Effective communication is a vital skill in healthcare, whether discussing sensitive or challenging topics, explaining decisions, supporting colleagues, welcoming staff, de-escalating situations, reviewing accolades and complaints or building rapport. Many people find it difficult to initiate, hold, conclude and follow-up conversations. Simulation-based education (SBE) has been identified as an effective way to improve communication skills, however, a structured communication skills framework is necessary. A plethora of established communication skills frameworks [1-3] exist, each excellent within their own sphere. Our purpose was to develop a generalizable, transferable framework to suit the broad range of communications covered in SBE; a framework which can be repeated, practised, and easily memorized.

Methods:

Experts in communication skills, healthcare education, and SBE reviewed existing communication skills frameworks. The new framework’s foundations were key skills, within every conversation, between healthcare professionals and colleagues, patients or relatives/carers, or between non-healthcare professionals and colleagues/clients. Thematic analysis of data from participants of sessions from the previous five years identified these themes:

Why, when, where and how to start a conversation

The best time to have a conversation

Showing empathy and listening (verbal and nonverbal skills)

Providing support, without being solution orientated

How to sense-check ourselves and others, after the conversation

The STEPS framework was developed two years ago and has been used by our facilitators in SBE, to assist participants to be confident in structuring and having conversations.

Results:

The five-step framework has a memorable mnemonic STEPS; Start, Time, Empathy, Provide-support, and Sense-check. STEPS has been well received by over 500 participants. They have reported that it is easy to remember and highly applicable to situations in and out of work. Post-intervention surveys showed significant improvement in learners’ confidence and perceived competence in holding conversations. Focus group discussions revealed that learners found the STEPS approach helpful in managing their own emotions and in creating an open dialogue with others.

Conclusion:

The STEPS approach is a generalizable communication skills framework that can be implemented in SBE activities to improve people’s understanding of structuring conversations. It has had a positive impact on participants particularly regarding their perceptions of having ‘challenging’ conversations. The STEPS approach can be used to guide healthcare and non-healthcare professionals in various settings and is a valuable tool in improving person-centred communication. STEPS helps people initiate, structure and navigate a conversation with kindness and in a way that makes constructive outcomes possible.

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 Clinical Education department at UHB has been running high fidelity simulation courses for undergraduates and postgraduates across three hospital sites for several years. Feedback from faculty and candidates has led to enhancement of all courses, yet a deliberate method of Quality Assurance (QA) was deemed requisite for educational governance, standardization and to attain accreditation with ASPiH.

Methods:

Drawing on ASPiH Standards [1], the departmental leads for simulation designed a framework with seven domains (Figure 1-A76) for this QA project with a view to also appraise novel simulation courses within the Trust. To minimize bias, details of how the domains were assessed, collection and analysis of data and generation of recommendations were performed by two Simulation Fellows who were new to the department, with no previous experience of attending or facilitating any of the courses.

Figure 1-A76:

The 7 domains used for quality assurance of simulation courses at UHB

Results:

Five undergraduate and four postgraduate courses were evaluated. Seven courses met or exceeded departmental standards in all seven domains, whilst the other two courses met or exceeded standards in six of the seven domains.

All courses had robust purposes, organization and resources at their disposal, which exceeded departmental expectations with their consistent focus on how human factors affect patient safety, and sound adherence to the relevant curricula and learning objectives. Scenario designs also incorporated a range of human and technological resources and moulage.

Despite an array of technology at the Trust’s disposal, its functioning did not always meet the departmental standards, with recurring audio difficulties and occasional software tethering issues. In response, microphone positions were changed, and the department’s Digital Innovation team consulted specialists to facilitate further improvements.

In the courses observed, debriefs were conducted in a holistic manner and candidate evaluation was always discussed. However, many courses lacked enough faculty members resulting in Objective Structured Assessments of Debriefing (OSADs) being performed infrequently. Swift changes were made, with a tightening of procedural behaviours within the courses, and a decision was taken for postgraduate courses to run with a minimum of four faculty members.

Conclusion:

This comprehensive QA process demonstrated that high-fidelity simulation courses at UHB are predominantly being delivered at a good standard. Some recommended changes have already been implemented for aspects found to be substandard, with implementation of additional changes planned at annual course reviews. Annual QA must then take place to guarantee maintenance of high standards and to provide a solid foundation for appraising novel simulation courses throughout the Trust.

Ethics statement:

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

The All Wales Simulation-Based Education and Training Strategy 2022 – 2027 specifies as one of its aims to promote quality assured simulation-based education and training across healthcare in Wales underpinned by standards and evaluated to ensure best practice in safe learning environments [1].

Methods:

The Simulation Team at Health Education and Improvement Wales (HEIW) has been working closely with the simulation community in Wales to identify their needs through iterative consultation during meetings, focussed discussions and webinars.

In 2021 stakeholders agreed that HEIW would promote the application of the Association for Simulated Practice in Healthcare (ASPiH) standards [2] and professional regulatory and statutory body standards relevant to SBET. Since then, a number of quality assurance tools as well as faculty development opportunities have been developed in order to embed these standards into simulation faculty development programmes and cascade their routine inclusion into everyday SBET practice.

Quality assurance (QA) resources developed by the Simulation Team at HEIW between August 2021 and February 2023 were packaged as the ‘Sim QA Bundle’ (Figure 1-A75) and presented to the simulation community in Wales in March 2023.

Figure 1-A75:

HEIW Simulation Quality Assurance Bundle

Results:

The ‘Sim QA Bundle’ consists of four components: 1.

Faculty development and continuous professional development (CPD): available resources include free access to the Essential Faculty Development Course, regular webinars, workshops and conferences.

Content development: guidance provided includes a standardized scenario scripting template, with links to relevant literature.

Content delivery: a standardized approach to debriefing has been developed which is supported by education opportunities and cognitive aids.

Evaluation tools: generic evaluation forms have been designed to assess the learners’ experience, faculty perspectives and adherence to standards.

Conclusion:

The Simulation Quality Assurance Bundle provides a wide range of resources available to simulation practitioners in order to promote and support the delivery of high-quality simulation-based education and training across the healthcare workforce in Wales.

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.

Recognizing and managing a deteriorating patient, in any setting, can be a challenging and distressing event for health care providers (HCPs). End of life care is a core component of nursing and medical education, yet historically has received minimal focus. Simulation Based Education (SBE) has been shown to be an effective tool for enhancing HCPs competence and confidence when involved with complex clinical scenarios and advocating patient-centred care [1]. The national drive to increase recognition and provision of timely, individualized end of life care is catalysing the need for multidisciplinary team education [2] [3].

Aim:

To design, deliver and modify SBE programme to enhance quality of patient care as they deteriorate. SBE will be utilized to achieve this by increasing both confidence and competence of a cohesive multidisciplinary team when involved in the care of deteriorating patients.

Activity:

Three SBE study days are held each year which are booked through an online portal. The sessions are facilitated by HCPs from intensive care, palliative medicine, and the practice development team. A handbook outlining SBE scenarios and learning objectives is distributed in advance, this pre-brief allows learners to prepare and understand the format of the day. The teaching day is structured with three clinical scenarios following a patient through different stages of their illness: initially an acute assessment and escalation, leading to consideration of individual treatment escalation plans and ultimately their end-of-life care. Learning through simulation is multifaceted through evidence-based role play, with observers as learners and collective debriefing through facilitated feedback after every scenario.

Findings:

Online feedback provided by all learners has been collated throughout the four-year course development process. Evaluations revealed three main themes; learners valued SBE in terms of replicating practice, de-briefing discussions consolidated learning and enabled learners the opportunity to understand how it will improve their practice and value was placed on multidisciplinary team learning.

Conclusion:

SBE is an effective method of enhancing the quality of individualized and coordinated care delivered to a deteriorating patient in any setting by HCPs. As an effective tool it also stands aligned with the national drive to improve recognition of patients at the end of their life with proactive advance care planning discussions and holistic care for the dying and their families.

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 two years prior to commencement of the project, data suggested that incidents related to patient safety were high on one Urgent Care Ward. Evidence also suggested that staff turnover and the number of junior staff in post were also higher than usual with little support available.

A series of monthly, clinical Simulation Based Education, (SBE) Sessions were held over eight months with the aim of allowing staff to practice, in a safe space, the specific clinical skills required to work in that environment ultimately resulting in safer patient care by increasing knowledge, skills and confidence, [1].

Activity:

Training consisted of monthly 3-hour sessions, 3 scenarios per session, each followed by a structured debriefing cementing understanding and learning. Scenarios were relevant to Urgent Care and as realistic as possible using High Fidelity Simulators.

A mixed methodology was used to collect qualitive and quantitative data over 11 months allowing for robust analysis, [2]. Pre and Post session Confidence Scales were completed by candidates as well as a feedback form to identify key learning points and to advise on the suitability. A comparison study was made, collecting patient safety data at the beginning and end of the project.

Findings:

26 candidates attended. 3 attended twice. Candidates were qualified and student Nurses and Health Care Assistants with varying levels of Urgent Care experience. Following sessions all candidates reported that they felt more confident managing deteriorating patients and that they felt more confident to summon assistance. They all reported that scenarios were relevant to practice. 65 learning points were identified with 7 common themes.

The most useful part of sessions was realism and relevance.

Patient Safety Data indicates some improvement in the number of reported incidents. Some variables could have influenced data and further study is required.

Results were positive and the project has been adopted throughout Urgent Care across the Trust to improve patient safety and retain staff

Conclusion:

The project aimed to improve patient safety by providing SBE to staff on one Urgent Care Ward. Analysis of data suggests there was some benefit to patient care and demonstrated a positive impact on staff confidence. It also identified key learning themes.

The educational program will be offered across the Trust and further study will enable more persuasive data.

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.

National Health Service England (NHSE) is committed to providing the highest quality, evidence-based and sustainable Technology Enhanced Learning (TEL) to the workforce of tomorrow [1]. Over the past 20 years, simulation-based education (SBE) facilities have developed across many NHS trusts, universities, and training programmes using different models of delivery and funding to match their local needs. More recently, technological advances and a pandemic-driven need for remote and supplementary training experiences has expanded the remit of TEL.

Our objective was to complete a wide-ranging census to map simulation and immersive learning (SimImm) resources across an entire NHSE region and how these are delivered. Most importantly, we aim to gather stakeholder opinions on the perceived challenges faced by the SimImm community in the coming 3-5 years.

Methods:

In December 2022, we launched a multi-phased regional online survey of SimImm providers. Phase one distribution included members of the two regional simulation networks. Phase two was distributed to simulation leads for postgraduate schools, training programmes and higher education institutions. Throughout, other stakeholders in the SimImm community had the opportunity to complete the ‘future challenges’ section only.

Results:

35 organizations had completed the full census, with a further 47 stakeholders completing the ‘future challenges’ section. Of the full census, 14 were secondary care simulation centres, 18 training programmes and 3 universities. The most common resources used were High-fidelity simulation (n = 28), simulated patients (n = 21) and advanced part-task simulators (n = 20). 15 organizations were delivering extended reality (XR) resources, with 6 delivering cadaveric simulation. Only 47% reported representation on regional simulation networks. 61% exclusively used faculty employed within their own organization, with 54% delivering in-house faculty development programmes. Most funding for course set-up and maintenance was derived from NHSE (formally HEE) through direct funding or the learning contract (formally SIFT/tariff). 22% had funding from NHS trusts for course maintenance.

Thematic analysis of the ‘future challenges’ section, revealed 5 primary areas of perceived challenges: Faculty development, maintenance, and retention; resources funding; collaborative working; strategy and equitable opportunities and adoption of new technology.

Conclusion:

Provisional results already demonstrate a huge variety of resources which are distributed widely across the region. Many of these are not necessarily in contact with regional simulation networks, particularly individual training programmes. The stakeholder opinions collated through this exercise will form the bedrock on which regional SimImm strategy and decision-making can be based.

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.

Educators and workforce planners appreciate that clinical skills development and simulation-based learning are key strategic responses to safe and effective service provision and a sustainable workforce. However, some simulation-based experiences require simulators costing tens of thousands of pounds. In order to promote a ‘Once for Scotland’ approach, collaboration is essential to encourage sustainability by enabling sharing of equipment, training materials, processes, procedures and faculty between boards. Although there have been other scoping exercises [1], we believe that this the first to take place at a national level. This scoping exercise aimed to:

Establish what equipment is available in the territorial health boards;

Clarify the types of skills-based courses being run across NHS Scotland;

Connect and encourage collaboration between simulation providers

Activity:

Information was gathered via Teams discussions and questionnaires. The responses were collated into Excel spreadsheets. These have been linked into an application to present the data in a more user-friendly manner online (Figure 1-A53).

Figure 1-A53:

Interactive map of simulation resources in Scotland

Findings:

Responses reveal that:

All health boards in Scotland have invested in simulation-based learning.

There is pioneering work with the establishment of medical and surgical bootcamps as well as national pharmacy simulation.

Additional work needs to be carried out to ensure that resources are invested wisely to areas of greatest need and that resources are shared within and between health boards.

It is clear where abundant simulation activities are taking place, as well as where there are gaps in equipment and faculty.

Conclusion:

Distribution of the information gathered will reduce duplication of effort, increase collaboration and encourage the sharing of equipment between health and social care workers across Scotland. It is hoped that this scoping project will support the creation of new relationships between people, not just for their mutual benefit, but for the benefit of the people of Scotland. The results are a first step to providing a detailed inventory of the resources available to help ensure best value for money. We hope to see an increase in the sharing of equipment across Scotland similar to the use of the NES surgical cut suit which was purchased by the Scottish Centre for Simulation and Clinical Human Factors and recently used by the simulation team at NHS Lothian to provide a multi-professional immersive paediatric training session. The plan is to update this database on a regular basis and to widen the results to incorporate all health boards as well as universities.

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.

Mistakes are an inherent learning opportunity within healthcare that can be used to prevent future loss of lives and reduce suffering. We aim to create a safe learning space within our organization that can be embedded within our quality improvement (QI) process.

Methods:

We have designed a bespoke framework (Figure 1-A30) to integrate our organizational QI process [1] with a 6-month iterative simulation programme. This utilizes multidisciplinary co-creation, embedded faculty development, and reflective practice to facilitate learning from each other.

Figure 1-A30:

Safe Interdepartmental Learning with a Quality Improvement Framework

Our tertiary hospital clinical governance team in collaboration with the multi-professional education, simulation, and patient safety departments has identified 5 topics based on the root cause analysis of serious clinical incidents. This description from our recent cohort involves the recruitment of 5 different specialty teams, each consisting of 1 experienced consultant faculty and 3 other facilitating clinicians with different levels of experience in healthcare simulation.

The teams prepared and designed the most suitable clinical scenario progression to address the learning objectives based on their allocated topics. Learner and peer feedback along with reflections on the session, highlighted possible change ideas to modify the subsequent scenario running. Over a period of 6 months, different learner sets were involved in the same simulation exercise with 2 further iterative modifications.

Results:

The 5 teams have generated a total of 15 hours of simulation sessions using standard pre-briefing, debriefing, and evidence-based simulation techniques. The level of independent facilitation and mentoring by more advanced debriefers has been adjusted to fit the individual pace of experiential learning. To further enhance the embedded faculty development a total of 270 minutes of online discussion, reflections, and 15 topics were presented by the facilitators to create a multi-professional learning experience. The content was structured to reflect the national outcome’s framework for faculty development and the ASPIH standards guidance for simulation-based education. The recorded simulation sessions, debriefing, and topic discussions have generated a useful asynchronous online reference for the current and future cohorts.

Conclusion:

The feasibility of implementing this simulation programme integrated with a QI framework is a major step for our future prospective evaluation of the impact of translational simulation as theorized in the current literature [2] on patient outcomes and healthcare performance indicators.

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 and clinical skills teaching are core elements of University programmes to underpin authentic practice learning for healthcare professionals. It is estimated that 1 bag of (non-infected) ‘clinical waste’ is produced per student group at each skills session for students in one year for the adult nursing programme at one University (504 bags) and increases when other programmes are included in the calculation. As the health sector is one of the largest emitters of carbon dioxide equivalents to the atmosphere [1], embedding environmental sustainability into professional healthcare education works towards the NHS England target of a NetZero health service by 2040 [2].

Waste from teaching sessions includes plastic gloves, aprons, dressing packs, syringes, solution vials and associated outer packaging etc., depending on the skills simulated. Most of this is not clinically infected although it is discarded in this way. Methods for the identification of interventions to reduce waste and procure services to enable recycling and reuse of waste elements are needed to raise awareness of the problem and potential solutions, thereby reducing the carbon footprint of clinical education. The aim of the presentation is to report a collaboration between Universities to increase sustainable practice in skills education through sharing experiences of teaching practice, whilst maintaining the authenticity of educational practice.

Activity:

Project methods include audits of the quantity and nature of clinical waste from taught sessions to identify waste reduction targets and explore alternative climate-friendly solutions; use of a Climate café to enhance collaboration with relevant stakeholder groups to raise awareness and action; and carbon foot printing analysis to identify points of action and measure change, drawing from the Sustainable quality improvement framework [3].

Findings:

Clinical waste audit findings will be described highlighting the carbon footprint impact and where sustainable improvements could be made. Key items that could be recycled, reused or managed through different disposal pathways will be identified with lessons for teaching and learning. Climate café qualitative data provide the perspectives of clinical skills teachers and simulation facilitators as well as student representatives. Potential cost savings will be estimated.

Conclusion:

Environmental sustainability is an emergency that needs prompt attention. The identification of the nature and amount of clinical waste from simulated education aids the strategic application of solutions to reduce, reuse and recycle key resources whilst maintaining the authenticity of clinical learning for students.

Ethics statement:

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

Gastroschisis is a congenital defect of the anterior abdominal wall characterized by the herniation of abdominal contents through a defect usually located to the right-side of the umbilical cord [1]. Team-working, collaboration and clear communication between the obstetric, neonatal, and paediatric surgical teams are critical to achieving optimal outcomes in gastrochisis [2]. A national cohort study of all surgical units in the UK and Ireland identified primary closure as the optimal surgical management for antenatally detected cases of simple gastroschisis [3].

A local retrospective audit in RBHSC identified a higher rate of staged gastroschisis repair in the last 10 years with 66% of patients requiring initial silo placement, when compared to 45% national average. Data also demonstrated that patient with silo placement took longer to achieve full feeds, prolonged TPN, delayed discharge, and increased complications rates.

Aims:

To create an interprofessional simulation programme for the preparation and management of a gastroschisis delivery, resuscitation, and initial stabilization. Aims of this project are to improve awareness of optimal stabilization management, efficiency of bowel wrapping and clear communication amongst the MDT with the overall goal of improving the rate of primary closure and outcomes in our unit.

Methods:

A gastroschisis simulation model was created using vegan-sausage casings, jelly, and food colouring to create the bowel. The simulation programme focused on; team education of optimal gastroschisis management, team and delivery room preparation, primary resuscitation and bowel wrapping with clingfilm. Following a lecture of gastroschisis management and demonstration of delivery room stabilization participants were divided into teams of five, given a scenario, asked to prepare equipment, allocate roles and work in sync to achieve effective resuscitation and stabilization of the new-born. Pre and Post simulation feedback was collected and course adapted using a PDSA cycle. For continued learning a post-course video for delivery room management of gastroschisis was created and available for everyone to reference at any time in any location.

Results:

Pre-simulation: 56% of participants had no previous training or clinical experience of the management of gastroschisis and 78% didn’t feel confident in providing delivery suite management and stabilization. 100% of attendees felt the simulation training improved their confidence of initial management and stabilization of gastroschisis and all would recommend this course to their peers.

Conclusion:

Simulation-based interdisciplinary team training can serve as a channel for the acquisition and maintenance of clinical skills. It is crucial to improving the management of complex neonatal conditions.

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 as a learning platform is recognized internationally as beneficial in terms of education, training and assessment of doctors [1,2]. This study aimed to introduce and evaluate a novel Palliative Medicine simulation session as a tool for Foundation Year 2 (FY2) doctors to gain competency and confidence in the assessment and management of life-limiting illness.

Methods:

We designed the palliative care (PC) simulation session based on the FY2 curriculum. The three scenarios involved management of opioid toxicity, breaking bad news and shared decision-making with a role-play patient with a gastrointestinal bleed. Session faculty included a mix of healthcare professionals, but always included a PC specialist.

We evaluated the session using a pre- and post-session questionnaire collecting data using 5-point Likert scales and free-text comments. We analysed qualitative data using content analysis. Researcher and methodological triangulation increased the credibility of the findings.

Results:

The three prevalent themes noted from the pre-content analysis were Communication, Prognostication and the Process of complex decision-making. Comments such as ‘Senior colleagues hesitant to have escalation discussions’ and ‘I find it difficult when the patient has a very different idea of how poorly they are’ were examples of quotes given by candidates as pre-session challenges. 95.6% of our candidates felt that the session addressed these challenges, mainly through the debrief process. The main learning points articulated were in relation to prescribing and communication skills. Candidates expressed the importance of ‘picking up communication techniques and phrases’. The debrief was the most highly valued, and frequently mentioned positive element of the content analysis. ‘Open discussions’ was mentioned on numerous occasions, ‘I felt comfortable asking questions’ and ‘Discussion after SIM was very useful’, all support the importance of skilled debrief.

Conclusion:

FY2 doctors identified communication as their biggest concern when managing Palliative Care patients. Our session addressed this through open and frank debrief discussion. This allowed reflection on previous experience and peer-to-peer learning of key vocabulary when talking to patients with a limited prognosis. Further qualitative evaluation of the impact of this session on clinical practice and how peer learning could be incorporated into day-to-day skills development on the wards would be of value.

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.