The clinical teacher. 2015;12(3):171–175.

COVID-19 enforced change in ways universities design and deliver undergraduate nursing programmes. Students who trained throughout the initial outbreak of COVID-19 had to embrace a different learning experience both in practice and during their theory block [1]. As the UK was reducing their restrictions on COVID-19, universities reviewed their regulatory procedures by allowing students (limited numbers per session) to return face to face on campus. A group of lecturers took this opportunity to design an interactive simulated crisis (major incident) based in secondary care.

Methods:

Lecturers created a ‘snapshot’ of a major incident and created a table top interactive activity. Students had the opportunity to work as a team and take on leadership roles to solve problems and manage risk in prioritising patient care. The table top activity comprised of three rooms running simultaneously, each with its global learning outcomes using a chain of command to communicate. Students completed a post-evaluation survey and staff who participated in facilitation provided feedback on preparedness for facilitating delivery and observations of how they felt the simulation ran.

Results:

25/97 students and 7 lecturers responded. The results were analysed and are presented in a summary of findings. Findings included that simulation was a great opportunity for students to learn through a different medium, promoting teamwork to solve problems within a safe environment, and encouraging students to reflect on their and others’ performance critically [2]. The feedback provided an important critique for developing further opportunities to improve students’ and staff experience in getting more out of the day’s activities.

Conclusion:

Major incident simulation is perceived by both nursing students and academics as an opportunity to practise leadership, risk management, and teamwork under pressure but within a safe environment.

References

1. Leigh J. Nurse education in the UK: moving beyond the EU regulations? British Journal of Nursing. 2021;30(12):756–757.

2. Gibson CE, Dickson C, Lawson B, McMillan A, Kelly H. Learning to deal with crisis in the home: Part 1-developing community simulation scenarios. British Journal of Community Nursing. 2015;20(11):536–540.

Over the last decade, research has demonstrated the positive impact of providing clinical simulation-based training (SBT) to both undergraduate students and clinical staff [1]. In-situ SBT is useful for skills improvement and team development [1]. We deliver SBT within our Intensive Care Unit (ICU) during clinical shifts. However, there are challenges to providing this education in the busy NHS environment [2]. Our aim was to address these and find solutions.

Methods:

An interdisciplinary team was formed to explore clinical simulation within a 20 bedded ICU. Our ICU is within a large inner-city teaching hospital, employing over 100 nurses and 14 consultants.

We deliver scenario-based simulation during clinical shifts with members of the interprofessional team. Scenarios include: unplanned extubation and major haemorrhage [3]. Evaluation of sessions is undertaken through anonymous questionnaires of those involved in the SBT. PDSA (Plan, Do, Study, Act) cycles have been adopted to test the change and improve delivery.

Results:

To date, 16 sessions have been carried out (from July 2018) involving a total of 51 members of the interprofessional team. Evaluation response rates are 100% (n= 51). These sessions have proven popular with staff, with feedback such as: ‘Learning under stress has helped me focus more, especially as it is a safe environment.’ Staff welcomed the opportunity to undertake this training in the ‘real’ clinical environment.

Challenges included risk of delay in care to our patients, increased unit workload, and establishing and maintaining a circle of trust. However, senior team ‘buy in’ has enabled sessions, consequently demonstrating the value placed in SBT. The COVID-19 pandemic created significant critical care skills gap. In-situ SBT addressed this by bringing teams together to explore cross-discipline working within the real clinical environment.

Conclusion:

We have demonstrated that the delivery of this type of education is safe and effective, and staff found it useful and accessible. Feedback suggests the impact of SBT alongside traditional competency-based teaching is beneficial in achieving different educational goals. In-situ simulation ideally enables a team of experts to become an expert team. Having a simulation champion to promote in-situ within the unit and demonstrate a return in investment to senior managers and participants of effort and time against clear educational goals for critical care.

References

1. Martin A, Cross S, Attoe C. The use of in situ simulation in healthcare education: current perspectives. Advances in Medical Education and Practice. 2020;11:893–903.

2. Stroud JM, Jenkins KD, Bhandary SP, Papadimos TJ. Putting the pieces together: the role of multidisciplinary simulation in medical education. International Journal of Academic Medicine. 2017;3(1):104–109.

3. Patterson MD, Geis GL, Falcone RA, LeMaster T, Wears RL. In situ simulation: detection of safety threats and teamwork training in a high-risk emergency department. BMJ Quality & Safety. 2013;22(6):468–477.

Three hundred and sixty-degree (360°) videos are becoming increasingly popular [1], allowing for an immersive viewing experience with high levels of fidelity, accessible via a range of devices. This is important for ease of use for training NHS staff. The videos often utilise a camera as a character of its own, the viewers seeing the narrative in first person rather than a passive third person perspective [2]. 360° video, in many ways, resembles a technological take on theatre in the round with its design being similarly based on audio amplification and the feeling of having nowhere to hide [3].

Methods:

Viewers can choose which character to follow through a scenario. When paired with debriefing or training, users can observe alternative outlooks on the exact same scenario by multiple characters. The scenario also unravels around the participant and allows, in some cases, actors to speak or appeal directly to the viewer. Maudsley Learning’s work with Kings College London on the Tackling Inequalities and Discrimination Experiences in health Services (TIDES) videos implements these ideas. The role of the debriefing is comparable to the role of a theatre audience where powerful experiences shown allow you to process, before giving space to replay and re-examine from other viewpoints as we leave the theatre. Themes of Race inequality were shown through the TIDES 360° videos followed by debriefing to enhance the learners’ experience.

Results:

Users reported being unable to take a step back from the action, which can be applied as bystander training when paired with content around themes such as discrimination and equality. Users reported being left with a feeling of helplessness or desire to intervene. When discussed, participants described feeling exposed, at the centre of the action happening around them. In a real-life scenario, a person would re-position themselves to where they feel more comfortable but are unable to do so with a 360° video.

This, along with the use of ambisionic sound, resembles the theatre in the round, where actors, have their backs to audience members, creating a more intimate and realistic dynamic for staging.

Conclusion:

360° video is an innovative tool that replicates the principles of theatre in the round to immerse learners in scenarios with a range of benefits. Producers encourage users to autonomously choose to follow a path from multiple available storylines, which creates rich debriefing discussions that enhance the learning value.

References

1. Bonnington C. You Can Now Watch and Upload 360-Degree Videos on YouTube. Wired. 2015. https://www.wired.com/2015/03/youtube-360-degree-video/ [Accessed on 28/06/2022]

2. Pavlik J. Experiential media and transforming storytelling: A theoretical analysis. Journal of Creative Industries and Cultural Studies. 2018;3:46–67.

3. Gurr A. Shakespeare’s Workplace: Essays on Shakespearean Theatre. Cambridge: Cambridge University Press; 2017.

With reducing rates of COVID-19 transmission, Health Education England (HEE) recognises the importance of re-establishing simulation-based education programmes that halted during the early phase of the COVID-19 pandemic [1]. After a 17-month hiatus, the Foundation Doctor’s simulation programme is one of several to re-start in a face-to-face format at the Royal Cornwall Hospital (RCH). However, during the first four months since restarting, attendance rates amongst doctors were noted to be significantly reduced at 19% (9 of 48) compared with 77% in the four months prior to the pandemic (34 of 44). The authors sought to establish any logistical or cultural changes that explained this.

Methods:

A four-month period of attendance to foundation simulation teaching was reviewed retrospectively. For every absence noted, a survey was sent to the absentee requesting an explanation for this. After subsequent implementation of a new online system for self-booking onto sessions, comparison of attendance rates was made for a further four-month period.

Results:

Over 6 teaching sessions delivered during the initial four-month period, there were 39 absences, for which 27 survey responses were received. In explanation of a given absence: 7 (25.9%) reported having been on a scheduled off-day or post-night rest-day, 4 (14.8%) had been working a night shift, 1 (3.7%) had been on annual leave, 11 (40.7%) had been unable to leave their clinical area due to poor staffing levels or high clinical workload, 1 (3.7%) had an alternate teaching commitment, and 3 (11.1%) had been unaware the teaching was taking place. None had attributed their absence to feelings of anxiety, concern over the transmission of COVID-19, or perceived lack of benefit in the teaching. After subsequent implementation of the new self-booking system, attendance rates improved to 69% (18 of 26).

Conclusion:

Poor planning and failure to coordinate with working rotas provides an explanation for a large proportion of absences initially seen. The newly implemented system enables doctors to self-allocate sessions at short notice to work around their rotas. Although this has improved overall attendance rates, the absolute number of attendees still remains relatively low compared to pre-pandemic levels. Concern remains around the 40.7% of absences that arose as a result of doctors feeling unable to leave their clinical areas to attend teaching. Ongoing efforts are therefore being made to improve local cultures in relation to releasing staff for mandatory training and ensuring staffing levels are bolstered to account for this.

Reference

1. Health Education England. COVID-19: National guidance on the safe delivery of simulation-based education. 2022.

MELISSA (Mobile Educational Learning, Improving Simulation and Safety Activities) is a mobile resource that has been designed to deliver healthcare education and training across the North East and North Cumbria. The double decker bus represents a partnership between the North East Simulation Network, I Can Prevent Delirium, Health Education North East Faculty of Patient Safety (FPS), and the Find Your Place in the North East and North Cumbria campaign. The main aim of the project is to provide equitable access to training, healthcare and wellbeing promotion for both workforces and the public. The facilities on board MELISSA include simulation equipment, a range of manikins, a bespoke audio/visual system including a separate control room, interchangeable display boards, and an expandable classroom space.

Activity:

The MELISSA project team works with multiple organisations supporting various workstreams in alignment with the FPS strategy. The scope of work includes on location training for multidisciplinary NHS staff, social care, non-professional carers [1], clinical delivery such as COVID-19 vaccination programme work [2], health and welfare checks for the homeless, healthcare conferences, career events and public engagement events supporting organisations such as Diabetes UK, Citizens Advice, and Healthworks.

Results:

From 2021 to June 2022, MELISSA supported more than 120 events, engaged with more than 15 organisations inclusive of Care Commissioning Groups, Foundation Trusts, Colleges, Councils, and Housing Associations. It facilitated delivery of 23 clinical training events and achieved over 600 clinical competency sign-offs, 10 public engagement events with 172 members of the public in attendance and providing support around health and wellbeing. The homeless welfare checks involved serious blood borne illness screening and subsequent referral to services for those individuals involved. During the pandemic, whilst training was restricted, MELISSA flexed her role to provide 68 clinics delivering over 13,750 vaccinations, including vulnerable patient groups. The flexibility of locations that MELISSA has visited included rural and remote medical centres, community hospitals, care homes, schools [3], town centres, and supermarket car parks.

Conclusion:

Through the initial waves of the COVID-19 pandemic, MELISSA provided a significant role in the delivery of the vaccination programme, particularly to areas in the North East with reduced uptake. With restrictions easing, the number of face-to-face clinical training sessions has quadrupled and reach within our region dramatically widened. MELISSA is a well utilised resource within the region with patient safety and public wellbeing being a priority.

References

1. Gateshead. Support, advice and training for carers at Gateshead Carers Week Roadshow. Gateshead Council. https://www.gateshead.gov.uk/article/20931/Support-advice-and-training-for-carers-at-Gateshead-Carers-Week-Roadshow [Accessed on 30/06/2022].

2. ITV. Vaccine bus returns to South Tyneside as NHS ramps up booster jab roll out. ITV News. 2021. https://www.itv.com/news/tyne-tees/2021-12-02/vaccine-bus-returns-to-south-tyneside-as-nhs-ramps-up-booster-jab-roll-out [Accessed on 30/06/2022].

3. Sunderland and Echo. Sunderland pupils learn vital life-saving skills as NHS education bus rolls into town. https://www.sunderlandecho.com/education/pupils-learn-vital-life-saving-skills-as-nhs-education-bus-rolls-into-town-3608132 [Accessed on 30/06/2022].

MELISSA (Mobile Educational Learning, Improving Simulation and Safety Activities) is a refurbished double decker bus which aims to provide equitable access to training, healthcare, and wellbeing promotion for both workforces and the public across the North East of England and North Cumbria [1]. One objective of the MELISSA project is to bring simulation and clinical training opportunities to rural and difficult to reach teams that would otherwise be required to travel long distances to static facilities at one or more main hospital sites.

Activity:

MELISSA facilitated the delivery of a face-to-face staff development week and over a period of six months (in association with North Cumbria Integrated Care (NCIC)). Six further one day training sessions were carried out at various remote sites across North Cumbria. These training sessions aimed to provide opportunities for staff to acquire sign-off for clinical procedural competences in line with Nursing and Midwifery Council (NMC) standards [2]. The Nursing and Midwifery Council requires nursing staff to evidence updates to their clinical skills and complete refresher training every three years. The trainers for the sessions are local educators to the NCIC.

Results:

The training covered practical skills for competency sign off including Blood Transfusion Administration, Verification of Expected Death, Care and Management of Central Venous Access Devices, Venepuncture, Cannulation, and Urethral Catheterisation. During the Staff Development week, 239 competencies were completed. A further 315 signoffs were completed over the course of the six remote site sessions. Positive feedback for the MELISSA project from faculty include increased accessibility for staff to attend essential training and minimising time lost due to travel. In evaluation, attendees also strongly commented on the benefits of not needing to travel significant distances and to multiple educational venues to complete the same training package that can be completed using MELISSA. Other positive feedback includes reduced time needed away from work, minimising impact on their personal lives, time, and travel costs.

Conclusion:

Utilisation of MELISSA to bring training and practical sessions to staff at their own workplace in rural areas has allowed NCIC to facilitate completing over 500 competencies by staff and provided the refresher training as required by the NMC in a six-month period. Due to the personal benefit to individuals and the success of the format, MELISSA will continue to support NCIC in delivering these training days across North Cumbria going forward at least once per month.

References

1. MELISSA. The NHS Training and Simulation Bus. NE Learning Trust. https://www.melissabus.co.uk/ [Accessed on 24/06/2022]

2. Nursing & Midwifery Council. The code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. London: Nursing & Midwifery Council. 2018.

Medical care at sporting events presents unique challenges. Often, the event is at a novel venue and services operate from temporary structures by a team who may have not met. Our interprofessional team includes doctors, nurses, physiotherapists, and first aiders providing high-quality and safe care whilst learning from each other. British Medical Association guidance [1] on medical care at sporting events suggests specific courses and education prior to an event, but does not address learning or practice at the event itself. We think in-situ simulations are essential to encourage team bonding, interprofessional learning, and promote patient safety in unfamiliar environments. In-situ simulation has been demonstrated to achieve this in the Emergency Department [2]. We have extrapolated this to the sporting event medicine setting and use simulations as part of the briefing process at our events. We anecdotally found that simulations increased the confidence of staff and identified potential barriers to patient safety. Therefore, we formally explored the experiences of staff and identified the value of our innovation of running simulations specifically in the sporting medicine setting.

Methods:

Between April and June 2022 participants were invited to provide feedback via an anonymous survey (gaining qualitative and quantitative data) after three simulations at sporting events. Simulations were facilitated and debriefed by an Emergency Medicine consultant with significant experience at sporting events and in simulation. The scenario was a collapsed athlete on the finish line of the event who required moving to the medical facility and then later into an ambulance. This allowed debriefing around clinical aspects as well as human factors and non-technical skills.

Results:

Twenty-five respondents provided feedback (Figure 1). Qualitative results demonstrate that our innovative approach is ‘invaluable’ and ‘promotes safe and effective working’. One participant stated that it ‘should be part of the team culture to run skills drills and simulations at all events’ suggesting that it has not been the case at other events. It was highlighted that the pre-simulation briefing could be improved.

Figure 1:

Responses of survey participants

Conclusion:

In-situ simulation is useful and valued in the sporting event medicine setting. There has been largely positive feedback from participants showing that our simulations should continue (and be improved upon), and invites further study on the impact of simulation in this environment. We suggest that it should be part of the briefing of clinical staff at all sporting events.

References

1. British Medical Association, Board of Science. An information resource for doctors providing medical care at sporting events. January 2014. https://bma.primo.exlibrisgroup.com/discovery/delivery/44BMA_INST:44BMA/1248851970006796 [Accessed on 23/08/2022]

2. Patterson MD, Geis GL, Falcone RA, LeMaster T, Wears RL. In situ simulation: detection of safety threats and teamwork training in a high-risk emergency department. BMJ Quality & Safety. 2013;22(6):468–477.

Virtual reality (VR) is an expanding area within medical education, accelerated by the COVID-19 pandemic. Use of VR has been explored within multiple areas but there is limited evidence relating its use in teaching clinical decision-making (medical ‘expert-thinking’) to medical students [1]. Before VR, the most realistic patient-less simulation environments utilised high-fidelity manikins (HFSim). These are effective in teaching management of numerous medical and surgical presentations, but limited by cost and logistics [2]. This is the first study to assess the efficacy of VR, compared to HFSim, in teaching medical students’ clinical decision-making.

Methods:

This ethically approved study utilised mixed methods to investigate:

Whether VR is as effective as HFSim at increasing students’ clinical decision-making competence and confidence;

The perceived value and experience of each; and

Where VR training should be placed temporally in relation to HFSim.

Sub-analyses explored whether outcomes were influenced by gender.

Students were randomly allocated to experience a simulated scenario in either VR or HFSim. After consenting, participants:

1. Completed baseline assessments of competence and confidence;

2. Received sepsis revision and familiarisation with the relevant environment;

3. Individually undertook an acute sepsis scenario with debriefing;

4. Completed follow-up confidence and competence assessments;

5. Undertook a second scenario in the alternate environment; and

6. Completed questionnaires regarding experiences of VR and HFSim, and preferred initial environment.

The collated data was analysed using the t-test in Excel®.

Results:

The study recruited 50 participants. Key findings were:

1. No difference in baseline confidence between VR and HFSim groups;

2. Statistically equal increase in confidence and competence regarding decision-making (confidence after VR +17% and HFSsim +19%, competence after VR +17% and HFSsim +15%). See Figure 1;

Figure 1:

VR versus HFSim: Comparing confidence and competence increases

3. Participants’ preference was for HFSim (71%, due to greater realism; increased pressure; and verbal communication);

4. Participants’ preference was to undertake VR before HFSim (80%, because less stressful and useful earlier in training); and

5. 100% recommended both environments (complement each other and different knowledge gained from each).

Sub-analysis revealed same outcomes with gender aggregation.

Conclusion:

Interim results suggest, regardless of gender, equivalent increases in confidence and competence are achieved in teaching clinical decision-making with either VR or HFSim. VR appears to have a natural place in the progression of teaching between theory and HFSim. Evidence suggests that teaching ‘expert-thinking’ should begin early in training [3]. VR simulation is a safe and more moderate technique through which this can be introduced.

References

1. Jiang H, Vimalesvaran S, Wang JK, Lim KB, Mogali SR and Car LT. Virtual Reality in Medical Students’ Education: Scoping Review. JMIR Med Educ. 2022; 8(1):e34860.

2. Haerling KA. Cost-utility analysis of virtual and mannequin-based simulation. Simul Healthc. 2018;13(1): 33–40.

3. Garfield J, Le L, Zieffler A and Ben-Zvi D. Developing students’ reasoning about samples and sampling variability as a path to expert statistical thinking. Educ Stud Math. 2015; 88(3): 327–342.

Immersive simulation is an expensive education modality with a high faculty requirement, for which its cost effectiveness can come under scrutiny [1]. Physical distancing during the COVID-19 pandemic necessitated decreased participant numbers on simulation courses, leading to significant training implications including an onus on remote learning [2]. We postulated a novel approach to increase course capacity, while maintaining quality, would be to facilitate a ‘double debriefing’. When compared with other strategies, such as online simulation or a hybrid model, this approach could improve effectiveness and engagement, which can be challenging with a ‘remote’ group of participants.

Methods:

Two simulation days, involving 28 foundation doctors, were chosen for the pilot study. Participants were randomly allocated to one of two debriefing rooms. Simulations were completed in pairs, with one participant from each room. Following the simulation, the participants returned to their respective debriefing rooms. The debriefing structure was standardised across both rooms through a 3-phase model (Description, Analysis, and Application) with clearly defined learning objectives. Debriefing facilitators rotated between each room. A post-course questionnaire was used to collect qualitative and quantitative data. Five questions explored: Overall course rating; positive aspects of the course; areas for improvement; perceptions of double debriefing; and comparison to previous foundation simulation days. The qualitative data then underwent thematic analysis.

Results:

All participants rated the courses as excellent or very good (17 and 11 respectively). 19 participants agreed or strongly agreed that double debriefing worked well. 5 neither agreed nor disagreed, 1 disagreed, and 3 did not answer. When compared to previous foundation simulation days, 14 participants stated the experience was better, 9 thought it was equivalent, 1 thought it was worse, 2 did not answer, and 2 had not previously attended. Smaller debriefing groups were seen as a positive, however participants also wanted a smaller overall group size to ensure everyone had the opportunity to participate in a simulation.

Conclusion:

A ‘double debrief’ approach to Foundation doctor simulation training is perceived as an acceptable and potentially desirable method to increase course capacity whilst controlling group sizes. This has implications for both increasing access to simulation-based education, but also in delivering more high-quality simulation-based education at minimally increased cost. Moreover, this could enhance the delivery of interprofessional simulation, which often involves larger groups [3]. Larger studies involving more diverse groups of healthcare professionals will be conducted to ascertain wider applicability.

References

1. Maloney S, Haines T. Issues of cost-benefit and cost-effectiveness for simulation in health professions education. Advances in Simulation. 2016;1(1):1–6.

2. Freer H, Jones S, Lewandowski, J, Randles D, Dores C. 138 Student Perspectives of a Novel Remote Simulation Course. International Journal of Healthcare Simulation. 2021. 1: Supplement 1. A60-A60.

3. Holmes C, Mellanby E. Debriefing strategies for interprofessional simulation – a qualitative study. Advances in Simulation. 2022;7(1):1–9.

Emergency presentations in General Practice (GP) are increasing, however teams may go months without having to manage one. While guidelines exist for emergency management, most are written for hospital practice, and applicability to primary care is limited. Similarly, simulation training to support teams in the management of emergencies is common in hospital but not in family medicine. An audit of GPs in the Thames Valley revealed significant concerns about providing care for acutely unwell patients and highlighted the conditions they were most worried about.

Methods:

We used a Delphi process with a panel of experts to design novel checklists for treating emergency conditions in primary care (Figure 1). Human factors principles informed the design of a GP Quick Reference Handbook (QRH) [1,2] and a review of the literature ensured we had the most up to date treatment protocols. Guidance from GPs informed pragmatic recommendations for treatment where limited resources are available. We used in-situ, low-fidelity simulation to train primary care teams to use the QRH. Sessions (lasting 3 hours) were delivered by experienced faculty at 15 practices. Feedback was collected on the design and content of the checklists and the simulation training.

Figure 1:

Flowchart describing the Delphi process for the development of the GP Quick Reference Handbook (QRH). Additional expertise and input was thought from the working group which comprised subject matter experts (from emergency medicine and paediatrics), GP receptionists, practice nurses and midwives, practice managers and patient representatives.

Results:

Seventeen checklists were produced: 14 to guide clinical actions in acute conditions (e.g. croup, anaphylaxis); one ‘key basic plan’ to be used when the diagnosis is unclear; a checklist to aid non-clinical staff; and an SBAR (Situation/Background/Assessment/Recommendation) guide for handover of key details to ambulance retrieval teams. The complete QRH can be printed in hard copy or accessed on an electronic device. Feedback on the QRH from multidisciplinary teams in primary care was universally positive. The simulation-based training was extremely popular with 100% agreeing they would like it embedded as normal practice in primary care.

Conclusion:

Checklists are a vital component of safe work processes in high reliability organisations and, more recently, in secondary care settings in healthcare. Emergency presentations are not easy to manage in GP environments and checklists could enhance team performance in rapidly evolving, uncertain circumstances [3]. We have developed the first QRH for primary care and used it in simulation-based training in 15 GP practices, but further work is required to analyse any improvements in team performance. In order to ensure sustainability of the project, we are working with regional ‘learning hubs’ for primary care to embed a train the trainer programme and share the QRH nationally.

References

1. Gawande AA. The Checklist Manifesto. London: Profile Books; 2010.

2. Anaesthetists. Anaesthesia emergencies: Quick reference handbook. https://anaesthetists.org/Home/Resources-publications/Safety-alerts/Anaesthesia-emergencies/Quick-Reference-Handbook [Accessed on 26/06/2022]

3. Hales BM, Pronovost PJ. The checklist-a tool for error management and performance improvement. J Crit Care. 2006;21(3):231–5.

Feedback is integral to simulation-based teaching to ensure effective learning [1]. Peer feedback is the process of providing assessment to students who have a similar level of competence [2]. Peer feedback has been shown to both aid in the development of the assessor’s knowledge and skills as well as the student who is being assessed [2]. However, it has been shown that without guidance students have found peer feedback a difficult process [2]. The aims of this study were to assess students’ self-perceived abilities at providing peer feedback at a high-fidelity simulation training day and whether the use of a peer feedback tool would improve their ability to provide peer feedback.

Methods:

12 students attended a high-fidelity medical emergencies simulation training day. The students completed a pre-course questionnaire evaluating their comfort at providing peer feedback and whether a peer feedback tool with guidance would improve their confidence and ability in providing peer feedback. 11 students subsequently piloted the peer feedback tool, which contained a combination of tick boxes and free text spaces. The tool aimed to help the students evaluate their peer’s scenario and provide feedback. The 11 students who piloted the peer feedback tool completed a post-course questionnaire to evaluate the usefulness of the tool.

Results:

The pre-course questionnaire was completed by 12 students. 11 students answered that a tool would help to provide peer feedback. The post-course questionnaire was completed by 11 students. 100% of the students found the peer feedback tool useful and that it improved their ability to provide feedback. 91% of the students found that providing feedback enhanced their learning. 91% of the students found that providing feedback helped to retain their interest in the scenario. 100% of the students found receiving peer feedback useful and improved their understanding of the scenario.

Conclusion:

The students felt that giving and receiving peer feedback is beneficial to their learning. The use of a peer feedback tool improved the students’ confidence in providing useful feedback to their peers. Going forward the peer feedback tool will be used at future simulation training days to enhance learning for the students. The effectiveness of the tool will be further evaluated by future students completing the post-course questionnaire.

References

1. Issenberg SB, McGaghie WC, Petrusa ER, Lee Gordon D, Scalese RJ. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach. 2005;27(1):10–28.

2. Yu JH, Lee MJ, Kim SS, Yang MJ, Cho HJ, Noh CK, Lee GH, Lee SK, Song MR, Lee JH, Kim M. Assessment of medical students’ clinical performance using high-fidelity simulation: comparison of peer and instructor assessment. BMC Medical Education. 2021;21(1):1–6

Health Education and Improvement Wales (HEIW) established a Simulation Team (Sim Team) in July 2020 to develop and implement a multi-professional strategy for simulation-based education and training for Wales [1]. The team comprises five interprofessional Associate Deans and a full-time manager.

Methods:

Work formally started on the strategy in spring 2021. An Associate Dean was allocated to lead.

Stage 1: The Sim Team obtained awareness to key strategy needs from engagement with the Welsh health and care simulation community (Sim Community). A range of internet-available simulation strategies were reviewed to gain knowledge of current approaches and strategic themes. A first draft vision, mission statements, domains, and workstreams were outlined (‘the plan on a page’). Work with HEIWs planning team followed, with extensive discussions to ensure appropriate key terminology.

Stage 2: Each Associate Dean defined objectives for each of their responsible workstreams. A Sim Team brainstorming day peer reviewed each other’s work to form the finalised draft strategy.

Stage 3: A programme of key stakeholder engagement events was planned for consultation and feedback on the draft strategy, including sessions with Welsh Simulation Experts, Learners, Patient/Service User representatives, and the wider Sim Community. The first event engaging simulation experts led to minor revisions to the mission statements, which were cascaded to subsequent consultations. Other revisions are being withheld until completion of all events. Update/Q&A sessions were provided at Sim Team webinars (June, December 2021, June 2022). At completion of each stage, the strategy was submitted to the HEIWs Executive Board for review and feedback.

Results:

The strategy is divided into four domains of work (Engaging People and Partnerships, Promoting Quality, Supporting Simulation Delivery, and Designing Future Directions) with three workstreams per domain. It has been positively received. Completion of the engagement events is planned for July 2022. Concluding revisions will then be made with submission of the finalised strategy to HEIWs Executive Team for closing sign off, which will complete Stage 4.

Conclusion:

We have developed a strategy that outlines HEIWs commitment of work to support simulation over the coming five years, which is nearing its final stages for publication. This has been written and revised in close consultation with key stakeholders to ensure its relevance and longevity. The next step will be the development of an implementation plan.

Reference

1. Health Education and Improvement Wales. Integrated Medium-Term Plan 2022–25 Version 1. 2022 https://view.officeapps.live.com/op/view.aspx?src=https%3A%2F%2Fheiw.nhs.wales%2Ffiles%2Fheiw-impt-2022-25%2F&wdOrigin=BROWSELINK [Accessed on 28/06/2022]

In response to a sector-wide lack of placement opportunities for undergraduate pharmacy students during the COVID-19 pandemic [1], a range of simulated placement experiences were developed by a university teaching team. These experiences were developed at a time of significant change for pharmacy education, with all pharmacists being annotated as independent prescribers at the point of registration from 2026 onwards [2]. This innovation was intended to support final year undergraduate pharmacy students in developing, refining and demonstrating clinical history taking and decision-making skills, which are skills essential to the existing single competency framework for prescribing practitioners [3].

Methods:

Four ‘experiential learning days’ (ELDs) were developed, focussing on a ‘day in the life’ of a pharmacist engaged in multiple spheres of practice: a community pharmacy, a hospital environment, a primary care setting and a care home environment. Experienced pharmacist practitioners co-developed sessions to ensure that the activities were reflective of the real-life setting. In designing these screen-based activities, the teaching team prioritised the development of an immersive event, which felt like a live activity despite being undertaken at a time and place chosen by the learner. Scheduled space in the timetable was allocated for students to undertake these ELDs, although they could be accessed at any time following this. A pre-recorded orientation lecture was provided one week ahead of the first scheduled date. The ELDs were developed through the Canvas VLE platform, making use of pre-requisites and conditional requirements to allow feedback and debriefing to be released after completion of activities. Patient Communication Simulator (PCS) Spark was utilised to integrate multiple patient interactions into each of the days.

Findings:

These interactions focussed on clinical history taking, clinical decision-making, and patient communication. Immersion was increased through the use of pre-recorded handover videos, realistic documentation and simulated patient interactions. Consolidation and testing of learning took place in multiple forms, including short multiple-choice quizzes, which tested collation of key patient information, understanding of physical assessment findings and plans for ongoing patient management. Additional mechanisms were selected to be reflective of day-to-day communication and included the recording of voicemail messages and responding to emails. Email responses that were received by students were screened for key information, and automatically generated replies were sent to learners to allow them to mark activities as completed. Feedback was released as a pre-recorded presentation to students who had completed all milestones, identifying key discussion points and encouraging reflection of learning and performance.

Conclusion:

A range of simulated screen-based virtual ‘day in the life experiences’ were developed and implemented in the undergraduate Master of Pharmacy (MPharm) curriculum, intended to support students in developing key skills including clinical decision-making and clinical history taking. A variety of mechanisms were used to maximise immersion, despite sessions being run asynchronously. A high level of student engagement was observed with the activities, and formal work to investigate student attitudes and perceptions to these events is ongoing.

References

1. Liu L, Caliph S, Simpson C, Khoo RZ, Neviles G, Muthumuni S, Lyons KM. Pharmacy Student Challenges and Strategies towards Initial COVID-19 Curriculum Changes. InHealthcare. 2021;9(10):1322.

2. General Pharmaceutical Council. Standards for the initial education and training of pharmacists. January 2021. https://ddec1-0-en-ctp.trendmicro.com:443/wis/clicktime/v1/query?url=https%3a%2f%2fwww.pharmacyregulation.org%2fsites%2fdefault%2ffiles%2fdocument%2fstandards%2dfor%2dthe%2dinitial%2deducation%2dand%2dtraining%2dof%2dpharmacists%2djanuary%2d2021%5f1.pdf&umid=557331e6-a625-4471-be2d-52126f877c7e&auth=6b639a990a359ff1d6cc8761081d57748ce3c81e-89f467ee17139335739043f4013d904870c9f291 [Accessed on 27/09/2022]

3. The Royal Pharmaceutical Society. A competency framework for all prescribers. September 2021. https://www.rpharms.com/Portals/0/RPS%20document%20library/Open%20access/Prescribing%20Competency%20Framework/RPS%20English%20Competency%20Framework%203.pdf [Accessed on 27/09/2022]

Physical health emergencies that occur in acute mental health settings are not frequently seen. This may lead to delays in patients receiving appropriate care [1]. Simulation is an underused training modality in mental health [2] and there are currently only a few courses that address this area. (https://www.hee.nhs.uk/sites/default/files/documents/RAMPPS%20course%20handbook.pdf).

Recognition and management of physical emergencies in mental health can be simulated and can focus on both technical and non-technical skills [3]. We aimed to facilitate simulation of physical health emergencies designed for staff who work within acute mental health settings. Opportunities for staff to simulate management of these scenarios in a safe environment with a view to improve their practice, improve patient safety and reduce mortality.

Methods:

Psychiatry and Emergency Medicine healthcare professionals were involved in developing scenarios to ensure key learning objectives were met. Five physical health scenarios were simulated based on real life cases where improvement in their recognition and management was needed (e.g. significant incidents). These were deliberate self-harm, acute stroke, sepsis, fractured neck of femur, and cardiac arrest. A combination of actors and manikins were used. Eight candidates attended the one-day course and were given equal opportunity to manage a scenario as if it were taking place in their own place of work. Candidates remained in the capacity in which they normally work, drawing on their existing skills and knowledge. Faculty members delivering the course all had significant emergency medicine experience and their current roles were in emergency medicine. Candidates were initially orientated to the simulation laboratory including a high-fidelity manikin. An introductory session discussing human factors was then delivered before the candidates progressed to the scenarios.

Findings:

Formal feedback was completed at the end of the session. All candidates found the experience enjoyable, found it relevant to their work, and found the scenarios challenging. All candidates agreed that this sort of training would improve patient safety and that the training should be repeated for others. The main limitation was that some medical equipment was different to what the candidates would use in their own place of work.

Conclusion:

Management of physical health emergencies in the mental health setting can be successfully demonstrated by simulation. This session provided a safe learning space for all of the candidates to demonstrate both technical and non-technical skills in a supportive environment.

References

1. Mwebe H. Physical health monitoring in mental health settings: a study exploring mental health nurses’ views of their role. Journal of Clinical Nursing. 2017;26(19–20):3067–3078.

2. Lavelle M, Attoe C, Tritschler C, Cross S. Managing medical emergencies in mental health settings using an interprofessional in-situ simulation training programme: a mixed methods evaluation study. Nurse Education Today. 2017;59:103–109.

3. Peate, I. Using Simulation to enhance safety, quality and education. Journal of Paramedic Practice. 2011; 3(8):429.

International medical graduates form an essential part of the NHS workforce. Transitioning into NHS work is not straightforward for many: IMGs are significantly more likely to receive complaints, face fitness to practice investigation, and fail postgraduate assessments [1,2]. Creating meaningful opportunities to support IMGs in their transition into the NHS is a daunting task. They represent a heterogeneous group of medical staff and there is no ‘one size fits all’ solution. With the support of Health Education England Southwest funding, we piloted a bespoke simulation-based education (SBE) course for IMGs working in paediatrics, who had been working in the NHS for less than 2 years.

Methods:

A survey of educational supervisors had suggested that focus areas should include communication, leadership, and team working. This, together with feedback from IMGs was used to design the course. The first course was delivered in Bristol in May 2022 to 8 participants. An introduction to SBE and human factors was followed by five scenarios. Two were manikin-based and focussed on managing the acutely unwell child. Two used simulated participants for communication-based scenarios covering medical error, safeguarding, and incivility. One scenario was a small group-based task prioritisation exercise. Feedback forms and interactive tools were used pre and post to collect mixed quantitative and qualitative data on the experience of participants, with self-reported confidence assessed across several domains.

Results:

Participants enjoyed and valued the course (Figure 1). Participants’ self-reported confidence increased in all domains studied, with the greatest increase seen in managing safeguarding cases (Table 1). Participants reported the learning environment to be friendly and supportive and that the course covered important and useful topics. All participants felt that they were able to ask questions, were given meaningful feedback, and that their ideas and experiences were valued, as well as feeling more valued as a member of the paediatrics community. Participants used the opportunity to complete portfolio assessments and have subsequently participated in other SBE activities.

Table 1:

Mean self-reported confidence scores (where 5 is most confident and 1 is least confident), pre- and post-course

Figure 1:

‘How are you feeling?’ pre- and post-course clouds from attendees.

Conclusion:

A bespoke simulation course has a role in supporting the professional development and confidence of IMGs, as well as paving the way to access other SBE opportunities. We are excited to refine this course for our next date following feedback from faculty and attendees, including more focussed quantitative and qualitative data collection on non-technical skill development. We look forward to exploring how this course can be incorporated as a longstanding part of the regional educational offer.

References

1. Woolf K, Rich A, Viney R, Needleman S, Griffin A. Perceived causes of differential attainment in UK postgraduate medical training: A national qualitative study. BMJ Open. 2016;6(11):1–9.

2. British Medical Association. Differential attainment: Making medical training fair for all. 2017;324(7343):952–957.

Interprofessional Education (IPE) has been defined and practised over decades. The World Health Organisation has stated that IPE ‘occurs when two or more professionals learn about, from, and with each other to enable effective collaboration and improve health outcomes’ [1]. There is a recognised improvement in learner’s practice in several aspects namely leadership, teamworking, communication, and negotiation skills along with trust, self-esteem, and shared decision-making [2]. A Cochrane review concluded that IPE improved working culture, patient satisfaction, decreased errors, improved patient management and the knowledge and skill of professionals [3]. It is, therefore, desirable that IPE should be incorporated wherever possible in simulation-based education. We endeavour to facilitate and encourage this practice across health and care professionals in Wales.

Activity:

For Interprofessional simulation-based education (SBE) to be successful, there needs to be significant coordination and resource interoperability. The undergraduate, pre-registration and post-registration postgraduate organisations, councils and health boards will have to work together. We recognised that the role of the Health Education and Improvement Wales (HEIW) Simulation Team would be that of a conduit in facilitating discussions between relevant stakeholders to identify wishes for simulation-based IPE, challenges and potential solutions and how this can be achieved by all stakeholders. After completing the project proposal, the simulation team invited individuals from all relevant stakeholders across health and care organisations and institutions in Wales.

Results:

All stakeholders agree that there are various challenges which has resulted in the preclusion of IPE in SBE so far, although the benefit has been well recognised. The stakeholder views from discussions so far are as below:

Communication and collaboration will be fundamental both internally and externally to institutions and organisations.

Sharing best practice and resources will be one of the keys to success.

IPE in simulation needs to be driven by the service/education need, not by technology

Joint interprofessional leadership in implementation and delivery is important.

An infrastructure and shared pathway is required between Health Boards/Trust and Health Education Institutions, so everyone has the same strategy/joint direction.

Conclusion:

Interprofessional SBE can be the focal point in promoting patient-centred care where professionals across healthcare learn about, of and from each other in a curriculum-based, validated teaching and training programme. We are continuing the conversation to identify the pathway for the successful implementation in Wales.

References

1. Organisation WHO. Referral Systems: A summary of key processes to guide health services managers. 2008.

2. Olenick M, Allen LR, Smego RA, Jr. Interprofessional education: a concept analysis. Adv Med Educ Pract. 2010;1:75–84.

3. Reeves S, Perrier L, Goldman J, Freeth D, Zwarenstein M. Interprofessional education: effects on professional practice and healthcare outcomes (update). Cochrane Database Syst Rev. 2013;2013(3):Cd002213.

Working in Emergency Departments (ED) can, at times, be challenging for staff who are expected to work as a team, manage a wide range of conditions, and respond rapidly in a changeable environment [1]. Simulation has been proven to be a psychologically safe approach allowing staff to practise and explore Human Factors (HF) skills [2]. WingFactors, HF trained pilots, joined the faculty to collaborate and run in-situ simulation [3]. Our aim was to integrate HF-focused simulation with application into clinical practice, utilising the novel and fresh aviation perspective.

Methods:

Simulations were designed by clinicians with both technical and non-technical learning outcomes. Patients were played with either a manikin, a pre-briefed actor, or both. The participants were mainly doctors and nurses but have included the wider multidisciplinary team. Senior doctors were embedded and briefed to be able to offer support as part of a staggered entry. After debriefing, each participant completed a feedback form evaluating their experience, confidence levels, and take-home messages.

Results:

Seven different scenarios were run gathering 65 responses. Participants’ agreement with five questions using 5-point Likert scales and free text thematic analysis allowed evaluation of the simulation experience. They were asked to consider the usefulness, understanding, and relevance of topics, as well as confidence gained. In addition, participants were asked how they felt the experience would change or enhance their clinical practice. High satisfaction and clinical relevance of the simulations were reported with a mean score of 4.85 across all domains (Table 1). Qualitative feedback showed participants had learnt both technical and specific non-technical learning objectives. Thematic analysis demonstrated that participants had gained skills such as improved emotional intelligence and confidence, ability to challenge authority gradients safely, team motivation, and shared decision-making. Some of the key themes from the feedback offered by the pilots include the importance of ‘read-back’ communication, pressure testing decision-making, and the power of pre-briefing.

Table 1:

Scenarios with participant numbers and average scores/5

Conclusion:

The involvement of the pilots added value to the teaching by bringing a new perspective, experience, and application of HF. Individuals have walked away with a better understanding of they can practically implement HF skills into everyday clinical practice, improve patient care and mitigate risk. We hope to progress this collaboration, trialling new HF concepts (e.g. managing error) involving more members, not only the multidisciplinary team, but service users as well and to explore the potential learning in offering more clinicians the patient’s perspective.

References

1. Bleetman A, Sanusi S, Dale T, Brace S. Human factors and error prevention in emergency medicine. Emerg Med J. 2012;29(5):389–393.

2. Petrosoniak A, Auerbach M, Wong AH, Hicks CM. In situ simulation in emergency medicine: moving beyond the simulation lab. Emergency Medicine Australasia. 2017;29(1):83–88.

3. WingFactors. Pilot Sim Programme. https://wingfactors.co.uk/pilot-sim/ [Accessed on 18/06/2022].

Simulation technicians are a vital part of simulation teams and facilitating simulation sessions. Additionally, they help to materialize the educators’ vision [1]. There is a gap between what educators expect from technicians and how well technical staff perform based on the instructions given. To support simulation-based education understanding of the educational philosophy underpinning simulation processes used by educators would improve and enhance the abilities of the technician. A survey-based review recommended exploring opportunities that simulation technicians have and to create more opportunities for technicians to get involved [2]. Not having sufficient knowledge and understanding can impact on the overall preparation and requirements from the technician. Full understanding between instructional and educational principles will close the gap and allow simulation technicians to have a deeper role and active part of simulation-based education. This allows simulation technicians to go beyond the technical skills and technical terminology especially for those whose background is non-clinical. The overall aim is to explore what opportunities simulation technicians have to participate in educational simulation events to enhance their knowledge, skills, and effectiveness of their role.

Methods:

Interestingly the Society in Europe for Simulation Applied to Medicine (SESAM) 2022 conference was attended by 607 delegates from 51 countries with only 36 simulation technicians attending. This meant that only 6% of the delegates were Simulation Technicians compared to other professionals, which is a small number. This data was never previously collected by SESAM so we do not know if this number has changed over the years [3].

Results:

The study is presently being submitted for ethical approval. It is the expectation that the data will be collected and analysed upon receiving the ethical approval.

Conclusion:

We will gain new understanding from the technicians’ perspective on the attendance at simulation-based educational events from the Simulation Technicians network across the United Kingdom. It will help us identify how often simulation technicians attend and what benefits there were to this continual professional development opportunity. Simulation technicians should have more opportunities to participate in conferences and educational events. This will close the technicians-educators’ educational gap and allow them to have a more meaningful part within the simulation community, resulting in more equity, parity, and diversity.

References

1. Bailey R, Taylor R, FitzGerald M, Kerrey B, LeMaster T, Geis G. Defining the Simulation Technician Role. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare. 2015;10(5):283–287.

2. Nicklin J. Review of Clinical Skills and Simulation Technicians/Technologists in the UK: Results of a Survey-Based Study. Aspih.org.uk. 2016. http://aspih.org.uk/wp-content/uploads/2017/06/results-of-a-survey-based-study-jnicklin-2016.pdf [Accessed on 28/06/2022]

3. SESAM personal communication by email 27/06/2022

Infant abductions from hospital are rare events but make headline news. A US study examined 247 infant abductions between 1983–2006 and found nearly half were abducted from healthcare settings [1]. Abduction risk reduction strategies are also considered during the Care Quality Commission’s inspection of each maternity unit [2]. The baby tagging system was updated in our hospital in April 2020, training undertaken and subsequently reinforced with e-learning. In our hospital, many families have safeguarding concerns. These are considered the highest potential risk for infant abduction so it is essential the system and processes provide protection. The aim of this simulation was to test the processes currently in place for a tagged baby abduction from an inpatient ward to highlight good practices and identify system failures.

Methods:

An activated tag was assigned to a manikin on the transitional care unit. The manikin was removed, in a carrier bag, by a faculty member (‘the abductor’) tailgating a leaving staff member thus preventing the ward doors from automatically locking when the tag is near the sensor. The ‘abductor’ took the lift to the ground floor and walked out of the main entrance within three minutes. Faculty members were placed in transitional care (TC), the main entrance, and another tracking the tag’s location. A timeline of events was recorded and analysed. Simulation participants were debriefed, including staff directly involved, parents on TC, front of house staff, and senior managers.

Results:

It was evident from the debriefing that this caused significant distress to some staff members who felt helpless and uncertain when faced with this scenario. It highlighted how quick and easy it is to leave the hospital with a baby. Important human factors were identified including discrepancies between emergency call requests and responses, and poor knowledge about the abduction of baby policy. System problems were found: hospital ‘lockdown’ locked internal doors preventing responder actions but not all external doors; and the tagging system did not respond as expected – locking the doors to the ward and an inaccurate final tag location.

Conclusion:

Multiple deficiencies in the system were found so an action plan has subsequently commenced. New external doors have been added to automatic lockdown and a new main entrance door system proposed. Tagging engineers are addressing the automatic locking of internal doors and tag location, switchboard calls are to be standardised, and the standard operating procedure is being reviewed and recirculated.

References

1. Burgess AW, Carr KE, Nahirny C, Rabun JB Jr. Nonfamily infant abductions, 1983–2006. Am J Nurs. 2008 Sep;108(9):32–8. doi: 10.1097/01.NAJ.0000334972.82359.58. PMID: 18756155.

2. Care Quality Commission NHS IH Maternity core service framework v7 (2018)

Simulation is known to improve clinical skills and team communication. A full-day neonatal emergency simulation course was established in 2018 for paediatric postgraduate doctors in training. It consists of four scenarios and two workshops for eight candidates; running 4 times per year. The candidates are split into 2 groups allowing each to ‘lead’ a scenario with traditionally faculty placed as nursing plants. In contrast, simulations run on our neonatal unit involve both nursing staff and medical candidates, allowing for true multidisciplinary working. Access and funding for simulation can be more difficult for nurses but it is known that the protected environment and the sense of security enhance nursing students’ self-esteem and confidence, thus promoting learning [1]. The aim of the study was to make the SHINE course more authentic to real life with a multidisciplinary approach to the scenarios; to see if inviting neonatal unit nurses to the course affected the postgraduate doctors in training feedback (which has always been consistently positive); and to assess if the nurses felt it was beneficial for their training.

Methods:

We invited four nurses to SHINE who were about to complete their Neonatal Qualified in Specialty (QIS) Course. They took the nursing role in the scenarios either caring for the baby (a manikin) in the neonatal unit or carrying the labour ward delivery nursing bleep. We evaluated the relevance, confidence levels, and the learning environment for both the doctors and nurses attending the course via a written anonymous survey.

Results:

The doctor’s feedback was very positive and comparable to previous courses ran with all of them recommending the course to their colleagues, and they felt they had enough opportunity to interact. The nurses felt sessions were very relevant to their current practice and all of them improved their level of confidence. They felt there was the correct number of scenarios and workshops; that the debriefings were well structured and educational; the learning environment was safe and supportive; and all would recommend the course to a colleague. Comments included ‘Really enjoyed the day and it has definitely helped me to feel more confident – especially as I’ve only just started holding the bleep.’

Conclusion:

SHINE is a well-established sought-after course shown to be effective and highly valued by paediatric postgraduate doctors in training. Given the positive feedback, we will be inviting four nurses to each SHINE course and integrating it in to Qualified in Specialty training.

Reference

1. Koukourikos K, Tsaloglidou A, Kourkouta L, Papathanasiou IV, Iliadis C, Fratzana A, Panagiotou A. Simulation in Clinical Nursing Education. Acta Inform Med. 2021;29(1):15–20.

Childbirth can be unpredictable in its timing and clinical course. Low-risk pregnant women can choose to deliver their infants at home, with 1 in 50 women in England and Wales choosing a home birth [1]. However, for those giving birth for the first time, there is an increased risk of adverse perinatal outcomes when compared to an obstetric unit – 5 in 1000 for a hospital birth compared to 9 in 1000 for a home birth [1], and 45% of nulliparous women are transferred to an obstetric unit [2]. Obstetric emergencies can occur and infants are born in poor condition. In these cases, every minute matters to reduce morbidity and mortality. Expertise and resources are also limited in the community; midwives and paramedic crews must work synergistically to achieve the best outcomes. Our aim was not only to show ideal clinical management of a combined neonatal and obstetric emergency but also to explore multidisciplinary team working, communication, and human factors of these complex situations.

Methods:

The simulation involved a low-risk term pregnant woman who has chosen to have a home birth. It was filmed in a house for authenticity. In attendance were a community midwife and maternity assistant. The baby was born in poor condition: floppy, pale with no respiratory effort, and bradycardic. Neonatal life support was given up to and including chest compressions with good recovery of heart rate but no spontaneous breathing, therefore, requiring supraglottic airway insertion. The handover was given to the paramedics and the infant was conveyed to the neonatal unit. The scenario then unfolded with the mother also having a postpartum haemorrhage requiring oxytocin, syntometrine, misoprostol, tranexamic acid, and fluid resuscitation, utilising a second paramedic crew and transfer.

Results:

The simulation was recorded as exemplary management of this situation. It will be used to deliver training to West Midlands Ambulance Service and community midwives; aiding as a discussion point for clinical management, communication strategies, team leadership, roles, and delegation. We will collate written feedback on its impact on both paramedic and midwifery confidence levels. The community midwife, midwifery assistant, and paramedics who attended stated how much it had increased their confidence in managing a dual emergency, and affirmed their roles and responsibilities in such cases.

Conclusion:

We expect that with increased staff education and confidence, the outcomes of babies born in the community in unexpectedly poor condition will improve.

References

1. NHS. (Reviewed 2021) Where to give birth: the options. https://www.nhs.uk/conditions/pregnancy-and-baby/where-can-i-give-birth/ [Accessed on 27/06/2022]

2. Brocklehurst P, Puddicombe D, Hollowell J, Stewart M, Linsell L, Macfarlane AJ, McCourt C. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. British Medical Journal (BMJ). 2011;343:d7400.

Neonates in intensive care are vulnerable to colonisation and invasive infections from multi-resistant gram-negative bacteria [1]. In 2021 our neonatal unit (NNU) fell victim to an ESBL-Klebsiella outbreak. An outbreak control plan was formulated that included education; hand-hygiene and cleaning auditing; cohorting infants; mass screening infants and environment; and reduction of equipment in clinical areas. Our NNU has an active multidisciplinary simulation programme. Simulation is an effective educational tool to increase competence of healthcare providers [2]. We wanted to use simulation to highlight the ease of transmission of particles from a colonised infant.

Methods:

The simulation involved a preterm 28-week infant corrected to 35-week gestation with numerous desaturation episodes. The baby was known to be colonised with pseudomonas. A ‘monitored’ low-fidelity manikin was placed in a cot in an isolation room. Candidates were unaware that the manikin was covered with ultraviolet powder. The manikin had numerous desaturation and bradycardic episodes necessitating airway and breathing support, clinical assessment, and septic screen. The spread of powder was assessed afterwards with a black-light.

Results:

The simulation lasted just 8 minutes. There were exemplary unprompted infection-prevention measures with appropriate handwashing and personal protective equipment. Despite this the powder spread to staff facemasks, stethoscope, resuscitation equipment, patient trolley, and monitor.

Conclusion:

This demonstrated the ease of transmission of particles to other surfaces despite adherence to infection prevention policies. Most striking was the transmission to candidates’ facemasks which are not routinely changed, and could be a potential risk of carriage of microbes to other infants.

References

1. Patel SJ, Green N, Clock SA, Paul DA, Perlman JM, Zaoutis T, Ferng YH, Alba L, Jia H, Larson EL, Saiman L. Gram-Negative Bacilli in Infants Hospitalized in The Neonatal Intensive Care Unit. J Pediatric Infect Dis Soc. 2017;6(3):227–230.

2. Aggarwal R, Mytton OT, Derbrew M, Hananel D, Heydenburg M, Issenberg B, MacAulay C, Mancini ME, Morimoto T, Soper N, Ziv A. Training and simulation for patient safety. BMJ Quality & Safety. 2010;19(Suppl 2):i34–43.

Childbirth can be unpredictable in its timing and clinical course. Unplanned pre-hospital birth occurs in 0.5% of babies [1]. Premature babies are also born in the community and in these cases, every minute matters in order to reduce morbidity and mortality. Hypothermia has been shown to causes a rise in mortality in low-birth-weight infants – in fact a 28% rise per 1 degree decrease in admission temperature [2].

In 2020–21 webinars were delivered to West Midlands Ambulance Service (WMAS) paramedics to improve their knowledge and expertise when attending preterm births [3]. This encompassed training on basic Neonatal Life Support skills and a focus on thermoregulation. A heated mattress is also now carried routinely by WMAS. There was overwhelming positive feedback [3] so the education was expanded.

Our aim was to show the clinical management of a marginal preterm infant in the community focussing on simple interventions known to improve outcomes such as delayed cord clamping and optimal thermal care.

Methods:

The simulation involved a low-risk term pregnant woman who went in to preterm labour and quickly delivered at 35 weeks. The paramedics attended as the baby delivered. It established regular respirations with simple airway manoeuvres. They used a heated gel mattress to maintain the baby’s temperature and allowed delayed cord clamping and then conveyed the mother and infant to hospital for assessment.

Results:

The simulation was recorded and is now being used to deliver training to West Midlands Ambulance Service. The paramedics who attended stated how much it had increased their confidence in managing a preterm delivery and consolidated their learning from the previous webinar.

Conclusion:

We expect that with increased staff training and confidence, the incidence of preterm babies admitted with hypothermia following an unexpected birth in the community will reduce, thus reducing mortality.

References

1. Loughney A, Collis R, Dastgir S. Birth before arrival at delivery suite: associations and consequences. British Journal of Midwifery. 2006;14(4):204–208.

2. Laptook AR, Salhab W, Bhaskar B; Neonatal Research Network. Admission temperature of low-birth-weight infants: predictors and associated morbidities. Pediatrics. 2007;119(3): e643-e649

3. Aguirre D, Henry S, Fernandez CP, Brown S. 46 ‘Born Too Soon’Virtual Simulation for Ambulance Services On Premature Babies Born Unexpectedly in the Community. International Journal of Healthcare Simulation. 2021; 1(suppl 1): A50.

Core medical training was replaced by Internal Medicine Training (IMT) in August 2019. One of the more notable changes was the introduction of a 3^rd year, known as IM3, to IMT. This year is considered a step-up year or a junior registrar year, where advice from a supervising physician is readily available. To assist with this transition, we created step-up simulation-based scenarios. Previously, it has been demonstrated that simulation is an important tool in improving the confidence and knowledge of first year doctors. Simulation provides doctors an ethically and educationally safe setting to develop their practice [1]. The purpose of these scenarios is to replicate the complex patients and dynamic environments that on call general medical registrars need to manage.

Methods:

We created an in-person teaching day, entitled ‘Step up’, which consisted of four 20-minute, IM3 specific, high-fidelity scenario-based simulations. In each scenario, a computerised full-body manikin (SimMan Essential) was used. The manikin could be programmed to provide physiological response to scenario participants’ actions. The participants were each tasked to assess an acutely deteriorating patient (the manikin), whilst managing a demanding bleep to add realistic distractions and human factor issues to the scenario. Each participant completed one scenario and watched their peers complete the others from a separate room. Following this, participants were debriefed by qualified member of staff and then taught by a speciality registrar or consultant. Feedback forms were collected. The participants were tasked to rate the simulation day, using a nominal Likert scale from 1 to 10, for usefulness, relevance, clarity, and overall quality. 1 represented strong disagreement and 10 strong agreements with a particular domain.

Results:

Across 4 full days, we had 11 IM3 doctors take part in the ‘step up’ scenario-based simulations. 9 of the 11 participants completed feedback forms. Scores ranged from 8 to 10. Median scores for all domains were 10.

Conclusion:

We have demonstrated that ‘step up’ scenarios are a useful and relevant aid for those transitioning into IM3. Further research utilising comparative data will provide more meaningful conclusions. We will be repeating the simulation programme for the next cohort. We will have baseline, one and three-month follow up questionnaires to assess these scenarios further.

References

1. Buist N, Webster CS. Simulation training to improve the ability of first-year doctors to assess and manage deteriorating patients: a systematic review and meta-analysis. Medical Science Educator. 2019;29(3):749–761.

It is ethically impermissible for medical students to perform invasive procedures on patients before being competent to do so safely [1,2]. Simulation offers obvious benefits, yet established simulation approaches can over-focus on technical tasks and overlook the need for simultaneous communication with patients and colleagues. Transdisciplinary Simulation (TS) addresses these issues by creating a safe, ‘low stakes’ learning environment based on an apparently unrelated field which in fact offers close parallels with medicine, in this case the kitchen. Expert chefs, like clinicians, must be skilled in preparing and organising their workplace (mise-en-place) [3], constantly attending to hygiene, precision, dexterity, and communication with colleagues and diners.

Activity:

The Medical Kitchen is an affordable and scalable instance of TS, developed to help second year medical students acquire psychomotor clinical skills while simultaneously communicating with a patient or colleague. The Medical Kitchen comprises self-guided learning of two new clinically-relevant skills followed by peer assessments; a subsequent whole class synchronous debrief; and individual guided reflections. Our team (clinical educators and a professional chef) selected ‘turning’ vegetables as a core skill, teaching students to shape courgettes or potatoes into regular and consistent shapes using a suitable knife. This requires dexterity and control, gained through repeated practice, and presents similarities with clinical skills. The knowledge gained from turning vegetables is then applied to the clinical skill of suturing while talking to a colleague, highlighting the need to integrate physical skills with sensitive communication.

Findings:

The Medical Kitchen programme has been delivered to over 700 second-year undergraduate medical students at Imperial College London over the course of two years. It is versatile and adaptable, having been delivered in both online and live session formats in response to the COVID-19 pandemic. Student feedback through guided reflections on perceived value has been overwhelmingly positive (though it is too early to establish the long-term effect on students’ clinical skills).

Conclusion:

The Medical Kitchen offers an innovative approach to clinical skills acquisition, using the world of professional gastronomy to simulate the clinical environment. It is an affordable and scalable programme grounded in theories of psychomotor skills development and has the potential for widespread implementation. As an example of transdisciplinary simulation, it raises wider possibilities for simulation design and innovation within clinical education.

References

1. Reznick RK, MacRae H. Teaching surgical skills – changes in the wind. New England Journal of Medicine. 2006;355(25):2664–2669.

2. Sadideen H, Kneebone R. Practical skills teaching in contemporary surgical education: how can educational theory be applied to promote effective learning?. The American Journal of Surgery. 2012;204(3):396–401.

3. Schlegel C, Flower K, Youssef J, Käser B, Kneebone R. Mise-en-place: Learning across disciplines. International Journal of Gastronomy and Food Science. 2019. 16:100147

Scottish cystoscopy service provision faces significant challenges in the years ahead driven by COVID-19’s impact on diagnostic waiting times, the development of national treatment centres to expand infrastructure/service delivery, and limited short-term medical capacity to support recovery. These factors have greatly increased demand for the rapid development of a supportive non-medical cystoscopist workforce [1]. There is currently no agreed national approach to non-medical cystoscopy training in Scotland despite clear guidance on competencies from the British Association of Urology Nurses (BAUN). Our proposed solution has been to collaboratively develop and pilot an accelerated learning programme, including a simulation ‘bootcamp’, that pump primes adaptation to the role and clinical training requirements through technical and non-technical skill rehearsal.

Methods:

We invited experts from clinical practice, education, and simulation to form a national short life working group (Figure 1) with two aims: To collaboratively develop a national education programme and oversee implementation, governance, and evaluation. Through an iterative process, the team reviewed current education provision, training frameworks, workforce recruitment and retention data, evidence on simulation accelerated training, existing academic models, and the Scottish Government guidance on advanced practice. This was used to collaboratively construct the programme.

Figure 1:

Diagram of the national short life working group

Results:

A unified model for pilot was developed, integrating clinical simulation, theory, and work-based learning (WBL). It focuses on core cystoscopy skills initially, providing the necessary knowledge and ‘hands on’ ability required for independent practice. The process is primed by a two-day ‘cystoscopy bootcamp’ using simulation-based education (SBE). This comprises of a variety of methods including high volume cystoscopy skill rehearsal of increasing realism, progressing to cadaver. Non-technical skills are simulated through bespoke scenarios relevant to the role including obtaining informed consent, team communication, and delivering bad news. Expert discussion and debriefing is interwoven throughout. Formal evaluation is ongoing with early reports of increased preparedness and quicker adaptation to the clinical environment. In addition to the anticipated benefits, bootcamp also established early peer support mechanisms and, through the engagement and networking of diverse faculty, fostered integration with the wider community of practice, and a commitment to building a continually improving, user-informed simulation programme.

Conclusion:

The method provides a cost-effective collaborative way to explore research, educational models, and the challenges of implementation in real time, through a multi-professional lens. The approach has been crucial to ownership, commitment and acceptance of the programme while fostering integrated cross discipline delivery.

Reference

1. Scottish Government Endoscopy and urology diagnostic recovery and renewal plan. 30 Nov 2021 Endoscopy and urology diagnostic: recovery and renewal plan – gov.scot (www.gov.scot) [Accessed on 21/06/22]

Delirium is an acute onset confusion that has fluctuating consciousness symptoms such as hallucinations, mood changes and distractibility. It is experienced by around 2 in 10 patients within the hospital [1]. Amongst these patients, 96% are older adults and their outcomes are consistently worse due to the delirium alone, including increased mortality rates [2]. It can also be extremely frightening and distressing. Hence, the attitudes and knowledge of healthcare professionals surrounding delirium is an important topic to address in order to aid prevention as well as manage delirium. Despite training, delirium is under reported and generally poorly managed. Studies have found that the use of virtual reality in medical education has improved empathy, depth of knowledge, and self-awareness [3]. Using a 360° camera and virtual reality headsets, an in-patient scenario was created whereby the effects of delirium such as hallucinations and disorientation were depicted. The aim of the project was to establish whether virtual reality can be used to improve healthcare professionals understanding and awareness of patients’ experience of delirium. The virtual reality video and the interviews can be found on YouTube.

Methods:

Eight people were recorded using the VR and five of them were interviewed afterwards. The interviews were conducted using an unstructured approach in which the topics of how the virtual reality tool changed their perception of dementia, what they learnt from the tool, and whether they thought the tool was useful, were discussed. Thematic analysis was carried out retrospectively.

Results:

The thematic analysis of the qualitative data highlighted four key themes amongst the healthcare professionals’ responses. These themes were education, insight, empathy, and future practice. The most common theme was insight, with comments such as ‘having the virtual reality, it breaks that barrier between you and them,’ ‘you realise how just isolated that person is,’ and how the virtual reality made them feel like they are ‘in the room,’ emphasising this theme.

Conclusion:

The outcome has been to prove concept and highlight the usefulness of virtual reality as a method of educating healthcare professionals. We have been emboldened by the feedback received. We are looking to incorporate the VR film as part of a broader simulation-based training. The training is already being adopted by local clinical teams and our local university partners.

References

1. Combined NHS (National Health Service). Delirium Training Video (Virtual Reality). 2022. https://www.youtube.com/watch?v=J-jT5AtsmOo [Accessed on 16/06/2022]

2. Royal College of Nursing. Delirium | Older people | Royal College of Nursing. The Royal College of Nursing. 2013. https://www.rcn.org.uk/clinical-topics/older-people/delirium [Accessed on 6/06/2022]

3. Dyer E, Swartzlander BJ, Gugliucci MR. Using virtual reality in medical education to teach empathy. Journal of the Medical Library Association. 2018;106(4):498–500.

With the ageing population in the UK, we have found a rising number of our patients are being diagnosed with dementia [1] and a significant proportion live in care homes. Education to care home staff to help support these residents has been inconsistent despite a need to continue to improve skills managing residents with dementia [2].

Methods:

We developed an interactive training event, ‘Communication in Dementia’, based on the learning needs from a local care home. We opted to use Forum Theatre as a tool to deliver this training. Forum Theatre is where a challenging real-life scenario is dramatised by actors using a pre-written script in front of a group of participants. The group is then facilitated to reflect on what they have observed and explore solutions in a safe environment. This method has been applied successfully in teaching of healthcare professionals such as in nurse education, but its use in the care home setting is uncommon [3]. Despite offering and confirming places to twelve care workers for a two-hour in-person session, only four were able to attend the session on the day. We collected pre- and post-session qualitative and quantitative feedback from the care workers and a written ethnographic reflection of the session.

Results:

Prior to this session, none of the care workers had experience of Forum Theatre. After the session, the feedback received was positive, particularly about the interactive element of the session, demonstrating how the use of Forum Theatre created an enjoyable and valuable learning experience and that all of the care workers felt more confident communicating with residents with dementia after the session. Thematic analysis of the care worker responses in the ethnographic data recorded demonstrated themes including building meaningful connections with residents and recognising burnout in care workers.

Conclusion:

We believe that the use of Forum Theatre to teach Communication in Dementia creates an insightful learning experience for care workers, promoting active involvement in the session. We were disappointed that so few care workers were relieved from duties to attend the session on the day. This may indicate the pressures that the workforce are experiencing. We hope that in sharing the learning from this event, we may promote the use of Forum Theatre in care homes as a means of developing care workers to enhance their skills and ultimately to improve the experience of residents with dementia in care homes.

References

1. Wittenberg R, Hu B, Barraza-Araiza L, Rehill A. Projections of older people with dementia and costs of dementia care in the United Kingdom, 2019–2040. London: London School of Economics. 2019 Nov.

2. Smith SJ, Parveen S, Sass C, Drury M, Oyebode JR, Surr CA. An audit of dementia education and training in UK health and social care: a comparison with national benchmark standards. BMC health services research. 2019;19(1):1–9.

3. Middlewick Y, Kettle TJ, Wilson JJ. Curtains up! Using forum theatre to rehearse the art of communication in healthcare education. Nurse education in practice. 2012;12(3):139–42.

The UK Emergency Medicine training pathway has three phases; Core (CT1-2), Intermediate (ST3), and Higher (ST4-6) [1]. The transition from Core to ST3 can be daunting – whilst not ‘registrars’, ST3s are often on ‘middle grade’ rotas. Trainees are expected to manage complex adult and paediatric cases with new portfolio requirements to demonstrate these competencies. They further develop leadership skills when supporting junior doctors and managing the department [2]. An ‘Introduction to ST3’ course was developed initially in the North West Deanery to address this transition. Using the original concepts, course content and format were adjusted for a Merseyside step up course.

Activity:

The redesigned three-day course contained workshops including ST3 challenges, paediatrics, night shifts, and wellbeing. 12 scenarios were organised into ‘leadership’ (sick medical and trauma patients), paediatrics (including major trauma and safeguarding), and ‘challenges’ (e.g. behavioural disturbance, burns, managing conflict with colleagues and supporting juniors). They took place in a simulation suite with either manikins or simulated patients. Data were analysed pre-course, post-course, and at one to two years post-course with thematic analysis used for free-text responses.

Results:

47 candidates took part in 2019–2021. Pre-course questionnaires showed a key concern was caring for paediatric patients. Other themes were supporting juniors, management skills, being an isolated leader, and confidence. Contemporaneous feedback showed the simulations and talks were rated positively throughout. Simulations were challenging and rated as a useful aspect. The highest rated talks have been night shift work (9.78/10, n=18), supervising others (9.67/10, n=12), and paediatrics (9.67/10, n=12). Improved confidence particularly in challenging situations has been a common theme. Lower rated talks from 2019 were replaced subsequently, and the course remains receptive to feedback. In 2021, ‘The Floor’ game [3] was incorporated for departmental management skills and participants found this particularly useful. One to two years later, candidates reiterated the importance of the course in their transition, particularly regarding paediatric cases. They highlighted the benefit of discussing portfolio requirements and the value of networking with peers.

Conclusion:

The step up course has been an important aid when transitioning to ST3 with feedback consistently positive at the time of the course and subsequently. Analysis of this feedback has informed improvements for the 2022 iteration happening shortly, and reinforced aspects including ‘The Floor’, to provide a supportive transition for trainees. As one trainee reported, the course ‘made me excited for ST3, [a] reminder why I’m an ED trainee’.

References

1. The Royal College of Emergency Medicine, 2021. Curriculum 2021. https://res.cloudinary.com/studio-republic/images/v1633447432/RCEM_Curriculum_2021_Master/RCEM_Curriculum_2021_Master.pdf?_i=AA [Accessed on 14/06/2022].

2. Walthall K, editor. Introduction to ST3; Course Guide. 2019. https://www.researchgate.net/publication/334250058_Introduction_to_ST3_Chapter_1. [Accessed on 14/06/2022].

3. Focus Games, 2022. The Floor Game. https://thefloorgame.com/ [Accessed on 14/06/2022].

Doctors joining Emergency Departments (ED) have individual training needs based on their experience and background of working in different countries or hospitals, and a large proportion of junior doctors work for less than a year in a single ED. We designed the AWARE project to analyse the challenges associated with familiarity with the physical workplace and resuscitation equipment for doctors new to an ED environment. The goals of the project were to assess the diverse learning needs [1], impact of unfamiliarity with environment and equipment on physician confidence, ability to participate in resuscitation scenarios, and to develop a simulation-based intervention to support new doctors in ED.

Methods:

We developed a questionnaire for multidisciplinary staff to explore problems with workplace unfamiliarity and its impact on different aspects of performance during resuscitation. We included questions (tailored to professional background) about the management of resuscitation and the location of vital equipment under the broad headings of: preparation, airway, breathing, circulation, and other critical interventions.

Results:

We collected 104 completed questionnaires (67 from doctors, 37 from nurses). Over 90% of staff felt that lack of workplace familiarity negatively affects performance and leads to delay in performing procedures. 92% of the nurses felt that it was easier and more efficient to work with doctors who were familiar with the workplace. Quantitative data revealed issues with locating equipment such as:

60% Doctors did not know where to find mechanical-CPR device (LUCAS). 81% of the Senior House Officers did not know where to find end-tidal CO₂ monitors. Qualitative data revealed additional important insights into the risks of lack of familiarity: ‘It’s been 2 days since I started (and) I don’t know where the equipment or the drugs are stored.’ ‘A simple task such as catheterisation takes a lot of time – trying to get access to the equipment room, access to drug cupboard etc.’

Conclusion:

We have identified familiarity with workplace and resuscitation equipment as a key learning need. The data from Phase 1 of the project have informed the development of scenarios for new induction processes in phase 2. Simulation is an important tool for education but also for induction and analysis of systems and pathways [2]. Phase 2 will also use novel technologies including 360° videos to allow staff new to the department to access ED environments and equipment virtually and at their convenience. Future work will involve monitoring the success of the interventions in phase 2.

References

1. Grant J. Learning needs assessment: Assessing the need. Br Med J. 2002;324(7330):156–9.

2. Health Education England. Simulation immersive technologies. https://www.hee.nhs.uk/our-work/technology-enhanced-learning/simulation-immersive-technologies [Accessed on 24/06/2022]

‘The future of learning is immersive. In the future, learning will take the shape of a story, a play, a game; involving multiple platforms and players; driven by dialogue and augmented with technology, an interplay of immersive experiences, data, and highly social virtual worlds’ [1]. Our simulation was designed to raise aspirations as to what is ‘possible’ for our wider faculty as we expand our simulation-based education (SBE). The ‘Godzilla’ multi-casualty exercise offered a fun and engaging theme to the serious focus on student development and assessment. Facilitated at a music venue enabling creative visual and audio backdrops, to a dynamic and immersive learning space. This exploited sensory boundaries in the form of challenging environments, whilst focusing expectations for our student cohorts to demonstrate clinical praxis. The directing staff (DS) included academics, Critical Care Practitioners, Nurses, and Paramedics who ensured a multidisciplinary overview of students’ safety and feedback discussions, appraising decision making, treatment, and management of multiple patient scenarios.

Methods:

Drawing upon the multimedia and interdisciplinary expertise from the faculty, a holistic set of skills brought together the creation of an authentic educational experience, with the evaluation of the students against clinical expectations of a modern healthcare response. The main points of contact were at ‘handover’ post patient extraction and assessment, to senior clinicians. This exercise modelled inclusive approaches, reflected in the seminal Delphi study that identified requirements and opportunities in Immersive Learning namely: Facilitating Authentic Learning Experiences and Developing the Capabilities of the Future Workforce [1]. This approach aligns with the NHS Simulation Strategy [2] but also with the psychological concept of flow and deep absorption in learning proposed by the Open University Innovating Pedagogy report [3]. Premised on the innovation of best learning moments, our student tasks were designed to engender deep involvement through memorable learning activities.

Results:

36 level 4 Paramedic students and 24 level 6 Paramedic students undertook the simulated challenges. Facilitators and learners reported high levels of satisfaction and attainment of praxis. Comparisons were recognised between cohorts that informed future adaptations and design, evaluating tasks for future ambitions, fusing interdisciplinary endeavours.

Conclusion:

This successful exercise met the key learning objectives and students identified this as a ‘memorable’ point in their learning. Inclusion of our allied health professions had handover scenarios filmed with 360° and conventional cameras, and videos were edited for future curricular inclusion. The learning from this inaugural event will inform the diversity and complexity of future tasks set for students. Further feedback capture methods will be used to quantify further investment into future simulation-based educational endeavours.

References

1. Lee MJ, Georgieva M, Alexander B, Craig E, Richter J. State of XR & Immersive Learning Outlook Report 2021. Immersive Learning Research Network, Walnut, CA. 2021.

2. Health Education England (HEE) A national vision for the role of simulation and immersive technologies in health and care. NHS: 2020

3. Kukulska-Hulme A, Bossu C, Coughlan T, Ferguson R, FitzGerald E, Gaved M, Herodotou C, Rienties B, Sargent J, Scanlon E, Tang J, Wang Q, Whitelock D, Zhang S. Innovating Pedagogy 2021: Open University. Innovation Report 9: 2021

The Clinical Communication Team at the University of Birmingham are undertaking an ambitious project where students across all healthcare programmes will interact within a single virtual healthcare community – ‘Wood Brooke’ – via simulation activities. The vertical nature of the programme means students can ‘follow’ the illness/life journeys of a series of families that they meet early in the course over a 3–4 year timeframe. Additionally, they can meet and interact with simulated healthcare professionals working in Wood Brooke’s virtual primary, community, and secondary care facilities. Wood Brooke is already well-established throughout our 4-year Pharmacy degree, being integrated into teaching and testing not just for communication, but linked to other clinical aspects of the Programme. We will share our model, and experiences, successes, and challenges.

Methods:

Recently Wood Brooke was adapted for Birmingham’s 3-year BNurs programme as a vertically integrated clinical communication/professionalisation strand. It is well documented that nursing students should be trained in patient-centred communication [1]. Students from Adult, Child, and Mental Health Nursing mix in the sessions for intra-professional learning and breadth of peer support and feedback. Sessions in Year 1 focus on cases relating to three families from Wood Brooke from patient and relative/carer perspectives. Year 2 builds on the simulation to consider intra and interprofessional colleague interactions in community-based and acute settings through telephone and face to face role play simulation. This builds on the 3 family cases introduced in the first year, introducing other members within the family. Year 3 is under development.

Results:

Feedback from learners about the Programme has been positive. This is not a research project so we will not be presenting ‘data’. A result in progress is rolling Wood Brooke out to other Programmes, including Medicine and Dentistry, as part of curriculum review. Discussion may focus on the potential benefits of healthcare students having shared visibility of patient narratives/experiences where that patient is accessing care under more than one service.

Conclusion:

Inclusivity and designing a ‘community’ reflective of the population has been central. The vertical development of patient narratives over several years enables adaption of the programme to meet new priorities and needs (including, e.g., shift to remote working for COVID-19, and evolving patient demographics).

References

1. Gutiérrez-Puertas L, Márquez-Hernández VV, Gutiérrez-Puertas V, Granados-Gámez G, Aguilera-Manrique G. Educational interventions for nursing students to develop communication skills with patients: a systematic review. International journal of environmental research and public health. 2020;17(7):2241.

The new Foundation Curriculum 2021 for Doctors in Training (DiT) in the United Kingdom calls for an increased focus on developing mental health-related skills [1], bringing them into parity with physical health. The importance of developing the core clinical skills needed to work with patients who have mental illness is now well-recognised within medical education [2,3].

Methods:

In collaboration with NHS Education Scotland (NES), we piloted a half-day programme of immersive high-fidelity simulation in Psychiatry for foundation year one (FY1) doctors working in NHS Lothian. Scenario design was by a core group consisting of simulation faculty and Foundation programme directors who were consultant psychiatrists and acted as content experts. The intended learning outcomes (ILOs) for these sessions were constructively aligned with key presentations set out in the revised Foundation Curriculum. The scenarios considered the limitations of practice for an FY1, particularly in regard to mental health law. The three immersive scenarios developed included management of an aggressive patient with delirium, challenging communication with relatives, and management of a depressed patient. Scenarios were based in general wards to maximise fidelity with FY1 experience. 18 sessions were run for FY1 doctors at the three main acute hospital sites in NHS Lothian to ensure equitable access. Participants completed a pre-session evaluation to determine their perceived ability to perform key skills, including assessment of a patient who has self-harmed, a patient with depressive symptoms, assessment of capacity and use of mental health legislation, use of verbal de-escalation, safe sedation, and how to take a collateral history. Assessments were made on a Likert scale and were repeated immediately following the session. We plan to repeat this questionnaire three months following the session.

Results:

A total of 68 FY1 doctors attended the pilot sessions. When considering the percentage of participants who felt prepared or very prepared, substantial improvements were seen in all assessed domains following the session (Table 1). The most marked improvements were in assessing capacity and the need for the mental health act (21% pre- and 90% post-session), and use verbal de-escalation to manage a patient (26% pre- and 88% post-session). 97% of candidates agreed that the scenarios seemed realistic while 92% had experienced similar clinical cases.

Table 1:

Percentage of candidates who reported feeling either prepared or very prepared to carry out they key skills included in the pilot sessions

Conclusion:

We have demonstrated that immersive simulation-based education can be used to improve knowledge and confidence in core aspects of psychiatry. With support from NES, we aim to offer this session to all FY1s in Scotland.

References

1. UK Foundation Programme (2021) UK Foundation Programme. https://foundationprogramme.nhs.uk/ [Accessed on 09/02/2022]

2. Piot MA, Dechartres A, Attoe C, Jollant F, Lemogne C, Layat Burn C, Rethans JJ, Michelet D, Cross S, Billon G, Guerrier G. Simulation in psychiatry for medical doctors: a systematic review and meta‐analysis. Medical Education. 2020;54(8):696–708.

3. Piot MA, Attoe C, Billon G, Cross S, Rethans JJ, Falissard B. Simulation training in psychiatry for medical education: a review. Frontiers in Psychiatry. 2021;12:658967.

Due to the COVID-19 pandemic, there has been a significant impact on undergraduate healthcare practice placement education [1]. In response, the Scottish Government, committed to ensuring Adult and Mental Health Nursing, Midwifery, and Paramedic Science students have adequate provision to student placements, awarded Higher Education Institutions (HEIs) funding to develop simulation placements. Within our HEI a Clinical Skills and Simulation Team (CSST) has been created comprising 3 Lecturers, a Simulation Technician, and a Digital Technologist. The team then built a Simulation Champions group (n=30) through fostering working relationships, to help promote simulation-based education (SBE) pedagogy across the HEI. The purpose of this study is to explore whether creating a simulation champions group has any impact on the delivery of simulated practice placements within undergraduate healthcare programmes.

Methods:

The Simulation Champions are a diverse group comprised of internal academic faculty and external National Health Service (NHS) partners (such as practice education facilitators) who are passionate educators in SBE. Each external partner has a contact within the HEI, aligned to their area of clinical expertise. Through an agreed Terms of Reference, their aim is to enhance, resource, and assist the delivery of high-quality, high-fidelity simulation placements to students by working collaboratively in line with the relevant professional body standards and proficiencies [2]. The CSST oversee the Simulation Champions, providing strategic direction, leadership, following the HEI strategy [3], and support the delivery of Simulation Placements. The group meets every quarter to discuss simulation practices, explore Continuous Professional Development (CPD) opportunities, and share knowledge and learning. The impact of this team will be measured through staff and student reflection using a framework to objectively analyse scenario diversity, achievement of learning outcomes, and alignment to professional body proficiencies.

Results:

Following ethical approval, a group of Year 1 Adult Nursing students (n=60) will have completed a 40-hour Simulated Practice Placement designed and delivered by Simulation Champions (n=10).

Conclusion:

This study will then evaluate and conclude whether there is a need to create and develop a diverse, multi-professional Simulation Champions Group before successful Simulated Practice Placements can be achieved. It will also help determine if securing strong working relationships ensures a smooth transfer of knowledge and skills from clinical practice to the simulation setting within a HEI, and if all of this enhances the student experience.

References

1. Caplan J, Clements R, Chadwick C, Kadirgamar J, Morgan J, Rao A. Medical education in 2020: developing COVID secure undergraduate hospital placements. Medical Science Educator. 2020;30(4):1677–83.

2. NMC 2018a, 2018b, 2018c, 2018d:

Nursing and Midwifery Council. The Code. Professional standards of practice and behaviour for nurses, midwives and nursing associates. https://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf [Accessed on 25/01/2022]

Nursing and Midwifery Council. Realising professionalism: Standards for education and training. Part 3: Standards for pre-registration midwifery programmes. https://www.nmc.org.uk/globalassets/sitedocuments/standards/standards-for-pre-registration-midwifery-programmes.pdf [Accessed on 25/01/2022]

Nursing and Midwifery Council. Realising professionalism: Standards for education and training. Part 3: Standards for pre-registration nursing programmes. https://www.nmc.org.uk/globalassets/sitedocuments/standards-of-proficiency/standards-for-pre-registration-nursing-programmes/programme-standards-nursing.pdf [Accessed on 25/01/2022]

3. University of the West of Scotland. Strategy 2025. 2020. uws-strategy-2025.pdf. [Accessed on 25/01/2022]

Demand for mental health nursing staff is rising with a drop-in staff of 8% in the last 10 years [1]. Preparing the future NHS healthcare workforce is therefore a vital component of educational delivery for Higher Education Institutions [2]. With funding Health Education England, the aim of this pilot project was to evaluate whether an online simulated learning programme helped students feel more prepared for their final placement in practice before qualifying.

Methods:

19 final year mental health nursing students participated in a one-day online simulated learning environment programme which focused on difficult conversations and complex communication scenarios, in partnership with an external organisation. It focused on introducing a bespoke context to develop clinically relevant skills, knowledge, and experience, complementing the range of clinical placements opportunities required by the nurses training curriculum. They were then asked to complete the Human Factor Skills for Healthcare Instrument [3].

Findings:

Participants showed a 7% increase in confidence in Human Factors Skills measured by the Human Factors Skills for Healthcare Instrument from their pre-course (M=93.54) and post-course (M=102.27) scores. Participants also showed a 9% increase in scores in the course specific questions relating to the learning objectives from their pre-course (M=50.86) and post-course (M=57.15) scores. We were unable to conduct paired samples t-tests due to the limited number of participants completing both the pre- and post-evaluation survey. Lastly, 100% of participants responded that they would recommend this course to others.

Conclusion:

The course is a novel and innovative training method for providing clinical experience to undergraduate nursing students to develop relevant skills and knowledge that complement their placements. The findings demonstrate that participants achieved a variety of learning outcomes including improved confidence in human factors skills and improved confidence across the learning objectives, covering de-escalation skills, working in a multidisciplinary team, identifying mental illness presentation, handover, and referral among other skills. This raft of benefits following training are likely to have a positive impact on interactions with service users or those experiencing mental illness, although further research into this impact would be of great interest.

References

1. Royal College of Nursing (2022) ‘There is no quick solution to the nurse staffing crisis’. https://www.rcn.org.uk/news-and-events/news/uk-there-is-no-quick-solution-to-the-nurse-staffing-crisis-091220 [Accessed on 19/06/2022]

2. Topal review: NHS (Feb 2019) Preparing the healthcare workforce to deliver the digital future. https://topol.hee.nhs.uk/wp-content/uploads/HEE-Topol-Review-2019.pdf [Accessed on 19/06/2022]

3. Reedy G, Lavelle M, Simpson T, Anderson J. Development of the Human Factors Skills for Healthcare Instrument: a valid and reliable tool for assessing interprofessional learning across healthcare practice settings. BMJ Simulation and Technology Enhanced Learning. 2017;3(4):135–141.

Silos of work are a reality in virtually every large organisation and invariably create duplicated workloads, inefficiencies, and in some cases a sense of ‘tribalism’ which risks the integrity and effectiveness of teams [1]. As simulation-based education gains traction and momentum as a teaching approach across Scotland and the UK, silos of work have emerged and risk the effectiveness and efficiency of programme delivery. Our aim was to create an effective simulation user network across the 14 Health Boards of Scotland to eliminate silos and create a collaboration of work across the country.

Methods:

Thanks to an investment from NHS Education for Scotland (NES), insight from the NHS Scotland Academy, and the expertise of the Clinical Skills Managed Education Network (CSMEN), a team of regional Senior Educators were recruited to create a functional regional and national collaborative for simulation in Scotland. The story here is how the team have come together and the lessons learned in networking, negotiating, and establishing a new and growing sense of collegiately across the country. Starting in the East of Scotland, a questionnaire was designed and delivered across simulation teams and stakeholders across four Health Boards. The data collected was used to feed discussion at an East Scotland Simulation Collaborative scoping meeting which was attended by representatives of all four Health Boards and included medics, nurses, physiotherapists, and pharmacist teams delivering simulation to both undergraduate and postgraduate teams.

Results:

An East Scotland Simulation Collaborative has been formally established with its inaugural meeting in Autumn 2023. An online space has been established to promote communication and the sharing of resources, and both a quarterly meeting and annual faculty development day designed for the group. Discussions are now ongoing for the development of an East Scotland Simulation Research group to develop new opportunities to conduct multisite studies for the first time. From a national perspective, North and West Scotland Simulation Collaborative groups are now in their formation stages.

Conclusion:

Like weeds in a garden, silos of work will grow all by itself. Like roses in a garden, an effective network takes both time and tending, but the investment pays dividends.

Reference

1. Beattie A. War and peace among the health tribes. 1995. In: Soothill K, Mackay L, Webb C (Eds). Interprofessional relations in health care. London: Edward Arnold.

Due to the effect of the global pandemic and rising student cohort numbers, simulated practice placements are being implemented into nursing curricula. To deliver simulation-based education (SBE) within the Higher Education Institutions (HEI) staff must be adequately prepared. For SBE to be effective, thoughtful consideration to appropriate staff training is important [1]. A structured unified approach is more beneficial as it sets the same aspirations and contributes to a shared philosophy [2]. This unified approach meant both Health Board and HEI staff were being trained to delivery simulation in the same way, which was new for this HEI. Creating a faculty for simulation emulates a community of practice and also comprises essential networking with other simulationists [2]. It helps support Benner’s novice to expert theory as staff start of as novices and subsequently develop emulating that robust educational training for SBE faculty development is essential [3]. Importantly, it addresses quality assurance and governance frameworks in meeting the requirement of the International Nursing Association for Clinical Simulation Learning (INACSL) [3], Association for Simulated Practice in Healthcare (ASPiH), and Nursing and Midwifery Council (NMC) standards. The overall aim of this innovation was to implement a unified approach to faculty development training for academic staff within an HEI.

Methods:

Three training sessions were delivered in January and February 2022. HEI staff attended a one-day session. Health Board Simulation Educators facilitated the sessions for the HEI Academic Staff.

Results:

Using a unified approach to this faculty development had a positive outcome in supporting HEI staff to be upskilled in the delivery of SBE. It has also resulted in the subsequent development and implementation of a 2-day training course comprising the following sessions: Session 1 – Introduction to clinical skills and simulation and writing learning outcomes and scenarios; Session 2: Technology supporting simulation; Session 3: Preparation, briefing, and debriefing; Session 4: Running an immersive simulation session. This in-house training programme will continue to be delivered to HEI staff undertaking SBE and evaluated.

Conclusion:

Using a unified approach enhances the quality and parity of the delivery of SBE within the HEI. A unified approach to faculty development within the HEI will continue to be delivered to upskill staff in SBE. Collaboration with clinical partners in faculty development is crucial in the delivery of SBE to ensure a unified evidence-based approach.

References

1. Bryant K, Aebersold ML, Jeffries PR, Kardong-Edgren S. Innovations in simulation: Nursing leaders’ exchange of best practices. Clinical Simulation in Nursing. 2020;41:33–40.

2. Peterson DT, Watts PI, Epps CA, White ML. Simulation faculty development: a tiered approach. Simulation in Healthcare. 2017;12(4):254–259.

3. Hallmark BF. Faculty development in simulation education. Nursing Clinics. 2015;50(2):389–397.

The potential for immersive technologies to augment healthcare training is gaining significant interest. However, its applicability and effectiveness are yet to be fully understood. This project was a response from a bid released by the Cardiff Capital Region to undertake a rapid innovation project, consisting of 3 main phases: 1) feasibility; 2) development; and 3) testing, across Welsh Health Boards.

Background:

Project governance was provided via the Small Business Research Initiative (SBRI) in Clinical Excellence, a project board, and a project team with clinical and educational expertise, alongside Virtual Reality (VR) industry and academic partners. We aim to explore the formation of a virtual reality training package with a multi-centred collaborative project to overcome the current challenges of respiratory education, with a particular focus on tracheostomy care, to meet the challenges of the COVID-19 pandemic and beyond [1].

Methods:

Phase 1 focused on the development of minimally viable solutions with a key focus on clinical content accuracy and education standards for single user learners. Phase 2 progressed to further develop the VR-based solutions including a multi-player system and virtual debriefing room, allowing the team to focus on key simulation-based learning best practice standards within the design and build [2]. Phase 3 is when system testing occurred over an 8-week period, across 6 Health Boards in NHS Wales involving over 100 multi-professional clinicians commencing in February 2022.

Results:

On site hospital clinical education session feedback regarding use of the system and perceived opportunities were highly favourable in terms of ease of use, potential for VR in practice, and providing flexibility for mass training needs. Multi-user training was particularly well received. The limitations were lack of resource and time to combine a formal research project regarding the educational impact within busy health boards. This is planned for the next phase.

Conclusion:

Empirical evidence from other industries demonstrates VR technology is an effective and efficient way of improving training [3]. Developing VR solutions to support healthcare training needs involves a collaborative approach with Health Boards, industry, and academic partners. The design, build, and implementation approach can embed simulation best practice standards to form innovative educational solutions to the challenges seen in the delivery of mass healthcare education. Formal research is required to begin to measure such factors as education transference, patient care impact, and return on investment questions.

References

1. Chiang DH, Huang CC, Cheng SC, Cheng JC, Wu CH, Huang SS, Yang YY, Yang LY, Kao SY, Chen CH, Shulruf B. Immersive virtual reality (VR) training increases the self-efficacy of in-hospital healthcare providers and patient families regarding tracheostomy-related knowledge and care skills: A prospective pre–post study. Medicine. 2022;101(2):e28570–e28570.

2. Rossler K, Molloy MA, Pastva AM, Brown M, Xavier N. Healthcare Simulation Standards of Best Practice^TM Simulation-Enhanced Interprofessional Education. Clinical Simulation in Nursing. 2021;58:49–53.

3. Manolakis K, Papagiannakis G. Virtual Reality simulation streamlines medical training for healthcare professionals. Journal of dentistry. 2022;121:103987.

Conducting child protection medical assessments (CPMA) where there are concerns of non-accidental injury (NAI) is a key clinical skill for paediatricians and part of the Royal College of Paediatrics and Child Health (RCPCH) curriculum [1]. Child Protection (CP) simulation training was commissioned following trainee feedback around unpreparedness when carrying out CPMA. The COVID-19 pandemic forced delivery of online CP simulation. Initial learners were paediatric trainees; with newly qualified school nursing and health visiting colleagues in subsequent delivery; allowing for multi-professional learning in the simulated environment. The session aims were to:

- increase familiarity with professional conversations in the CP context

- formulate an evidence-based opinion in cases of suspected NAI

- rehearse discussing outcomes of CPMA with parents/carers and social workers

Methods:

We rehearsed, modified, and then, using Zoom as a synchronous platform, with a trained simulated patient (SP) and faculty as role players created three 10-minute community-based CP scenarios for a twice-yearly programme. Pre-course information and a pre-briefing explained the online limitations and opportunities, including how we co-create psychological safety, the option of a wellbeing ‘wobble’ room, also outlining the Diamond debriefing model [2]. Pre- and post-course surveys were sent to the 18 participants. Likert scale ratings on confidence and anxiety levels when approaching a CP medical; familiarity with and likelihood of using the HEADSSS tool [3] was analysed using paired T-test probability.

Results:

94% (17/18) had no previous CP simulation experience. Confidence in carrying out CPMA increased post-simulation (p= 0.00418) Anxiety going into the CPMA decreased post-simulation (p=0.00624). 44% were familiar with HEADSSS tool pre-course and 94% were more likely to use it post-course (Likert rating 4or5). Confidence in expressing concerns to parent/carer rose from 11% to 82.3% post-course (Likert rating 4or5). Free text learning points included ‘Use what you can agree on (parent and doctor) as a foundation for developing rapport.’ ‘… very useful in preparation for community.’ ‘… very helpful in giving me more confidence in carrying out medicals.’ ‘Never undertaken a simulation with an actor, it felt real (I was surprised)’, ‘interesting to share learning… as practitioners have different perspectives.’

Conclusion:

Despite sensitivity of the subject and the emotive realism brought by the SP’s, psychological safety was achieved in this online interprofessional CP simulation training through detailed preparation in course design and faculty preparedness. The pilot was successful in preparing participants to fulfil their safeguarding role. Online training continues to be a synchronous induction for 2022.

References

1. RCPCH. Progress curriculum. Royal College of Paediatrics and Child Health 2018. https://www.rcpch.ac.uk/education-careers/training/progress/curriculum [Accessed on 27/09/2022]

2. Jaye P, Thomas L, Reedy G. The Diamond: a structure for simulation debrief. The Clinical Teacher. 2015; 12(3):171–175.

3. Cohen E, Mackenzie RG, Yates GL. HEADSS, a psychosocial risk assessment instrument: implications for designing effective intervention programs for runaway youth. Journal of Adolescent Health. 1991;12(7):539–44.

At present there are limited resources for simulation faculty development and educators are unable to access face-to-face courses uniformly across the region. Currently available online resources lack interactive reflective activity and recorded faculty videos which leads to a less engaging and effective learner experience. We aimed to create a structured and accredited simulation faculty development course on the Bridge online platform for educators who are novice in simulation-based education using a blended learning approach by incorporating recorded faculty videos and current available resources on eLearning For Healthcare (eLFH), Scottish Simulation framework and provide a platform with links to online resources.

Methods:

A scoping review was conducted to review current available online resources and face to face courses across the East of England region. Faculty across the region were contacted to understand the learning objectives, outcomes, and content of their courses. A survey was sent out to Bridge users across the region to determine how best to deliver the simulation faculty development course and whether they would find a Bridge course useful. We received 158 responses of which 94% respondents were keen to develop their simulation education skills, 74% had not received any formal training, and nearly 90% wanted a blended learning course.

SIMSTEPS has been developed following a detailed gap analysis and scoping review. The course has been designed incorporating the eLFH learning modules, the Scottish framework for Simulation Faculty development. It does not replace face to face teaching but gives a starting point to develop the learners’ knowledge and skills about simulation-based education which can be enhanced further in face-to-face courses or workshops. Modules have been developed on key topics relevant to simulation-based education [1] with links to videos, recorded Faculty sessions, and online educational resources. Learners are encouraged for continuing reflective practice [2] and prompted to reflect after modules. The course would be accessible to all Bridge users (Interprofessional educators) in the East of England at no cost and can be completed by them at their own pace and time. We planned meticulously to ensure the course content meets learning objectives and ensured quality assurance by independent review of the course by established and experienced faculty.

Results:

Post-course evaluation by learners will be done on course completion.

Conclusion:

A blended learning course like SIM-STEPS can potentially provide an effective resource on Simulation faculty development and improve learner experience and engagement.

References

1. Motola I, Devine LA, Chung HS, Sullivan JE, Issenberg SB. Simulation in healthcare education: a best evidence practical guide. AMEE Guide No. 82. Medical teacher. 2013;35(10):e1511–1530.

2. Brydges R, Manzone J, Shanks D, Hatala R, Hamstra SJ, Zendejas B, Cook DA. Self‐regulated learning in simulation‐based training: a systematic review and meta‐analysis. Medical education. 2015;49(4):368–378.

Virtual Reality (VR) simulation has opened to a lot of trainees an ability to experience various clinical scenarios in a virtual space at a time and place that suits them [1]. It also gives an opportunity for deliberate practice as one can repeat the scenario as many times as one likes till proficiency is reached. Research over the years has shown most of the learning occurs during the debriefing [2] and the VR scenario gives a unique opportunity for self-debriefing or peer-peer debriefing in small groups [3]. However, in the current VR scenarios available to trainees, there is no provision of any link at the end of the scenario to access current best practice guidelines on the topic/scenario which the learner could use as part of their self-debriefing. The project aims to create wraparound learning module around the Virtual Reality clinical scenario to include a patient journey through the hospital, current guidelines, and teaching videos so that learners could conceptualize and consolidate their learning from the VR experience

Methods:

VR scenarios available to Foundation doctors were chosen and a review of the topic and related standard best practice guidelines were reviewed on NICE, BTS, and similar resources. We also searched for real patient stories and easy to access procedural videos related to the topic and incorporated them on the module. Wraparound learning modules were created using a blended learning approach on Bridge online platform on topics like pneumothorax and infective exacerbation of Chronic Obstructive Pulmonary Disease. More modules are being created for the benefit of the Foundation doctors across East of England. Throughout the module reflection is encouraged and the topic is aligned to the Foundation curriculum and reviewed for quality assurance. A Likert scale survey would be sent out to the trainees who have completed the modules to assess the increase in their confidence in managing a clinical case after finishing the wraparound module.

Results:

The results of the pre-course and post-course levels of knowledge, skills and confidence are being analysed.

Conclusion:

Wraparound learning modules could potentially improve learners’ experience of the VR scenario and improve learning and confidence in the clinical setting.

References

1. Cheng A, Kolbe M, Grant V, Eller S, Hales R, Symon B, Griswold S, Eppich W. A practical guide to virtual debriefings: communities of inquiry perspective. Advances in Simulation. 2020;5(1):1–9.

2. Rudolph JW, Simon R, Dufresne RL, Raemer DB. There’s no such thing as ‘non-judgmental’ debriefing: a theory and method for debriefing with good judgment. Simul Healthcare. 2006;1(1):49–55.

3. Pottle J. Virtual reality and the transformation of medical education. Future healthcare journal. 2019;6(3):181–185.

The critical care environment is stressful with complex clinical cases and high levels of workload [1]. Adequate exposure to various clinical experiences is essential to develop effective clinical reasoning skills [2]. Taking into consideration the risk of clinical practice mistakes and the importance of patient safety, simulation is an effective method to immerse learners in scenarios that mimic clinical situations with focused learning opportunities. Guided reflection through reflective learning conversations following simulation activities is recognized as an effective method to develop clinical reasoning skills [3]. We describe a co-design process to develop a simulation guided reflective learning conversation model to optimize the clinical reasoning skills for critical care nurses attending simulation-based activities.

Methods:

A co-design working group of 10 critical care nurses of varying levels of seniority, experience, nationality, and gender; two critical care doctors; three patient representatives; 2 researchers, and 5–6 critical care educators are working collaboratively to co-design the guided reflective learning conversation model, in which clinical reasoning can be optimized with consideration to a wide range of case complexity, subspecialty, and competence levels. The co-design working group is meeting online for 4–6 workshops of 4 hours. The co-design process is built on valid and reliable clinical reasoning and educational theoretical frameworks and models. The inputs to the process, exercises, and activities are taking place during the workshops and the outputs of the workshops are described to establish the co-design process. The final draft of the model will be validated and tested. The study sample will be grouped into experimental and control cohorts of critical care nurses who attend critical care simulation-based courses (N=300). Data will be collected through surveys, focus groups, and simulation-based objective assessment and observations. The study has received Institutional Review Board approval from the Hamad Medical Corporation Medical Research Centre (MRC-01-22-117) and the University of Hertfordshire (HSK/PGR/UH/04728).

Results:

The first draft of the co-design model is presented in Figure 1. The final draft of the model will be released, validated, and tested in the near future using mixed methods research with comparative quasi-experimental and pre-test/post-test design.

Figure 1:

Simulation-Based Reflective Learning Conversation Model (SBRLCM) under development

Conclusion:

Clinical reasoning is multidimensional with difficulty to structure and evaluate during debriefing. Developing a guided reflective learning conversation model in which clinical reasoning skills are actively and effectively embedded, would therefore enable critical care nurses developing clinical reasoning skills to meet the special demands of critical care.

References

1. Vahedian-Azimi A, Hajiesmaeili M, Kangasniemi M, Fornés-Vives J, Hunsucker RL, Rahimibashar F, Pourhoseingholi MA, Farrokhvar L, Miller AC. Effects of stress on critical care nurses: a national cross-sectional study. Journal of intensive care medicine. 2019;34(4):311–22.

2. Kang H, Kang HY. The effects of simulation-based education on the clinical reasoning competence, clinical competence, and educational satisfaction. Journal of the Korea Academia-Industrial cooperation Society. 2020;21(8):107–14.

3. Decker S, Alinier G, Crawford SB, Gordon RM, Jenkins D, Wilson C. Healthcare Simulation Standards of Best Practice^TM The Debriefing Process. Clinical Simulation in Nursing. 2021;58:27–32.

Creating additional placements for undergraduate paramedic learners is being driven by Health Education England (HEE). With the increase in numbers undertaking paramedic training by education providers, there is limited additional capacity for placements within the current placement areas (e.g. Ambulance Trusts).

Methods:

Working in partnership with a dedicated simulation team, the paramedic science lecturers co-created a simulated placement. One aspect included the students undertaking a one-day ‘Train the trainer course’ prior to the day of facilitating led by the simulation lecturer and this course referred to research and best practice standards [1]. Seventy-six third-year students across two different cohorts undertook this activity. From two cohorts, eleven different simulation activities were created. Three focused on trauma injuries (e.g., a severed arm in a factory). In the remaining eight simulation designs, the paramedic students chose areas of their professional practice they wanted to focus on, including a lady with domestic violence.

Results:

All students were asked to complete an online evaluation tool that focused on their learning both as a facilitator and as a learner undertaking their peers’ simulation activities. Overwhelmingly all seventy-six learners rated their own experiences as a facilitator highly, citing that to create their own designs, they had to revisit course work and search for evidence and guidelines. This aspect they felt improved their knowledge and confidence. Reviewing the data as a learner, the paramedic students felt the scenarios were richer and closer to practice and provided a richer discussion. Participating in debriefing as both the facilitator and learner, the participants reported that they felt more comfortable about critiquing care that learning how to use open questions.

Conclusion:

The students created their own community of practice [2] and actively sought literature and evidence-based practice to create the designs and the parameters and behaviours for their own cases that they facilitated. The debriefing sessions evolved into reflection surrounding their identity and the agency of practice in the clinical arena. As faculty, the expectations prior to this project were that the designs created would be trauma only and found all were authentic and professionally written. The faculty will be implementing this project across all years of undergraduate training for paramedics. Supporting students to write and deliver their own SBES at intervals allows them to be involved in their own learning. This additional knowledge and skills will assist them into professional practice.

References

1. Persico L, Belle A, DiGregorio H, Wilson-Keates B, Shelton C. Healthcare simulation standards of best practice^TM facilitation. Clinical Simulation in Nursing. 2021;58:22–26.

2. Wenger E. Communities of practice: learning, meaning, and identity. 1999. Cambridge, UK, Cambridge University Press.

Simulation is an educational approach in health and care that is often used to address patient/service user safety issues, technical and non-technical skills, teamwork, problem solving, and decision-making. The goal of simulation is to create an authentic learning experience. To be effective it needs to be designed and planned appropriately [1]. Following feedback from a health and care simulation community at webinars and other engagement events, a designated simulation team has designed a scenario template to promote the development and sharing of high-quality standardised scenarios.

Methods:

A scoping exercise was undertaken to review and identify relevant literature and published scenario templates. A database search was undertaken through CINAHL, Pubmed, and Medline using the search terms: simulation, simulation scenarios, scenario template, simulation guidance, using a time-frame of 2010 to 2022.

Findings:

The lack of breadth of literature on scenario writing was a surprising finding. However, the available literature identifies that an effective robust scenario must consider the prospective learners and the intended learning objectives and outcomes. Additionally, knowledge of educational principles and best practices in both simulation and clinical practice are needed [2]. Scenario design must also consider the modality and fidelity of the simulation, faculty members, use of supplementary resources, moulage, other participants, simulators, and/or standardized patients [3]. An evidence-based scenario template was developed and peer reviewed. It was then presented to and tested by the health and care simulation community during a free, inclusive, and well attended scenario writing online workshop facilitated by a simulation team in collaboration with experts.

Conclusion:

The scenario template provides step-by-step guidance on scenario writing best practice and includes a didactic element by signposting to further reading. It was revised based on constructive comments made by the health and care simulation community, which included more prescriptive facilitator guidance, and will be published via simulation web-pages as an open access resource for use by anyone across the health and care simulation education and training workforce (https://heiw.nhs.wales/files/simulation-scenario-template/). The team is aiming to further evaluate the use of the template, with the intention of contributing to further evidence base in this area.

References

1. Dieckmann P, Gaba D, Rall M. Deepening the theoretical foundations of patient simulation as social practice. Simulation in Healthcare. 2007;2(3):183–93.

2. Bambini D. Writing a simulation scenario: a step-by-step guide. AACN advanced critical care. 2016;27(1):62–70.

3. Harrington D, Simon L. Designing a Simulation Scenario. Accessed via Designing a Simulation Scenario. 2021. StatPearls, NCBI Bookshelf (nih.gov).

Health Education and Improvement Wales’s (HEIW) simulation team is in the process of developing a Simulation-Based Education (SBE) strategy for Wales which will include a definition of SBE. The simulation team originally agreed a working definition of SBE for Wales when the team was formed. However, numerous definitions of simulation or SBE exist in the literature. A shared understanding of SBE is required to optimise its use as an educational strategy [1]. We aimed to reach consensus upon an All-Wales definition of SBE.

Methods:

Ethical approval for the study was granted by Cardiff University. A participant information sheet was provided and informed consent obtained from all participants. A modified Delphi technique was used [2], comprising three rounds of online surveys. Definitions and characteristics of simulation described in the existing literature formed the basis of the first survey round [3]. Any statements not reaching consensus and any new statements offered by participants during round one were included in the second survey round. In the final round, participants were asked to rank all statements which reached consensus in rounds one and two in order of priority from 1- the most important to 10- the least important. Responses were inversely scored and collated. Three members of the research team reviewed and validated the consensus statements at the end of each round.

Results:

A total of 27 participants from a range of professional backgrounds (nurses, doctors, allied health professionals, and simulation technicians) agreed to be part of the expert panel, of whom 26 (96%) completed the round one survey, 26/26 (100%) returned the round two survey, and 22/26 (81%) responded to the round three survey. Participants reached consensus with high levels of agreement (where the median was less than or equal to 2 with a small IQR; less than or equal to 1.5) upon 39 statements organised under five sections. The highest ranked statement from each section were included in the final definition and the agreed upon definition is shown in Table 1.

Table 1:

Final definition agreed following the modified Delphi technique for the term ‘Simulation-based education’

Conclusion:

This appears to be the first study to have used a Delphi technique to agree an interprofessional definition of SBE at a national level. Future planned work would be to share the developed definition more widely with key stakeholders from across the four nations of the UK. There is scope for this to lead to further work on reaching UK-wide consensus or internationally.

References

1. Posner GD, Clark ML, Grant VJ. Simulation in the clinical setting: towards a standard lexicon. Advances in Simulation. 2017;2(1):1–5.

2. Keeney S, Hasson F, McKenna H. Consulting the oracle: ten lessons from using the Delphi technique in nursing research. Journal of advanced nursing. 2006;53(2):205–212.

3. Hsu CC, Sandford BA. Minimizing non-response in the Delphi process: How to respond to non-response. Practical Assessment, Research, and Evaluation. 2007;12(17):1–6.

When placed in District General Hospitals, medical students have reported limited exposure to major trauma, which is a key part of their Acute and Critical Care curriculum. Several studies have been conducted showing that simulation-based trauma education for undergraduate students can effectively prepare medical students for trauma resuscitation [1]. Targeting 4^th year medical students, we sought to enhance their knowledge of, and confidence in, assessment and management of major trauma presentations in an Emergency Department setting through simulation. Key learning outcomes were to understand and perform a primary survey, identify key life-threatening injuries, and perform early interventions in life and limb threatening situations.

Methods:

A one-day session was designed, including a pre-course video, practical demonstrations, and an introductory presentation covering primary surveys and management of common trauma presentations. 5 scenarios covered situations across the trauma spectrum, such as tension pneumothorax, severe intracranial bleed and loss of airway, major haemorrhage, and spinal injury. Students were expected to independently assess patients and perform practical procedures if required. Self-reported confidence in trauma management was measured with a pre- and post-course questionnaire. Responses were recorded on a 7-point Likert scale with open fields for direct feedback.

Results:

In the pre-course questionnaire, students reported low levels of confidence in their assessment and management of trauma. In the post-course questionnaire, students reported feeling substantially more confident in assessing, investigating, and managing common diagnoses in trauma patients. Many reported feeling they had insufficient teaching about traumatic presentations during medical school and little prior exposure to simulation-based teaching. After the session, students reported feeling better prepared to work within a trauma team. All students who attended the day found simulation-based teaching to be a useful part of their learning experience.

Conclusion:

Targeted trauma teaching introduced as a direct response to students’ expressed needs improved knowledge of, and confidence in, managing common and serious trauma presentations. Simulation sessions such as these can help fill gaps in experience that may be associated with placements in non-specialist centres.

Reference

1. Borggreve AS, Meijer JM, Schreuder HW, Ten Cate O. Simulation-based trauma education for medical students: a review of literature. Medical teacher. 2017;39(6):631–638.

VSP uses browser-based virtual environments to simulate life-like and challenging clinical scenarios. They are an innovative and creative way to develop proficiency capabilities of healthcare professionals as an adjunct to their studies and practice placement. Evidence suggests that a simulated environment can better equip nursing and allied health professional students for practice [1–3]. The concept of VSP may have been brought forward by the COVID-19 pandemic but was inevitable with the increasing access to technology-enhanced learning and the emerging evidence of its benefit.

Methods:

This VSP was a collaboration between UK simulationists and Indonesian academics with a two-month deadline. Work was completed online using videoconferencing and translation services, the evaluation (with ethical approval) was completed using a JISC online survey in March 2022. The Indonesia VSP consists of four patient scenarios, one scenario from each of the fields of children and young people, adult, mental health and learning disability nursing and is set within the emergency department and is aimed at learners in their final year of a nursing programme in Indonesia. The Indonesia VSP scenarios were designed in line with the UK Nursing and Midwifery Council (NMC) proficiencies and the Indonesian equivalents and were designed based on clinical scenarios that are not commonly seen in clinical practice or may be particularly challenging to enhance learners’ skills and build their confidence with managing such situations. The VSP was designed for 10 hours of learning and was made available to adult nursing students from 37 Poltekkes across the Indonesian continent.

Results:

The VSP project was delivered on time with the evaluation from the pilot group being overwhelmingly positive with 82% of respondents being satisfied with the quality of VSP (response rate of 30% n=51/171) The key themes identified were: ‘real-life patient scenarios based on holistic and patient-centered care’ and the VSP enabling learners to use ‘critical thinking skills and relate the content to previous knowledge’ gained on their course so far.

Conclusion:

VSP is a meaningful way of enhancing exposure to experiences that are not guaranteed for all learners leading to greater equity of experience. The reflective and blended nature of the VSP leads to a better understanding of difficult topics. The VSP platform enables knowledge transfer that allows our team to take our in-house digital innovations to a global platform to support the training of the future nursing workforce of Indonesia.

References

1. Akselbo I, Olufsen V, Ingebrigtsen O, Aune I. Simulation as a learning method in public health nurse education. Public Health Nurs. 2019;36(2):226–232.

2. Bogossian FE, Cant RP, Ballard EL, Cooper SJ, Levett‐Jones TL, McKenna LG, Ng LC, Seaton PC. Locating ‘gold standard’ evidence for simulation as a substitute for clinical practice in prelicensure health professional education: a systematic review. J Clin Nurs. 2019;28(21–22):3759–3775.

3. Mills BW, Carter OB, Rudd CJ, Ross NP, Claxton LA. 2015. Clinical placement before or after simulated learning environments? A naturalistic study of clinical skills acquisition among early-stage paramedicine students. Simul Healthc. 2015;10(5):263–269.

In the light of the practice placement limitations due to COVID-19, the Faculty Practice Simulation Group at a University in South West England, commissioned a pilot programme of simulated practice components for 200 second year adult nursing students over five consecutive days. The aim was to support the development of communication skills required by the Nursing and Midwifery Council Standards [1].

Methods:

In partnership with an external communication skills organisation, the University provided each student with 37 hours of simulated practice placement, focused on communication skills through participative simulation with simulated patients (SPs) in bespoke, authentic scenarios. This included facilitated participation, structured live feedback from SPs, discussion with students, debriefing and reflection according to ASPiH guidelines for best practice in simulation [2]. Scenarios were designed to challenge and explore the range of skills required in Annex A of the Standards [1], at a level expected of first year students. Learning outcomes included the development of caring conversation techniques, patient management and colleague communication in multiple, varied situations. Students interacted with SPs and relatives who reflected diverse characteristics and ages, and a range of physical and mental health challenges. Students also interacted with simulated colleagues in a variety of professional situations. 106 students completed feedback questionnaires consisting of 41 5-point Likert items, before and after their sessions.

Results:

Facilitators noted that students described the simulation as a meaningful learning opportunity which allowed them to explore and develop their communication skills and better prepared them for the practice element of their degree. They also noted that students said they preferred simulation as it gave them time to stop and think and to get advice and ideas from their colleagues. This was particularly so in ‘breaking bad news’ scenarios as most had never had to approach this and appreciated the opportunity to consider and practise their response. Consequently, students stated that simulation would have been even more beneficial had it been timed prior to attending practice placement. Facilitators observed the improvement in communication skills was in student’s confidence and their awareness and sensitivity, particularly in complex multi-factorial situations. Evaluations for the programme have yet to be analysed.

Conclusion:

Experiential learning through simulation-based education with SPs provides a powerful approach, offering a safe and supportive environment, which avoids unsafe situations and enables students to effectively practise and prepare for real world experiences.

References

1. Nursing and Midwifery Council, Standards of Proficiency for registered nurses. https://www.nmc.org.uk/standards/standards-for-nurses/standards-of-proficiency-for-registered-nurses/ [Accessed on 21/06/2022]

2. Simulation-Based Education in Healthcare. 2016. Standards Framework and Guidance. Association for simulated practice in healthcare (ASPiH) standards for simulation-based education. https://aspih.org.uk/standards-framework-for-sbe/ [Accessed on 21/06/2022]

As part of the SIMEX Series exercise [1] the University hosted a simulated mass casualty incident where Nursing/Allied Health students were joined by colleagues from the local Hospital Trust to treat simulated patients with a variety of presentations. The exercise was an educational activity and at key points in the simulation, action was paused to enable everyone to learn from significant injuries. The students involved were able to assist the emergency team to test disaster event response and build vital skills including interpersonal communication, supporting distressed patients, de-escalation techniques, and recognition of deteriorating patients.

Methods:

Nursing students assumed the roles of Band 5 Nurses and were allocated a shift. Also participating were Radiographer and Operating Department Practitioners students. Each student was designated an area (e.g. minors, majors) and was linked with a Nurse from the Acute Trust who coordinated care. The exercise used 43 simulated casualties, consisting of drama and healthcare students. Professional actors helped to support the authenticity of the event, especially around some of the more complex injuries such as a lady who required a Perimortem C Section and a patient presenting with schizophrenia. An amputee actor played the role of a person who required an amputation as a result of the simulated emergency. He was able to draw upon his own experience adding depth to the role. Simulations were designed in coordination with the hospital team to rehearse treatment of uncommon presentations. Further scenarios were developed to enable the students to achieve their proficiencies and to display the professional values required to support patients in challenging situations.

Results:

Initial feedback has been very positive, highlighting how the event has helped the students build upon and consolidate the fundamental skills required to be confident and competent in their future roles [2].

We are currently awaiting formalised evaluation from a partnering university who undertook pre- and post-evaluation from all ‘players’. Immediate feedback included the students using language such as ‘empowered’, ‘empathy’, ‘unity’, and ‘team spirit’ to describe their experiences. Furthermore, the students identified that the exercise had high-fidelity and enabled them to embark on interprofessional learning to test not only their physical skills but also their emotional intelligence.

Conclusion:

Following the success of SIMEX 2022, discussions surrounding SIMEX 2023 have commenced and it is hoped the event will expand to a larger number of students across the Faculty, in line with Nursing and Midwifery Council Standards [3].

References

1. The Simex Series Disaster & Emergency Response Exercise. https://thesimexseries.org/ [Accessed on 19/06/2022]

2. Nursing and Midwifery Council (2018) Standards of proficiency for registered nurses. https://www.nmc.org.uk/standards/standards-for-nurses/standards-of-proficiency-for-registered-nurses/

3. Nursing and Midwifery.(2018) The Code: Professional standards of practice and behaviour for nurses, midwives and nursing. associateshttps://www.nmc.org.uk/globalassets/sitedocuments/nmc-publications/nmc-code.pdf [Accessed on 1/06/2022]

Delivering safe and best practice is dependent on robust structural processes and optimal acquisition of skills and knowledge across disciplines [1]. An in-situ simulation-based education model was implemented to optimise the provision of best practice in emergency medicine [2].

Methods:

In-situ simulation cases were developed based on critical incidents, complaints, and interesting cases. These simulations were designed to be complex cases, aimed at high-level multi-specialty working. Maintaining the real-life integrity of the simulation cases was paramount. The simulations were run in a busy Emergency Department (ED), during the working day while the normal service continued. Participants were instructed to make-up medication, collect blood products, and contact specialities in real time. Debriefing initially included identifying communication, human factor and process issues, and concluded with medical teaching on the topic covered, and included the speciality perspective on optimal medical management. Logistical support was provided by the simulation faculty. Data from feedback forms was collected.

Results:

Over 12 months, 20 simulations cases were conducted in the resuscitation area of the ED. Simulations involved multidisciplinary, multi-speciality workforce covering the management of acute bronchitis in an infant, an episode of acute psychosis, upper gastrointestinal bleed requiring major haemorrhage protocol activation, and many other emergencies covering the full spectrum of specialities. All feedback strongly agreed/agreed that the simulation exercises were beneficial and would lead to an improvement in the participants’ clinical practice. The multidisciplinary approach was key to the discovery of system weaknesses and risk-factors. These were then addressed and improvements in system learning, and processes were proven by the re-running of similar scenarios. The learning points were communicated via the hospital ED guideline application (AskEarl) and departmental communication channels. Changes have included updating standard operating procedures, guidelines, and the application of a business case for a blood fridge located in ED to reduce blood administration length of time.

Conclusion:

These detailed simulations successfully tested the current hospital processes and resulted in significant improvements to the daily structural delivery of best practise. Additionally, the SBE model decreased clinician teaching preparation burden and increased simulation efficiency and effectiveness. After the success of this model, it is being rolled out to other specialities.

Acknowledgement:

We would like to acknowledge and thank the Dinwoodie Charitable Company for their support.

References

1. Gressgård LJ. Knowledge management and safety compliance in a high-risk distributed organizational system. Safety and health at work. 2014;5(2):53–59.

2. Petrosoniak A, Auerbach M, Wong AH, Hicks CM. In situ simulation in emergency medicine: moving beyond the simulation lab. Emergency Medicine Australasia. 2017;29(1):83–88.

Gynaecological/Male Urogenital Teaching Associate (GTA/MUTA) methodology is considered the gold standard of invasive genital examination technique. Lay persons are trained in the technique of invasive genital examinations and patient-centred, trauma informed communication, and autonomously instruct learners on how to comfortably perform this examination using their own bodies as a teaching tool.

Methods:

GTAs/MUTAs function simultaneously as an autonomous instructor and a simulated patient during the exam. GTAs and MUTAs instruct clinical invasive examination techniques in a structured educational setting with a predetermined curriculum on which they have been trained, while letting learners perform these exam techniques on their bodies. Existing alternatives to GTA/MUTA education include the use of anesthetized patients, cadavers, plastic anatomical models (task trainers) and/or voluntary examinations on peers.

Findings:

There are unique benefits to the GTA/MUTA programme from both an institutional and learner perspective. Learner’s benefits unique to GTA/MUTA education include decreased learner anxiety [1], immediate feedback on examination technique with regard to patient’s physical comfort, and the opportunity to practise patient communication skills while performing such examinations. Institutional benefits unique to GTA/MUTA methodology are that after the initial setup cost, funds are saved removing the need for faculty to perform the examination instruction. Learner proficiency is higher compared to learners taught by physicians [1], and increased proficiency saves time and cost associated with learners being taken off clinical rotation to receive supplemental genital examination technique instruction. The use of simultaneous patient-instructors also introduces ‘elements of sensitivity and humanism’ to the examination [2] by having students learn to involve their patient and incorporate their perspective with regard to comfort and patient education information. By learning this examination from GTAs/MUTAs, a new model of physician patient relationship is taught, with GTAs/MUTAs functioning as informed collaborators rather than docile, uninformed patients [3].

Conclusion:

In order to implement such a programme in an institution, among the first tasks is to obtain funding. This funding can be sought from grants or via institutional funds. Institutions may even choose to grow their GTA/MUTA programme to contract with outside institutions where this clinical examination instruction is needed. Other preparatory steps include establishing a curriculum, observing an established GTA/MUTA programme session to assess the format, and recruitment and training of GTAs and MUTAs. Once the programme is established, a clinical skills training day may be implemented. Implementing such a programme improves the learners’ experience and provides them with an increased understanding of sound technique that will benefit their patients in the long term.

References

1. Theroux R, Pearce C. Graduate students’ experiences with standardized patients as adjuncts for teaching pelvic examinations. Journal of the American Academy of Nurse Practitioners. 2006;18(9):429–35.

2. Kretzschmar RM. Evolution of the Gynecology Teaching Associate: an education specialist. American Journal of obstetrics and gynecology. 1978;131(4):367–73.

3. Underman K. Feeling Medicine: How the Pelvic Exam Shapes Medical Training. New York, New York University Press; 2020.

The UK medical profession is becoming increasingly diverse as the number of international medical graduates (IMGs) joining the UK medical workforce increases every year. However, IMGs face a number of significant sociocultural and educational challenges. Recent studies show that IMGs lack insight into the system and lack clarity in relation to the role of a supervisor, career pathways, and medico-legal and ethical issues [1,2]. They exhibit differences in clinical practices and team dynamics. Recent studies suggest the introduction of dedicated induction programs in the form of formal teaching sessions, or tailored online induction for IMGs prior to their first job [1–3]. Most IMGs have minimal exposure to simulation and human factors training with international medical schools favouring more didactic methods of education. We have designed a high-fidelity simulation course with frequently encountered clinical scenarios to improve inclusion and a harmonious transition for the IMGs. This provides an opportunity to familiarise themselves with the healthcare system and team dynamics within the NHS and instils confidence to perform to the best of their ability in their respective roles.

Methods:

The course has been designed specifically tailored to the needs of IMGs who may find it daunting at first to make their place in a completely new system. We employ high-fidelity simulation encompassing multiple frequently encountered clinical scenarios. The scenarios are followed by a debriefing, with a special focus on human factors, interpersonal and communication skills, and understanding of authority gradients. The attendees are also encouraged to reflect on their performance and to participate in the discussion, share their professional opinions, experiences, and cultural influences. The attendees are asked to fill a pre-course and post-course questionnaire.

Results:

Two pilot courses were conducted with a total of 22 attendees. Pre- and post-course feedback with reflective questions about various aspects of the course was obtained. The scenarios assessed 5 categories, which the IMGs graded on a Likert scale. Pairwise comparison was performed between pre- and post-course feedback, showing a statistically significant increase in confidence levels related to all assessed categories; basic management skills (p <0.001), clinical skills (p=0.006), communication skills (p<0.001), teamwork (p<0.001), and leadership (p<0.001).

Conclusion:

Based on the positive feedback from attendees we believe that this induction simulation course can greatly help IMGs have a smooth transition into the NHS, and ensure inclusivity by equipping them with confidence, a knowledge of the system, and human factors.

References

1. Rasquinha M. Difficulties and educational challenges faced by international medical graduates in trust grade roles in the UK. British Journal of Hospital Medicine. 2022;83(4):1–7.

2. Hashim A. Educational challenges faced by international medical graduates in the UK. Advances in Medical Education and Practice. 2017;8:441–445.

3. Emery L, Jackson B, Oliver P, Mitchell C. International graduates’ experiences of reflection in postgraduate training: a cross-sectional survey. BJGP open. 2022.

Simulation-based education is frequently used to develop empathic behaviours in medical and nursing students [1] however to our knowledge, there is no previous literature that develops such behaviours by allowing students to adopt the role of simulated patient as they are admitted acutely to hospital. The aim of our project was to explore changes in empathy, compassion, and communication styles by asking students to adopt the role of the simulated patient during the undergraduate multidisciplinary simulation.

Methods:

Undergraduate final and penultimate year medical and nursing students who were undertaking their emergency medicine rotations were asked to participate. The simulation was delivered every 5 weeks, with one student adopting the role of the patient during the scenario. Two other students involved in the scenario adopted the role of the nurse and physician respectively. Data was collected via questionnaires and focus groups which were conducted immediately following the simulation. Questionnaires asked students to rank their agreement to several statements relating to improvements in empathy, compassion, and communication skills using a 1–5 ranking system, with 1 strongly disagreeing and 5 strongly agreeing. Focus groups were used to explore student opinions with the data transcribed and analysed into themes.

Results:

61 undergraduate students have participated thus far. 95% of participants agreed that adopting the role of patient provided them with a greater insight into the patient journey through the emergency department. 91% of participants agreed that they felt more empathy towards patients admitted acutely to hospital. Analysis of qualitative data shows improved empathy, compassion, teamwork, and communication with patients and colleagues within the multidisciplinary team. Students also developed a greater insight into how the unfamiliar hospital environment, lack of visitors, and COVID-19 precautions can negatively impact the patient’s journey. Finally, all students commented on how this simulation will positively influence their future practice.

Conclusion:

Providing students with the opportunity to adopt the patient’s role has been shown to positively influence their empathy, compassion, teamwork, and communication skills. Future work will focus on whether these changes have been sustained and incorporated into clinical practice.

Reference

1. Karvelytė M, Rogers J, Gormley GJ. ‘Walking in the shoes of our patients’: a scoping review of healthcare professionals learning from the simulation of patient illness experiences. Advances in Simulation. 2021;6(1):1–11.

‘Translational’ simulation activities are effective at improving patient safety when directed towards a specific patient journey [1]. North Bristol NHS Trust cares for around 6,000 obstetric patients per annum, with around 1,000 infants delivered by unplanned caesarean section each year. The in-situ simulation presented here facilitated an in-depth exploration of our cross-departmental response to a hypertensive pregnant patient presenting to the Emergency Department (ED). Severe pre-eclampsia in a preterm patient is a complex clinical scenario which, akin to previous successes seen with trauma care, may benefit from simulation focused on teamwork behaviours. The potential for benefit was optimised by application of the ASPiH Standards for Simulation-Based Education [2].

Methods:

The aim of the simulation was to prospectively identify latent safety threats to emergency obstetric care in patients presenting to the Emergency Department at Southmead Hospital. An in-situ simulation was conducted to simulate a pre-term woman presenting with pre-eclampsia and reduced conscious level. The high-fidelity scenario involved collaboration from 28 staff in emergency medicine, radiology, obstetrics, neonatal medicine, anaesthetics, and theatres as the patient journey evolved, ending in emergency caesarean section in the non-obstetric emergency theatre complex. Members of the expert panel acted as passive observers to record an accurate log of events during the scenario. A formal debriefing was conducted at the conclusion of the simulation where participants were invited to discuss potential hazards arising from the scenario. Failure modes and effects analysis was employed to assess the identified latent risks [3].

Results:

Ten latent safety threats were identified from the simulation. These were stratified according to severity and action plans were agreed to address them. Cross-departmental changes are being instigated and tested. These include amendments to emergency grab-bags, implementation of site-wide tools for location mapping in clinical emergencies, wider availability of the obstetric WHO checklist in emergency theatres, and clarification on the availability of blood for neonatal transfusion in non-obstetric theatres.

Conclusion:

This immersive scenario engaged clinical teams from a number of specialities and clinical areas across the hospital. Reflecting a real-life patient journey allowed for a rich and nuanced understanding of the response to an evolving emergency scenario. Cross-departmental collaboration in simulation-based training can be effective in assessing latent safety threats, particularly where staff operate in unfamiliar environments. Through carefully conducted debriefing, task allocation and follow-up, it is possible to diagnose and treat a broad range of latent threats to workflow, systems and processes.

References

1. Brazil V. Translational simulation: not ‘where?’ but ‘why?’ A functional view of in-situ simulation. Advances in Simulation. 2017; 2(1):1–5.

2. Association for Simulated Practice in Healthcare. Simulation-based education in healthcare: standards framework and guidance (2016).

3. Davis S, Riley W, Gurses AP, Miller K, Hansen H. Failure Modes and Effects Analysis Based on In-Situ Simulations: A Methodology to Improve Understanding of Risks and Failures. In: Henriksen K, Battles JB, Keyes MA, Grady ML (Eds). Advances in Patient safety: New Directions and Alternative Approaches (Vol. 3: Performance and Tools). Rockville(MD): Agency for Healthcare Research and Quality (US); 2008.

For many years, simulation-based education (SBE) at Walsall Manor Hospital (WMH) was carried by a one-man simulation technician, with intermittent input from department facilitators. Inadvertently creating SBE dis-equality across departments. Studies have demonstrated that formalized SBE plans improve training [1] and clinical outcomes [2]. We aimed to create standardisation and equity in SBE across departments by formulating a SBE training and delivery plan and governance structure at WMH.

Methods:

In the Autumn 2021, WMH started standardising SBE across the Trust in order to improve both the undergraduate and postgraduate standard of education [3]. The team grew to incorporate five multidisciplinary members; SIM technician, SIM lead (consultant), SIM nurse, SIM project support, and SIM technician support. With further expansion to now include speciality simulation leads in emergency medicine (EM) and paediatrics. Currently there is active recruitment for speciality leads in other departments. The SIM staff were appointed already holding simulation education related qualifications and/or experience. In addition, staff attended the University of Stafford foundations in simulation and debriefing courses. The governance process has been developed and implemented around the appointment of simulation speciality staff, formation of simulation courses, and simulation delivery. Furthermore, collection of attendance, feedback forms, certificates of participation and attendance have been made mandatory element of simulation delivery. In addition, there has been internal and external investment in increasing simulation equipment, including paediatric manikins and immersive technology.

Results:

In seven months, achievements have included: a range of simulation-based training events, the implementation of in-situ simulation in acute medicine, simulated sessions for final year medical students, the development of a simulation Foundation Year 1 and 2 curriculum, successful construction and running of mock royal college of physicians viva examination, multiple medical procedure courses, the re-introduction of Ill Medical Patients’ Acute Care Treatment (IMPACT) course, and simulation sessions for student nurses. SBE activities were delivered by and to a multidisciplinary team.

Conclusion:

Putting together a simulation team and formalizing the governance process around SBE delivery has increased the number of educational activities for both undergraduate medical/nursing students and postgraduate doctors and allied health care professionals. Feedback scores have been good to excellent and multidisciplinary work in EM has improved. The SIM team will continue to promote, implement, embed, and sustain SBE within the Trust to bigger and bolder activities.

Acknowledgement:

We would like to thank and acknowledge the Dinwoodie charitable company for their support.

References

1. Weaver SJ, Salas E, Lyons R, Lazzara EH, Rosen MA, DiazGranados D, Grim JG, Augenstein JS, Birnbach DJ, King H. Simulation-based team training at the sharp end: A qualitative study of simulation-based team training design, implementation, and evaluation in healthcare. Journal of Emergencies, Trauma and Shock. 2010;3(4):369–377.

2. Houzé-Cerfon CH, Boet S, Marhar F, Saint-Jean M, Geeraerts T. Simulation-based interprofessional education for critical care teams: Concept, implementation and assessment. Presse Medicale (Paris, France: 1983). 2019;48(7–8 Pt 1):780–787.

3. Irwin PM, Brown RA, Butler S. The undergraduate simulation framework: standardising design and delivery’. Higher Education, Skills and Work-Based Learning. 2020;11(2):576–586.

Simulation-based education is well established as a teaching strategy but is often taught in dedicated simulation centres. In-situ simulation had previously been less prominent as a teaching tool within the Trust due to lack of awareness of its benefits and versatility. The aim of this project was to utilise in-situ simulations to increase knowledge and implementation of Trust processes, encourage self-reflection, collaboration, and communication within the clinical teams [1].

Methods:

As part of a year-long collaborative project between our nursing education and simulation teams, an in-situ simulation programme was designed for delivery to established teams. Simulation topics came from various sources including local patient safety agenda, patient safety incidents, curricular requirements, and educational priorities. The simulations were undertaken in their native clinical setting and sessions were supported by subject-matter experts to ensure accuracy and appropriate complexity. These sessions were aimed to reach all members of the multidisciplinary team with the focus on nursing workforce and allied healthcare professionals. Over a period of four months, thirty sessions were delivered, at approximately thirty minutes per session, in five clinical areas. These sessions encompassed key priorities including care of the deteriorating patient, falls, end of life care, and tissue viability. This included a pre-simulation discussion and a debriefing immediately after.

Results:

Feedback was gathered from the 113 participants using a post-course survey, featuring both quantitative and qualitative questions to analyse pre- and post-simulation experience, confidence, and knowledge of how to care for patients with a focus on the identified key priorities. The results collected showed a 25% increase in confidence partaking in simulation again, 10% increase of confidence working and communicating within a multidisciplinary team, 14% increase in confidence assessing patients, and 6% increased awareness of personal/professional limitations. The main themes reported by participants were increased awareness of Trust protocols and incident reporting, improved value of self-reflection through the debriefings, and increased awareness of effective team communication to support patient safety. Additionally, the delivery of more regular sessions would aid with exploring different topics in greater detail and further solidify their knowledge. Participants valued the provision of live actors and authentic learning experiences in the workplace.

Conclusion:

In-situ simulation is an effective method of delivering multidimensional, realistic scenarios allowing participants the opportunity to continuously explore various clinical priorities and human factors. Regular, reoccurring simulation sessions in the clinical setting would prove more effective in improving patient safety along with staff’s confidence and competence.

References

1. Martin A, Cross S, Attoe C. The Use of in-situ Simulation in Healthcare Education: Current Perspectives. Adv Med Educ Pract. 2020;11:893–903.

Success of just-in-time in-situ simulation to find new ways of working, test processes, and uncover latent error to promote patient and staff safety is well documented from the COVID-19 pandemic [1,2]. We used just-in-time simulation in a unique situation where imminent transfer of a critically unwell patient with VHF was required to our high-level isolation unit (HLIU). The Trexler isolator tent is custom made for treating high consequence infectious diseases (HCID), requires specific training. Staff provide care by ‘stepping’ into ‘suits’ in the plastic walls. Transfers into the tent are time-critical to reduce potential exposure risk to staff. This was the first time ever an intubated, ventilated patient was to be transferred into the tent.

Methods:

Simulation, Infectious Diseases, and Intensive Care teams collaborated within a few hours’ notice to simulate in-situ the mechanism of transferring a patient (using a Laerdal SimMan 3G) intubated and ventilated with multiple drug infusions running, headfirst from a transport trolley into the foot end of the isolator tent. This was repeated subsequently in several Plan-Do-Study-Act (PDSA) cycles to refine the process and reduce transfer time taken. There were multiple pauses as problems, latent threats, and potential failure points were identified, and time outs to discuss solutions.

Results:

Transfer teams informally reported increased confidence being able to troubleshoot and rehearse the transfer process before patient arrival. Key learning related to leadership, communication, highlighting safety steps, and sharing mental models between teams such as airway management, significance during transfer and ergonomics of airway-trained personnel positioning in the tent. This was written up as a visual aid for the transfer team. Environmental latent threats found included safe ventilator mounting, IV pump management, emergency drug preparation, and allowed for enhanced consideration of the practicalities of caring for an intensive care patient in the HLIU tent. The actual transfer of the patient went smoothly and without incident. Further simulations were run during the patient care episode to rehearse and potential anticipate airway and ventilation management issues.

Conclusion:

Just-in-time in-situ simulation provided a valuable opportunity to rehearse a high-stakes, never done before activity, and facilitated identification of environmental latent threats before patient arrival. It created a shared mental model between different specialities of patient needs contributing towards an increased situational awareness and ability to forward plan and project, ultimately increasing patient and staff safety.

References

1. Guris RJ, Doshi A, Boyer DL, Good G, Gurnaney HG, Rosenblatt S, McGowan N, Widmeier K, Kishida M, Nadkarni V, Nishisaki A. Just-in-time simulation to guide workflow design for coronavirus disease 2019 difficult airway management. Pediatric Critical Care Medicine. 2020;21(8):e485.

2. Zucco L, Chen MJ, Levy N, Obeidat SS, Needham MJ, Hyatt A, Keane JR, Pollard RJ, Mitchell JD, Ramachandran SK. Just-in-Time In Situ Simulation Training as a Preparedness Measure for the Perioperative Care of COVID-19 Patients. Simulation in Healthcare: Journal of the Society for Simulation in Healthcare. 2022 Feb 10; Published Ahead of Print. doi: 10.1097/SIH.0000000000000635

Acknowledgments

We acknowledge the hard work and expertise of the Infectious diseases and Intensive care medical and nursing leads and team who supported the delivery of this simulation, and the clinical and support staff who maintain and run the HLIU, and the NHS England Contact High Consequence Infectious Diseases Network.

Simulation-based clinical systems testing (SbCST) is a process that allows clinicians and hospital stakeholders to evaluate work carried out in new environments. Unlike work-as-imagined, SbCST takes into account the complex interactions resulting from human performance limitations [1]. These factors can result in errors that may even lead to patient harm [2]. Therefore, we used SbCST to evaluate a newly built children’s emergency department with the aim of identifying latent errors and implementing changes to minimise the risk of their occurrence, whilst also ensuring that the simulation experience was an independently valuable educational opportunity.

Methods:

Scenarios were created according to two criteria. Firstly, that they tested at least one specific environmental issue and secondly, that they focused on topics that the paediatric and Accident and Emergency departments felt would be educationally valuable to the participants. Once created, these scenarios were then carried out as un-announced in-situ simulations during the first 8-weeks of departmental opening. The participants were instructed to treat the scenarios as real, including the manner in which they called for help. Any equipment required came from the department and if single use, it was exchanged for training equipment. The participants then undertook a hot debriefing before feedback was gathered about both the educational value of the scenarios as well as any issues identified within the new department.

Results:

In total there were 38 multidisciplinary participants including nurses, operating department practitioners, and doctors from 6 different specialties. The feedback from the sessions was positive with an average ranking of >4 out of 5 in 8 out of the 9 measured domains, including; realism, enhancement of knowledge, and usefulness of in-situ simulation in a new environment. We also identified greater than 50 problems spanning all 5 of the categories from the ‘SHEEP’ model [3]. Approximately 60% of issues were resolved within the 8 weeks, whilst the remaining are on the risk register and awaiting review at a stakeholder level.

Conclusion:

In-situ simulation is an excellent mechanism for carrying out clinical systems testing of new environments due to the fact that it simulates realistic events which are prone to the same errors as the real events, without the risk of patient harm. Once the source of an error is exposed the debriefing can help to identify methods to minimise the risk of future reoccurrences. At the same time, with appropriate planning, the scenarios can also provide an opportunity to deliver multidisciplinary training.

References

1. Colman N, Doughty C, Arnold J, Stone K, Reid J, Dalpiaz A, Hebbar KB. Simulation-based clinical systems testing for healthcare spaces: from intake through implementation. Advances in Simulation. 2019;4(1):1–9.

2. Reason J. Human error: models and management. Br Med J. 2000;320:768–770.

3. Rosenorn-Lanng D. Human factors in healthcare: level one. Oxford: Oxford university press. 2014.

10% of 50,000 doctors in postgraduate training programmes in England are taking approved time out of training at any time [1]. The NHS People Plan [2] aims to welcome back colleagues who want to return, which can be a stressful experience for trainees. It is our duty as educators to provide support. Health Education England offer SuppoRTT funding to create opportunities for trainee development. Despite regional courses, returning trainees felt their individual needs were not met. We aimed to provide additional, bespoke 1:1 training within a psychologically safe environment to paediatric trainees in our hospital before their return to training.

Methods:

Trainee participants had email and phone correspondence with a consultant paediatrician prior to their return date. A half-day bespoke simulation course was co-designed with the participant at a mutually convenient date. Teaching was delivered by a consultant or senior registrar trained in simulation and debriefing. The bespoke course included a variety of activities to meet personal goals, including basic procedures, scenarios in the simulation centre, and if ready, a short in-situ simulation with multidisciplinary staff (if available). In addition, trainees were signposted to existing courses and resources. The simulation centre also offered support to the Educational Supervisor in completing SuppoRTT Funding applications. Afterwards, returning trainees were asked to provide feedback via email. This experience has led us to develop a framework for future learners from different specialities and the wider multidisciplinary team; the CUSTOM framework, Creating Unique Support for Trainees and Others with the Multidisciplinary team.

Results:

In three years, we provided bespoke training to six paediatric doctors, four of whom were returning after maternity leave and two from research. Five trainees had bespoke sessions, one trainee chose to attend a simulation course with additional support and feedback rather than requesting an individualised course which would have had to be created. Themes from feedback included a positive learning environment, appreciation for bespoke training opportunities, increasing trainee confidence and appreciation for general support (Table 1). One trainee who returned after their second maternity leave said ‘it was noticeable how much quicker I returned to feeling comfortable after this second leave.’

Table 1:

Feedback received from trainees

Conclusion:

Our bespoke courses were successful and well received by paediatric trainees. We are launching a new framework, CUSTOM, Creating Unique Support for Trainees and Others with the Multidisciplinary Team. CUSTOM will support other departments to offer bespoke courses. Going forward, we aspire to expand this support to returners from the multidisciplinary team.

References

1. Health Education England. SuppoRTT. Health Education England. 2022. https://www.hee.nhs.uk/our-work/supporting-doctors-returning-training-after-time-out [Accessed on 19/06/2022]

2. NHS England. NHS England NHS People Plan. England.nhs.uk. 2022. https://www.england.nhs.uk/ournhspeople/ [Accessed on 19/06/2022]

Lifestyle factors are a significant cause of mortality and morbidity in England [1]. Physiotherapists are well placed to help people to make healthy lifestyle choices, however junior physiotherapists do not feel well equipped to have these conversations [2]. An innovative teaching session was carried out with physiotherapy students to 1) increase their confidence in addressing lifestyle choices and 2) equip them with communication skills to decrease fear of these difficult conversations. The session was grounded in the theory of motivational interviewing [3].

Activity:

Teaching staff created role play scenarios. These were reviewed by service users for authenticity. The scenarios included a teenager with cystic fibrosis who was not compliant with chest clearance exercises and a person suffering falls secondary to alcohol misuse. The final scenario involved a discussion about smoking with a person recently diagnosed with a chronic lung condition and their partner. In a face-to-face immersive fishbowl setting, students took part in the scenarios with experienced actors as service users. The session was collaborative, where students could ‘time out’ to seek guidance from their peers. The actors adapted their communication depending on how they felt in the conversation. After each scenario the actors provided feedback from the service user perspective.

Results:

There was excellent engagement in the session. Students found the final scenario the most challenging as they struggled to gain a rapport with the patient actor due to the partner frequently interrupting. The cohort expressed different ideas of how to manage this situation. Feedback from the actors helped the students to consider the perspective of the partner and how their interference was due to worry. Pre- and post-session data on a five-point Likert scale demonstrated improved knowledge of motivational interviewing and improved confidence to have lifestyle change conversations (Figure 1). Importantly, all students (n=12) felt empowered by the session and wanted to make changes to their communication style. Subjective data collected from the students was uniformly positive. Students commented that the role play felt ‘real’, demonstrated by this quote ‘Amazing! Very realistic and made me think further and delve deeper’.

Figure 1:

Likert scores to the pre- and post-motivational interviewing simulation training

Conclusion:

The immersive simulation experience motivated and empowered the physiotherapy students to talk about lifestyle change with service users. The participative forum felt ‘real’ and students left the session better equipped to have lifestyle change conversations with service users. This should help to create future physiotherapists who can help people to live healthy lives.

References

1. Office for National Statistics. What is happening to life expectancy in England? England: The King’s Fund; 2022. https://www.kingsfund.org.uk/publications/whats-happening-life-expectancy-england [Accessed on 13/05/2022]

2. Walkenden S, Walker KM. Perceptions of physiotherapists about their role in health promotion at an acute hospital: a qualitative study. Physiotherapy. 2015;101(2):226–231

3. Rollnick S, Miller WR, Butler CC. Motivational Interviewing in Health Care. London: The Guildford Press, 2008.

The National Early Warning Score (NEWS) is used to collate measurements of patients’ vital functions, identifying patients who require management to prevent deterioration [1]. Not following NEWS escalation protocols is linked to adverse events and may occur due to prioritising clinical judgement over scores and communication failures [2]. Patients with learning disabilities are even more at risk of avoidable adverse events in hospital, but education to improve the understanding of the needs of these patients may be a protection against this [3]. This research assessed the improved confidence of nurses in escalation following a simulation-based course focused on escalating an unwell patient with learning difficulties.

Methods:

The course started with an interactive talk on how to measure NEWS by a nurse educator. A simulation-based video we created of a mismanaged scenario involving a patient with learning disabilities was shown, followed by a discussion about handover using the SBAR structure. The simulation required the attendee accurately calculating a NEWS score of an actor connected to a monitor we could control and escalate to a doctor over the phone. This simulation was shown in real time to the other attendees, and the debriefing was facilitated by a doctor trained in debriefing. Pre- and post-course questionnaires were completed by attendees to assess their nursing experience, confidence in assessing NEWS, and escalation rated on a scale of 0 (very unconfident) to 5 (very confident).

Results:

The course was run 6 times for a total of 26 nurses. The median length of nursing experience was 17 months (range 1–249months). More attendees were confident (defined as 4 or 5 out of 5 in the confidence scale) in assessing NEWS, escalating to the medical team, and using SBAR post-course (96%, 96%, and 93% respectively) compared to pre-course (68%, 57%, and 54% respectively), which can be seen in figure 1. Improvements were seen in calculation of NEWS and the use of SBAR in freeform written handovers between pre- and post-course questionnaires. Five respondents suggested involving doctors or other members of the multidisciplinary team in the course.

Figure 1:

Confidence of the participating nurses before and after the course.

Conclusion:

This simulation-based course focusing on care of a patient with learning disabilities has improved confidence in assessing NEWS and escalation with a structured handover to the medical team. Further research should be focused on multidisciplinary simulation on escalation in the acute care setting, and how including cases involving learning disabilities improves outcomes in this at-risk group.

References

1. Royal College of Physicians. National Early Warning Score (NEWS) 2 Standardising the assessment of acute-illness severity in the NHS. Updated report of a working party. London: 2017. www.rcplondon.ac.uk

2. Ede J, Jeffs E, Vollam S, Watkinson P. A qualitative exploration of escalation of care in the acute ward setting. Nursing in Critical Care. 2020;25:171–178.

3. Louch G, Albutt A, Harlow-Trigg J, Moore S, Smyth K, Ramsey L, O’Hara JK. Exploring patient safety outcomes for people with learning disabilities in acute hospital settings: a scoping review. BMJ Open 2021;11:47102.

Recent advances in simulation have yielded great outcomes in training ophthalmology residents worldwide [1]. However, repetitive tasks may lead to burnout and loss of interest. The safe learning environments provided by surgical simulation create space for exploring creative practices and the introduction of gamification [2]. We held one such tournament for ophthalmology residents to compare and compete on their cataract surgery skills [3]. The aim was to generate interest and sportsmanship amongst the residents, and engage senior surgeons on the utility of simulation.

Methods:

We designed a knockout tournament with 3 rounds, for 8 participants (Figure 1). Specific tasks for each round were selected on the EyeSi course software (V3.0.6). Round 1 was ‘Capsulorhexis-high tension’, round 2 ‘Capsulorhexis-errant tear’, and round 3 ‘Milky-White Cataract’. Rules were displayed to the participants before the event and the highest score of three consecutive attempts was considered a passing score. A live performance was projected on a screen with an audience, along with a scoreboard display keeping track of scores and progression of participants.

Figure 1:

Illustration of the knockout tournament in three rounds.

Results:

Round 1 scores for the 8 participants ranged from 0 to 94 out of 100, and the top 4 scorers who qualified for the next round scored 94, 94, 94, and 90 in their highest scoring attempt. The mean time taken per task in round 1 was 2 min 24 sec. Round 2 highest scores were 89, 86, 79, and 74, and the mean time taken was 2 min 18 sec. Final round 3 scores were 69 and 65, and a champion was declared. The whole event took 3 hours and successfully generated sportsmanship spirit and significant interest in surgical simulation. Furthermore, the simulator noted a total injured corneal area of 18.78 mm2 and capsular damage of 4.7 mm.

Conclusion:

The design of the tournament not only ensured excitement amongst all participants but also encouraged participants to excel in the tasks in the provided course by bringing sportsman spirit, boosting the confidence of performing live surgery in front of an audience, and by collecting and analyzing their cumulative data. Gamification of surgical simulation allows residents to compete in a safe learning environment. We recommend this exercise to all centers equipped with surgical simulators. In the future, different surgical themes and future international tournaments may be explored.

References

1. Ahmed TM, Hussain B, Siddiqui MAR. Can simulators be applied to improve cataract surgery training: a systematic review. BMJ Open Ophthalmology. 2020;5(1):e000488.

2. van Gaalen AEJ, Brouwer J, Schönrock-Adema J, Bouwkamp-Timmer T, Jaarsma ADC, Georgiadis JR. Gamification of health professions education: a systematic review. Advances in Health Sciences Education. 2021;26(2):683–711.

3. Aga Khan University. EyeSurg Tournament. https://www.aku.edu/news/pages/News_Details.aspx?nid=NEWS-002602 [Accessed on 19/06/2022]

The transition from medical student to Foundation Year 1 (FY1) doctor represents a vital stage in the development of a newly qualified doctor. It is well established that medical students struggle with this transition [1]. There is evidence that simulation-based education (SBE) improves competence and confidence [2]. At our Trust, medical students undergo a Transition to Foundation Year 1 (TTF1) placement to prepare them for their upcoming roles. This study’s aim was to improve the confidence of final year medical students beginning their FY1 jobs in August 2022 by introducing them to common FY1 situations like prioritising tasks, handing over, being part of the on-call team, and practising clinical skills to improve patient safety as per the General Medical Council (GMC) outcomes for graduates [3]. We designed and implemented a simulation-based training day during their TTF1 placement.

Methods:

We collected feedback from a focus group of nine final year medical students regarding what would help best prepare them. We mapped these against their medical school’s curriculum and the GMC’s framework [3]. They reported they were inadequately prepared for FY1 and all agreed to have a training day covering different domains to increase their confidence. We designed a TTF1 training day that included lecture-based teaching on how to survive FY1, three scenarios based on common FY1 situations and a teaching session on ultrasound guided cannulation. The training day was delivered to five cohorts (29 medical students) during their TTF1 placements in 2022. During this training day, medical students completed a pre- and post-programme questionnaire which measured self-reported changes in confidence levels via a 5-point Likert scale across domains: verifying deaths, prioritising tasks, cannulation, handing over, and being part of the on-call team. The questionnaire also explored their expectations of the day and what they had learnt from the day. This was analysed using the framework analysis.

Results:

Quantitative results revealed: increased preparedness for their FY1 role (+24%; <0.001) and being part of the on-call team (+58.7%; p<0.001), increased confidence in prioritising tasks (+28.6%; <0.001), verifying deaths (+131.5%: <0.001), and cannulation (+50%; <0.001). Analysis of qualitative results revealed common themes of improved confidence in ultrasound guided cannulation, increased knowledge-base, clearer understanding of handling common FY1 situations, and 100% of participants agreed that this training day was useful.

Conclusion:

The implementation of a TTF1 training day proved to increase the students’ confidence and levels of preparedness for their upcoming jobs.

References

1. Cameron A, Millar J, Szmidt N, Hanlon K, Cleland J. Can new doctors be prepared for practice? A review. Clin Teach. 2014;11:188–192.

2. Lateef F. Simulation-based learning: Just like the real thing. Journal of Emergencies, Trauma and Shock. 2010;3(4):348.

3. General Medical Council. Outcomes for Graduates 2018. 2018. https://www.gmc-uk.org/-/media/documents/dc11326-outcomes-for-graduates-2018_pdf-75040796.pdf [Accessed on 1/06/2022]

Healthcare professionals work in a diverse community of different specialities and skills. However, most healthcare professional courses are insular and isolating in their training methods. This results in highly trained individuals, who are unfamiliar with the true multidisciplinary team (MDT) approach in health services [1], leaving them unprepared for working in the NHS. One specific area where teamwork, good communication and appreciation of others’ skills sets are crucial is during medical emergencies and cardiac arrests, where multiple professions (including: Doctors, Nurses, Resuscitation officers, Operating Department Practitioners) work together to achieve the best outcome patients. We aimed to introduce Interprofessional Education (IPE) to cardiac arrest simulations for final year undergraduate medical and nursing students to improve their understanding of working as part of a MDT, to enhance their confidence in dealing with cardiac arrests and prepare them for work in the NHS.

Methods:

Reviewing the literature, there are several key components required to successfully instil IPE including: commitment to IPE, expert facilitation, understanding of roles in different professions, and positive role modelling [2]. When designing the course, we obtained each profession’s learning outcomes for cardiac arrest and planned them into the course; paying particular attention to equal weighting of learning outcomes for both professions and mutual learning outcomes. Furthermore, we identified key skills which we wanted students to demonstrate and designed simulations to incorporate these. For example, nursing students using the defibrillator in manual mode independently and medical students to independently use the defibrillator in automatic mode. To add value to the course we wanted high quality role modelling and profession specific feedback. To do this, we ensured both qualified nurses and doctors with experience in delivering feedback and real-life cardiac arrest cases were present for all sessions.

Results:

Feedback collated from students and faculty positively supported the introduction of IPE in cardiac arrest simulation, with students specifically commenting on the benefits of teamwork, understanding each other’s competencies, and benefits of workings as an MDT.

Conclusion:

Due to these simple changes and keeping IPE at the centre of our design and implementation of the cardiac arrest simulation course, we were able to successfully introduce IPE to final year undergraduate medical and nursing students.

References

1. Choudhury RI, Mathur J, Choudhury SR. How interprofessional education could benefit the future of healthcare–medical students’ perspective. BMC Medical Education. 2020;20(1):1–4.

2. Buring SM, Bhushan A, Broeseker A, Conway S, Duncan-Hewitt W, Hansen L, Westberg S. Interprofessional education: definitions, student competencies, and guidelines for implementation. American journal of pharmaceutical education. 2009;73(4).

People with Learning Disability (LD) often receive inequitable care within the NHS, something Mencap has described as ‘institutional discrimination’ [1]. The NHS Long Term Plan states the need to improve the care of patients with LD [2]. Simulation with debriefing is a useful approach for improving patient care with Human Factors teaching. To improve education around LD, we created a de novo course with concurrent LD theme for nursing educators to become trained in debriefing and simulation, to allow them to become champions in facilitating learning, especially in relation to LD.

Methods:

To establish the current educational needs of our organisation around LD, we conducted a staff survey to further understand the educational needs of our colleagues. 108 professionals from a variety of disciplinary backgrounds (including nurses, dietitians, and doctors) across 4 sites within our Trust responded. Thematic analysis highlighted the need for further education, with anxiety about inequitable treatment of LD patients, and staff and patient physical safety when looking after a patient with LD. We subsequently ran a 2-day ‘Train the Trainers’ course for nursing educators, which used communication scenarios (online videos and actors) and games to develop generic debriefing skills. Day 2 focused on simulation design and incorporating LD into simulation design, and at the end of the course participants facilitated a high-fidelity simulation to the rest of the group. Throughout the course, patient feedback, serious incidents, staff survey, and our Trust LD specialist nurse’s expertise were incorporated.

Results:

8 nurses attended our course, taught by a diverse multidisciplinary faculty. Before the course, confidence in debriefing was on average 2.8/5 (5 being most confident). Afterwards they rated their confidence 3.8/5. Learners were asked about their confidence raising awareness of LD within their department. The rating was improved from the initial 2.6/5 to 3.6/5 after the course. To date, 1 participant has delivered LD-related teaching to their department using debriefing skills following an online LD video used on the course.

Conclusion:

Our staff survey highlighted the need for further education within our organisation. The course was successful in increasing nursing educators’ confidence in debriefing and their confidence in raising awareness of LD during teaching sessions. We are currently creating further resources to aid teaching, including videos with service users. We will further signpost to existing resources and request delayed feedback to assess if our nursing educators have become LD Champions.

References

1. Mencap. Mencap.org.uk. 2022 https://www.mencap.org.uk/sites/default/files/2016-08/Death%20by%20Indifference%20-%2074%20deaths%20and%20counting.pdf [Accessed on 18/06/2022]

2. NHS England. NHS Long Term Plan. NHS Long Term Plan. 2022. https://www.longtermplan.nhs.uk [Accessed on 19/06/2022]

Mental simulation assists learners in repetitive, solitary, deliberate practice. Mental simulation can complement laboratory simulation-based learning and clinical practice in learning skills and increasing self-efficacy [1]. Mental simulation is a quasi-sensory or quasi-perceptual experience without stimuli and overt physical movement. Mental simulation occurs when one imitates actions in an imaged state but does not trigger the action itself [2]. Mental simulation is based on the ‘simulation theory of action’. This theory suggests that observing an action, imaging an action, or understanding an action will activate the neural networks involved in the actual execution of that action. While these states differ, there is a partial overlap between covert and overt action [2]. The images produced during mental simulation must be vivid or high-fidelity to activate the said neural networks. Higher fidelity images create greater ‘functional equivalence’, increasing the likelihood that the imager will learn from their experience [3]. The aim was to create a mental simulation protocol rich in motor and sensory cues that would assist pre-registration nurses [students] in imagining performing cardiac arrest skills. The protocol had to be designed to increase the mental simulation exercise’s functional equivalence and increase the possibility that learning would take place.

Methods:

The protocol had several elements to improve functional equivalence, and these were: i) a narrated audio script with embedded sound effects that described the scenario. The script was based on PETTLEP mental simulation framework (physical, environment, task, timing, learning, emotion and perspective) [3]. The author used a tripartite script design. The scripts were designed between 1) the [first] author, 2) the [2015] BLS and ALS guidelines, and 3) students with real-world cardiac arrest experience; ii) a first-person [1-P] film of a cardiac arrest to assist in evoking high-fidelity images from a 1-P perspective; iii) a patient back story; iv) resuscitation algorithms, and v) a glossary of terms to help inexperienced students to understand cardiac arrest terminology. The glossary would assist students in turning language into images.

Findings:

This novel approach to creating a mental simulation protocol created a scenario rich in detail and rich in stimulus, response and meaning cues that could help students learn cardiac arrest skills outside the simulation laboratory.

Conclusion:

This is a new and novel way to design mental simulation protocols for learning cardiac arrest skills outside the simulation laboratory.

References

1. Geoffrion R, Gebhart J, Dooley Y, Bent A, Dandolu V, Meeks R, Baker K, Tang S, Ross S, Robert M. The mind’s scalpel in surgical education: a randomised controlled trial of mental imagery. Int J Obstet Gy. 2012;119(9):1040–1048.

2. Jeannerod M. Neural Simulation of Action: A Unifying Mechanism for Motor Cognition. NeuroImage Clin. 2001;14(1 pt. 2):S103–109.

3. Holmes PS, Collins DJ. The PETTLEP Approach to Motor Imagery: A Functional Equivalence Model for Sport Psychologists. J. Appl. Sport Psychol. 2001;13(1):60–83.

Aspiration of gastric contents remains the commonest cause of death during anaesthesia, accounting for 50% of deaths and occurring more frequently than cannot intubate, cannot oxygenate (CICO) events [1]. Despite this, training for CICO is ubiquitous while rehearsal of aspiration management is rare. Soiled airway simulation has been shown to reduce the time to intubation with less volume entering the lungs, a factor known to correlate with the severity of aspiration [2]. Initially developed by Dr DuCanto, high-fidelity vomit simulators have existed since 2014 however cost (£1,595) precludes their widespread use. Low-cost models have since been described, however, the materials are sourced from hardware stores, relatively expensive, require skills to construct, utilise noisy pumps, and some even require electrical safety considerations [3]. We aimed to improve access to aspiration training by designing an aspiration simulator that is easy to construct and low-cost.

Methods:

Employing an iterative design process we created an aspiration simulator using materials readily available in the operating theatre. The final model requires an intubatable manikin with an oesophagus, such as the Laerdal Airway Management Trainer^TM. The oesophagus is intubated distally with a shortened size 9.0 cuffed endotracheal tube (acting as both a conduit and seal), which is then connected to a shortened bladder irrigation set and two 3-litre bags containing simulated regurgitation (made from propofol, water, and green food colouring), elevated and manually pressurised to 300 mmHg (Figure 1, upper left).

Results:

The setup silently produces a titratable flow of up to 250 ml per minute, sufficient to flood the oropharynx within 30 seconds. The simulation itself can be set up in under 10 minutes, used several times before requiring refilling, and is easily transported between theatres as a part-task trainer or concealed for a multi-disciplinary simulation (Figure 1, bottom left). All parts are reusable and the total cost equals £9.90 (excluding the manikin, which is undamaged). Our simulator was tested on a cohort of 16 middle-grade anaesthetic trainees and its performance was evaluated using pre and post-course questionnaires (scale 0–10). All successfully intubated the simulator. Average user-rating scores for realism were 8.4/10 while confidence in managing soiled airways improved from 6.2/10 to 8.9/10 after exposure to the simulation.

Conclusion:

Soiled airway simulation can be simple and affordable, creating a realistic environment to practise the unique skills necessary to manage this important yet under-rehearsed cause of death during anaesthesia.

References

1. Cook T, Woodall N, Frerk C. Major complications of airway management in the UK: results of the Fourth National Audit Project of the Royal College of Anaesthetists and the Difficult Airway Society. Part 1: Anaesthesia †. British Journal of Anaesthesia. 2011;106(5):617–631

2. Jensen M, Louka A, Barmaan B. Effect of Suction Assisted Laryngoscopy Airway Decontamination (SALAD) Training on Intubation Quality Metrics. Air Medical Journal. 2019;38(5):325.

3. Sampson C, Pauly J, Horner J. Low-cost Portable Suction-Assisted Laryngoscopy Airway Decontamination (SALAD) Simulator for Dynamic Emesis. Journal of Education and Teaching in Emergency Medicine. 2019;4(2).

14.4% enter school reception obese [1]. The Paediatric Emergency Department (PED) offers opportunities for professionals to identify obesity and provide support to children and young people (CYP). Our PED launched an Obesity Toolkit: a medical education project created to help Make Every Contact Count, and to increase opportunistic diagnosis and sensitive communication about obesity (2). This includes teaching resources including communication scenarios and videos. Staff focus groups identified the main barrier for professionals was fear around communicating about obesity in a sensitive way. We aimed to collaborate with CYP to develop our communication simulation programme within the Toolkit. In addition, we aimed to involve families in the evaluation of the project.

Methods:

We developed written patient leaflets, written and filmed communication scenarios incorporating feedback given by focus groups with Youth Empowerment Squad (YES), our local Trust CYP forum. The feedback included preferred language, which was emphasised in the debriefings of simulated sessions. The educational role-play scenario videos, which can be debriefed in teaching sessions, were filmed with a CYP taking on the role of a patient. After the release of the toolkit and accompanying simulation programme, 10 patients diagnosed as overweight or obese were randomly selected 2 to 4 months after attendance, as part of a patient experience survey. This telephone call explored parent opinions about the obesity discussion.

Results:

Learning from CYP in YES helped us explore their preferred language, such as focussing on healthy living over the concept of obesity and explaining what is meant by body mass index (BMI). We included this in our debriefings. Our role-play videos are used in training to give examples of obesity discussions with CYP. These were semi-scripted to allow the CYP to incorporate their own voice and provide their insight into how they or their peers might react. In the patient experience survey, all parents were positive about the approach, rating the conversation on average 7.6/10 for being helpful (10 most helpful). Notable comments from parents included ‘the approach was sensitive, they spoke about positive change, not negative’.

Conclusion:

Parents talked positively about conversations that they had about obesity with staff trained using our simulation programme designed following CYP collaboration. It is encouraging that these conversations have been useful for CYP and families. Based on this feedback, we will continue to engage CYP and parents. Feedback from CYP is planned. The Obesity Toolkit is made free and Open Access for any interested departments.

References

1. NHS Digital. National Child Measurement Programme, England 2020/21 School Year – NHS Digital. NHS Digital. 2022. https://digital.nhs.uk/data-and-information/publications/statistical/national-child-measurement-programme/2020-21-school-year [Accessed on 17/06/2022]

2. Health Education England. Making Every Contact Count (MECC). 2022. http://makingeverycontactcount.co.uk [Accessed on 17/06/2022]

Training in simulated environments allows clinicians to practise procedures and make mistakes without risk to patients. It is important training models offer sufficient fidelity, allowing the trainee to face the same difficulties and hazards that they would in clinical practice. This is particularly true of technical skills training using part-task trainers. Current designs of central-venous cannulation simulators may not fully meet this need. Not all training models allow for the guidewire in the Seldinger technique to be over-inserted. This means guidewire loss cannot be demonstrated in many simulators, which undermines recognition of this important complication, one of the preventable and significant hazards of the procedure [1]. Our simulation centre uses Blue Phantom’s Gen II Central Line Ultrasound Training Model. This simulator replicates the upper torso and neck, with a right internal jugular vein and carotid artery that can be cannulated. The simulated vessels terminate in clear tubes that run outside of the manikin’s torso and contain a reservoir of fluid. Full insertion of the line is blocked due to the diameter of the reservoir tubing being too small to accommodate the J-tip of the guidewire.

Methods:

In order to permit over-insertion of the guidewire, the tubing connected to the internal jugular vein has to be replaced with one of a larger diameter, sufficient to allow passage of the guidewire’s J-tip. We developed a 3D printed adaptor which allows smooth passage of the wire into the larger-diameter tubing. The connection between the tube and adaptor is then made water-tight with silicone sealant. The modifications were designed using SolidWorks, Dassault Systèmes, and printed using VeroWhitePlus™ on a Object500 Connex1™ by Stratasys. Since the reservoir tubing can now accommodate guidewire retention, a further modification was required to allow for retrieval of the wire at the end of the simulation. We have achieved this by including access to the tubing secured by a screw cap.

Results:

With the modifications made (Figure 1), the guidewire can now be over inserted and easily recovered by faculty at the end of the simulation. This is an important modification because it eliminates the artificial feedback trainees would receive in other models on attempting to over-insert their wire.

Figure 1:

Modified central line insertion model with over-inserted guidewire.

Conclusion:

The trainee cannot now rely on the manikin preventing them from making this potentially serious mistake, so training now more accurately replicates the real-life experience. This allows for a richer training experience and a more valuable post-simulation learning conversation.

Reference

1- Cheung ME, Mellert LT, Firstenberg MS. Bedside Procedure: Retained Central Venous Catheter. In: Firstenberg MS & Stawicki SP, editors. Vignettes in Patient Safety – Volume 2. London: IntechOpen; 2017. https://www.intechopen.com/chapters/56490 doi: 10.5772/intechopen.69748 [Accessed on 10/06/2022].

Historically, attaining medical procedural competency during training has been challenging [1–3]. At a small district general hospital, initiatives were implemented to address these mandatory curriculum components.

Methods:

1) Ten skill-sessions were organized, to encompass all mandatory procedures such as skills in central venous catheter, chest drain, ascitic drain, lumbar puncture, DC cardioversion, pacing, and interosseous access. Doctors, advanced clinical and nurse practitioners were invited to attend a face-to-face procedure session. Manikins alongside medical procedure toolkits were provided to assist in simulation training. Pre- and post-Likert Scale questionnaire was used to assess skill-specific confidence levels.

2) A specific WhatsApp group was used to alert doctors of procedural training opportunities within the hospital. Terms of reference and clear clinical governance guidance were provided prior to sign-up. To assess the effectiveness of this method, a questionnaire was distributed amongst the users.

Results:

Thirty-eight professionals in training attended the sessions. The cumulative rating of all skills revealed an improvement in skill confidence from 15% to 80%. This was most marked in the interosseous access (17% to 100%) and abdominal paracentesis (27% to 100%). However, aptitude in central venous catheter was identified as having the lowest confidence skill level both pre-and post-sessions (0% to 60%). 86% of trainees found the WhatsApp group to be effective or very effective to communicate procedural training opportunities within the hospital. Within six-months, bedside training in DC cardioversion, ascitic drains, interosseous access, pleural aspiration, and drains were achieved.

Conclusion:

The training sessions improved skill-specific confidence. Equally, the more challenging procedural skills were identified for more training. Further plans for this Quality Improvement Programme will include utilizing the hospital’s online communication platform, organizing procedure-specific human factors teaching, and extending training sessions to consultants to evidence the upkeep of procedural competency.

Acknowledgement:

We would like to thank and acknowledge the contribution of the Dinwoodie Charity Company of Physicians. The medical registrar: Empowering the unsung heroes of patient care. RCP, 2013.

References

1. Tasker F, Dacombe P, Goddard AF, Burr B. Improving core medical training – Innovative and feasible ideas to better training. Clinical Medicine. 2014;14(6):612–617.

2. Tasker F, Newbery N, Burr B, Goddard AF. Survey of core medical trainees in the United Kingdom 2013 – Inconsistencies in training experience and competing with service demands. Clinical Medicine. 2014;14(2):149–156.

3. Lim CT, Gibbs V, Lim CS. Invasive medical procedure skills amongst Foundation Year Doctors – a questionnaire study. JRSM Open. 2014;5(5):2054270414527934.

Due to the current placement capacity issues for nursing students [1] within the West Midlands and the continuation of the Nursing and Midwifery recovery standards [2], this enabled academic institutions to utilise up to 300hours of practice learning utilising a range of innovative practice-based simulations. At Birmingham City University (BCU) we were faced with providing simulation to large cohorts of students in excess of 500, reduced staffing and resources. The aim was to provide simulation based on the Nursing and Midwifery Council annexes A and B proficiencies [3] in large groups and still maintain an element of clinical realism and immersion.

Methods:

The skills and simulation team developed several simulations which incorporated films, live actors, low-fidelity simulation, and problem-solving activities for students within the Future Nurse Course. Each simulation had pre- and post-work to be completed which was monitored and recorded via our online learning platform. The simulations developed and tested were: •

Breaking bad news- A traumatic below knee amputation of a young farm worker which looks at issues with partner/autistic child/overprotective mother.

Hypoglycaemia- Adult hypoglycaemic patient within a General Practice setting with Paramedic input/Child hypoglycaemia/digital healthcare through use of Libre sensor.

Conflict Resolution- Case study around the care of a patient with dementia who keeps falling and a Matron who does not have time.

Pre-operative simulation- A 13-year-old high functioning Autistic child with torte teste requiring surgery and preoperative checking and Practice Assessor input.

Allergies and Sensitivities- Management of allergies and sensitivities, Use of EpiPen for anaphylaxis.

Hygiene- Shaving oral care/eyecare/female and male genitalia cleansing.

The deteriorating patient- A to E assessment.

Mobility and access- Use of equipment simulating frailty and disability.

Assistance dogs for medical and neurodevelopmental conditions.

Safeguarding- Looking at Trans/same sex couples/heterosexual domestic violence.

Female genital mutilation.

Results:

The simulations were evaluated by the students (N=550) and conclusions drawn from the feedback received. The large size of the groups being around 60 students is an issue both with staff and students, but it was recognised that this was beyond our control and that the large-scale sessions were ‘immersive in nature’ and reproduced substantial aspects of the real world interactively. Several students highlighted in their evaluation that they found the simulation content relevant to their clinical practice due to it demonstrating difficult situations that allowed them to practise their skills in a safe environment, promoting patient safety, and enhancing their situational awareness through guided experience.

Conclusion:

Learners appreciate the relevance of the simulations to their developing clinical skills and recognised that the learning could be more targeted than within the practice setting although did not recognise it as clinical practice time.

References

1. Ford S. (2022) Placement delivery is vital for the future of nursing. Nursing Times. https://www.nursingtimes.net/opinion/placement-delivery-is-vital-for-the-future-of-nursing-31-08-2022/ [Accessed on 27/09/2022]

2. Nursing and Midwifery Standards (2020 updated January 2022) Current Recovery programme Standards. NMC, London. https://www.nmc.org.uk/globalassets/sitedocuments/education-standards/current-recovery-programme-standards.pdf [Accessed on 21/06/2022]

3. Nursing and Midwifery (2018) Future nurse: Standards of proficiency for registered nurses. NMC, London. https://www.nmc.org.uk/globalassets/sitedocuments/standards-of-proficiency/nurses/future-nurse-proficiencies.pdf [Accessed on 21/06/2022]

Pre-registration nurses (students) must be prepared to be part of a cardiac arrest team at a moment’s notice. Basic Life Support (BLS) must be performed proficiently and accurately. Proficient performance relies on repetitive practice, but time without practice results in skill decay [1]. Mental simulation offers the opportunity for repetitive, solitary, deliberate practice. Mental simulation is a quasi-perceptual experience in the absence of stimuli and overt physical movement [2]. Mental simulation has been well researched within healthcare education with promising results. Mental simulation has previously been shown to objectively improve performance of cardiopulmonary resuscitation (CPR) skills [3]. We aim to: 1) understand how participants integrate mental simulation into their busy lives over several weeks; 2) understand how the participants experience imagining a cardiac arrest and what this means to them; 3) and understand the value that students place on experiencing cardiac arrest and life-support education through mental simulation.

Methods:

Phase-1 was the design of a mental simulation script. The protocol was engineered to assist the students in creating functionally equivalent, high-fidelity images. Phase-2 was a qualitative interview study undertaken from a constructionist perspective. Eleven pre-registration nurses were asked to use the mental simulation protocol for 4-weeks. At the end of this period, semi-structured interviews and thematic analysis were employed to co-construct an understanding of student perceptions.

Findings:

Several themes were identified (Table 1). The participants were motivated to undertake the mental simulations mainly due to feelings of low self-efficacy. These motivations created the volition required to problem-solve and make decisions that overcame environmental and time management challenges. The scripts assisted participants in coding images evoked from the language within the script narration. Unique to the participants, these images created individualised, emotionally laden, authentic scenarios high in psychological fidelity. This generated a realistic scenario akin to a real-world practice experience. Mental simulation acted as a reflective tool, and reflective practice allowed the participants to demystify the complexities of cardiac arrest life-support processes, leading to increased self-efficacy. Whilst CPR practice has been objectively shown to increase skill, these findings show the processes that occurred during learning (Figure 1).

Table 1:

Theme and subtheme definitions

Figure 1:

Representation of the learning process during mental simulation

Conclusion:

Using mental simulation creates an authentic cardiac arrest learning experience. It creates self-efficacious, knowledgeable students who are ready for clinical practice. The author recommends mental simulation adjuncts mandatory BLS training within their organisation. Mental simulation could be rolled out to other staff groups, however, more mental simulation research into its efficacy is required.

References

1. Roel S, Bjørk IT. Comparing Nursing Student Competence in CPR before and after a Pedagogical Intervention. Nurs. Res. Prac. 2020;2020:1–6.

2. Arora S, Aggarwal R, Sirimanna P, Moran A, Grantcharov T, Kneebone R, Sevdalis N, Darzi A. Mental practice enhances surgical technical skills: a randomised controlled study. Ann Surg. 2011;253(2):265–70.

3. Fountouki A, Kotrotsiou S, Paralikas T, Malliarou M, Konstanti Z, Tsioumanis G, Theofanidis D. Professional Mental Rehearsal: the Power of ‘Imagination’ in Nursing Skills Training. Mater Sociomed. 2021;33(3):174–178

Simulation-Based Education (SBE) is a widely used educational tool in healthcare, but with a skew to secondary care. Our work is part of a growing movement to bring the benefits of SBE into primary care [1]. There is an expanding and diversifying number of staff groups in general practice, with the potential to bring additional expertise and experience to benefit primary care patients; notably the Additional Roles Reimbursement Scheme is bringing new paramedics, pharmacists, physiotherapists, physician’s associates, and social prescribers, among others, into the traditional primary care workforce. There have been significant challenges in embedding these new roles, creating a sense of belonging, forming new ways of multi-disciplinary working, as well as understanding of their strengths and training needs [2]. The aim of the programme is to build a sustainable local network of simulation practitioners to continue to deliver in-situ simulations to the general practice teams. This will contribute to the training and education of clinicians, improving patient experience and safety, and embracing the broadening and expanding primary care workforce.

Methods:

We are training a network of ‘Simulation Ambassadors’ to work in local Primary Care Networks – clusters of practices serving up to 100,000 patients – to bring SBE to primary care teams, enabling training and education targeted to local needs, in multidisciplinary settings, including established and new staff groups. This has the intended benefit of allowing focused training sessions in GP practices, fostering closer working relationships between members of different staff groups while sharing knowledge and learning between these different groups.

Results:

6 ‘Simulation Ambassadors’ have received training to deliver and debrief simulation sessions and are further supported by a Primary Care Simulation Fellow, who provides resources, mentoring, and fosters a community of practice. The simulation sessions cover a range of topics including ‘acute’ scenarios (e.g. the unwell patient in a waiting room), as well as scenarios focused on consultation and communication skills (e.g. safeguarding, explanations and diagnoses of chronic pain conditions, paediatric asthma management).

Conclusion:

We have encountered several challenges during this process, including the novelty and unfamiliarity of simulation in primary care, and the difficulty of asking already stretched staff to dedicate time, either as educators or learners, away from direct clinical care. As the programme rolls out, we intend to demonstrate the value of simulation as an educational medium and will encourage wider use locally within Primary Care.

References

1. Akram M and Ismail F. Simulation training in primary care. InnovAiT. 2017;10(12):765–767.

2. Baird B, Lamming L, Beech J, Bhatt R, Dale V. Integrating additional roles into primary care networks, Kings Fund report, 2022.

We have been developing 360° simulated practice videos for healthcare science students. The students who have taken part in the filming and watched the videos provided feedback on whether this would benefit their learning. We are doing this to continue to strive forward with innovations in virtual learning in line with Health Education England [1]. The simulation-based videos have been created to add to the healthcare sciences units to aid in ‘real-life’ teaching styles, to help build confidence and resilience in healthcare students, and to provide multidisciplinary, patient-focused scenarios that can be included in assessments [2].

Methods:

First and third-year paramedic students took part in mass casualty scenarios filmed at our student’s union building. They worked with Critical Care Practitioners, Academics, Nurses in practice, and the National Ambulance Resilience Unit to create handover videos involving assessing casualties to create videos for other healthcare professionals. Follow-up videos were then filmed on the 360° cameras in the simulation suites to represent an accident and emergency environment as this is where mental health crisis assessments can take place. The adult psychosis presentation was filmed and shows ‘psychiatric liaison nurses’ played by second-year MSc and BSc mental health students assessing the person with suspected psychosis and making clinical decisions. The scenario mental state examination and the case study were scripted. Students could view the 360° videos using virtual reality headsets such as the Oculus Rift [3]. The student feedback evaluation data was collected via an online survey and focus group discussions (FGDs).

Results:

A survey was completed with n=30 students across all fields of nursing students and paramedic students. The student FGD evaluations were very positive about alternative simulated learning styles with one student quoting ‘It will make an assessment of mental health patients a lot easier for students using appropriate tools and models’.

Conclusion:

Students found that simulation-based learning experience is an excellent addition to traditional learning approaches as it met the requirements for different learning styles. This research project brought together academics and practitioners from across practice and university. Future work should build on these resources based on feedback from students and service users.

References

1. National Health Service/Health Education England. 2020. A national vision for the role of simulation and immersive technologies in health and care.https://www.hee.nhs.uk/sites/default/files/documents/National%20Strategic%20Vision%20of%20Sim%20in%20Health%20and%20Care.pdf [Accessed on 17/06/2022]

2. ASPiH/HEE. 2016. Simulation-based Education in Healthcare Simulation-Based Education in Healthcare (aspih.org.uk) [Accessed on 17/06/2022]

3. Topal review: NHS. 2019. Preparing the healthcare workforce to deliver the digital future. https://topol.hee.nhs.uk/wp-content/uploads/HEE-Topol-Review-2019.pdf [Accessed on 17/06/ 2022]

We introduced a pilot of medical emergency simulations using a high-fidelity manikin to fifth year medical students. These students were undertaking ‘Preparation for Practice’ two months before they started as junior doctors in the UK. The University specified a number of medical emergencies that students should experience during this time, but the timing of these can be sporadic leading to a lack of student exposure. High-fidelity simulation has been shown to lead to higher retention of knowledge and skill in the longer term within medical students compared to lecture alone [1], while increasing confidence and performance of learned skills when applied to real patients [2]. The aims of this project were to increase student exposure to medical emergencies, improve confidence, and ability to manage acute emergencies, and improve patient care and outcomes.

Methods:

Our cohort were 42 fifth year medical students who had passed final examinations and were undertaking ‘Preparation for Practice’ in a district general hospital. There were varying levels of previous simulation exposure within these students. There was no previous simulation incorporated into ‘Preparation for Practice’. The in-person scenarios included recreating life-threatening conditions on a high-fidelity manikin that can closely mimic a human presentation. The scenarios correlated with the core medical emergencies specified by the University for students to experience, discuss, and record in their logbooks. A session had four students, with four medical emergency scenarios per session. Each student was lead for one scenario, helper for another, and then observed two further scenarios. The lead student assessed the patient, initiated management, and prescribed in real time. There was discussion and feedback at the end of each scenario. Afterwards, students anonymously filled out an online feedback questionnaire.

Results:

We assessed confidence regarding management of medical emergencies pre- and post-simulation via a subjective rating scale. The data collected from students demonstrated an overall improvement in confidence by 25% after the high-fidelity simulation. 95% stated they felt confident in their ability to manage the case mix presented to them as a junior doctor after the session. 95% felt there was a role for simulation training within ‘Preparation for Practice’.

Conclusion:

We believe that simulation should be a core part of university curriculum, particularly in the transition period from medical student to junior doctor. We plan to incorporate this to future ‘Preparation for Practice’ programmes at our hospital, whilst bringing the idea to the University for consideration at other sites.

References

1. Waters PS, McVeigh T, Kelly BD, Flaherty GT, Devitt D, Barry K, Kerin MJ. The acquisition and retention of urinary catheterisation skills using surgical simulator devices: teaching method or student traits. BMC medical education. 2014;14(1):1–8.

2. Tuggy ML. Virtual reality flexible sigmoidoscopy simulator training: impact on resident performance. J Am Board Fam Pract. 1998;11(6):426–433.

It is well established that trainee doctors struggle with the transition into a new department. There is evidence that simulation-based education (SBE) improves competence and confidence [1]. At our Trust, there is a one-day induction for Obstetrics and Gynaecology (O&G) introducing logistics of the Department and basic skills (e.g. rota and speculum examination). However, it had limited coverage of clinical knowledge, trust protocols, and management of common O&G presentations. The aim of this study was to improve the confidence of new doctors beginning their O&G clinical rotation by increasing their knowledge-base of common presentations, protocols, and procedures through designing and implementing a trainee-focused simulation-based training programme into their induction.

Methods:

We collected feedback from six trainees who had undergone the previous induction programme regarding its utility and how confident the trainees felt on starting their rotation. It was evident from this that the induction did not adequately prepare them for their role and all were in agreement to have simulation embedded into the induction programme. We designed six scenarios based on common O&G presentations and used Trust Protocols (consenting, postnatal ward round checks, bleeding in pregnancy) as a guide for best practice. The programme was delivered to two cohorts (total of 12 trainees) in December 2021 and April 2022. During the new simulation-based induction, trainees completed a pre- and post-programme questionnaire which measured self-reported changes in confidence levels, O&G knowledge, and departmental protocols via a 5-point Likert scale. The questionnaire also explored their expectations of the day, whether they were met, and if this programme should feature permanently in the O&G departmental induction. These responses were analysed using the framework analysis.

Results:

Quantitative results revealed: increased confidence (+80%; p<0.001), decreased anxiety (-53.4%; p<0.001), increased knowledgebase (+50%; p=0.003), increased knowledge of Trust protocols (+82.6%: p=0.001), and all 12 participants were able to locate them when needed. Analysis of qualitative results revealed common themes of improved confidence, increased knowledgebase, clearer expectations of their job roles, and 100% of participants agreed that simulation should form a permanent part of their induction. Furthermore, their expectations of the programme were met was confirmed by the thematic analysis of participants’ expectations before and after the induction.

Conclusion:

We recommend the use of simulation in departmental inductions as it is essential in improving trainee confidence; increasing their knowledge of common O&G presentations and of Trust protocols and procedures, and of their roles within the department.

Reference

1. Lateef F. Simulation-based learning: Just like the real thing. Journal of Emergencies, Trauma and Shock. 2010;3(4):348.

Anaphylaxis is an important emergency which forms part of the adult Advanced Life Support guidelines. The guidelines for anaphylaxis have recently undergone a change in the 2021 revision, with steroids and antihistamine no longer advised for acute anaphylaxis and an adrenaline infusion included as part of the new refractory anaphylaxis algorithm [1]. Scenarios for the medical trainees run at our simulation centre identified a lack of awareness of the revised anaphylaxis guidelines among learners. A QIP was completed to improve the level of learners’ awareness and confidence of the revised anaphylaxis guidelines in conjunction with the simulation team.

Methods:

Online surveys were sent out to the medical registrars and internal medicine trainees regarding the revised anaphylaxis guidelines. This was followed by an email sent two weeks later with the revised guidelines highlighting key changes. The same group were subsequently re-surveyed two weeks following the intervention to identify changes in clinical practice. Concurrently, scenarios based on the revised anaphylaxis guidelines were run for the medical trainees with specific emphasis on whether trainees were aware of the need for an adrenaline infusion (managed in a specialist setting) if symptoms were ongoing despite two IM doses of adrenaline. In the post-simulation debriefing, discussion was focused on the change in the anaphylaxis guidelines.

Results:

In the first cycle, 100% of 23 respondents felt confident managing anaphylaxis but only 50% of respondents were aware (and were confident) that the guidelines had been revised. 2/3 of respondents had not managed a case of anaphylaxis in the last 12 months. In the second cycle, 100% of 4 respondents were aware of the revised guidelines but only 75% of respondents were confident in following the guidelines. 75% of respondents had not managed a case of anaphylaxis in the last 12 months. The significant drop in number of responders is likely to be multifactorial but may reflect a change in focus of educational needs due to the ongoing COVID-19 pandemic leading to a change in the educational landscape. A survey done on the attitude of medical students during the COVID-19 pandemic towards online learning found that only 54.1% of respondents felt that interactive discussion could occur through e-learning [2].

Conclusion:

Following the QI results, the cardiac arrest trolleys were checked and the emergency box with adrenaline now includes the revised anaphylaxis algorithm but not hydrocortisone and chlorphenamine. Refractory anaphylaxis is now a standard scenario for the medical trainees in our simulation centre.

References

1. Resuscitation Council UK. Emergency treatment of anaphylaxis: Guidelines for healthcare providers. 2021. https://www.resus.org.uk/sites/default/files/2021-05/Emergency%20Treatment%20of%20Anaphylaxis%20May%202021_0.pdf [Accessed on 1/06/2022]

2. Alsoufi A, Alsuyihili A, Msherghi A, Elhadi A, Atiyah H, Ashini A, Ashwieb A, Ghula M, Ben Hasan H, Abudabuos S, Alameen H, Abokhdhir T, Anaiba M, Nagib T, Shuwayyah A, Benothman R, Arrefae G, Alkhwayildi A, Alhadi A, Zaid A, Elhadi M. Impact of the COVID-19 pandemic on medical education: Medical students’ knowledge, attitudes, and practices regarding electronic learning. PLoS One. 2020;15(11):e0242905.

Current evidence suggests that despite being well placed to use psychological strategies to improve complex communication with patients, physiotherapists lack confidence in the application of such strategies [1]. Training to help them to navigate complex interactions with patients presenting with psychological distress is therefore recommended within prequalifying physiotherapy education [2]. A brief therapeutic interaction tool (the model of emotions, adaptation, and hope; MEAH) has been developed for this purpose [3]. The aim of this qualitative study was to explore the experiences of physiotherapy students applying the brief therapeutic interaction using the MEAH in an online setting compared to an in-person setting, within a simulated learning environment.

Methods:

An interpretive hermeneutic phenomenological study design was utilised. Two simulation learning environment settings were selected; (1) 25 final year physiotherapy students experienced the simulation-based activity in the in-person setting on a university campus, and (2) 13 second year physiotherapy students experienced the simulation-based activity in an online setting. A 50-minute pre-recorded e-training lecture was completed prior to all students participating in an individual 10-minute simulation. The simulated patient was played by the same actor in both settings. Two methods of data collection were used: (1) a single semi-structured interview, to consider the experiences of all students across both settings. This data was analysed using reflexive thematic analysis. (2) a live recording of 24 of the in-person student interactions were captured. This data was analysed using conversation analysis.

Results:

Thematic analysis: Four major themes across both groups were identified: (a) the content and value of the e-training (b) the experience and perception of the simulation, (c) the application of the MEAH screening tool, and (d) future training needs. Conversational analysis: Three types of interaction were identified. Type 1 interactions (15/24, 62.5%) followed the form in a very exacting way. Type 2 interactions (3/24, 12.5%) used the tool as an aid to their conversation. Type 3 interactions (6/24, 25%) deviated from the main focus of the tool. Factors which influenced the interaction were identified.

Conclusion:

The simulated practice learning environment provided an ideal way to enhance students’ communication skills, through safe and deliberate practice with a simulated patient. Use of the MEAH tool demonstrated that brief and focused teaching enhanced the perceived confidence of physiotherapy students to undertake difficult patient interactions. Online experiences were perceived more positively compared to in-person training, making it a useful platform to develop student confidence that should be explored further within simulation-based education.

References

1. Driver C, Lovell GP, Oprescu F. Psychosocial strategies for physiotherapy: A qualitative examination of physiotherapists’ reported training preferences. Nursing & Health Sciences. 2021;23(1):136–47.

2. Lennon O, Ryan C, Helm M, Moore K, Sheridan A, Probst M, Cunningham C. Psychological distress among patients attending physiotherapy: A survey-based investigation of Irish physiotherapists’ current practice and opinions. Physiotherapy Canada. 2020;72:239–248.

3. Soundy A, Hemmings L, Gardiner L, Rosewilliam S, Heneghan NR, Reid K. E-learning communication skills training for physiotherapy students: A two phased sequential mixed methods study. Patient Education and Counselling. 2021;104:2045–2503.

Simulation has been part of medical education for many years. It has evolved and advanced alongside training needs and practice. Although student experiences within simulation have been well documented, educators’ experiences are lacking in the literature. Most of the literature around this topic relates to educators learning experiences, the development and planning of simulation in general, and faculty development [1,2]. Consequently, this gap in the literature forms the basis of this study.

Methods:

A qualitative phenomenological approach of Interpretive Phenomenological Analysis (IPA) was adopted for this study. This was so that the lived experiences of educators involved in a simulation day for final year medical students could be analysed and interpreted. Ethical Committee Approval was obtained, and 6 educators involved in this day were interviewed using semi-structured interviews. The transcripts were then analysed for themes and interpreted.

Results:

Analysis of the interview transcripts identified four main themes. Journey into simulation, which focused on passion for simulation and training needs; what simulation means, which included topics around fidelity and debriefing; developing in simulation, which described personal and faculty development, imposter syndrome, and technology; and the culture of simulation, of which teamwork, hierarchy, and the wider community featured.

Discussion:

The lived experiences and themes presented carry with them the processes that facilitate the growth and development of our medical simulation educators, as well as some of the barriers and stressors. These facilitators include passion, apprenticeship and immersive experiences, teamwork, and reflection, with barriers and stressors being technology, developing debriefing skills, and imposter syndrome. Implications for practice include recognising and making time for formal and informal reflection as a team, understanding the role workplace learning has in faculty development and debriefing, ensuring faculty understand the objectives of each simulation-based activity, and developing coaching and mentoring opportunities to explore feeling around imposter syndrome and hierarchy.

References

1. Dieckmann P, Birkvad Rasmussen M, Issenberg SB, Søreide E, Østergaard D, Ringsted C. Long-term experiences of being a simulation-educator: a multinational interview study. Medical teacher. 2018;40(7):713–20.

2. Gordon M, Patricio M, Horne L, Muston A, Alston SR, Pammi M, Thammasitboon S, Park S, Pawlikowska T, Rees EL, Doyle AJ. Developments in medical education in response to the COVID-19 pandemic: a rapid BEME systematic review: BEME Guide No. 63. Medical teacher. 2020;42(11):1202–15.

Simulation-based education has an established role in the training of healthcare professionals. Annually, a mandatory simulation course is run for foundation doctors at a London teaching hospital. Nurses and allied health professionals (AHPs) are also invited as ‘staff that work together should train together’ [1]. The COVID-19 pandemic resulted in fewer learning opportunities, and attendance from nurses and AHPs was subsequently reduced on the 2021–2022 programme. The aim was to bring attention to, create discussion, and offer solutions to address the ongoing barrier of the pandemic to effective interprofessional education (IPE).

Methods:

Pre- and post-course questionnaire responses were collected via SurveyMonkey using the Human Factors Skills for Healthcare Instrument (HuFSHI) [2] and clinical-based questions. These were paired anonymously with mean improvements calculated for each. The post-course questionnaire contained free-text questions.

Results:

23 courses were scheduled but 7 were cancelled due to poor attendance. There was a lack of nurses and AHPs signing up (153 doctors, 22 nurses, and 8 AHPs). Overall, 100 learners attended, consisting of 91 doctors, 8 nurses, and 1 AHP. The low proportion of nurses and AHPs was commented on by medical participants in their feedback. Of the 16 courses, 9 were attended solely by doctors and 5 sessions had only 1 nurse/AHP. The course was well received with positive average change scores across the 12 HuFSHI questions and clinical-based questions.

Conclusion:

Whilst results show the course had a positive influence, the lack of nurses and AHPs meant the known value of IPE was diminished. As training is linked to improved resilience and wellbeing [3], nursing and AHP staff missed out, creating disparity across professions. This is significant following the impact of the pandemic on training and wellbeing – which this piece suggests is ongoing. Formal data was not collected regarding the reasons for poor attendance, but cancellation of nurse’s study leave across the Trust for a short period, plus covering isolation and sickness were likely contributing factors. Unexplained non-attendance on the day proved the most challenging although contacting participants beforehand combatted this to some degree. There are plans to introduce a text reminder system for next year. Proactive and integrated planning with stakeholders has enabled the early release of dates for next year, with doctors allocated automatically to sessions to promote a balanced spread of professions represented. Alternatively, in-situ simulation provides another way to increase accessibility and attendance.

References

1. Ockenden D, 2022. Findings, conclusions and essential actions from the independent review of maternity services at The Shrewsbury and Telford Hospital NHS Trust. Final Report. London UK: Department of Health and Social Care. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1064302/Final-Ockenden-Report-web-accessible.pdf [Accessed on 16/05/2022]

2. Reedy GB, Lavelle M, Simpson T, Anderson JE. Development of the Human Factors Skills for Healthcare Instrument: a valid and reliable tool for assessing inter-professional learning across healthcare practice settings. BMJ Simulation & Technology Enhanced Learning. 2017;3(4):135–141.

3. Brennan EJ. Towards resilience and wellbeing in nurses. British Journal of Nursing. 2017;26(1):43–47

Simulation equipment is often prohibitively expensive. More so for smaller remote settings and developing countries. Reducing costs is essential to increase widespread uptake of high-fidelity simulation tools.

Methods:

We describe the evolution of a cooperative simulation model development team incorporating the local Emergency Medicine Department clinical staff and local Secondary school pupils. This was a symbiotic relationship that utilised the clinical expertise of the doctors while giving the students project management experience while using the significant resources of the schools for physical product development. Roughly 15,000 tracheostomies are performed each year in the UK. After looking further in depth at emergency tracheostomies, we recognised a gap in this area of healthcare training [1]. Consequently, developing a surgical airway trainer was selected as the model to produce over the course of an academic year. The partnership project required infrequent visit from the clinical team to inform on clinical particulars and review model progression. Ultimately 2 models were selected from various prototypes to take to completion. These represented 3 core areas we wished to develop. The first model was a high-fidelity model completed using latest technology available in the school’s workshops. The second was built with minimal technology and aimed to be reproducible following simple instructions with widely available materials and be completely biodegradable.

Results:

This project resulted in successful development of two surgical airway models – both clinically and anatomically accurate, reusable, which deliver high quality simulation to a group of doctors and students at the local hospital. Both models are easily reproducible with minimal skills, but varied in both the detail and tools required to produce and degree of sustainability. Maximum cost of materials was £15.

Conclusion:

Partnership with local schools gives hospitals access to resources not otherwise available that can lead to the development of innovative simulation models that can significantly reduce the cost of simulation. Both parties gain significantly from this partnership. Going forwards we aim to continue the partnership with aims to develop a central line training model over the next academic year.

Reference

1. Taylor C. Training for tracheostomy. BJA: British Journal of Anaesthesia. 2013;111(5):842–843.

Students intercalating in BSc Urgent and Emergency Care/BSc Critical Care degrees undertake placements in 32 NHS Trusts across the UK. A collaborative simulation day was planned between the University and a geographically distant hospital, aiming to explore bias within healthcare. Inequality has been examined through simulation previously and recommendations exist on maximising simulation effectiveness [1].

Activity:

A hybrid simulation day took place with 11 students present ‘in-situ’ and 49 remote students across the UK joining a livestream. High-definition cameras provided multi-angle simulation views plus a patient monitor with separate audio from ceiling-mounted boundary microphones. A webcam and cardioid microphone captured the debriefing. The free programme OBS Studio controlled the livestream as a single ‘virtual camera’, with test results overlaid as appropriate. Scenarios involved an atypical myocardial infarction, sickle cell crisis, and female genital mutilation/trauma in pregnancy.

Findings:

Feedback from learners (n=21) rated the content most useful for ‘trauma in pregnancy’ (2.95/5) and ‘teamworking’ (2.90/5), whilst ‘networking with peers’ was lowest rated (2.21/5). Scenarios were realistic (75%) and appropriate for training level (86%). However, the audio-visual system was rated adequate by only 57%. Comments described difficulty with simultaneous speech during the simulation. Satisfaction with reflective debriefing was 76%, however free-text comments revealed verbal feedback delivered to simulation teams by ‘remote’ peers was perceived more critically than feedback received from local faculty.

Conclusion:

A novel technological setup with OBS Studio was used for a collaborative simulation event viewed across the UK. Scenarios were rated positively. There was difficulty discerning multiple audio streams during the simulation. We plan to provide team leaders with dedicated microphones for overall commentary. We recognised the lack of diversity in simulation manikins within the host hospital and, as recommended [1], are now arranging representative manikins that can be used routinely and not for stereotypical scenarios. Feedback from a remote group to a smaller ‘in-situ’ participant group can feel daunting and direct. This may reflect the challenging topics explored, but also difficulties recognising the nuances of nonverbal cues in a virtual space. As such, care must be taken with ground rules, and facilitating appropriate exploration of learning points. Although feedback has identified areas for improvement, hybrid simulation can deliver immersive experiences to geographically-dispersed learners which are time- and cost-effective, with reduced environmental impact from travel. Alongside allowing physical-distancing, it may support distance-learning and facilitate cross-institutional collaborations. We recommend exploring OBS Studio for livestreaming simulations [2].

References

1. Vora S, Dahlen B, Adler M, Kessler DO, Jones VF, Kimble S, Calhoun A. Recommendations and Guidelines for the Use of Simulation to Address Structural Racism and Implicit Bias. Simulation in Healthcare. 2021;16(4):275–294.

2. Gumble E. Setting up for remote simulation using OBS Studio. 2021. https://www.youtube.com/watch?v=5nWfyIgsKsI. [Accessed on 27/05/2022]

A new curriculum for Acute Common Care Stem (ACCS) trainees was introduced in 2021 and included a mandatory requirement to have specific practical assessments performed, known as Direct Observation of Procedural Skills (DOPS). These aimed to provide evidence of competence and enable progression through training. The curriculum change prompted the creation of a novel one-day skills-based course in order to ensure that all the ACCS trainees met the required level of competence. An enhanced simulation-based mastery learning method was used to ensure that trainees have the clinical knowledge to identify when future practical emergency skills are indicated and have the psychomotor skills necessary to perform these procedures safely and efficiently. This study was aimed at exploring the impact of a simulation-based mastery learning (SBML) [1] in a one-day procedural skills course.

Methods:

New curriculum content was reviewed in order to establish the different practical skills required for the second year of ACCS training. Regional trainees were then sent an online survey to ask which specific procedures they would like included on a skills course. There were five procedures requested: chest drain insertion (Seldinger and open), aspiration of air, DC cardioversion, and external cardiac pacing. Meetings with the local training programme director and simulation lead assisted in the formation of the skills day. Faculty were formed by registrars and consultants in Emergency Medicine. Trainees aimed to reach a competence level that would mean they still need in hospital supervision for any future procedures. Eight ACCS trainees attended a one-day skills-based course in May 2022. The course was preceded by multiple online e-learning resources and videos. The SBML day consisted of a demonstration with deliberate practice followed by DOPS assessments using simulation and trainee-focused feedback. Anonymised pre- and post-course questionnaires were completed by all trainees containing questions surrounding their experience and confidence in performing these procedural skills.

Results:

All trainees achieved the required level of competence needed at their stage in training. Each trainee stated that their confidence levels improved in performing all five procedures after attending the course (Figure 1).

Figure 1:

Mean confidence levels in procedures pre- and post-course using Likert scale (1–5)

Conclusion:

An enhanced SBML method in a one-day course enabled efficient, standardised procedural skills practice and assessment for a group of ACCS trainees. Training, practice, and assessment in necessary curricular competences were achieved together while improving the level of confidence in trainees performing these procedures.

Reference

1. Scahill E, Oliver N, Tallentire V, Edgar S, Tiernan J. An enhanced approach to simulation-based mastery learning: optimising the educational impact of a novel, National Postgraduate Medical Boot Camp. Advances in Simulation. 2021;6(1).

With the increasing number of International Medical Graduates (IMGs) hired by the UK National Healthcare Service (NHS), a unification of training becomes essential. One of the main obstacles facing IMGs is insufficient simulation-based training [1]. In 2021, 19,977 doctors were registered to the General Medical Council (GMC). 10,009 of them studied medicine outside the United Kingdom (UK) [2]. Blended learning offers the opportunity for engagement and interaction to facilitate learning experiences [3].

Methods:

We created and distributed a survey to Anaesthetic trainees in the ‘Kent Surrey Sussex (KSS)’ Deanery. We received a total of 76 responses, 49 (64.5%) UK graduates (UKGs) and 27 (35.5%) international graduates. The survey was designed to ascertain their medical training, simulation experience, and their perception of that simulation experience. We also included additional questions aimed specifically at IMGs to demonstrate the best way they could be supported to acquaint themselves with the simulation process further.

Findings:

IMGs were less likely to have simulation training as an undergraduate (24% IMGs vs 96% UKGs), and 37% of IMGs had no simulation exposure before coming to the UK. IMGs were also exposed to fewer simulation sessions during their career when compared with UKGs. When asked how simulation can improve human factor variables, including teamworking, leadership, and managing stressful situations, both groups responded similarly. An exception was that IMGs were much more likely to ‘strongly agree’ that simulation improved their communication skills (41% vs 29%). IMGs were less likely to find the overall simulation experience ‘excellent’ (24% vs 51% in UKGs), suggesting more can be done to improve their perception of simulation (Table 1). Most IMGs (88.9%) believed they would benefit from blended learning. These included methods such as; an introductory video describing simulation (59%), pre-course materials (59%), manikin familiarisation (59%), a virtual tour (52%), and attending as an observer before simulation sessions (56%).

Table 1:

Comparison of UKGs versus IMGs simulation experience. As well as asking about how simulation improved communication skills, responders were asked the impact simulation had in improving other core skills including teamwork, leadership, and managing stressful situations with both groups responding similarly.

Conclusion:

There is a clear discrepancy in simulation exposure and perception of simulation between IMGs and UKGs. We believe blended learning may be the solution to help bridge this gap. Our survey highlighted potential resources we can introduce, including introductory videos, additional learning materials, and attending simulation as an observer. We hope to incorporate some of these in the future within our Trust Simulation Department and, if successfully received, expand throughout the KSS deanery.

References

1. Martinerie L, Rasoaherinomenjanahary F, Ronot M, Fournier P, Dousset B, Tesnière A, Mariette C, Gaujoux S, Gronnier C. Health care simulation in developing countries and low-resource situations. J Contin Educ Health Prof. 2018;38(3):205–212

2. Campbell D. NHS hiring more doctors from outside UK and EEA than inside for first time. The Guardian. 8 June 2022. https://www.theguardian.com/society/2022/jun/08/nhs-hiring-more-doctors-from-outside-uk-and-eea-than-inside-for-first-time. [Accessed on 29/09/2022]

3. Singh H. Building effective blended learning programs. Educational Technology. 2003; 43:51–54

NHS Trusts must deliver 30 hours of teaching to Foundation Year 1 doctors (FY1s) per year [1]. Our Trust previously delivered weekly hour-long didactic teaching sessions. Feedback was poor, so a new approach was required. Our Trust employs nine FY3 and FY4 junior doctors as Clinical Fellows in Education and Simulation. It was felt that the team, having recently completed FY1 themselves, could develop a useful and enjoyable FY1 teaching program.

Activity:

STR1DE – Simulation, Teaching, and Reflection for FY1 Development and Education – was developed and delivered by the Fellows. STR1DE involves six full teaching days throughout the year. Each day runs four times with a quarter of FY1s attending, to ensure reasonable class sizes. The team felt that simulation would be beneficial in teaching newly-qualified junior doctors. Simulation is an excellent way to help learners put theory into clinical practice [2], and it was felt that using carefully-designed scenarios would ensure FY1s felt the teaching was useful and relevant. Each STR1DE day therefore involves half a day of simulation using the Trusts’ high-fidelity facilities, alongside half a day of teaching including practical skills, small group teaching, and reflective sessions. All scenarios are designed around clinical scenarios which are commonly faced by FY1s in their clinical practice, alongside a variety of human factors. The scenario is observed remotely by other FY1s and the Fellows. The Fellows lead post-scenario debriefings with emphasis on reflection and peer-to-peer discussion and learning.

Findings:

Feedback has been excellent, with 100% of FY1s rating each session as ‘good’ or ‘very good’. The usage of near-peer teachers, the post-simulation debriefings, and the relevance of scenarios to FY1s’ clinical practice have been noted as factors contributing to this success. The benefits of near-peer teaching have been widely discussed in the literature, though often focus on junior doctors teaching medical students [3]. STR1DE demonstrates that teaching (including simulations) developed and delivered by junior doctors for more junior doctors can be relevant, useful, and enjoyable. Full-day teaching sessions seem to be preferable to shorter weekly teaching, allowing FY1s to focus on learning without worrying about work building up back on the wards. This approach also allows the usage of simulation, which would be difficult to deliver in a shorter session.

Conclusion:

Full-day teaching sessions, delivered by near-peers, with heavy usage of simulation, can be a highly effective way to deliver FY1 core teaching.

References

1. UK Foundation Programme. UK Foundation Programme Curriculum. London: UKFPO; 2021.

2. Okuda Y, Bryson E, DeMaria S, Jacobson L, Quinones J, Shen B, Levine AI. The Utility of Simulation in Medical Education: What Is the Evidence?. Mount Sinai Journal of Medicine: A Journal of Translational and Personalized Medicine. 2009;76(4):330–343.

3. Rees E, Quinn P, Davies B, Fotheringham V. How does peer teaching compare to faculty teaching? A systematic review and meta-analysis. Medical Teacher. 2015;38(8):829–837.

Medical specialty applications typically include a structured interview or series of interviews. Since 2021, due to restrictions caused by the COVID-19 pandemic, these interviews have been conducted online, using a range of platforms. This has necessitated changes to the format of some of the interviews and may require interviewees to develop a new skill set compared to what they require for traditional face-to-face interviews. Studies looking at the USA residency matching programme demonstrate that interviewees prefer face-to-face interviews and feel they are more likely to be able to present themselves to their satisfaction [1]. Online interviews have several intrinsic disadvantages: transmission of non-verbal cues are limited; the possibility of poor audio-visual coordination can disrupt the natural flow of conversation; and the combination of these issues can negatively impact application impression and interviewer rating [2]. With this in mind, we developed a programme of online mock interviews, aimed at foundation doctors and clinical fellows applying for CT/ST1 level training posts.

Methods:

The programme was offered in January 2021, just before the core interview period. All foundation doctors and clinical fellows in the Trust were given the opportunity to sign up for an online mock interview. The interviews were conducted via Teams, followed the format specified by the relevant Royal College, and were conducted by consultants or registrars from that specialty. Following the interview, the interviewers gave feedback and advice on performance. Interviewees were invited to give feedback via an online survey.

Results:

Thirty-two mock interviews were conducted, and twenty participants gave feedback. 100% of respondents stated they were ‘Very likely’ to recommend the mock interviews to a colleague; 100% felt the mock interview and feedback were ‘Quite helpful’ or ‘Very helpful’ in preparing for their interview.

Qualitative comments from interviewees included: that they valued the mock interview following the same format as the actual interview; that the feedback was beneficial; and that it was useful to have two interviewers. Suggestions for improvements included: allowing more time for feedback; and providing two mock interviews to allow interviewees to implement suggested changes.

Conclusion:

Overall, this mock online interview programme was a valued and beneficial method for potential applicants to practise for their interviews. We hope to continue this programme in the future and will incorporate the above suggestions.

References

1. Seifi A, Mirahmadizadeh A, Eslami V. Perception of medical students and residents about virtual interviews for residency applications in the United States. PLoS One. 2020;15(8):e0238239

2. McCain C, Kemp B, Baier MB, Zea AH, Sabottke C, Schachner ER, Pirtle C, McLean A, Maupin R, Detiege P, Spieler B. A Framework for the Virtual Medical Interview Process: Considerations for the Applicant and the Interviewer. Ochsner J. 2022;22(1):61–70.

Post-graduate doctors typically apply for speciality training during, or soon after, the Foundation Two Year, however many have very limited exposure to Paediatrics. This was compounded during the COVID-19 pandemic, as access to taster days was significantly reduced. Previously, simulation-based taster days in Undergraduate Medicine [1] and Anaesthetics [2] have been shown to be valuable. We therefore provided an ‘Introduction to Paediatrics’ course aimed at doctors with an interest in pursuing a career in Paediatrics. The aims of the course were to: experience a range of common Paediatric presentations and procedural skills, learn about applying for Paediatrics, and learn about a career in Paediatrics.

Methods:

Learners attended a one-day face-to-face programme held in our Learning and Resource centre, including a simulation suite. Learners were exposed to four scenarios designed to cover a wide range of common Paediatric scenarios. These included: bronchiolitis in an ex-preterm baby; bilious vomiting in a neonate; febrile seizures; and diagnosis of diabetes in a teenager. The scenarios were designed to be challenging but accessible to doctors without previous experience of Paediatrics. An embedded faculty member in the role of a Paediatric registrar was available to provide support during the scenario if requested. Complementing these scenarios were two procedural skills stations (neonatal life support and umbilical venous catheterisation), and a series of short talks on a career in Paediatrics. The participants were asked to feedback via an online survey.

Results:

Nine foundation doctors attended the pilot course. Only one of them had any formal postgraduate experience in Paediatrics, and all of them were considering applying to Paediatric training. All the participants stated that they would recommend the course to someone who was considering Paediatric training and that the day was useful in deciding whether to do Paediatrics training or not. Using a Likert scale, they rated all the scenarios and the procedural skills as ‘Good’ or ‘Very good’. When asked to give a star rating out of 5, the mean was 4.9.

Conclusion:

This course appears to be an effective way of providing foundation doctors with a ‘taster’ of Paediatrics. The participants enjoyed the course and would recommend it to others. Although not a substitute for clinical Paediatric experience, it provides another opportunity for interested foundation doctors to learn about a specialty. Based on the success of this course, we hope to deliver this course on a regular basis.

References

1. Thorley-Dickinson V, Kasfiki E, Stephenson T, Purva M.‘A day in the life of a doctor’: Simulation-based taster day for college students intending to apply to medical school. BMJ Simulation and Technology Enhanced Learning. 2014;1:A47

2. Khoud, Ahmed Ben, Matthew Aldridge and Jeremy Purdell-Lewis. ‘P8 The anaesthetic taster course: our experience of running a simulation taster course with near-peer tutors.’ BMJ Simulation and Technology Enhanced Learning. 2018;4:A54–A55.

Simulation is widely recognised as a safe, valuable learning modality [1]. However, it is greatly underutilised in End of Life (EoL) care [2] where the majority of learning has been theoretical. A plethora of challenges exist around introducing a simulation programme in a hospice environment, both organisational and psychological [3], including implementing a new idea at a time when healthcare workers are experiencing unprecedented levels of burnout following a pandemic. As part of a one-year project funded by Health Education England, we sought to create and introduce a comprehensive simulation-based programme for rollout across the Hospice with clear benefits and relevant subject matter that engages our wide range of MDTs as well as non-clinical staff.

Methods:

Posters were used to begin to introduce the concept of simulation. A mixture of questionnaires, interviews and online sessions were held to establish current knowledge and views of staff on simulation-based learning. Time was set aside to thoroughly outline the project and its benefits to teams throughout the Hospice, clinical and non-clinical staff.

Results:

Questionnaire results from 52 respondents show that 35% of staff had no knowledge of simulation prior to the information given as part of this project. Despite this, when simulation was explained more clearly, all respondents felt that they would be able to gain something positive from introduction of a simulation-based programme as shown in Figure 1. There was very little in the way of negativity towards the introduction of simulation, with only 1.9% of respondents citing that they felt ‘disinterested’ by the project.

Figure 1:

Participants’ response to the question: What participants expect simulation-based learning to improve in their practice?

Conclusion:

Teams amongst the hospice recognise that simulation provides a valuable learning opportunity. By ensuring understanding of the project, encouraging involvement of all teams, and recognising their unique concerns, thoughts and pressures, it is possible to implement a successful simulation-based programme in the Hospice environment leading to quality improvement in End-of-Life care.

References

1. Randall DC. Pragmatic children’s nursing: A theory for children and their childhoods. Routledge; 2015.

2. Bassah N, Seymour J, Cox K. A modified systematic review of research evidence about education for pre-registration nurses in palliative care. BMC Palliative Care. 2014;13(1):1–10.

3. Patterson MD, Blike GT, Nadkarni VM. Advances in Patient Safety. Situ Simulation: Challenges and Results. In: Kerm Henriksen, James B. Battles, MA Keyes und ML Grady (Hg.): Advances in Patient Safety. New directions and alternative approaches, 3, p.4. 2008

The COVID-19 pandemic has significantly impacted the clinical placement experiences of undergraduate Physiotherapists [1], many of whom started working as preceptee Physiotherapists shortly after qualifying in 2021. Consequently, it was important to provide training in the key skills required to work within an acute inpatient setting to preceptee Physiotherapists starting at an acute NHS Trust in 2021.

A one-day simulation course was developed to expose preceptees to common scenarios occurring in clinical practice to increase their confidence in managing these situations.

Methods:

Six simulation courses were delivered with 22 preceptees each attending a single course. The course started with a group tactical decision exercise to develop caseload management skills. Participants took part in a simulated multidisciplinary team (MDT) ward handover and were provided the opportunity to gather more information from MDT colleagues, simulated medical notes, and admission systems to help them prioritise their simulated caseload. Participants then used this information to make decisions regarding the prioritisation of their simulated workload. The influence of information on participants’ decision-making was then discussed. Participants subsequently undertook five high-fidelity scenarios in pairs; examining themes of discharge planning, managing an unwitnessed fall, the acutely unwell patient, conflict resolution, and acute confusion management. Each scenario was followed by a faculty-led debriefing to facilitate learning through discussion and reflection.

Findings:

Participants completed a self-rating questionnaire based on the 5-point perceived self-efficacy scale before and after course attendance. It evaluated confidence and competence in aspects of inpatient care. Overall self-rated confidence and competence improved post-course in all question categories.

Significant differences (R>0.5) were seen for self-rated confidence in managing a ward handover (1.2), prioritising daily workload (0.6), communicating with the multidisciplinary team (0.6), communicating with patients and relatives (0.6), and responding to unpredictable workload and environments (1.2).

Significant differences were also seen for self-rated competence in managing a ward handover (0.9), prioritising a daily workload (0.5), and responding to unpredictable workload and environments (0.8).

Free text analysis of participants’ course key learning points identified themes surrounding confidence in own abilities, escalation, and communication.

Conclusion:

Simulation-based training was effective in enhancing confidence for preceptee Physiotherapists in managing aspects of acute inpatient care. Further work is required to establish its utility in addressing competence. The development of preceptee simulation training for multi-professional groups is also required. For 2022, a joint Physiotherapy and Occupational Therapy preceptee induction simulation course is planned.

Reference

1. Gough S, Orr R, Stirling A, Raikos A, Schram B, Hing W. Health Sciences and Medicine Education in Lockdown: Lessons Learned During the COVID-19 Global Pandemic. In Nestel D, Reedy G, McKenna L, Gough S. Clinical education for the health professions: theory and practice. Springer; 2021.

During the COVID-19 pandemic our respiratory high dependency unit (RHDU) increased bed capacity by 200%, recruited new staff to provide high flow nasal oxygen (HFNO) and continuous positive airway pressure (CPAP) support, and was relocated within the hospital. This created the need to upskill new staff to provide level 2 care to sick patients in a new environment [1]. We aimed to provide training to nurses, healthcare assistants (HCA), and junior doctors on RHDU via a multidisciplinary (MDT) simulation programmed to manage deteriorating respiratory patients. We also aimed to identify gaps in learning, policy, and procedures due to the relocation of RHDU.

Methods:

The pilot included 22 sessions of in-situ simulation, run weekly by a core faculty including a respiratory consultant, ward sister, senior HCA, and clinical educator. All scenarios focused on MDT working with effective assessments and handovers.

Results:

All staff members on the ward wore the same scrubs making it challenging to identify the job role or seniority of staff, and this was noticeable during the simulations. Coloured lanyards identifying job role were purchased and are now worn by all RHDU staff. An anaphylaxis simulation identified a time delay in finding the key to access emergency medication. A key safe has been purchased by the ward to house this key, ensuring it is always available in an emergency. The themes identified were: an increase in the confidence, competence, and knowledge of the MDT in recognising, responding, and treating medical emergencies. It also developed the working relationships between MDT members by highlighting the skill set of different professions, allowing for an exchange of knowledge across all working levels.

Conclusion:

Simulation is an excellent resource in problem solving and teaching. It provides a safe place to practise new skills and breaks down the barriers to effective communication within the MDT by creating a cohesive learning environment. Simulation must be an ongoing development for staff to ensure that skills are honed resulting in the best outcomes for our patients in an acute emergency. A monthly training programme has been developed consisting of four hours of simulation-based training using different levels of fidelity. We will continue to employ the use of MDT working to reflect real life working conditions based on the success of this pilot.

Reference

1. Almomani E, Sullivan J, Hajjieh M, Leighton K. Simulation-based education programme for upskilling non-critical care nurses for COVID-19 deployment. BMJ Simulation & Technology Enhanced Learning. 2020;7(5): 319–322.

Simulation is increasingly valued as a versatile and effective tool for medical education [1]. This is even timelier with the recent release of the Ockenden Report which recommends in-situ simulation in obstetric units to promote safety [2]. With the recent change of speciality training curricula, especially in anaesthetics, there has been an increased requirement for simulation-based training. However, the COVID-19 pandemic has had a significant negative impact on medical training, both in terms of clinical breadth and opportunities for educational activities [3]. In order to tackle all these requirements, we developed an in-situ multidisciplinary obstetric simulation programme.

Methods:

This was supported by the anaesthetic simulation fellow, obstetric anaesthetic lead and fellow and obstetric safety fellow, together with senior midwifery input. This allowed simulation development, running and debriefing to benefit from the skill and experience of a multidisciplinary team. The local simulation centre provided technical support which allowed us to take the simulation to multiple locations on the labour ward. Learners were from anaesthetic, midwifery, theatre, and operating department practitioner backgrounds and we conducted this simulation programme as three-monthly sessions corresponding with trainees’ rotations. The scenarios were based around previous critical incidents while ensuring the psychological safety of the candidates. This demonstrates an open learning culture where lessons learnt can be shared and patient safety prioritised. It was also be useful in applying a systems approach to understanding how errors occurred.

Results:

Feedback confirmed the in-situ aspect of this session provided experiential learning and improved familiarity of the environment. This was especially pertinent as the sessions were conducted with trainees new to the department. It also allowed midwifery and theatre staff to take part in the session who otherwise may not have. A multidisciplinary approach allowed flattening of team hierarchy as shown by feedback. We ensured challenges associated with in-situ simulation were met with the team ready to respond to clinical needs in the department. No simulated equipment or medication was used and all documentation was labelled appropriately.

Conclusion:

Obstetric emergencies can be life changing and can significantly affect those involved. This simulation session addressed several learning needs while rising to the challenges of in-situ simulations. We hope to continue developing this programme with more specialities represented and integrating learning from critical incidents while ensuring psychological safety.

References

1. Higham H, Baxendale B. To err is human: use of simulation to enhance training and patient safety in anaesthesia. BJA: British Journal of Anaesthesia. 2017;119(suppl_1):i106–14.

2. Ockenden D. Emerging findings and recommendations from the independent review of maternity services at the Shrewsbury and Telford Hospital NHS Trust. House of Commons. 2020 Dec 10.

3. Seifman MA, Fuzzard SK, To H, Nestel D. COVID-19 impact on junior doctor education and training: a scoping review. Postgraduate medical journal. 2022;98(1160):466–76.

Simulated practice has become ever-more common within undergraduate nursing programmes. This initiative looks to further this practice by asking students to create simulations, thus developing their ability and knowledge surrounding application of theory to practice.

Methods:

Twenty-five level-five adult nursing students attended a four-week placement where they created virtual and face-to-face simulations. Five groups focused on one module each, and used the learning outcomes of the module, the clinical skills pertinent to the associated part of the programme, and their experiences to create three days of online simulation and one day of face-to-face simulation. The students presented their simulations to the adult nursing lecturers. As no simulations were run over this time, the effectiveness and monitoring of the placement consisted of daily informal conversations with students.

Results:

Table 1 presents an overview of the activities produced against the learning outcomes.

Table 1:

Learning outcomes and associated activities produced by each student group

The five student groups focused on the following themes:

Group one: Foundations of nursing.

Group two: Communication.

Group three: Long-term conditions.

Group four: Public health.

Group five: Decision-making.

After the end of the placement, the students stated ‘I don’t feel it’s fair that we have had this experience and others haven’t. I have progressed far more, and now understand how to apply the theory to practice’ and ‘I now understand how university learning and practical learning work together’.

Discussion:

Self-Learning Methodology in Simulated Environments (MAES) (Spanish acronym) is a pedagogy that encourages student groups to develop their own simulations [1,2]. Groups are carefully formed and developed to create a group identity. The co-reliance is used to motivate students, leading to increased confidence and professional identity [1]. This has shown to enhance retention of learning more than simulation alone [2]. Although the placement discussed did not perform the simulations within the timeframe described, the students were engaged within their groups, demonstrating innovation and self-development, with pride in their outcome. Namely, the students were aware that their creations would be used with other students, presenting empowerment and accountability. Belonging, interdependence and empowerment are all predictors of motivation [3].

Conclusion:

The act of creating and innovating simulations motivates students to explore concepts in greater depth. As a result, students achieve cognitive flexibility within their learning, highlighting an ability to use it within multiple settings. Also, the act of creating learning experiences which are used for other students provides a sense of pride and subsequent engagement.

References

1. Díaz JL, Leal C, García JA, Hernández E, Adánez MG, Sáez A. Self-learning methodology in simulated environments (MAES©): elements and characteristics. Clinical Simulation in Nursing. 2016;12(7):268–274.

2. Peñataro-Pintado E, Díaz-Agea JL, Castillo I, Leal-Costa C, Ramos-Morcillo AJ, Ruzafa-Martínez M, Rodríguez-Higueras E. Self-learning methodology in simulated environments (MAES©) as a learning tool in perioperative nursing. An evidence-based practice model for acquiring clinical safety competencies. International Journal of Environmental Research and Public Health. 2021;18(15):7893.

3. Perry C, Henderson A, Grealish L. The behaviours of nurses that increase student accountability for learning in clinical practice: An integrative review. Nurse Educ Today. 2018;65:177–186.

Second-year Operating Department Practitioner (ODP) students in an English University need to undertake a teaching activity lasting 10 minutes on any topic not necessarily health related as part of their undergraduate curriculum as a formative assessment. ODPs practise in high acuity settings including theatre and intensive care, and are usually key members of a hospital’s resuscitation team. Teaching strategies for resilience is required when working in changing environments. To combine these two elements, an alternative approach was offered to replace the teaching activity. Student ODPs were offered how to create and lead a simulation activity based on ODP practice in lieu of the 10-minute activity as part of a pilot project. The TALK [2] tool was chosen as the mode of debriefing and focuses on improving interprofessional communication and the recognition of behaviours and strategies that are successful and should be adopted.

Methods:

Twenty-eight students volunteered to undertake the pilot. The students supported by a simulation and ODP lecturer over a day were introduced to experiential learning, and simulation education approaches including design, facilitation [1], and debriefing. In pairs, the students created designs and were taught to use the Talk Framework [2].

Results:

The students completed an online evaluation tool in relation to their experience as educators. The students reported that they felt more confident with the difference between teaching and facilitating. The students felt they understood the stages of writing for education and enjoyed the session on learning outcomes. The students stated that teaching using simulation was more useful than randomly teaching any skill as this links to their practice. Through a discussion at the end of the sessions, the students felt that in practice they saw aspects of patient care that they do not understand or were unable to seek clarification about, and TALK [2] would help. The students also felt that the TALK [2] tool should be introduced in year one.

Conclusion:

From the online evaluation and subsequent discussions, the project team has met with the Course Director and discussions are underway to review the current assessments for teaching. The students’ feedback about the TALK [2] tool being used as a strategy to learn how to speak to practice supervisors or other members of the healthcare team has brought about an immediate change. The tool will be used across all first-year ODP students from September 2022 with further research activities.

References

1. Persico L, Belle A, DiGregorio H, Wilson-Keates B, Shelton C. Healthcare simulation standards of best practice^TM facilitation. Clinical Simulation in Nursing. 2021;58:22–26.

2. Diaz-Navarro C, Leon-Castelao E, Hadfield A, Pierce S, Szyld D. Clinical debriefing: TALK© to learn and improve together in healthcare environments. Trends in Anaesthesia and Critical Care. 2021;40:4–8.

Effective simulation-based-education (SBE) relies on the use of psychological safety to encourage participants to adopt learning-orientated behaviours [1]. Excessive levels of anxiety or stress can present a challenge for establishing this psychologically safe container [2]. The idea of stress inoculation describes graded exposure to potentially anxiety inducing stimuli with the aim of enhancing performance by encouraging a state of ‘flow’ versus ‘freeze’ [3]. Potentially this could also improve the efficacy of SBE by reducing anxiety and improving psychological safety. We aimed to create a new SBE programme for novice anaesthetists in their first 3 months before starting on-call work. This was designed to create stress inoculation with frequent and regular SBE sessions, and we aimed to assess the impact of this change on pre-session anxiety levels.

Methods:

This new SBE programme was delivered to the 5 novice anaesthetists at our institution over a 12-week period from February to May 2022 and consisted of weekly 30-minute SBE sessions. These were designed to fit with clinical commitments and minimise disruption to training in theatres, whilst following the ASPiH Standards Framework. Alongside weekly post-session evaluation (7-point Likert and free text), learners were asked to retrospectively rate their perceived pre-session anxiety levels from 1–10.

Results:

Overall feedback from the new programme has been consistently positive, particularly mentioning the benefits of a safe space for discussion, the open and supportive environment, and the benefits of learning from others’ experiences. One learner specifically credited the frequent nature of the sessions with an improvement in their confidence. Self-reported anxiety levels fell across subsequent early sessions (median anxiety score: week 1=4/10, week 3=2/10). Anxiety scores then peaked again at week 8 (median=5/10) before falling again. There was also significant inter-learner variability with one learner recording persistently higher anxiety scores.

Conclusion:

This new format with regular short sessions appears to be very popular with excellent feedback. There is a reduction in self-reported pre-session anxiety with repeated frequent sessions. However, this is variable between individuals and across the placement, with an increase towards the end potentially reflecting anxiety about starting on the anaesthetic on-call rota. This demonstrates the importance of adapting SBE to both individual learners and the timing of a specific session within a wider SBE programme. Potentially routine evaluation of learner anxiety could allow a more tailored approach and further optimise individual learning.

References

1. Kolbe M, Eppich W, Rudolph J, Meguerdichian M, Catena H, Cripps A, Grant V, Cheng A. Managing psychological safety in debriefings: a dynamic balancing act. BMJ Simulation & Technology Enhanced Learning. 2020;6(3):164–171

2. Al-Ghareeb A, Cooper S, McKenna L. Anxiety and Clinical Performance in Simulated Setting in Undergraduate Health Professionals Education: An Integrative Review. Clinical Simulation in Nursing. 2017;13(10):478–491

3. LeBlanc, V, Posner, G. Emotions in simulation-based education: friends or foes of learning?. Advances in Simulation. 2022;7(3)

The Royal College of Anaesthetists recommends use of simulation-based-education (SBE) during the initial 12-week novice placement for new anaesthetic trainees [1]. For many UK anaesthetic departments, the complexity and cost of patient simulators [2] may reduce opportunities for SBE during novice training. However, avoiding the physical fidelity trap [3] and utilising both conceptual and psychological fidelity to good effect might mitigate this issue. As novice trainees are already familiar with the theatre environment from day-to-day clinical practice, the learning outcomes from SBE generally cover rarer emergencies which can still be covered during SBE outside of the theatre environment. We aimed to assess the feasibility of running weekly low physical fidelity SBE across the entire 12-week novice period instead of the smaller number of ad-hoc sessions delivered previously.

Methods:

Our new SBE programme consisted of 30-minute sessions held in the anaesthetic department conference room to minimise impact on stretched theatre capacity and educator availability. To further maximise efficiency, we created a portable simulation set-up using a basic resuscitation manikin on a patient trolley, a disused anaesthetic machine, and a tablet device with a simulated monitor application. This could all be set-up and stored away in under 5 minutes. Our focus on conceptual and psychological fidelity led to the creation of a new scenario bank which identified common issues encountered by new anaesthetic trainees, rather than emergencies rarely encountered by even an experienced anaesthetist. Scenarios needed to be highly plausible and solvable by the novice trainee. Learners were then asked to complete a feedback survey after each session.

Findings:

Feedback from this new simulation programme was very positive and comparable to previous feedback. Across all sessions (n=12) and trainees (n=5), the median Likert scores for perceived relevance, realism, and appropriate challenge were 6/7, 5/7, and 6/7 respectively. All trainees across all sessions indicated they found it useful, enjoyable, and would attend again. In particular, free text responses praised the ability to focus on a single simulated issue without the cognitive overload of the wider theatre environment experienced by new trainees, and the psychological safety benefits of simulation and debriefing in a more relaxed non-theatre setting.

Conclusion:

This appears to be a feasible and well accepted alternative to our traditional approach, with additional benefits for trainees and reduced impact on service delivery. We now intend to explore use of this approach to deliver increased SBE to the wider anaesthetic and multidisciplinary team.

References

1. Royal College of Anaesthetists. Simulation Strategy 2018–2023. London: RCoA 2018

2. Fletcher J, Wind A. Cost Considerations in Using Simulations for Medical Training. Military Medicine. 2013;178(10S):37–46.

3. Helyer R, Dickens P. Progress in the utilization of high-fidelity simulation in basic science education. Advances in Physiology Education. 2016;40(2):143–144.

The development of the Advanced Clinical Practitioner (ACP) framework at Lancashire Teaching Hospitals began in 2017. There are now 13 non-medical consultants, 73 Qualified Advanced and Specialist Clinical Practitioners, and 25 trainee ACP’s across the organisation. Part of the competency framework included the ability to manage common medical emergencies that are not necessarily a routine part of that ACP’s case load, for example managing a patient with chest pain on a surgical ward or assessing a ward patient following a fall.

Methods:

A one-day simulation-based course was developed to allow ACP’s to manage patients with these conditions in a safe and supportive environment. The day includes a lecture introducing human factors and decision-making theories, followed by six scenarios with debriefing facilitated by senior faculty to discuss learning points with the group. Scenarios were designed in line with ASPiH standards [1] to include clinical competencies which are not common-place in the trainee’s current working environments, giving them a chance to undertake the management of these rarer occurrences in a safe and controlled environment.

Results:

Feedback was collected using anonymous self-scoring feedback forms and was overwhelmingly positive, with candidates feeling more confident in managing these clinical scenarios in practice. All candidates felt the scenarios were pitched to the correct level. Written feedback also highlighted how beneficial it was to get together as a group for shared learning across different directorates.

Conclusion:

Simulation-based learning can improve the confidence of ACP’s in managing unfamiliar clinical emergencies. In future courses will be advertised and opened to ACP’s from other Trust’s to allow further discussion.

Reference

1. Association for Simulated Practice in Healthcare. Simulation-Based Education in Healthcare. 2016. Standards Framework and Guidance. Association for simulated practice in healthcare (ASPiH) standards for simulation-based education. https://aspih.org.uk/standards-framework-for-sbe/ [Accessed on 26/06/2022]

Following the redevelopment of the day case theatre complex at Chorley District General Hospital it was identified that new ways of working were required, and changes to patient processes would need to be made. Some of these were normal, expected, adaptations to be made when moving to a new working environment, such as the location and storage of equipment.

Methods:

The Resuscitation and Simulation Team, led by the associate Clinical Lead for Simulation, modelled the theatre list for the first day using simulated patients and in line with the ASPiH standards [1]. This gave the theatre staff the opportunity to run through cases in real time and gauge when patients needed to be sent for, how long was needed for setting up, and at what time they could safely call for the next patient without causing unnecessary delays or having patients waiting in corridors. Each step in the process was followed by a debriefing so that the actions could be discussed and any changes made.

Results:

The feedback was positive and team members found it extremely useful to simulate their upcoming lists. As expected, there were several patient flow related issues raised, mainly around timings and logistics (Table 1). The day also allowed teams to anticipate other minor issues such as kit storage, stocking and availability to ensure the theatre lists ran smoothly on the day.

Table 1:

Issues identified following simulation of a theatre list

Conclusion:

Simulation of normal business can be successfully used to improve patient safety and the confidence of clinical staff when developing new clinical areas.

Reference

1. Association for Simulated Practice in Healthcare. Simulation-Based Education in Healthcare. 2016. Standards Framework and Guidance. Association for simulated practice in healthcare (ASPiH) standards for simulation-based education. https://aspih.org.uk/standards-framework-for-sbe/ [Accessed on 26/06/2022]

Endoscopic Submucosal Dissection (ESD) is a technique for removing lesions in the gastro-intestinal tract. It involves precise cutting into the submucosal layer, allowing for the lesion to be removed in one piece, and has been shown to have a high curative resection rate [1]. It is a technically challenging endoscopy technique that requires experience and practice. As one of the common complications from ESD is perforation [2], training on ex-vivo models is becoming popular with 84% of surveyed centres in the UK requiring Endoscopists to complete a number of ESDs on animal models before progressing to train on patients [3]. While training was accessible at other centres, this was infrequent and less accessible.

Methods:

Sessions were created at the hospital training centre. This was done using decommissioned endoscopy stacks and endoscopes, so that these were always available and designated for ex-vivo use only. The animal model was a porcine oesophagus, stomach, and start of duodenum prepared in a box with a hole for endoscope insertion. The duodenum was clamped to ensure inflation would be possible. The days ran from 0830-1530 with a drop-in option. After 7 sessions were run over 5 months, a survey was sent out to the 8 people that had participated to assess the benefits of the service (including faculty doing the training and trainees).

Results:

8 responses (100%) were collected. 62% (n=5) of responders had used ex-vivo models before. 83.3% of trainees (n=5) said they had come to our hospital specifically to train in ESD technique. Responders attended between 1 and 10 sessions at our centre. All trainees and faculty said they found the training extremely beneficial and that they thought the ex-vivo model work well the way it was set up. All responders said they would recommend the sessions to a colleague. All trainees said that training with an experienced Endoscopist was more beneficial than training alone. Suggestions for improvement included a more consistent timetable of when they could access sessions, more accessibility and wider range of endoscopy kit, and involving the wider nursing team in the sessions.

Conclusion:

The ex-vivo ESD training sessions were well received by both faculty and trainees and were said to be very beneficial to their training. We will therefore be putting on more of these sessions, taking into account the suggestion for a regular accessible timetable.

References

1. Ahmed Y, Othman M. EMR/ESD: techniques, complications, and evidence. Current Gastroenterology Reports. 2020;22(8):1–2.

2. Kim SG, Hwang JH. How to decrease the risk of perforation in endoscopic submucosal dissection (ESD). Techniques in Gastrointestinal Endoscopy. 2019;21(2):99–103.

3. Küttner-Magalhães R, Pimentel-Nunes P, Araújo-Martins M, Libânio D, Borges-Canha M, Marcos-Pinto R, Koch AD, Dinis-Ribeiro M. Endoscopic submucosal dissection (ESD): how do Western endoscopists value animal models?. Scandinavian Journal of Gastroenterology. 2021;56(4):492–7.

The Trust felt that a targeted programme was needed to help further prepare Internal Medical Trainees’ (IMT) for their current duties and forthcoming roles as registrars. We wanted to provide them with the opportunity to boost their confidence and practice working alongside junior medical colleagues, in order to enhance patient safety [1]. These programmes could also work alongside the regional THRIVE and STRIVE sessions.

Methods:

A three-year programme was introduced. For IMT year 1, it is a half-day of 3 scenarios following a patient’s journey through an admission with key objectives being around difficult decision-making and communication. For IMT year 2, this includes a day of 5 challenging scenarios based around situations the IMT’s are called for. They look at non-technical aspects of their job in the context of complex clinical situations including bradycardia, supraventricular tachycardia, cardiac arrests, mental capacity, and duty of candour. IMT year 3, includes two days with the IMT3A course involving trainees working with Foundation Year Doctors over 5 scenarios where they are escalated to as the senior on call. The focus is developing skills such as prioritisation, leadership and communication. All candidates take part in the debriefing. The IMT3B course is a day of 5 extremely challenging scenarios in difficult settings such as out of hours or with limited senior presence. These scenarios are devised to push the IMT3 candidates in order to help prepare them for working under pressure. Scenarios include difficult ethical decision-making, litigation issues, and complex patients (e.g. pregnancy).

Results:

The sessions were positively evaluated by the IMT who expressed how they will help change their practice and enhance patient safety (see Table 1). All aspects of the course are devised to help and progress with the trainee introducing best practice and quality assurance. Debriefings are effective with discussions between peers being both positive as well as informative. We have kept class sizes to 6 participants as we have found this gives the right amount of support without being too overwhelming.

Table 1:

Feedback from the internal medical trainees

Conclusion:

We feel that as the IMT work through the programme prepares them for what is a difficult transition. Over their IMT simulation training they will take part in 18 scenarios either as a candidate or in the debriefing. It has given the IMT the chance to have high quality training in a high-fidelity environment thus promoting enhanced care and patient safety.

Reference

1. Wayne D, Didwania A, Feinglass J, Fudala M, Barsuk J,McGaghie W. Simulation-based education improves quality of care during cardiac arrest team responses at an academic teaching hospital: A case controlled study. Chest. 2008;133(1):6–9.

The development and ongoing critique of simulation-based scenarios is critical to ensure a researched and standardised approach to learning [1]. This is achieved by creating scenarios that have set learning objectives to improve clinical practice within multidisciplinary teams and patient safety. Additionally, a robust scenario leads to stimulating and open debriefings [2]. Whilst a paper-based scenario will do this, the aim is to highlight the benefits of using a digital platform for both creating and updating scenarios.

Methods:

Paper scenarios have been used for many years to achieve the goals highlighted above but it became increasingly obvious that the resources needed to review, critique, and update those scenarios were no longer effective. This situation was emphasised due to the need to have multiple copies of scenarios across many sites. In order to maintain a quality service, whilst still being able to maintain resources to redevelop and enhance existing scenarios, we implemented a digital authoring platform called IRIS.

Results:

Scenarios were transferred and created allowing a centrally controlled catalogue that could be audited and version controlled. Any changes made would automatically update the scenario on all the users’ tablets thus ensuring the same version of the scenario was used across all sites. An immediate benefit was the reduction in time spent redeveloping scenarios. This allowed for added details to be entered dependent on if it was a standardised patient or manikin driven scenario. Another benefit was the ability to rapidly collaborate and co-author with peers and subject matter experts. IRIS interfaces with manikins from leading vendors, sending patient data states directly to the manikins reducing setup time. We noticed an increase in simulation engagement as authors were able to log on remotely to update work.

Conclusion:

IRIS allows easy design and supports the development of high-quality scenarios. Its implementation saved resources in terms of time, staffing and environmental footprint. It enabled us to have a central hub of scenarios that dismissed the need to do multiple updates in multiple places and enabled us to have an audit trail of changes, by date time and user. Moving to a digital platform enhanced the experience of our users giving them a better learning experience leading to improved patient care.

References

1. Alinier G. Developing high-fidelity health care simulation scenarios: A guide for educators and professionals. Simulation & Gaming. 2011;42(1):9–26.

2. Dieckmann G, Gaba D, Rall M. Deepening the theoretical foundations of patient simulation as social practice. Simulation in Healthcare Journal. 2007;2(3):183–193.

The Simulation Centre, in a largest district general hospital, provides a large portfolio of scenario-based courses, for all staffing groups, including the development of modified rapid cycle deliberate practice (RCDP) simulation. Modified RCDP is a model of simulation where learners repeat a scenario, with micro-debriefings, allowing for improvement upon each cycle, in a dynamic learning experience [1]. The centre developed a hybrid style of RCDP and simulation to create a model called Die, Debrief, and Develop, with a focus on the initial response during a cardiac arrest, based upon safety learning events and staff confidence during these emergency events. The aim of the sessions was to improve learner confidence, focusing on technical and non-technical skills in a safe learning environment. The simulation approach was delivered within the clinical environment, utilizing a manikin and equipment on the ward, including the cardiac arrest trolley. A clear pre-briefing was provided to ensure transparency around the expectations within the scenario, for example, the patient will be in cardiac arrest. Due to the repetitive nature of the simulation, there was also the freedom to fail [2].

Methods:

Each cycle was 5 minutes and repeated 3 times, with a micro-debriefing between each cycle. The improvement between each cycle included patient assessment, ergonomics, human factors, critical thinking, communication, clinical skills and latent threats using elements of gamification. The micro-debriefing between each cycle allowed candidates to reflect on the experience to allow for improvement during each cycle.

Results:

As well as learning personal safety in the pre-briefing, patients and relatives in the clinical area were informed that the session would be taking place. The feedback from learning following the simulation sessions included:

‘I enjoyed cardiac arrest practice it made much more sense and more relatable than talking through what you would do!’

‘Was valuable learning and very relevant to our ward’

‘Has helped me understand cardiac arrest’

‘I feel empowered!’

‘Now I know where things are on the crash trolley’

Conclusion:

As a result of the RCDP model of training, this has been replicated in simulation sessions for Preceptorship and Internationally Educated Nurses. The outcome from this training has demonstrated the impact of RCDP in learner confidence and in technical and non-technical skills, that can be replicated in other forms of scenario-based training.

References

1. Peng CR, Schertzer, K. Rapid Cycle Deliberate Practice in Medical Simulation. Treasure Island, Florida: StatPearls Publishing; 2022. https://www.ncbi.nlm.nih.gov/books/NBK551533/

2. Erickson A, Lundell J, Michela E, Pfleger PI. Gamification. In: Kimmons R, Caskurlu S (eds.) The Students’ Guide to Learning Design and Research. EdTech Books; 2020. https://edtechbooks.org/studentguide/gamification

Continuous Positive Airway Pressure (CPAP) was being used on patients within designated wards to help reduce pressures on the Intensive Care Unit [1] and the number of intubated patients. Those patients presenting with COVID-19 associated respiratory failure within 48 hours of diagnosis were placed on CPAP [2]. The aim was to reduce mortality from hypoxaemia and promote patient safety. Those eligible for CPAP showed deterioration in oxygenation on arterial gas sampling or were showing increased work of breathing including an unsustainably high respiratory rate [3]. The simulated education sessions were to upskill registered intermediate care nurses in the use of CPAP, our most advanced airway procedure outside of the intensive care unit, and support redeployed nurses rostered onto the COVID-19 wards from other non-COVID-19 clinical areas. The aim was to empower nurses to feel more confident in the management of patients requiring CPAP and for them to be able to troubleshoot common problems giving patients the best care and chance of survival.

Methods:

Methods included coordinating exposure for each nurse to a CPAP preloading session following Trust policy, proformas and competency, then ensuring clinicians attended a dedicated two-hour practical simulation-based session using a mixture of high-fidelity manikins and real persons as simulated patients. Scenarios were developed based on issues that had previously happened or could occur in clinical practice. This created both a progressive simulation or shorter sessions followed by a debriefing depending on the experience of the nurse and how they performed on the day. Staff were asked to complete a feedback form about how they found the session and then assessment was made in clinical practice with the signing off of the CPAP clinical competency

Results:

Within two months the team delivered training to all nurses rostered onto the COVID-19 ward and 95% had the clinical competency signed off. The feedback following the debriefing sessions stated that they felt more confident in managing the CPAP machine and the patient. They felt that the educational processes now in place facilitated patient safety and improved the quality of care delivered.

Conclusion:

Simulation-based education with the CPAP machine improved not only theoretical but also practical knowledge to help staff feel more empowered and confident when in clinical practice. Using a real person for several of the scenarios instead of the manikins meant staff could experience and respond appropriately to situations as they developed. This not only improved realism but enabled more immersive experiences for all involved.

References

1. Vaschetto R, Barone-Adesi F, Racca F, Pissaia C, Maestrone C, Colombo D, Olivieri C, De Vita N, Santangelo E, Scotti L, Castello L. Outcomes of COVID-19 patients treated with continuous positive airway pressure outside the intensive care unit. ERJ Open Research. 2021;7(1).

2. Ashish A, Unsworth A, Martindale J, Sundar R, Kavuri K, Sedda L, Farrier M. CPAP management of COVID-19 respiratory failure: a first quantitative analysis from an inpatient service evaluation. BMJ open respiratory research. 2020;7(1):e000692.

3. Talbot-Ponsonby J, Shrestha A, Vijayasingam A, Breck S, Motazed R, Raste Y. Adaptation of a respiratory service to provide CPAP for patients with COVID-19 pneumonia, outside of a critical care setting, in a district general hospital. Future Healthcare Journal. 2021;8(2):302–306.

Continued collaboration between Senior Speech and Language Therapists (SLT) and the Simulation Centre at an acute hospital, led to further research into safety learning themes identifying issues with basic dysphagia care on the wards despite ongoing lecture-based training. This was interpreted as training being focussed on one way of learning for medical staff and not providing an equitable training service for those with differentiated learning needs [1]. This led to the SLT team creating a training programme titled ‘dysphagia friendly wards’. As part of this, the SLT and Simulation Centre developed a simulation programme which was a hybrid of open theatre forum style and simulation using a bell to increase interaction within the scenarios. We created a realistic ward environment increasing the validity of the scenario with groups of up to four healthcare care assistants and nursing staff from stroke wards.

Methods:

Three scenarios were designed around the safety learning themes identified in the incident reports such as poor mouth care, incorrect diet textures, and choking hazards which were noted on the ward by the SLT team. This created a realistic and interactive session using a live actor to demonstrate different swallowing difficulties, poor oral hygiene, and the importance of dysphagia management. The live actors are professionally trained and members of the simulation education team.

Results:

Currently the programme is ongoing and we are due to finish our first ward by the end of March 2023 with the hope of rolling this out hospital-wide. Each ward is estimated to take 2 months to complete. Feedback during and after the sessions has been positive and participants have engaged by asking thoughtful questions and putting information into practice on the wards. Communication issues highlighted our diverse workforce and patients which was found in real time during the simulation. Supporting evidence has been written and available for presentation.

Conclusion:

Very few SLT teams have used simulation training within their practice and the opportunity to create a programme that is proactive and differentiated for different learners is fantastic, and creates a work force that feels valued alongside giving gold standard care to patients with both communication and dysphagia.

Reference

1. L. Raffaelli (2014) 18 Teacher-Tested Strategies for Differentiated Instruction. Edutopia. Available online https://www.edutopia.org/discussion/18-teacher-tested-strategies-differentiated-instruction [Accessed on 15/06/2021]

Year 3 Internal Medicine Trainee (IMT3) is a new (in 2021) grade of medical trainee intended to bridge the chasm between the supported environment of being a senior house officer and the more independent role of a medical registrar. We identified an unmet need for simulation experience to develop skills in emergency management, team leadership, and medicolegal/ethical judgement needed by the medical registrar [1]. Medical simulation and human factors training are essential for the development of IMT3s [2]. We created a novel high-fidelity simulation programme to address this training requirement and support this new grade of junior registrars.

Methods:

We designed five scenarios according to current curriculum guidance and Trust human factors framework. These scenarios were: (i) managing a Jehovah’s witness with an upper gastrointestinal tract bleed but lacking capacity, (ii) tricyclic antidepressant overdose, (iii) cardiac arrest in pregnancy, (iv) duty of candour after a fatal medical error, and (v) a hypoxic COVID-19 patient refusing treatment. The scenarios were piloted to a focus group with iterative improvements made. Participants responded to a Likert-type scale on both pre- and post-course questionnaires regarding their perceived confidence in managing difficult clinical and ethical conundrums, and their ability to share decision-making and communicate effectively during these situations.

Results:

23 out of 30 (77%) of the Trust’s IMT3s attended the programme which ran from January to May 2022, 22 (96%) of whom have completed both pre- and post-course questionnaires across the six sessions held. Mean course satisfaction and subjective knowledge gained ratings amongst participants following attendance at the course was 4.9/5. There was a 34.9% increase in mean confidence rating towards the management of challenging ethico-legal dilemmas (pre- versus post-course: 6.6/10 versus 8.9/10). Similarly, the average confidence towards the delivery of effective resuscitation in acutely deteriorating patients rose from 7.3 to 8.8/10 (20.5%), while average confidence in sharing decision-making and effective communication increased from 7 to 9/10 (28.6%) amongst the participants. Unclear audio system and lack of handouts were reported as limitations. Pauses in study leave access due to COVID-19 surges posed a challenge to the delivery of sessions and additional sessions were instituted to limit this impact.

Conclusion:

This is a novel programme for a new grade of doctors. The pilot data suggested that the implementation of a high-fidelity simulation programme appeared to be an effective modality to support the progression of this junior medical registrar cohort.

References

1. Joint Royal Colleges of Physicians Training Board (JRCPTB). Internal Medicine Training (IMT) Stage 1 ARCP Decision Aid. 2019 (last updated 2022).

https://www.jrcptb.org.uk/sites/default/files/IMT%20ARCP%20Decision%20Aid%202019%20%282022%20update%29%20FINAL.pdf [Accessed on 4/06/2022].

2. Joint Royal Colleges of Physicians Training Board (JRCPTB). Rough Guide to Internal Medicine Training: Guidance for training programme directors, supervisors and trainees. 2019 (last updated June 2019)

https://www.jrcptb.org.uk/sites/default/files/Rough guide to IMT June 2019.docx %282%29.pdf [Accessed on 17/05/2022].

Simulation is increasingly being used in allied health professional and nursing education. There is evidence that student satisfaction with simulation is high, but limited research regarding educators’ attitudes and no existing review of this [1]. Placement capacity is an increasing issue and simulation could be used to address this, but adoption of this involves acceptance by educators and other stakeholders [2]. Therefore, the aim of this literature review was to explore the attitudes and experiences of allied health professional and nursing educators regarding the use of simulation in relation to practice education with the objectives of making recommendations for future practice and identifying areas for future research.

Methods:

A qualitative systematic review was completed. Scopus, CINAHL, Medline, and AMED databases were searched in March 2022 using relevant search terms and subject headings where available. Inclusion/exclusion criteria were applied to identify appropriate peer-reviewed studies. The quality of articles was appraised using the Critical Appraisal Skills Programme qualitative studies checklist and data extracted using a table. NVivo 1.5 software was used to support the analysis of data using a simplified approach to thematic analysis to inform the discussion of the results [3].

Results:

Five studies were included from a variety of professions and countries (Figure 1) and overall quality of these was judged to be good. Three main themes were identified: Preparation, Educator Factors, and Outcomes. Each of these included several sub-themes and can be discussed in relation to the existing evidence. Educators value the opportunities simulation can provide such as standardisation, but this requires careful preparation and constructive alignment. Resources are required to achieve this, and more robust evidence is needed. The use of simulation is a change and educators noted that motivation to embrace this is needed and expectations regarding what can be achieved differs and should be clear. Outcomes recognised for students relate to what students themselves report. Educators see potential for simulation to increase placement capacity but there is concern that educators and students will need to work harder if time in practice is decreased.

Figure 1:

Prisma Flow Diagram of the literature review exploring the attitudes and experiences of allied health professional and nursing educators regarding the use of simulation in relation to practice education

Conclusion:

Overall attitudes towards simulation and practice education were found to be positive. Benefits and risks from educators’ points of view were identified and can be used to inform practice. Areas for future study were identified for example exploring these concepts within the UK and other health professions.

References

1. Beveridge J, Pentland D. A mapping review of models of practice education in allied health and social care professions. British Journal of Occupational Therapy. 2020;83:488–513.

2. Buckley S, Hensman M, Thomas S, Dudley R, Nevin G, Coleman J. Developing interprofessional simulation in the undergraduate setting: Experience with five different professional groups. Journal of Interprofessional Care. 2012;26:362–369.

3. Aveyard H. Doing a literature review in health and social care: a practical guide. Open University Press; 2018.

COVID-19 has been disruptive to the delivery of medical education, which was felt particularly by final year students transitioning from student to Doctor [1]. ‘Preparation for practice’ (pfp) teaching in this cohort has been shown to significantly increase confidence and possibly patient care [2], therefore the quality of this teaching must be maintained despite restrictions. We created a session in which students watched video cases then they were asked to scribe the consultation, create a jobs list, and complete tasks within small groups. Feedback was provided in a group debriefing. The aim of this study was to test a novel method of teaching: using videos of simulated ward round encounters to practise clinical reasoning and clinical ward skills such as documentation and requesting. The study would assess perceived usefulness in general and when compared with written cases.

Methods:

Fourteen final year medical students from a UK university attended one of two sessions, with the same resources and facilitator. Qualitative and quantitative data was collected by a survey composed of four Likert scale questions and three free text box questions.

Findings:

Feedback was overwhelmingly positive and with a 100% completion rate. Students enjoyed the session, would like to see video cases used in future, and preferred videos over written cases. Positive themes from free-text answers were skills practice, realism, and increased interest. Themes for improvement were audio quality and challenge level.

Discussion:

The intended outcomes for the session were focussed on clinical knowledge and reasoning, however students seemed to benefit more from the clinical skills practised (an unintended but positive outcome). Future sessions could be tailored around clinical skills or clinical reasoning- we feel video cases would be useful in both areas. For validity the study would benefit from a larger group size, along with a direct comparison with a ‘control’ session using written cases. The Likert scale questions were positively skewed toward the video cases, so in a repeat study this should be considered.

Conclusion:

Our use of video cases was a success, with students benefiting in areas both intended and unexpected. This highlighted to us the scope to expand their use in more areas of the curriculum. We hope that by using innovative techniques such as these, we can maintain a high level of ‘pfp’. Further research is needed to assess the credibility and transferability of the video cases as these could prove to be a useful tool in modern medical education.

References

1. Choi B, Jegatheeswaran L, Minocha A, Alhilani M, Nakhoul M, Mutengesa E. The impact of the COVID-19 pandemic on final year medical students in the United Kingdom: a national survey. BMC Medical Education. 2020;20(1):1–1.

2. Beedham W, Wanigasooriya K, Layton GR, Taing Chan L, Darr A, Mittapalli D. The Effectiveness of a Foundation Year 1 Doctor Preparation Course for Final Year Medical Students. Journal of medical education and curricular development. 2021 Jan;8:2382120520984184.

Transition from medical student to foundation doctor can be a daunting process. There is growing interest for research into ‘how prepared medical graduates are for practice’, with a systematic review showing graduates feel unprepared for prescribing, clinical reasoning/diagnosis, and emergency management [1]. Following reports by medical students describing the benefits from simulation programmes for preparation to practice [2], a group of doctors established a junior-led near-peer simulated patient teaching programme at a district general teaching hospital to supplement the medical education programme. With qualitative evaluation demonstrating positive reception from teachers and students, this study aimed to quantitatively evaluate the effectiveness of the programme on improving the knowledge of medical students/junior doctors and providing junior doctors with opportunities to gain teaching experience.

Methods:

Nine simulation teaching sessions were run between 7/1/22 – 31/3/22, with a total of 22 medical students and 17 Near-Peer Teachers (NPTs) [3] involved. Knowledge tests were completed by medical students and NPTs before and after each simulation session, as well as feedback forms enquiring about confidence in managing different cases (choosing from the options of: very confident; confident; mildly anxious; anxious). NPTs were also asked to report on their confidence in teaching cases and whether they wanted feedback by a supervising clinician in the form of ‘Developing the Clinical Teacher’ assessment; a mandatory task for foundation year trainees. The difference in examination scores and confidence rankings before and after the sessions were calculated for students and teachers, allowing for quantification of improvement following simulation sessions.

Results:

Medical students demonstrated an average improvement in test score of 13% from a simulation teaching session, whilst NPTs had an average test score increase of 5%. 86% of students reported an improvement in confidence of managing cases related to their scenarios after the teaching session. 75% of NPTs reported an improvement in confidence of both managing and teaching scenarios. Almost half (46%) of foundation year doctors completed mandatory ‘Developing the Clinical Teacher’ assessment through this initiative.

Conclusion:

A junior-led simulated patient teaching programme improves both medical student and NPT knowledge of managing clinical on-call scenarios. This programme also contributed to foundation year trainees achieving the mandatory teaching assessments. Such programmes benefit both students and teachers demonstrating the potential for junior-led programmes to supplement student teaching and doctor training programmes.

References

1. Monrouxe L, Grundy L, Mann M, John Z, Panagoulas E, Bullock A, Mattick K. How prepared are UK medical graduates for practice? A rapid review of the literature 2009–2014. BMJ Open. 2017;7(1):e013656.

2. Manalayil J, Muston A, Ball A, Chevalier D. 1HR ON-CALL – Using Simulated ON-CALL to Underpin Experiential Learning in Final Year Medical Students. Journal of European CME. 2020;9(1):1832749.

3. Aba Alkhail B. Near-peer-assisted learning (NPAL) in undergraduate medical students and their perception of having medical interns as their near peer teacher. Medical Teacher. 2015;37(sup1):S33-S39.

High-fidelity simulation-based scenarios develop the knowledge and practical skills of medical students by recreating a more accurate reflection of managing difficult cases in high pressure environments. In circumstances with limited resources, ingenuity must be employed to recreate immersive environments. One creative method of achieving this is utilising ‘near peer tutors’ (NPTs), defined as ‘a trainee one or more years senior to another trainee’ [1]. NPTs can be employed as facilitators and simulated patients [2]. We aimed to design, implement and qualitatively evaluate a minimal resource simulation teaching programme for medical students that utilises NPTs, at a rural District General Hospital.

Methods:

A lesson plan was designed for the teaching sessions. This included a pre-session examination; a pre-session presentation; simulation cases followed by a ‘STOP5 Hot’ debriefing [3]; a post-session examination and participant feedback collection. 17 NPTs were recruited from Foundation Year (FY) 1 and 2 Doctors, with two or more allocated to facilitate each session. Roles divided amongst the NPTs included acting as a patient, acting as a nurse, leading the scenario. The ‘STOP5 Hot’ debrief was then facilitated by the lead NPT. Three lead clinicians were responsible for administration: a FY2 Doctor provided session resources; an Internal Medicine Trainee supervised each session; a FY1 Doctor communicated with NPTs and students. Qualitative feedback was collected from students at the end of each session in the form of a questionnaire.

Results:

A total of 9 sessions were run from 7/1/22 – 31/3/22 attended by 22 medical students. The sessions were positively received by both students and teachers who described the sessions as ‘well organised’; an ‘open/accessible/safe learning environment’ and included ‘realistic scenarios’. Students described benefiting from ‘clear, useful feedback’; ‘observing the life-cycle of management within a scenario’ and the use of NPTs memory aids (including mnemonic devices). NPTs reported that the teaching ‘reinforced their skills in emergency assessments’, ‘time management of sessions was efficient’, and that the scenarios provided had ‘appropriate level of background information’. Suggested improvements included ‘greater variety/complexity of cases’, ‘scenario specific tick-lists to review management steps’, and ‘expanding the use of technology’.

Conclusion:

A junior-led near-peer simulated patient teaching programme was well received by both students and near-peer tutors. Further research could evaluate the improvement in knowledge of students following the sessions and the effectiveness of providing teaching opportunities to junior doctors. Future aspirations include expanding the portfolio of scenarios by collecting cases from junior doctors’ reflections.

References

1. Aba Alkhail B. Near-peer-assisted learning (NPAL) in undergraduate medical students and their perception of having medical interns as their near peer teacher. Medical Teacher. 2015;37(sup1):S33-S39.

2. Williams B, Song J. Are simulated patients effective in facilitating development of clinical competence for healthcare students? A scoping review. Advances in Simulation. 2016;1(1).

3. Walker C, McGregor L, Taylor C, Robinson S. STOP5: a hot debriefing model for resuscitation cases in the emergency department. Clinical and Experimental Emergency Medicine. 2020;7(4):259–266.

A significant body of work has been surrounding simulation design, pre-briefing, debriefing, and evaluation within healthcare simulation that has informed several frameworks and national guidelines [1]. The 2021 INACSL Standards of Best Practice Facilitation direct the facilitator to deliver cues to redirect learners during the scenario to achieve the learning outcomes within the scenario [1]. Cue is the term used to describe additional information provided by the facilitator to the learners about the patient to achieve the learning outcomes [1]. Cueing examples include providing additional blood results or changing a vital sign [1]. The facilitator chooses cues based on their learners’ perception within the scenario [1]. There is no guidance on the types of cues used or when and how to use them. Interestingly no other strategies are suggested to support learners. This research is exploring how simulation facilitators working with undergraduate nursing students can support learning through simulation at a university in England using a descriptive case study [2]. A case study will reveal current practices from the perspectives of facilitators and learners within a scenario. The research questions (RQ) to be addressed are: How do facilitators support student nurses in simulation-based scenarios? What support do student nurses require from facilitators in simulation-based scenarios to aid their learning?

Methods:

A small number of student nurses and facilitators have been interviewed via semi-structured interviews to describe the current situation. The pilot study has been granted Ethical Approval by the Institution (HREC 4853). The interviews have been recorded and transcribed using MS Teams and are being analyzed using Thematic Analysis (TA). TA is one method to analyze qualitative data using the transcripts and field notes documented during the semi-structured interviews for the pilot study. Data from the study is coded and categorized using TA. Codes will be found and identified that suggest themes to answer the two RQ. Braun and Clarke [3] suggest that TA is a method with a clear set of procedures to identify themes and patterns about specific RQs. This approach was chosen as it is not linked to a specific method.

Conclusion:

Preliminary findings suggest there is a mismatch between what learners and facilitators need for support through the scenario phase. Facilitators appear to intervene based on their perceptions of what they see with no pre-determined approach.

References

1. Persico L, Belle A, DiGregorio H, Wilson-Keates B, Shelton C. Healthcare simulation standards of best practice^TM facilitation. Clinical Simulation in Nursing. 2021;58:22–26. DOI: 10.1016/j.ecns.2021.08.010.

2. Yin R. Case Study Research and Applications, 6th Edn, London, SAGE. 2018

3. Braun V, Clarke V. Using thematic analysis in psychology. Qualitative research in psychology. 2006;3(2):77–101.

International Medical graduates (IMGs) contribute significantly to the NHS medical workforce, but often face unique challenges which are not always catered for within medical education [1]. The Medical Support Worker (MSW) role was created in response to the COVID-19 pandemic, providing an opportunity for doctors seeking GMC registration to gain clinical experience within a supervised NHS placement [2]. Our Trust’s Postgraduate Medical Education department was asked to deliver a teaching programme to the Trust’s first cohort of 29 MSW’s, 28 of whom are from Myanmar. The aims of this programme were to provide support for the MSW role and preparation for working as an NHS doctor.

Methods:

Based on a scoping questionnaire of the MSWs’ perceived learning needs and our prior experiences of working clinically with IMGs, we developed an innovative tailored programme, consisting of three days covering frequently-encountered clinical scenarios, non-technical, procedural and communication skills.

Results:

Throughout the teaching programme, several themes unique to MSWs became apparent. These learners’ previous experiences of medical education were predominantly behaviourist, consisting of didactic teaching in which learner contribution was not encouraged. Their only prior experience of simulation was for assessment. It was therefore vital that we ensured a psychologically safe environment in which they felt confident and were encouraged to participate in near-peer learning. We achieved this by explicit conversations about different styles of medical education and modelling these behaviours consistently. A particular challenge we encountered was introducing the learners to the hidden curriculum of the NHS [3]. This refers to the behaviours and values that form an acceptable professional identity and may differ between international healthcare systems. It became apparent during simulation that dedicated human factors training would be valuable. This was integrated via two half-day sessions focussing on non-technical skills and communication-based simulation. Cultural differences, especially in communication styles, became apparent. This included: a doctor-centred versus patient-centred agenda; challenges inherent to communicating in a second language; and different cultural values and legal frameworks. We endeavoured to expose our learners to scenarios that provoked discussions around these issues, for example communicating with a teenager requesting contraception.

Conclusion:

IMGs face unique challenges when entering the NHS workforce and it is inherent upon medical educationalists to consider and meet these needs. We have identified three major themes (different educational models; the hidden curriculum of the NHS; and cultural differences) that must be addressed to ensure high quality care and patient safety.

References

1. Slowther A, Lewando Hundt GA, Purkis J, Taylor R. Experiences of non-UK-qualified doctors working within the UK regulatory framework: a qualitative study. J R Soc Med 2012: 105:157 –165

2. Temporary Medical Support Worker (MSW) Secondary Care – Job description and person specification. NHS England and NHS Improvement. https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/12/msw-secondary-care-jd-march-22.pdf [Accessed 16/06/2022]

3. Hafferty FW, O’Donnell JF. The Hidden Curriculum in Health Professional Education. 2014.Hanover, NH: Dartmouth College Press

A simulation-based programme was developed for the Medical Support Workers (MSW) within the Trust. The MSW role was created in response to the COVID-19 pandemic, providing an opportunity for doctors seeking GMC registration to gain clinical experience within a supervised NHS placement [1]. This project explored the MSWs’ perceptions and previous experience of simulation and their overall confidence working within the NHS before and after the teaching programme. The aim was to assess if simulation is a useful tool to help international medical graduates transition into working in the NHS.

Methods:

29 MSWs (28 of whom were from Myanmar) worked in acute and medical specialties across the Trust, performing roles including: writing in medical notes, taking collateral histories, examining patients under supervision, procedures such as venepuncture and writing discharge summaries. Each MSW was invited to attend three training days between January and March 2022. We provided a programme incorporating medical and surgical simulation, communication workshops, and procedural skills, supported by human factors teaching. We delivered the sessions in our learning and research building, including our simulation suite. We collated data by sending out pre- and post-training surveys. There were 22 and 18 responses to the two initial surveys and 20 responses to the post-training survey.

Results:

44% had prior experience of clinical simulation and only 9% had previous experience working as a doctor in the NHS. On further analysis, 50% felt either quite unconfident, or neither confident or unconfident working in the NHS. A minority felt confident dealing with medical emergencies (18%) and surgical emergencies (13%) and with their communication (32%) and leadership skills (23%). In the post-simulation feedback, 100% reported that simulation was a useful method to help doctors transition into working in the NHS and felt it improved their confidence in the workplace. Furthermore, 100% stated that the simulation sessions had changed their clinical practice and addressed their learning needs. The participants reported that the sessions had improved their stepwise approach to emergencies (100%), communication (95%), teamwork (100%), leadership (70%), and decision-making skills (95%).

Conclusion:

This project demonstrated that simulation is a popular and useful educational resource in helping improve international doctors’ confidence when transitioning into working in the NHS. Given that 100% of our participants wanted further simulation sessions, our Trust plans to employ a dedicated MSW simulation fellow to support further cohorts.

Reference

1. Temporary Medical Support Worker (MSW) Secondary Care – Job description and person specification. NHS England and NHS Improvement. https://www.england.nhs.uk/coronavirus/wp-content/uploads/sites/52/2020/12/msw-secondary-care-jd-march-22.pdf [Accessed 17/06/2022]

This simulation aimed to meet the indicative content of a communication module, which focused on breaking bad news. The aim of this session was for first year paramedic students to observe bad news being given in a simulated environment. The objectives were for students to understand the emotive realism [1] behind breaking bad news, highlight the importance of integrating service users into simulated healthcare education, and to recognise the impact of observation and feedback.

Methods:

The first-year paramedic students were introduced to the SPIKES [2] model prior to the event being commended due to its ability to allow patients and relatives to have their own reaction to bad news. The first year students then observed the second and third year students undertake two simulations and used the SPIKES tool to structure feedback on how they broke the bad news. One of the simulations was a cardiac arrest case in which the patient was pronounced deceased by the paramedics, and the second was the treatment of a patient that was suffering from a myocardial infarction. Within both simulations the students were expected to treat the patient utilising best practice and then break the bad news. The final element to this simulation was the inclusion of service users who acted as patients and relatives, and were given the opportunity to feedback as to how they felt during the communication [3].

Results:

We gathered feedback via a Microsoft form from all parties with a total of 23 responses: 11 first year students, five 2^nd and 3^rd year students, and four service users. 17/23 of the participants ‘strongly agreed’ that the day was beneficial to their clinical practice. All participants stated they would want to take part in this educational intervention event again. Service users reported that there was a collegiate atmosphere that was developed between them and the staff. They also appreciated the opportunity to feedback to the students. The main feedback from the observing students was the realistic nature of the day and that they learnt by watching the more experienced students doing the simulation. Students involved in the simulation highlighted that they learnt a lot from the feedback they received and being involved in a realistic simulated environment.

Conclusion:

Overall, this simulation-based activity brought together the theoretical subject matter of communication and created an inclusive learning space for a variety of people to learn.

References

1. Buckman R. How to break bad news: a guide for health care professionals. University of Toronto Press; 1992 Aug 8

2. Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES – a six-step protocol for delivering bad news: application to the patient with cancer. The oncologist. 2000;5(4):302–11.

3. Orr F, Kellehear K, Armari E, Pearson A, Holmes D. The distress of voice-hearing: The use of simulation for awareness, understanding and communication skill development in undergraduate nursing education. Nurse Education in Practice. 2013;13(6):529–35.

Simulation-based education has been shown to improve clinical practice [1]. It offers an environment whereby complex real world situations can safely be practised facilitating learning through immersion, reflection, and feedback [2].There has been an increasing awareness amongst the medical profession as to the importance of simulation, we therefore created a sustainable simulation programme for the multidisciplinary team (MDT) at the Horton General Hospital (HGH) Emergency Department (ED) – Oxford University Hospitals NHS Foundation Trust.

Methods:

Several simulations were designed involving trauma, airway management, and acute adult and acute paediatric presentations. The focus of the simulations was based on identifying errors due to human factors. The simulations were designed utilising feedback forms as well as analysing information from clinical incident forms. These provided a platform to understand areas of improvement and targeted scenarios were created. A weekly simulation programme was then created involving the ED MDT (doctors, nurses, allied healthcare professionals) as well as other specialities (Paediatrics, Trauma and Orthopaedics, Anaesthetics and Acute General Medicine). The session was run every week for 2 hours in the ED as an ‘in-situ’ educational activity to provide a higher level of fidelity and provide an immersive environment for the participants. These scenarios were then debriefed by senior members of the team including speciality registrars and consultants trained on debriefing and human factors.

Results:

The debriefings involved the discussion of human factors pertaining to the simulations and were learner-led. The feedback from the MDT was grossly positive; nursing staff and healthcare professionals in particular felt more empowered after the sessions to raise concern. Feedback was collected using an online survey which was sent to the participants following the session. Feedback obtained from participants aided improvement of targeted learning points and therefore aided debriefing.

Conclusion:

Our simulation programme has been run over 18 months and has had excellent feedback. We continue to improve our simulations and increase the participant numbers through the use of video links for the sessions; thereby engaging a wider audience. This has been crucial throughout the pandemic due to various reasons (room constraints, staff isolation).

References

1. Al-Elq AH. Simulation-based medical teaching and learning. Journal of Family & Community Medicine. 2010;17(1):35–40.

2. Datta R, Upadhyay KK, Jaideep CN. Simulation and its role in medical education. Medical Journal of the Armed forces India. 2012;68(2):167–72

Simulation in medical education is often associated with acute specialities, however there is evidence in the literature to suggest exposing medical students to a simulated General Practice (GP) environment can be beneficial to their clinical reasoning and non-technical skills [1] and that this may even be superior to that gained from a GP practice placement [2].

Methods:

22 junior medical students participated in a simulated GP clinic where they reviewed 4 simulated patients. Patients were faculty members who also acted as assessors to ask 3 pre-defined questions and provide feedback after each station, rotating between candidates. The session was concluded with a presentation to clarify correct diagnoses and management for each case. Candidates completed a feedback form to evaluate the session.

Results:

In terms of clinical reasoning, >85% of students reported the session greatly improved their history taking, recognition of red flags, and ability to formulate management plans in the community. For non-technical skills, >75% reported a great improvement in their professionalism, communication, and decision-making ability. However, 2 students (~10%) reported their professionalism had not been affected at all. Individual feedback after each station and the concluding presentation were reported as useful aspects of the session. 3 students (~14%) requested to include examination practice in future sessions.

Discussion:

The majority of students felt that they benefited significantly from participating in the simulated GP clinic, both with respect to their clinical reasoning and non-technical skills. This may be due to the combined immersive nature of the simulation and the psychological safety provided by the absence of formal assessment [1]. The aspect which candidates felt least improved by the session was their professionalism, which may be in part due to an inability to suspend their disbelief. The benefit of adding clinical examination to this activity is not clear.

Conclusion:

A simulated GP surgery environment can be used to improve history taking ability, recognition of red flags, and formulation of management plans in primary care, as well as non-technical skills in junior medical students. However, more research is required to establish whether this is transferable to clinical practice.

References

1. Young JE, Williamson MI, Egan TG. Students’ reflections on the relationships between safe learning environments, learning challenge and positive experiences of learning in a simulated GP clinic. Advances in Health Sciences Education. 2016;21(1): 63–77.

2. Lytton K, Woolley T, Rasalam R, Gorton S, Heggarty P. Benefits of simulated General Practice clinics in the preparation of medical students for primary healthcare. Education for Primary Care. 2019;30(5): 275–281.

Cataract surgery is one of the most performed procedure worldwide with a fascinating evolution in the use of technology [1]. EyeSi is a high-fidelity, task-oriented, virtual reality, intraocular surgery simulator widely adopted by residency programs across the developed world for skill development in cataract surgery, with proven effectiveness and decrease in complication rates [2]. We aim to provide a trainee’s reflective perspective on learning cataract surgery via virtual reality simulation and performing first real surgery from a low middle-income, developing country [3].

Methods:

Simulation training as part of formal residency curriculum was documented, hence ethical approval was exempted. EyeSi course software (V3.0.6) was used for skill development as a self-learning tool, reinforced with real cataract surgery training, documented over a period of 8 months for a single participant. EyeSi provides a binocular microscopic viewing system, with hand-piece instruments and foot pedals of the same configuration as used in operating theatres. The software generates feedback reports for each task using microscopic calibrations inside the model eye.

Results:

By the end of the 8-month period, simulation data showed a logged time of 45.7 hours, 74 intraocular lenses injected, 1,581 intraocular tasks completed and 772 capsulorhexis done with complications including 679mm2 of injured corneal area, 113 mm2 of injured lens area and 862 posterior capsule ruptures. In comparison, the real surgery logbook noted 30 intraocular lenses injected, 86 intraocular tasks and 31 capsulorhexis complete with a total of 1 complication and 1 complete cataract case performed. Subjective comparison reported increased confidence, lower stress levels, good preparation of left-hand skills, and passive learning of surgical theory and technicalities (Table 1).

Table 1:

Comparison of virtual reality and real surgery experience

Conclusion:

Despite challenges of affordability and traditional surgical culture in a low middle-income country, simulation training provides safe learning alternatives to trainees which are effective and should be widely adopted. Although the learning curve is slightly longer, but skills acquired are replicable in operation theatre and significantly reduce the complication rate in the interest of patient safety.

References

1. Davis G. The Evolution of Cataract Surgery. Missouri Medicine. 2016;113(1):58. https://pmc/articles/PMC6139750/

2. Ahmed TM, Hussain B, Siddiqui MR. Can simulators be applied to improve cataract surgery training: a systematic review. BMJ Open Ophthalmology. 2020;5(1):e000488.

3. Aga Khan University. Simulation success story: Eye surgery. https://www.aku.edu/news/Pages/News_Details.aspx?nid=NEWS-002669 [Accessed on 26/08/2022]

Atypical sensory processing is described as a difficulty in regulating and managing sensory input in a meaningful, ordered way to make sense of the world and environment in which you find yourself. Sensory processing disorder (SPD) is common in individuals with autism, pervasive development disorders, and neurodivergent conditions [1,2,3]. The National Institute of Clinical Excellence (NICE) [2] suggest sensory processing disorders are often overlooked by education, social, and healthcare professionals, leading to health and social inequalities with individuals less able to access ‘support and services that they need to live independently’ [2 p5]. The Experiencing Sensory Overload Project (ESOP) aims to champion inclusive practice and reduce health inequalities by encouraging and enabling healthcare professionals to reconsider their approach, and their working environments to create sensorily safe spaces for individuals who may experience sensory overload.

Activity:

The authors recognised there was insufficient education on SPD within the current nursing curriculum. To address this theory/practice gap, training was sought externally. This consisted of a short simulation-based activity with training delivered by carers who had experience of sensory overload. This was well evaluated by the student participants; however lecturing staff felt the training did not meet our university teaching and learning standards. The positive student feedback provided the impetus to forge links with digital arts colleagues to co-create a robust, pedagogically sound and immersive learning experience.

Findings:

The collaborative journey of ESOP has been led and facilitated by academics from the School of Nursing and Midwifery and the School of Arts in a cross-school alliance (Figure 1). Nursing academics acted as ‘clients’ whilst the creative media team worked as ‘creatives’ developing a high-fidelity Virtual Reality (VR) experience that gives users an insight into sensory overload. Post-pandemic, this project has relaunched with the creation of a film of two young people with SPD, frankly, discussing their life opportunities and challenges. Further work continues on immersive learning experiences. These resources have been scaffolded to form a cohesive simulation programme that draws on sound pedagogical approaches and blended learning for healthcare professionals.

Conclusion:

Immersive learning experiences that recognise and champion diversity must be integrated into the curricular of all healthcare professionals to promote the highest standards of patient care. Meeting this demand with innovative, immersive technology demands collaborative working. This cross-school alliance has produced a learning experience that can work towards reducing health inequalities, promoting independence, and championing inclusive practice.

Figure 1:

The experiencing sensory overload project (ESOP) collaborative journey 2019–2022

References

1. Walbam KM. The relevance of sensory processing disorder to social work practice: An interdisciplinary approach. Child and Adolescent Social Work Journal. 2014;31(1):61–70.

2. National institute Clinical Excellence. Autism spectrum disorder in adults: diagnosis and management. London: NICE; 2012. 1–42. CG142

3. Bolaños C, Gomez MM, Ramos G, Rios del Rio J. Developmental risk signals as a screening tool for early identification of sensory processing disorders. Occupational therapy international. 2016;23(2):154–164.

Building upon the use of simulation to improve systems, as considered during last year’s conference ^[1], diversity and inclusion have been key topics of discussions and initiatives, with growing interest in the past years in the UK and many other countries worldwide. Why are we making such a big deal about this? Some may argue that if a patient has asthma, then we treat the asthma and that we should not treat anyone differently regardless of how different they may be from their socio-economical, cultural, gender, belief, and ethnic characteristics. This, in fact, is a misconception and patients with the same disease should be treated or approached differently, with care adjusted to their needs. This may mean that we need to adjust the type or amount of information or explanation regarding their condition. Nevertheless, our implicit bias makes us treat patients with the same disease differently. From under-prescribing pain relief in some ethnic groups to the discrimination against transgender people in healthcare ^[2,3]. Health and social care professionals are not immune to the biases and prejudices that exist in the wider population. What place does simulation have in all of this?

The simulation community has been attentive to the issues raised and must not shy away from exploring deeper these underlying issues that may impair adequate care. Sensitive to this need, diversity and inclusion are the themes of this year’s Association for Simulated Practice in Healthcare (ASPiH) annual conference. Many abstract submissions show how these topics can be meaningfully incorporated within simulation activities, scenario design, debriefings, and are applicable to various simulation modalities ^[4-7]. Simulation can provide one of the safest psychological contexts to unpack such topics in depth and from different perspectives, including that of simulated patients who may be involved and affected by the activity ^[8], or the perspective of colleagues of different backgrounds^[9]. People can (and do) admit to mistakes or misconceptions and people can (and do) discover ways to improve their performance by changing behaviours and attitudes. Creating safe environments to explore about inequalities and biases is critical. This generally promotes reflection related to the engagement and empathy of healthcare practitioners with their patients as well as their relatives, addressing more efficiently their needs, but also towards their co-workers, reinforcing the cooperation and unity within the healthcare teams. More and more health and social care workers have access and are being exposed to simulation activities. The significant impact of variation in treatment based on gender, ethnicity, sexual orientation, cultural differences, etc. means that simulation, with its orientation toward learning, can have a profound effect on how people are eventually cared for. The application of some form of simulation, using role play, has already been reported to show specific patient encounters illustrating implicit bias or best behaviour ^[10,11].

But diversity and inclusion are also highly relevant with regards to our colleagues in the clinical setting as well as within our simulation circle. We need to consider our own educational community of practice by being role models in terms of diversity and inclusivity. We hope to see a very diverse and inclusive groups of delegates attending the 2022 ASPiH Conference in Birmingham, 6-8^th November 2022, which has a vibrant and rich scientific programme as illustrated by the abstracts selected for publication in this special issue of the International Journal of Healthcare Simulation.

Acknowledgements

Thank you to everyone who responded to the call for abstracts for this year’s ASPiH conference. Thank you also to all the reviewers involved in the selection process as we couldn’t run the conference without you. Now is the time to start thinking about your contribution for next year!

References

1. Moneypenny M, Weldon SM, Hamilton C, Buttery A, Alinier G. ASPiH 2021 Conference–Moving upstream: using simulation to improve systems. International Journal of Healthcare Simulation. 2022;1(1):1–2.

2. Lee P, Le Saux M, Siegel R, Goyal M, Chen C, Ma Y, Meltzer AC. Racial and ethnic disparities in the management of acute pain in US emergency departments: Meta-analysis and systematic review. The American journal of emergency medicine. 2019;37(9):1770–7.

3. Drabish K, Theeke LA. Health impact of stigma, discrimination, prejudice, and bias experienced by transgender people: a systematic review of quantitative studies. Issues in mental health nursing. 2022;43(2):111–8.

4. Knickle K, Weir K, McNaughton N. Authoring and othering: examining bias in scenario design. International Journal of Healthcare Simulation. 2021;1(1):45–8.

5. Bignell A, Baxey E, Saunders A, Ortega-Vega M. Reducing Restrictive Practices- Using simulation education to tackle mental health stigma. International Journal of Healthcare Simulation. 2022. doi: 10.54531/WCNV4657 (In this current special issue)

6. Welsh H, Clay G, Fisher M, Ortega-Vega M, Virk K, Evans G. The Power and Influence of the Theatre on Immersive 360° Videos. International Journal of Healthcare Simulation. 2022. doi: 10.54531/CRTF6001 (In this current special issue)

7. Wadsworth J, Blair J, Millett R, Damberg K, Esposito M, Van Vuren E, Marshall E. Using a systems-based approach to explore the enablers and barriers to equality, diversity, and inclusion within a simulation-based education service. International Journal of Healthcare Simulation. 2022. doi: 10.54531/INKE9149 (In this current special issue)

8. Paul O, Connor DB. Fostering diversity in healthcare simulation. International Journal of Healthcare Simulation. 2022 Jul 29(null):1–2.

9. Kulkarni S, Tsigerides J, Sule Medha. Walk in Their Shoes - Immersive 360-degree VR experience of Diversity and Inclusivity in the NHS. International Journal of Healthcare Simulation. 2022. doi: 10.54531/LADH8978 (In this current special issue)

10. FitzGerald C, Hurst S. Implicit bias in healthcare professionals: a systematic review. BMC Medical Ethics. 2017;18(1):1–8.

11. Vora S, Dahlen B, Adler M, Kessler DO, Jones VF, Kimble S, Calhoun A. Recommendations and guidelines for the use of simulation to address structural racism and implicit bias. Simulation in Healthcare. 2021;16(4):275–84.