Conflict is a consistent and unavoidable issue within healthcare [1], both within interdisciplinary teams and during therapeutic interactions. Confidence to manage conflict and its resolution using effective communication are considered essential graduate skills [2]. Studies have shown that by integrating simulated scenarios into conflict resolution training allows students to improve academic practice in group settings and even demonstrate more positive views towards conflict [3]. Simulation can potentially provide a safe and supportive learning environment in which students can develop the necessary skills and confidence to manage conflict, through the use of realistic and challenging scenarios and structured debrief.

The aim of this evaluation was to determine the effectiveness of using simulation for conflict resolution training in developing confidence prior to placement for pre-registration MSc and BSc Physiotherapy students.

Activity:

22 Pre-Registration MSc and 42 BSc Physiotherapy students participated in a newly developed conflict resolution simulation as part of their first year Developing Values Based Professional Practice module. This consisted of three clinical scenarios; 1) Interdisciplinary team communication and scope of practice; 2) Maintaining confidentiality and managing challenging behaviour; and 3) Managing unrealistic expectations which align with Core Skills Training Framework (CSTF) [2]. Each scenario was followed by an interactive debrief period, led by a trained facilitator. The students were invited to complete an anonymous online post-session evaluation regarding their perceived level of confidence and competence in managing challenging scenarios in practice.

Findings:

There was an overall response rate of 77% (48 respondents in total; 13 MSc and 25 BSc students), 27% were pre-registration MSc students and 73% were BSc students. 98% were active in each of the three scenarios as either a Physiotherapy student in the scenario or as an active participant in the post scenario debrief. Following the simulation scenarios, 92% of students felt either ‘a little confident’ or ‘very confident’ in managing challenging behaviour on placement and 94% of students felt either ‘a little confident’ or ‘very confident’ having a conversation with a patient around managing their expectations. 96% of the students rated the session as 8/10 or above in terms of benefit for preparation for practice (Figure 1-A105).

Figure 1-A105:

Graph to show student response that the overall conflict resolution experience was well received and considered to be an 8 out of 10 or higher

Conclusion:

Student satisfaction scores suggest that simulation is a useful tool to enhance pre-registration MSc and BSc Physiotherapy students’ conflict resolution skills required for clinical practice. Additional research into how the development of these skills carry over into placement is warranted.

Ethics statement:

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

In recent years many Higher Education Institutions (HEIs) have recognized the benefits of Simulation Based Education (SBE) and incorporated it into their teaching programs, in some cases utilizing it to replace traditional ‘clinical placement’ hours [1]. This has been catalysed by the COVID-19 pandemic whereby there has been unprecedented demands on NHS services, forcing the industry to offer alternative placement models [2].

Aim:

To contribute to placement expansion by offering a simulation-based student placement.

Activity:

We created a six week non-clinical, simulation placement designed to host two Physiotherapy students. The overarching objective of this placement was to enable students to create and run their own simulation training session by their final week. They were based in the simulation team and networked with other students and clinicians to guide their research and planning.

We collated feedback from the students at the end of their six-week placement via anonymous, online Microsoft feedback forms.

Findings:

Throughout 2022 we ran this placement twice and collated data from the 4 Physiotherapy students, all who were in their second year of study.

Thematic analysis suggested the most common skills students felt they gained were soft skills (i.e. organization and prioritization) and development of varied communication styles. Additional themes that were mentioned included simulation specific skills. There were two areas where students felt they were unable to develop due to the placement communicating with ‘real’ patients and clinical note writing.

Students were asked to score their clinical knowledge relating to their chosen simulation topic area at the beginning and end of the placement. Scores increased from ‘Good’ (2 students) and ‘Average’ (2 students) at the beginning of the placement to ‘Good’ (1 student) and ‘Very Good’ (3 Students) at the end of the placement.

Qualitative themes suggested the students felt the overall variety of activities and exposure to clinical scenarios/teams they may not have seen before was unique to this placement and both enjoyable and valuable.

Conclusion:

Previous studies have identified misconceptions relating to the purpose of simulation and its aims [1]. Our data reflected this concept as students rated their knowledge of simulation at the beginning of the placement as ‘Very Minimal’. However, our placement offering has proven to successfully increase this awareness and offer the opportunity to develop transferable skills and clinical knowledge in a way that is both exciting and aids placement expansion whilst incurring minimal cost.

Ethics statement:

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

In recent years we have seen an exponential increase in the use of simulation-based education (SBE) within surgical training. Early evidence supported initial integration of simulation to Trauma & Orthopaedic (T&O) training [1] with more contemporary evidence focused on refining training methods and technology usage [2,3]. We aim to assess the integration of established as well as novel SBE components within our T&O training programme in Northern Ireland.

Activity:

Simulation sessions were introduced to the Northern Ireland (NI) T&O Core Curriculum in academic year 2022/23:

Trauma Simulation Scenario Training: Pelvic trauma scenarios were delivered to all T&O specialist trainees as part of Core Curriculum teaching in a regional simulation centre. Multi-professional input was sought and delivered by Blood Transfusion Service (Major Haemorrhage Protocol training) and Urological micro-teaching session (traumatic urological injuries in setting of pelvic trauma).

Arthroscopy Simulation Course: A knee arthroscopy course was developed in conjunction with industry for all T&O trainees in NI utilizing passive haptic feedback arthroscopy simulators. Pre + post simulation surveys were completed assessing educational value, engagement with SBE as method of teaching, desire for further SBE content and suggestions for topics of same. Focus groups of lead educators were set up to plan development of further SBE training within T&O curriculum.

Findings:

Trainees reported increased confidence in management of pelvic trauma. Overwhelmingly positive response to integration of SBE sessions to core curriculum with 89% in favour of further multi-specialty simulation training sessions. There was a preference seen within feedback for a variety of SBE iterations with in-situ and operative/ procedural simulation being slightly preferred to scenario-based training. With majority of trainees requesting procedural SBE training as topic for future sessions, Knee Arthroscopy Simulation Course was subsequently developed (to be delivered as part of Core Curriculum in May 2023).

From lead educator focus groups further simulation-based training sessions are planned for development in 2023/24 including shoulder arthroscopy simulation course, rare approaches simulation and advanced supracondylar simulation sessions. Feedback will be sought throughout to ensure training is tailored to needs of trainees as well as curriculum requirements. Recognition of benefits and scope of SBE training within T&O has prompted development of formal simulation trainee role as result of initial regional experience.

Conclusion:

Our experience of integrating SBE training methods to T&O core curriculum has been hugely positive with demand amongst trainees high for a wide range of further sessions and courses.

Ethics statement:

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

Simulation based education (SBE) has been used to help attract school students into healthcare previously but commonly this is in a try it and see format using manikins to gain insight into history taking or physical examination. Also traditionally we tend to focus on more traditional healthcare professions such as nursing medicine and physiotherapy as common examples.

In our region we have been working closely with our national youth academy looking at novel ways to attract and recruit our young people into more difficult to fill roles within health and social care such as home care roles and healthcare support worker roles.

There are many good examples across the general workforce where simulation training can aid successful transition into the work place [1]. We are aware that certain areas of health and social care are more difficult to recruit to and wondered if values-based simulation could aid successful recruitment in this area?

Activity:

An immersive simulation session was designed based on 2 scenarios with space for reflection on who am I and what matters to me as a human. The first scenario was based on a reablement opportunity and focussed in on mutual goal setting giving space to express needs in the social care environment. The young learner was able to explore what skills they had and whether they were true to their own values. The second scenario was based in a hospital and looked at a health care support worker accompanying a patient to theatre. The school students had a chance to practice active listening and looking after a person who was anxious. It was amazing to see the skill set that the young people brought to both scenarios.

The session has been delivered in schools, colleges and a national event. There are plans to bring the immersive simulation session to recruitment fairs.

Findings:

The take home messages from the sessions have been in alignment with the individuals and social care core values reflecting compassion, motivational techniques and mutual goal setting. Comments such as ‘I am astonished that I could make a difference to that person’ and ‘I hadn’t thought about a career in social care before but now I know how rewarding it feels I’m considering it’ reflect these findings. We will also look at the effect on recruitment as we roll out and scale up the work.

Conclusion:

Immersive simulation respects the young person’s core values when enabling them to make meaningful and lasting choices about careers in health and social care.

Ethics statement:

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

FY2 doctors in Greater Glasgow and Clyde (GGC) participate in simulation-based learning [1] to improve communication skills in difficult consultations. COVID-19 pandemic restrictions from 2020 – 2022 meant actors could not be present in person for this. Scenarios were therefore adapted to run as remote consultations - two were conducted using Zoom video calls and one by telephone with professional actors, and one ward-based manikin scenario with faculty as actors. We compared the effectiveness of the session, and of each scenario, in improving confidence in communication.

Methods:

Questionnaires were completed before and after simulation. Confidence levels were assessed using a Likert Scale (1 – 5) for each scenario. Participants were also asked to rank each scenario (1 – 4) for engagement, realism and relevance to practice at the end of the session, and for which of the three Intended Learning Objectives (ILOs) for each scenario they had gained most information.

Results:

Over 10 days, 126 FY2s (6 - 8 per group) and 23 Faculty members participated. 92 completed questionnaires were obtained. ‘Take Forward Messages’ (TFM) from scenario debriefs from 12 groups were correlated with the ILOs.

Overall, there was a significant improvement in confidence in dealing with difficult communication scenarios after the session; (mean ± SEM) score pre 2.87 ± 0.11, post 3.69 ± 0.08, p < 0.01. These values did not differ significantly from 2019 when actors were present in person.

When asked to rank which scenario was most effective in different aspects, the case on how to deal with an angry patient (Zoom video call) performed best overall (Figure 1-A83). The manikin-based scenario was lowest rated, but confidence in being ‘assertive under pressure’, one of its ILOs, did improve by 44% from baseline. Confidence levels improved to a lesser degree in the other scenarios on evidence-based medicine (Zoom) and safeguarding a vulnerable adult (telephone). The ILOs participants rated best achieved best by the session were ‘Managing Confrontation and Anger’ (69%) and ‘Assertiveness under Pressure’ (52%). These ILOs were also the most frequently mentioned in TFMs, 100% (12/12) and 92% (11/12), respectively. All other ILOs were mentioned < 50 % of the time in both participant questionnaires and TFMs.

Figure 1-A83:

Scenario Quality Assessment and Improvement in Participant Confidence Levels

Conclusion:

Zoom and telephone consultations, and manikin-based scenarios can be used to provide effective simulation sessions to improve communication skills. Perception of scenario quality does not always correlate with success in achieving the learning objectives.

Ethics statement:

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

Physician Associates (PAs) are an increasingly prevalent member of the medical team, with approximately 3000 working within UK health organizations [1]. The role offers continuity and stability to the multi-disciplinary team, addressing the issue of foundation doctors rotating 4-monthly and the impact of this on day-to-day ward work, speciality specific skills and knowledge.

Due to their disparate, and sometimes non-medical, backgrounds, qualified PAs have varied exposure to the recognition and management of specific medical emergencies. They also have limited opportunity for simulation experience during their training. At present, there is no national PA teaching programme once qualified (as a Foundation doctor would have), yet PAs are still expected to continue their personal and professional development, in addition to completing a re-certification exam to remain registered.

Activity:

We developed an innovative PA teaching programme, combining simulation scenarios with interactive workshops, with all sessions linked to the PA Competence and Curriculum Framework [2], mirroring the set-up of the Foundation doctor teaching programme. Each session aimed to develop knowledge and confidence, whilst also offering opportunities to develop non-technical skills such as teamwork, communication, handover and breaking bad news.

Simulation sessions focused on assessment and management of a simulated patient with an acute medical problem whereas workshops allowed case discussion of topics such as endocrine emergencies, resuscitation decisions and dementia & delirium. Written feedback and Likert scales were used to evaluate the sessions.

Findings:

To date, 7 sessions have been run, with average attendance of 8.5 PAs of the 12 PAs working within the Trust. 100% of attendees agreed the scenarios have been useful and provided more confidence to deal with conditions covered. Written feedback praised the ‘transferable nature’ of topics discussed, relevant to PAs working across multiple secondary care specialties.

Conclusion:

Introducing this educational programme has been beneficial for the PAs. PAs within our trust have noted the benefits to their practice, allowing them to develop improved clinical assessment skills alongside widening their knowledge base outside of their current specialty. This supports personal and professional development, as well as providing exposure to multiple secondary care settings. We aim to repeat the same simulation scenarios after 4 months to evaluate if knowledge has been retained by adding an extra level of complexity when the scenarios are repeated. We will also look to share our learning and scenarios with other local trusts, with the potential to create a regional PA teaching programme within the South West.

Ethics statement:

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

While the use of simulation-based education (SBE) is embedded within clinical courses delivered in higher education, it’s use within further education is extremely limited, leading to a perception that students may be at a disadvantage, particularly those from a neurodiverse background, where kinesthetic learning is their preferred style [1]. The same principles also apply to assessment. Supported through funding from the NCFE (originally known as the Northern Council for Further Education), a pilot project was developed with the following objectives:

To transform the assessment methodology within further education (FE) via the use of immersive technologies

To facilitate collaborative development of bespoke virtual reality (VR) scenarios incorporating course learning outcomes (T level and Care Certificate)

For digital technology students to work jointly with industry in VR development

To gain feedback from students, employers and other key stakeholders with regards to using immersive technology as a method of assessment.

Activity:

Scenario development

Three prototype scenarios were developed in the iRIS platform to aid adherence to ASPiH and INACSL standards as well as collaboration across the development and project teams. The VR development was undertaken in Unity by digital students led by industry experts.

Evaluation

The University of Huddersfield led on the evaluation of the project using a qualitative approach encompassing the three degrees of validity [2], using student and employer/stakeholder focus groups and 1:1 interviews both pre and post scenario testing. Discussions were transcribed and template analysis [3] applied.

Findings:

While final evaluation is still ongoing, initial findings are as follows:

iRIS proved to be an invaluable platform for scenario development across organizations greatly aiding communication and decision-making

Both students and faculty need have reached a minimum competency with the VR equipment and environment prior to assessment

Course learning outcomes can be readily incorporated into bespoke VR scenarios

VR would be a suitable mode for assessment for some learning outcomes but not all

The prototype scenarios provided adequate realism, face and construct validity for assessing the identified learning outcomes

Conclusion:

VR simulation has the potential to be suitable and acceptable mode of delivery for assessment in health and social care. Funding applications have been submitted for phase two of the project which would include an impact study.

Ethics statement:

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

NHS England’s Long-Term Plan for Mental Health highlights need to develop PNMH services and train staff ensuring service user involvement [1]. Women experiencing PNMH disorders often initially present to non-specialist healthcare professionals (NSHCP), meaning that they need specific training in assessment and management of PNMH disorders. A co-produced and co-facilitated simulation-based training programme in perinatal mental health was developed in 2019 by Sussex Partnership Specialist Perinatal Service in conjunction with University Hospital’s Sussex Simulation team.

Primary Aim: Evaluate self-reported changes in confidence and competence of learners attending perinatal mental-health (PNMH) simulation training across multiple domains relating to assessment and management of PNMH problems.

Secondary Aims: Evaluate impact of service user co-facilitation on PNMH simulation training; Assess whether participant demographics reflect training’s target professional groups.

Methods:

Service User Consultants (SUCs) were employed as faculty members and trained in simulation facilitation alongside professional faculty. Scenarios were developed in a multidisciplinary workshop, and aligned to the Health Education England (HEE) Competency framework in PNMH. Courses were co-facilitated by a Perinatal Psychiatrist and SUC. Data on participants’ confidence and knowledge across the competency framework domains was collated using a survey monkey questionnaire, pre and post-course.

Results:

242 responses were collected from participants from more than ten different staff groups e.g. junior doctors, (18%), health visitors (17%) & midwives (26%). Participant confidence improved significantly across all training domains. 93.5% of participants graded contribution of SUCs either useful or very-useful. 99.2% found the simulation training useful or very-useful, with all participants agreeing their future practice would consequently change.

Conclusion:

The simulation-based training programme increased confidence and understanding of NSHCPs from across the PNMH care pathway, on a number of domains set by HEE PNMH competency framework. Participants were overwhelmingly in support of SUC involvement in the provision of valuable training which resembled real-life clinical encounters via scenarios.

Increased pressures within the NHS, shortened learning hours and disruptions caused by the COVID-19 pandemic has significantly impacted surgical training. Current courses focus on single training levels, but errors occur through systemwide failures [1]. We developed a SSEP targeting cross specialty and team-based patient management, focused on clinical knowledge and skills, cognitive simulation, leadership and human factors based upon real life events to optimize training in a system that lacks time and exposure.

Methods:

A six-month pilot program was designed with monthly sessions, attended by surgical nurses, junior doctors and consultants, covering common surgical scenarios mapped to the ISCP curriculum [2], and topics highlighted through local clinical governance. Immersive interactive sessions were delivered by a dedicated consultant led education team to provide a mixed reality environment for each simulated scenario. Faculty encompassed emergency, anaesthetic and surgical consultants to facilitate realistic multidisciplinary team working. The professional identity and grade of participants were maintained during each simulation to ensure sessions were representative of real-life events with a clear mutual goal to improve knowledge and skills to transpose into safer patient care at all levels of seniority. Sessions combined simulated scenarios with structured teaching, clear learning objectives, detailed peer feedback and opportunity for juniors to complete work-based assessments with consultants. Senior trainees benefited from participation in the design and delivery of sessions providing opportunities to strengthen their leadership skills. We recorded participants pre- and post-simulation confidence, and knowledge, were measured using 5-point Likert scale feedback forms, and multiple-choice questionnaire (MCQ) paper respectively.

Results:

Two-paired T analysis showed statistically significant improvements in participant confidence across all 4 simulations (Table 1-70). Participants also received statistically significant higher scores in the post-simulation MCQ test compared with their pre-simulation scores (4.07 ±0.53, 4.43 ±0.26, p = 0.02, n = 14) at the 95% confidence interval. Limitations included variable attendance due to service needs and strikes.

Table 1-A70:

Pooled two-paired T-Test analysis of participant self-rated confidence, in managing clinical scenarios and core topics, before and after participation in 4 high-fidelity simulated scenarios, at the 95% confidence interval (*Significance α = ≤0.05). df = difference

		N = No of participants	Mean	Variance	df	t Stat	T critical two-paired	Significance P (T<=t) two-tail
Simulation 1: Sepsis and Anaphylaxis	Pre-simulation	14	8.29	2.219	13	-2.687	2.160	0.002
	Post-simulation	14	9.00	1.538
Simulation 2: Post-operative anastomotic leak	Pre-simulation	8	8.25	1.642	7	-2.376	2.365	0.024
	Post-simulation	8	8.88	1.267
Simulation 3: Acute Abdomen	Pre-simulation	19	16.84	2.760	18	-3.693	1.734	0.002
	Post-simulation	19	18.26	2.760
Simulation 4: Post-operative PE and Cardiac arrest	Pre-simulation	14	15.79	5.566	13	-4.387	2.160	0.000*
	Post-simulation	14	18.00	1.231

Conclusion:

Our SSEP is an effective strategy for the improvement of trainees’ confidence and knowledge in managing challenging surgical scenarios, which actively contributes to the development of skills for clinical practice. Evaluation of long-term knowledge retention is necessary. Our ambition is to develop the program as a quality improvement project (QIP) that implements learning from significant events and demonstrate improved outcomes in these domains. We endeavour to embed this simulation training across the region.

Ethics statement:

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

Debriefing after simulation practice offers a crucial opportunity for guided reflection and learning. However, there are many structures and models available [1].

Health Education and Improvement Wales (HEIW) holds regular simulation webinars, workshops and conferences. During these events, the simulation community in Wales expressed their willingness to standardize debriefing in order to facilitate faculty sharing and to support interprofessional simulation.

Activity:

National debriefing experts carried out a review of the relevant literature and devised the Triangular Approach to Debriefing, incorporating agreed debriefing principles, a simple structure and recommended strategies with links to relevant key articles.

This approach was shared and piloted by simulation faculty at a national workshop in September 2022. The feedback received was excellent. Comments received guided a document review. The final version was incorporated in the Essential Faculty Development Course and is currently in available in Welsh and English.

Findings:

The triangular approach embraces a set of collaboratively identified principles, an easy to use structure and a summary of well referenced strategies: •

Principles adopted include facilitating safe and constructive discussions, with Inclusion of all participants and respect for different learner needs, aiming to guide reflective practice and sharing of mental models with the highest level of facilitation possible.

A four-step structure (see Figure 1-A66) guides the debriefer to introduce the debriefing and facilitate a chronological review with intercalated description – analysis – application (DAA) cycles. Then the learners are invited to share their new insights and the facilitator offers opportunities for questions and summarizes the discussion. The supporting cognitive aid includes examples of phrases that might be useful in each step.

Recommended strategies cover psychological safety (such as ground rules, time management, authenticity and validation of contributions), how to focus the discussion, facilitation techniques, closing and meta-debriefing.

Figure 1-A66:

Debriefing structure in the Triangular Approach to debriefing

Conclusion:

The Triangular Approach to debriefing has been welcomed by the simulation community in Wales. It is not expected to be the only way that facilitators debrief, but a gateway into good quality debriefing for new faculty, supporting the development of national expertise and encouraging to explore other available models as well as key debriefing literature.

Ethics statement:

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

The Nursing and Allied Health Professions (AHP) Departments of one of the largest providers of health and social care education in the UK, have implemented simulated practice-based learning placements across a range of their pre-registration healthcare courses. These simulated placements aim to improve students’ preparedness to practice, enhance the student experience and increase placement capacity. The simulation leads from each department identified that there was no cross-department collaboration around these new innovations. They developed and introduced a Simulation Community of Practice (CoP) across the three nursing fields and eight AHP professions. The aims were to share knowledge and best practice, enhance skills, creation of new knowledge and improve practice. A CoP is defined as a ‘group of people who share a concern, a set of problems, or a passion about a topic, and who deepen their knowledge and expertise in this area by interacting on an ongoing basis’ [1].

Activity:

The development of the CoP was led by the nursing and AHP simulation leads and was based on Wenger’s (2002) CoP framework [1]. Support was gained from senior management to ensure commitment and resources. Terms of reference for the group were developed with clear aims and objectives. Relevant staff across all professions were identified and invited to join. Meetings occur every two months for a duration of two hours, initially online and more recently face to face or hybrid format. Agenda items include sharing and reflections of practice, challenges and solutions; demonstrations of simulated scenarios, online learning packages and virtual reality. Guest speakers are invited to share simulation expertise and research. A Teams site is used to house information, share new developments and opportunities and to allow staff to ask questions and maintain communication between meetings.

Findings:

Staff have gained valuable professional development by learning from others, sharing designs and experiences of simulated placements and learning about best practice. They have enjoyed networking and connecting with others from different professions. They have valued seeing examples of simulated scenarios and innovations and having dedicated time to reflect and discuss innovations and research opportunities. They have found it a supportive environment and a creative space. 100% of staff involved would recommend the CoP to others.

Conclusion:

The successful introduction of a multidisciplinary Simulation CoP has enabled collaboration and development of knowledge and skills around simulated practice-based learning, including the underpinning pedagogies of simulation design and debriefing.

Ethics statement:

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

Collaborative, patient-centred care delivered by interprofessional clinical teams is known to improve healthcare efficiency, as well as patient and staff satisfaction [1]. Therefore, inclusion of interprofessional education as an accredited element within prequalifying healthcare programmes is growing [2]. The use of simulation-based learning may provide an effective method of delivering high quality, safe and effective interprofessional education in challenging but transferable settings like caring for patients presenting with mental health difficulties.

Activity:

A half-day simulation course consisting of three scenarios was designed. Actors trained in the portrayal of mental health difficulties by service users were workshopped into the scenarios, with representation from each professional group to enhance authenticity. Each scenario was followed by a facilitated debrief that allowed for whole group learning, using a debrief model [3]. Effective interprofessional collaboration and professional representation was modelled by an interprofessional faculty. Facilitators were encouraged to reflect on their own biases around other professions, recognizing the impact these may have on their debriefing choices. During debriefing, participants were encouraged to consider the impact that collaborative practice has on patient-centred care. Facilitators were encouraged to draw out unconscious biases and highlight issues that can inhibit the successful delivery of collaborative, patient-centred care. Staff development was supported through mentorship and faculty debriefing.

Findings:

The pilot programme ran four times for 72 nursing and medical students. 50 of the 72 (69%) participants provided anonymous feedback via a mixed methods questionnaire. Of these, 54% were medical students and 46% were nursing students. On a Likert scale (1 = poor, 10 = excellent), all participants rated the experience 7/10 or above, with 74% rating it 9 or 10/10. Likert scale questions regarding applicability, course design elements and perceived learning were also highly rated. Thematic analysis was used to analyse the free text questions by two discrete researchers. The results were broadly categorized into learner experience and learning outcomes. Participant perspectives of the benefits of the simulation training on aspects of interprofessional collaboration can be seen in Figure 1-A64.

Figure 1-A64:

Participant perspectives of the benefits of the simulation training on aspects of interprofessional collaboration

Conclusion:

This pilot demonstrates that interprofessional education can be successfully delivered in this way, and has been adopted into the medical and nursing student curricula. The next run includes 300 students from medical, nursing and allied health programmes across two institutions, and will be re-evaluated. A qualitative research study to explore the learning that higher educational institutions can gain by delivering interprofessional learning using simulation is also underway.

Ethics statement:

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

In the United Kingdom, trainee doctors rotate through different specialities during their training. They are often unfamiliar with systems, environments, and personnel. Working on a general paediatric ward in a district general hospital can be anxiety inducing for those new to paediatrics.

Fortnightly low-fidelity simulation scenarios are embedded in our local teaching schedule to improve confidence amongst the medical and nursing team. These are performed on the ward addressing varied scenarios, aiming to increase confidence with clinical cases, improve local environment and systems awareness, and enhance communication between professionals.

Methods:

Fortnightly 30-minute simulation sessions are run by the paediatric simulation team on the paediatric ward at our trust. The wider multidisciplinary team are invited, including nurses and health care assistants. The emergency buzzer from a bed space is pulled, and those involved attend and a scenario is undertaken. The scenario is structured to involve the wider team to improve interdisciplinary working and non-technical skills, as well as address clinical outcomes. Equipment is provided using a grab bag. Once the scenario has ended, a debrief is performed involving candidates and observers of all disciplines, to discuss technical and non-technical skills.

Post session feedback was collected on each occasion with quantitative data via Likert scales and qualitative data by free text questions.

Results:

In-situ simulation has been part of the departmental paediatric teaching rota since 2009 but has been a regular fortnightly occurrence since 2018. This is because it has been rostered into our working hours before the medical team assume clinical duties.

We have collected feedback since September 2018. We have had 616 participants and delivered 82 scenarios in the clinical environment. This includes during the Covid pandemic. The weighted average confidence recorded by candidates pre-scenario was 2.51 with confidence post-scenario recorded as 3.69. 83% reported improved confidence following the scenario. This is an important finding as 45% had never encountered the scenario before in their practice.

Thematic analysis has highlighted key aspects including communication, escalation, teamwork and available resources.

Conclusion:

In-situ, low fidelity simulation is an effective tool to improve human factors amongst the multidisciplinary team on a paediatric ward. By regularly simulating clinical practice in their daily working environment, all candidates have demonstrated improved clinical confidence and better familiarity with the ward environment. Additionally, the fortnightly in-situ simulation has improved working relationships through recognition of the roles of the ward multidisciplinary team, communication skills and team and leaderships skills.

Ethics statement:

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

GP teams manage a wide spectrum of acutely unwell and deteriorating patients, these are unexpected, high risk, low frequency events. Ambulance delays mean patients may need prolonged input prior to transfer. There is little best practice guidance for many emergencies seen in primary care. Evidence from secondary care shows improved non-technical skills when checklists are used in emergency simulations.

We have previously presented early phases of the MAGIC project to design a Quick Reference Handbook (QRH) for GP teams and now present the final handbook along with plans for embedding it in primary care.

Activity:

Previous presentations at scientific conferences (ASPiH) covered the Delphi process used to develop the QRH and the pilot training programme incorporating in-situ simulation.

We incorporated feedback from 14 GP teams who used the checklists in the context of in situ simulations and used a round of tabletop simulations at six GP practices to finalize the checklists in the handbook.

The development process was guided by the ‘CLEAR’ principles proposed by Greig et al [1] and the design of the QRH for anaesthetic emergencies [2] which followed human factors principles.

Since completing the GP QRH we have been focusing on plans for sustainability. The QRH will be incorporated into in situ simulation or tabletop exercises [3]. We have written standardized ‘MiniSim’ scenarios using low fidelity techniques and accompanied by the relevant checklist. They will be uploaded on the iRIS platform to ensure ease of access. We are working with colleagues in GP training hubs around the HEE South-East and South-West regions to embed the QRH and then share the work nationally.

Findings:

We have completed a GP QRH including 16 checklists: fourteen to guide clinical actions in acute conditions (Figure 1-A43), one to be used when the diagnosis is unclear, and one to aid non-clinical staff. Additionally, we have included guidance on the use of equipment (e.g. oxygen cylinders and AED) and supporting documents including emergency scoring systems (e.g. NEWS), normal physiological values in children, and a recommended medication and equipment list. These checklists will be made freely available. Feedback on the QRH and in-situ training to date has been universally positive.

Figure 1-A43:

An example of a checklist from the GP quick reference handbook

Conclusion:

Checklists improve non-technical skills and team performance in emergency situations. We have developed the world’s first GP QRH to support safer care of emergencies in primary care. The GP QRH will be freely available together with training materials to embed it in practice.

Ethics statement:

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

Simulation faculty should be trained and competent [1, 2]. A strategic objective of the Health Education and Improvement Wales (HEIW) Simulation team is to provide equitable access to a standardized simulation faculty development programme across Wales.

Methods:

A consultation process involving meetings, focussed discussions and webinars with key stakeholders, educators and clinicians from a range of professional backgrounds was carried out. The following priority areas were identified:

development of a tiered programme supporting a competency-based approach

to develop educational skills, knowledge and behaviours required to deliver high quality simulation-based education and training (SBET) in safe learning environments

to promote interprofessional SBET and offer flexible and accessible faculty training opportunities.

A tiered programme framework consisting of 3 standalone courses (essential, advanced and expert) comprising 4 blended learning modules each, was designed collaboratively and informed by the literature [2,3].

Following content mapping and creation by experts, the Essential Course was launched in October 2022. It entails 5 hours of self-directed e- learning followed by a 5-hour facilitated (virtually or face to face) session, fully funded by HEIW.

Advanced Course content is under development, due to commence in March 2024.

Results:

Thirty-eight participants completed the essential course between October 2022 and February 2023, n = 28 undertaking face to face sessions and n = 10 a virtual session.

Learners were asked to rate the usefulness of each e-learning module on a Likert scale, with 1 equating to ‘not at all’ and 5 to ‘very much’. The number of participants that evaluated each module and reported them ≥4 is as follows: ‘Introduction to simulation’ n = 35/37 (95%), ‘Human factors’ n = 24/26 (92%), ‘Designing and Facilitating Simulation’ n = 23/24 (96%) and ‘Debriefing’ n = 20/20 (100%) (see Figure 1-A34).

Figure 1-A34:

Evaluation of the essential course e-learning modules

Response rate to the evaluation of the face-to-face sessions was 24/28 (86%) and 8/10 (80%) for the virtual session. All responders 32/32 (100%) rated the face to face and virtual sessions ≥4 regarding relevance and usefulness, with 31/32 (97%) agreeing that the learning objectives were met. Common themes identified as ‘most useful’ were the ability to practise running a scenario and opportunity to practise debriefing and gain feedback.

Conclusion:

The Essential Course of the Sim FD Wales Programme has been well received and evaluated so far. Uptake has been high, with demand outstripping places available. Further evaluation is required to determine the effectiveness and impact of each course and the programme as a whole.

Ethics statement:

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

Taking simulation from concept through to scalable delivery is complex, contested and an under-theorized process. The traditional approaches to scaling innovations, proposed by Everett Rogers in the 1960s is the notion of diffusion of innovation; we argue that this is of limited use in our context of working with NHS health professionals supporting their learning post-covid. Our approach to scaling draws the upon the well-tested seminal works on taxonomies by Coburn (2003) [1] and her dimensional framework, Dede et al (2007) [2], with their educational scaling model, plus the systematic review of Greenhalgh et al (2004) [3] in health services.

Activity:

By considering the ways in which our eight Health Education England (HEE) simulation projects have been delivered, this work presents an emerging framework, designed to enable the orchestration of team discourse about theory, the production of simulation artefacts as tools for design discourse and the identification of scalable systemic pain points. We pay particular attention to scaling innovations in practice and organizational change, which are in our view enabling factors in the sustainable adoption of learning technologies by end users in the workplace.

Findings:

Successful scaling is more than just being about the number of users we can reach. It requires underpinning by an understanding about the changes in practice an innovation can bring about, and how valuable these changes are to stakeholders. Challenges remain as to whether such changes can be sustained over time, and the extent to which users and stakeholders are involved in co-creating the innovation. Individuals within the organizations – and their attitudes, beliefs, and habits – play an equally important role in exploring new technologies and practices with an open mind and perceiving these as an added value in their work environment and daily routines.

Conclusion:

This work illustrates the need to strategically involve the ‘missing middle’ and starts to identify the key role these people play in that space between where scaling factors reside between top-down strategy and bottom-up initiatives.

Ethics statement:

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

Simulation-based learning is an increasingly popular pedagogical approach. In some areas of physiotherapy, it is better been documented, for example, cardiorespiratory physiotherapy [1]. However, its use in other physiotherapy-related settings is less clear. Therefore, the aim of this project was to review the literature on simulation-based learning in prequalifying physiotherapy education, in order to explore where studies have taken place, which physiotherapy settings it is used in and indication of its effectiveness in teaching.

Methods:

This study was carried out based on the scoping review methodology outlined by Arksey and O’Malley [2]. The following databases were searched: AMED, BNI, CINAHL, Embase, Emcare, HMIC, Medline and PsychInfo, using specific search terms, to find studies involving the use of simulation in a prequalifying physiotherapy setting. Returned papers were screened using inclusion and exclusion criteria by two reviewers. The database search results were recorded and managed using Rayyan™ [3].

Results:

The database search retrieved 280 papers. Following the removal of duplicates, screening titles and abstracts and then screening full-text papers, 39 papers were included. The included studies were conducted in USA (n = 23), Australia (n = 10), Canada (n = 1), Finland (n = 1), Germany (1), Spain (1), Taiwan (1), UK (1). Simulation-based learning activities took place in a variety of physiotherapy settings. Most took place in an acute care or cardiorespiratory setting. There was a high level of variation in the reporting of the described simulation activity. This made it difficult to establish whether simulations were of high or low fidelity. Where reporting was well described, simulation activities tended to follow a framework of pre-brief, simulation and then debriefing. The majority of studies reported some measure of the effectiveness or feasibility of simulation-based learning.

Conclusion:

This scoping review identified a growing body of evidence supporting simulation-based learning in prequalifying physiotherapy education. However, to date, its use in pedagogical research has tended to focus on the cardiorespiratory setting, and it has often been researched as a tool to explore or enhance interprofessional collaboration. Whilst both of these areas are of value to the profession, there is scope to explore the use of simulation-based learning in settings such as musculoskeletal teaching. Further work on its use and value in the teaching of discrete complex tasks, in addition to collaborative practice, such as team working, de-escalation and communication is also needed.

Ethics statement:

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

On-call respiratory physiotherapy is utilized when an acutely unwell patient could deteriorate without immediate assessment and treatment overnight. Education related to this topic varies greatly and is often of poor quality. Simulation-based education (SBE) has been increasingly used within other areas of healthcare yet, Gough et al. [1] completed a study in 2013, which found only 39% of acute trusts used simulation for respiratory on-call training.

Aim:

To determine from existing research, whether SBE can enhance the development of registered physiotherapists respiratory ‘on-call’ skills in order to impact future practice.

Methods:

A qualitative literature review was completed as part of a PgCert in Health Simulation at Coventry University, in March 2023. Ethical approval was gained from Coventry University (P149952). Studies included were found by searching AMED, CINAHL Embase and Medline databases. Figure 1-A20 presents the PRISMA flow diagram [2]. Final reports included were critically analysed using the Critical Appraisal Skills Programme framework [3] and data extracted and formatted into a table. General themes were identified using an inductive approach.

Figure 1-A20:

PRISMA flow diagram

Results:

Eleven papers were selected to be reviewed after the removal of duplicates, screening and the exclusion criteria were applied. The main themes identified were the use of high-fidelity simulation, the measure of confidence and/or competence, and findings of positive implications for practice. SBE is widely used for other healthcare professions with positive outcomes; however, its use within respiratory physiotherapy is limited. Most studies chose to measure self-reported levels of competence and confidence, which is an example of Kirkpatrick level-one evaluation. These measures have only casual links to transfer of knowledge and behaviour change, which are key requirements when applying training to clinical settings. Interestingly, the review also demonstrates favourable use of high-fidelity manikins within this population. Although this was not discussed by the researchers, this may be a barrier for further implementation due to cost and technical knowledge required to use the equipment.

Conclusion:

The use of SBE has been beneficial in other healthcare professions and similar positives were found for its use with respiratory physiotherapists. However, much of the research is of low quality, and further research is required to review other confounding factors that may influence the outcomes and longitudinal staff behaviour.

Ethics statement:

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

Simulation can immerse learners in scenarios that mimic clinical situations, simultaneously mitigating safety risks and increasing standardization in healthcare education [1]. Through simulation, learners can get the chance to develop clinical reasoning with focused learning opportunities [2]. Clinical reasoning is multidimensional in nature, and underdeveloped clinical reasoning skills and the risk of cognitive overload can potentially threaten patient safety and delay care, so it is important to systematize, optimize and structure clinical reasoning for simulation-based education [3]. That can be achieved through using valid clinical reasoning models but with careful consideration to the contributing and influencing factors of case complexity, staff seniority, competence, scope of practice, specialty and subspecialty.

Methods:

A scoping review was undertaken to answer the questions: what are the best available valid and reliable clinical reasoning models for simulation-based education? We searched Medline, Scopus, Education Research Complete and Google Scholar to identify relevant recent primary research conducted on this topic from 2000 onwards. The search included MeSH topics of ‘Clinical reasoning’, ‘Simulation-based education’ and ‘Clinical Reasoning models’. The inclusion criteria were primary studies describing the clinical reasoning models developed for simulation-based courses. Two independent researchers agreed on the inclusion of the identified articles for full-text review. This review followed the review guidelines of Joanne Briggs Institute.

Results:

Five valid and reliable models to structure the clinical reasoning process while attending simulation-based training were identified and are reported in Table 1-19. However, their validity and reliability were tested on working and undergraduate student nurses, and there was no consideration for different seniority and competence levels, and applicability to other healthcare professions.

Table 1-A19:

Identified clinical reasoning models based on the scoping review

Model	Objective	Methodology/description	Findings
TANNER’s Model (Tanner 2006)	To describe the clinical judgment of nurses, and to guide educators to help undergraduate students diagnose breakdowns, identify areas for improvement, and consider learning experiences that focus attention on those areas.	Literature synthesis on clinical judgment and conclusions derived from the literature.	Nurses enter the care of patients with a fundamental sense of clinical judgment about what is good and right, and a perception for what is high quality care.
DML Model Debriefing for meaningful learning (Dreifuerst, 2011).	To discover the effect of the use of DML on the development of clinical reasoning in undergraduate nursing students.	Exploratory, non-equivalent group quasi-experimental, pre-test/post-test design. Participants were assigned to either the experimental or control group where the DML was compared to customary debriefing using the Health Sciences Reasoning Test (HSRT) before and after the debriefing experience, and the Debriefing Assessment for Simulation in Healthcare–Student Version (DASH–SV)	DML Model positively influenced the undergraduate nursing students’ development of clinical reasoning skills, as compared to customary debriefing.
The Outcome-Present State Test (OPT) clinical reasoning model (Pesut and Herman, 1998).	The OPT model is a concurrent, iterative model of clinical reasoning that emphasizes reflective self-monitoring. It requires learners to use all the elements of the nursing process and to build on prior knowledge in an iterative fashion to further hone nursing thinking skills.	The model is designed based on the literature review of the history of nursing process over time. The components of the OPT model include the client-in-context story, keystone issue, cue logic, reflection, framing, testing, decision-making, and judgments. The OPT model focuses on outcomes and encourages backward thinking to move the client from his or her current health status (present state) to the desired (outcome) state. The present state is derived from an analysis and synthesis of relationships between and among nursing and client nursing care needs.	The model can be used to enhance educational practices. It reinforces thinking skills, as learners analyse nursing problems from different aspects based on a high-level thinking process. It also serves as a structure for teaching, for clinical supervision, and for developing middle range theories organized around nursing knowledge taxonomies.
The Self-Regulated Learning (SRL) Model for reflective clinical reasoning (Kuiper and Pesut, 2004).	To explore the impact of self-regulated learning theory on reflective practice in nursing, and to advance the idea that both cognitive and metacognitive skills support the development of clinical reasoning skills.	Integrative review of published literature in social science, educational psychology, nursing education, and professional education. The SRL model describes self-regulation as a dynamic process that includes the observations of behaviours and self-regulation of reactions to make self-judgments of competence and areas for improvement for clinical reasoning. The environmental self-regulation of skills, activities, physical context and relationships with preceptors, staff and patients is necessary to determine the context where clinical reasoning takes place. Metacognitive self-regulation includes metacognitive (reflective) self-correction associated with the use of knowledge and thinking strategies that are used to determine goals.	The SRL model is offered to support teaching and learning of reflective clinical reasoning. The model supports the development and acquisition of higher order thinking skills such as interpretation, analysis, inference, explanation, and evaluation.
The Clinical Reasoning Model (CRM) (Levett-Jones, 2010)	To enhance nurses’ clinical reasoning skills and consequently their ability to manage ‘at risk’ patients.	A literature review and an examination of research data to identify commonly occurring thinking strategies. The model describes an eight-step cyclical process: look, collect, process, decide, plan, act, evaluate, and reflect. Effective use of the CRM by nursing students and its application in practice by novice nurses is directly linked to the five rights of clinical reasoning, that is, the ability to collect the right cues and take the right action for the right patient at the right time, and for the right reason	The CRM has applications for classroom teaching and provides a structure that links well with problem-based and enquiry-based learning. The phases and steps in the model are appropriate for self-directed learning and can be used to develop computerized learning packages and case studies. The CRM also provides an approach that can be used in simulation-based learning experiences using patient simulators or standardized patients

Conclusion:

There is an adequate number of clinical reasoning models to be used while taking part in simulation-based training; however, there is a significant basis to test the reliability and validity of these models against different competence and seniority levels, and applicability to other healthcare professions. The authors are presently working on the development of a new model using an innovative and rigorous approach.

Ethics statement:

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

The effectiveness of simulation-based education (SBE) in improving healthcare education among practising healthcare professionals (HCPs) is well recognized [1–3]. However, there is limited research available that explores the facilitators and barriers to the use of these activities amongst this population. The aim of this study was to determine those barriers and facilitators that exist to the use of healthcare simulation amongst practising HCPs through the systematic review of existing qualitative literature.

Methods:

Searches were performed using Medline and CINAHL from February to May 2022 with an updated search performed in June 2022. Reference list searches of included studies were also conducted. English-language, peer-reviewed studies that used qualitative methodology to examine barriers and/or facilitators to the use of SBE activities amongst HCPs practising in a hospital setting were included. Data were extracted and a quality appraisal tool was applied by the primary author, with 30% of included studies independently extracted and appraised by a second author to examine the agreement. Barriers and facilitators were coded inductively using thematic analysis.

Results:

Thirteen studies were included out of a total of 2109 screened. Four main themes related to facilitators and barriers were identified: (1) management and leadership; (2) resources; (3) perceived impact and (4) learning experience (see Table 1-A18). Amongst studies, positive learning experience was a commonly identified facilitator (n = 10), while leadership and management were a frequently cited barrier (n = 13).

Table 1-A18:

Thematic analysis of facilitators and barriers to the use and uptake of SBE activities

Themes	Facilitator codes	No. of studies, empirical sources	Barrier codes	No. of studies, empirical sources
(1) Management and leadership	-Responsive/ supportive leadership -Effective scheduling -Dealing appropriately with difficult environment -Visibility of managerial personnel -Simulation as mandatory assessment and training tool -Collaboration with other centres -Common vision -Good communication	N = 7 (64.6%)	-Lack of responsive leadership -Lack of time/poor scheduling -Staff shortages -Perceptions of hierarchy -Lack of interprofessional involvement -Poor work culture -Competing vision -Poor communication	N = 13 (100%)
(2) Resources	-High standard equipment -Engaging scenarios -Familiarity with equipment/environment -Appropriate personnel -Adequate preparation -Advanced technology -High degree of realism	N = 8 (72.7%)	-Poor realism -Financial restraints -Lack of equipment/facilities -Limited technology -Lack of best practice standards -Lack of appropriate personnel (e.g., trainers, SP, limited learners) -Unfamiliar equipment or facilities	N = 10 (76.9%)
(3) Perceived impact	-Perceived quality and safety benefits -Improved culture -Multidisciplinary collaboration -Core job responsibility/role accountability -Valued experience -Improved teaching skills and techniques -Demonstrable cost-benefit	N = 7 (64.6%)	-Participant stress/anxiety/discomfort -Interprofessional conflict - Ineffective use of effort or time -Benefits of simulation unclear	N = 6 (46.2%)
(4) Learning experience	-Consistency in delivery -Material aligned to staff interest/needs -Trainer expertise -High-impact learning -Safe and positive environment -Individualized feedback	N = 10 (90.9%)	-Inconsistency in programme delivery -Trainers seen as outsiders -Limited engagement -Curriculum not adapted to needs -Purpose not clear	N = 7 (53.8%)

Conclusion:

This study identified common barriers and facilitators to the use of SBE activities. By anticipating and addressing these adequately, the use and uptake of SBE activities amongst practising HCPs can be further enhanced.

Ethics statement:

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

There is a plethora of research on the benefit of a collaborative learning amongst participants in inter-professional education and simulation-based education [1,2]. It would be insightful to explore how this concept of shared learning extends to the faculty members facilitating these educational sessions. From the perspective of the clinical nurse educator, this research study offers a unique insight into the nature of the collaborative teaching experience, processes of knowledge acquisition, and transferability of learning and their influence on both clinical and teaching practice.

Aim:

To illuminate the lived experiences of clinical nurse educators facilitating inter-professional simulation-based education (IPSBE) to gain deeper insight into how this approach can influence their future practice.

Methods:

An interpretative phenomenology analysis (IPA) was chosen as the qualitative research approach for this study as it sought to illuminate the experiences of clinical nurse educators through the interpretation and validation of their unique ‘first-hand’ experiences. A small purposive sample of clinical nurse educators who facilitated IPSBE was recruited to take part in semi-structured interviews. Data were inductively analysed using a systematic, step-by-step approach, generating meaningful themes and concepts that can be applied to the context of practice [3].

Results:

Four master concepts were derived from the interpretative analysis of the interviews: ‘looking at things through a different lens’; the centrality of the debrief; ‘we are actually learning all the time’ and personal and professional growth. It was evident from the interviews that the clinical nurse educators learned from the participants and fellow faculty members when facilitating IPSBE. There was a recognition of the significance and importance of working, learning and teaching together. IPSBE creates a safe space for learning that promotes an opportunity for shared learning to occur which can positively influence inter-professional relationships and practices, which can influence patient care and safety. In addition, the clinical nurse educators expressed that their experiences had enabled them to develop a deeper insight, understanding and respect for educational theory that underpins adult learning which has been transformational to their teaching practices.

Conclusion:

IPSBE creates a safe space for learning that promotes an opportunity for shared learning amongst faculty to occur which can positively influence inter-professional relationships and practices. These positive team-based behaviours are transferable to educational and clinical practice. The detailed analysis and interpretation of the research findings led to recommendations for practice, education, policy and research.

Ethics statement:

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

Autoethnography is an emerging category of qualitative research that seeks to connect the rigorous analysis of traditional science with the undeniable influence of human experience [1]. Despite remaining under-utilized within surgical and simulation-based education research [2], autoethnography has great potential for sharing systematic, personal reflections with the wider readership, particularly with surgical trainees who rely on experiential learning as a cornerstone of their training. This study examines the use of autoethnography to investigate virtual reality (VR) temporal bone (TB) drilling simulation as a learning tool for Ear, Nose and Throat (ENT) training from the perspective of a surgical novice.

Methods:

The primary researcher undertook 16 three-hour sessions learning to perform a virtual cortical mastoidectomy on the Voxel-Man TempoSurg (VMT) TB simulator from October 2021 to July 2022. Qualitative data including field notes and reflective journal logs were collected using a template. These data were coded using NVivo12 and analysed using inductive thematic analysis. Additional quantitative data on surgical simulation performance derived from the Modified Welling Scale and Modified Stanford Assessment were plotted using Microsoft Excel and statistically analysed using simple linear regression.

Results:

Six themes were ultimately yielded relating to the learning experience: (1) VMT as a surgical learning tool, (2) internal and external causes of rushing leading to inaccuracy, (3) overcoming VMT technological issues, (4) reflecting on reflection and the importance of feedback, (5) the physical impact of surgery on the operator and (6) overcoming demotivation. The author’s reflections on each theme were subsequently discussed in detail and analysed in the context of the current literature to meet the study objectives. Statistical analysis of the quantitative data demonstrated statistically significant improvements in procedural skills and ability over the 16-session period (p < .001).

Conclusion:

This study demonstrates a novel application of autoethnography showing VR TB simulation to be an effective ENT training tool for learning anatomy and technical skills when used in combination with the regimented reflection and feedback of autoethnography. We found that rushing caused by assessment-driven behaviour and hunger led to errors. These errors led to demotivation and stress, emotions frequently experienced by operating surgeons [3]. Therefore, we have also demonstrated that VR TB simulation can successfully model several human factors commonly found in operating theatres which must be self-identified and prompt seeking senior support to prevent patient harm. This evidence should provide a springboard for future autoethnographic research in the field of surgical and simulation-based literature.

Ethics statement:

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

Surgical chest drain insertion is indicated in pneumothorax or haemothorax secondary to thoracic trauma. It is a mandatory emergency procedure that is incorporated as a part of the core medical training curriculum [1]. However, sparse training opportunities result in low clinician competency and increased risk of complications. While simulation training can offer a solution, the affordability of commercial models and hygiene and ethical implications of animal carcasses are significant limiting factors. The aim of this project is to build a reusable, high-fidelity, low-cost human chest cavity model excluding animal use for simulation-based teaching of surgical chest drain insertion.

Methods:

To construct the model, plaster gauze, metal wires and u-channel rubber trims were used to build a ribcage. Soy-protein-based sausage casing was used to create the pleural layers, and the muscles and subcutaneous fat were represented with ADAMgel (Aqueous Dietary fibre Antifreeze Mix gel), a novel material with tactility and dissection sensation similar to human soft tissue [2]. Synthetic chamois leather was used to represent skin. The resulting model allowed locating the safe triangle using anatomical landmarks, blunt dissection of muscles, pleural puncturing and advancement and suturing of the chest tube. The model cost less than £130, and it could be repaired after over 20 uses with less than £15. Verbal consent on study participation was obtained from all participants who performed chest drain insertion on the model and evaluated its fidelity and educational value using an anonymized Likert scale questionnaire. All questionnaire responses were converted to numerical values for data quantification, as shown in Table 1-A4.

Table 1-A4:

Median and range of questionnaire responses collected from study participants

Questionnaire item	Experienced clinicians	Inexperienced clinicians
	Median [range]	Median [range]
Model in general allowed learning of chest drainage techniques.	4 [1–5]	5 [4–5]
Model in general adequately resembles real-life patients.	4 [3–5]	3 [2–5]
If you have experience with other models: this model resembles real-life patients better than other simulation models.	4 [2–5]	3 [2–5]
Model is appropriate as simulation-based teaching material for inexperienced trainees.	4 [4–5]	4 [4–5]
I would recommend this learning tool to others.	4 [4–5]	5 [4–5]
I would use this model for teaching purposes.	4 [3–5]	N/A
Overall, I am satisfied with the training model.	4 [3–5]	5 [4–5]

Results:

Sixteen senior clinicians with multiple experience on chest drain insertion and 11 junior clinicians with limited experience took part in the study. Anatomical and haptic fidelity of the model was evaluated very highly amongst experienced clinicians. Junior doctors stated increased confidence in performing the procedure, overall assessing the model as an appropriate learning tool. Twenty participants with previous training experience compared the quality of this model to other commercial or animal-based models, and 18 rated this model to be of the same or superior quality.

Conclusion:

This chest cavity model is suitable for simulation training of chest drain insertion. Importantly, the model excluded the use of animals under the principle of replacing, refining and reducing animal use in research [3]. Further training opportunities that utilize this model can increase clinician competence in the procedure, which can improve clinical practice and reduce patient mortality.

Ethics statement:

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