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

Activity:

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

Findings:

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

Conclusion:

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

Ethics statement:

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

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

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

Activity:

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

Findings:

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

Conclusion:

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

Ethics statement:

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

Simulation-based education (SBE) is one of the leading teaching methods in healthcare. Debriefing is the cornerstone of effective simulation-based medical education. Debriefing is considered vital part to learning from simulation, and for the transfer of learning so that it can be applied to other situations [1]. Feedback from four simulation faculty development days identified that debriefers lacked the confidence to address conflict or use the principles of civility to enhance their debriefs. Teaching which has structured debrief covering civility and human factors are the cornerstone to deliver sessions that instil confidence and patient safety within the organization [2]. Human factor principles that employ psychological safety were introduced in the debriefing course with the purpose of upskilling the debriefers.

Activity:

There are various models of debriefing however, the focus was to provide the three-phase conversation structure. The course covered human factor principles alongside debriefing techniques using the three-phase conversation structure and interactive workshops. We enlisted the services of a specialist human factor/civility lecturer, simulation lead and a simulation lecturer to deliver the course. At the end of the course, the participants had to undertake a debrief to consolidate their learning in a supportive environment and immediate evaluation was obtained using a structured questionnaire (see Table 1-A113).

Table 1-A113:

Evaluation themed responses

Themes emerged from the immediate evaluation feedback.	Well structured, relevant information. Lovely supportive facilitators. Human factors session was very insightful thank you. The flexibility to explore different approaches to feedback and practice. Learning about different debriefing formats.
Main themes from interviews	More scenarios to debrief during the session. Felt prepared to deal with challenges from seniors and learners. Definitely prepared me better from the faculty development course as this is more in depth of how to debrief.

Additionally, a pilot study of five participants who had attended the course were randomly selected for a face-to-face interview twenty-four hours after the course. Three open-ended questions were asked. These focussed on whether the application of psychological safety and human factors enhanced their debriefing skills and suggestions for further course development.

Findings:

The results highlighted the value of the inclusion of human factor principles. Both evaluation methods were positive. Attendees commented on the value-added to their simulation training and wanted these principles to be adapted as a structured course. Acknowledging the fact that the sample recruited was small and may not be statistically significant, a future study will include a bigger sample size.

Conclusion:

Currently, this is the only organization within the North-East of England that offers standalone debriefing course. There was an overwhelming demand for a course aimed at educators who are engaged in SBE with emphasis on debriefing to consolidate learners’ experience. This course is intended to be delivered to all educators across the North-East region and beyond.

Ethics statement:

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

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

Activity:

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

Scope of practice and autonomous practice

Professional judgement

Culture, equality, diversity and non-discriminatory practice

Confidentiality and professionalism

Team working

Communication skills, face to face and telephone

Safe practice environments

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

Findings:

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

Conclusion:

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

Ethics statement:

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

Choosing the right university and programme is crucial for aspiring nursing students and their families. With so many options available, it can be challenging to make an informed decision [1-3]. The aim of this initiative was to provide student nurse offer-holders and their parents/partners with an overview of the undergraduate nursing programme’s content, in an effort to encourage them to select the right university.

Activity:

The initiative was developed and conducted over six months (Dec 2022 - May 2023). It consisted of five Saturday morning sessions, each included taster lectures, clinical skills sessions, and simulations with actor role players. Offer-holders attended one rotation, while the parents/partners of offer-holders attended another rotation. The facilitated simulations were collaboratively designed by the University branch specialists and the education provider, and involved actor role players. In order to cover child, adult and mental health branches, for aspiring students, the scenario content was broad based and applicable to all. -

Scenario 1: Communication with relatives of a baby failing to thrive

Scenario 2: Communication with an adult patient and her husband

Both simulations were conducted as forum theatre and aligned with NHS values.

Findings:

Evaluation forms completed by potential nursing students and their parents/partners were overwhelmingly positive. Attendees reported that the sessions were informative and enjoyable, with the simulations being a particular highlight. The use of actor role players helped to make the simulations more realistic and engaging. Attendees felt that the sessions assisted them to better understand what to expect from the nursing programme, which would aid them in making a more informed decision about which university to choose.

Conclusion:

Offer holders and their families need to make an informed decision when choosing a nursing programme. The study showed that providing a comprehensive overview of the programme’s content through taster lectures, clinical skills sessions, and simulations can be an effective way to encourage students to select the right university. The use of actor role players in the simulations helped to create a realistic and engaging learning experience for attendees. Overall, this initiative highlights the importance of providing potential nursing students with the necessary information to make a decision about their education. By making an informed decision, the fit is likely to be right and the chances of attrition reduced. Further studies will be conducted by the university admissions teams to establish if these tasters assist with retention.

Ethics statement:

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

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

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

Activity:

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

Findings:

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

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

Conclusion:

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

Ethics statement:

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

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

Activity:

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

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

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

Findings:

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

Conclusion:

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

Ethics statement:

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

A local course has been delivered since 2018 to provide training in rare, time-critical, life-saving procedures that emergency medicine trainees may need to perform, including emergency lateral thoracotomy. Previously pig thoraxes have been used to provide thoracotomy training in this course. In 2022 a part-task model was purchased for thoracotomy training to replace this. We compare the use of this to animal models in our provision of simulation teaching of this skill.

Activity:

Animal models are useful due to availability, low cost, and provision of hands-on experience for learners. However, there are associated ethical, religious, psychological limitations with using animals for educational purposes. They may less accurately represent human anatomy and pathology. Their timely acquisition can pose a challenge with defrosting requirements and variable condition which can impact on the quality of training. There are infection risks due to fluid leakage, associated unpleasant odour and animal products require incineration for disposal.

The high-fidelity part-task mannequin can anatomically and physiologically replicate the thoracotomy experience to provide realistic simulation training. The mannequin is equipped with realistic external human features and internal organ anatomy, including a beating heat and blood, to provide an immersive training experience. It is reusable with repair, which could be cost-effective long term and more environmentally-friendly. This model enables thoracotomy skill practice in a safe, controlled environment without infection risk. Another advantage is the ability to provide standardized training, better allowing for objective evaluation of performance which can be challenging with animal models.

Findings:

This model (Figure 1-A108) has been a source of highly stimulating learning for both faculty and participants taking part in the course. The accurate anatomy has given an enhanced learning of real time simulated emergency requiring lateral thoracotomy and this has been reflected in participant feedback. There was a significant upfront cost which will depend on the continuation of the course, committed faculty and upkeep of the model to prove it cost-effective in the long run. The education team attended a course on the repair and maintenance of the model and it takes approximately 4-6hours to clean and repair the model after each use. The model requires a large heavy box for safe storage posing a relative burden given its infrequent use.

Figure 1-A108:

The immersive lateral thoracotomy model we are using, which is fully repairable to be used multiple times for authentic learner experience

Conclusion:

There are disadvantages to use of this model for the department, but the overall learning experience and sustainability is felt to be superior to animal models for training in emergency thoracotomy.

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 significant variation of foundation programme tracks across the United Kingdom, giving a range of clinical exposure to newly qualified doctors [1]. Common themes in tracks can be identified to include acute/emergency, community, general medicine, surgery and psychiatry components. In the deanery, many Foundation Trainees (FTs) on psychiatry will have up to 3 additional simulation days devoted to psychiatry themes and this is felt to be an especially effective way to supplement education on psychiatry consultation skills [2]. FTs who do not have psychiatry posts will not have the opportunity to attend this training. Typically, mandatory foundation simulation training focuses on human factors related to acute medical and surgical problems [3]. Our education department has developed a pilot programme to support simulation training on key mental health consultations to support well rounded training of FTs.

Activity:

Half day sessions have been delivered to small groups of FTs who do not have psychiatry posts. Faculty has included experienced simulation faculty and psychiatry doctors and the scenarios conducted in a small group format with professional actors playing patients for increased realism of scenarios. The participants rotated between 3 key scenarios covering essential themes of mental state examination, psychiatry team liaison, patient risk assessment and explaining mental health presentations.

Findings:

2 sessions have been delivered for a total of 18 FTs. FTs showed insight to a number of challenges related to mental health presentations they had experienced outside of psychiatric settings and this formed the outline of the learning objectives for the session. The participants further reflected on discussions in their feedback from the session and portfolio. The sessions were well received, with improvement in confidence in managing these consultations demonstrated in pre and post course survey comparison from the majority of participants. Given the initial success of the session, the team is building a database of local faculty for continuity of the course and looking to secure relevant funding from HEE to provide further sessions for the FTs in the next academic year.

Conclusion:

This simulation pilot has shown promise to be a useful addition to supplement the education of FTs for mental health consultations applicable in all areas of their clinical 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.

Final year medical students are often anxious about commencing foundation training and feel underprepared for the practical responsibilities they are expected to conduct independently [1]. Consequently, a full day programme was created to facilitate immersive simulation of a typical working day of a Foundation Year 1 (FY1) doctor.

Aim: To provide an enriching programme empowering final year medical students to experience the practical aspects of foundation training (including areas of expressed difficulty), whilst creating a safe and realistic learning environment and providing opportunities for interprofessional learning and near-peer teaching.

Methods:

Junior doctors from FY1s to Medical Registrars delivered the programme’s content. In the morning, three interprofessional simulation scenarios were delivered to the medical students and included nursing students for added realism. Each scenario reflected common ward-based and acute-setting situations that had minimal coverage in their undergraduate curricula. Afternoon stations were created to attenuate the medical students’ anxieties about the aspects of foundation training they perceived as difficult. Using a simulated ward, a mock handover was conducted. Students were then expected to complete the tasks of death verification, complex prescribing and female catheterization. The other stations simulated interpreting blood results, discussions with a microbiologist and requesting and discussing radiological imaging. During completion of all stations, the medical students carried and answered a bleep mimicking realistic distractions. Morning and afternoon debriefing occurred in small groups.

Results:

Following programme completion, all the medical students (n = 21) felt more confident in assessing deteriorating patients, escalating to a senior and felt better prepared to commence foundation training. Though not statistically significant (p = 0.2), confidence to commence foundation training and preparedness to perform the clinical and practical responsibilities of an FY1 quadrupled. In addition, over 50% of the medical students felt better able to independently prioritize clinical tasks and undertake complex prescribing on completion of this programme. Qualitative data suggested the medical students found the morning of interprofessional learning (IPL) invaluable and sought future IPL opportunities as they felt this made the programme even more realistic of working life. Furthermore, students felt the programme created a safe learning environment and was relevant in their preparation for foundation training as they felt more confident and better prepared to troubleshoot and apply their knowledge in unknown clinical situations.

Conclusion:

‘FY1 for a day’ is an effective and sustainable educational programme to potently prepare final year medical students for their foundation training whilst safeguarding psychological safety and fortifying multidisciplinary relationships.

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.

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.

Within health care provision many case history assessments are now performed online [1], with students expected to utilize a variety of virtual platforms in a safe, effective and professional manner.

Aim: To approximate a real environment for students to practice virtual skills of case history assessment with service users.

Objectives: Student development of: 1. Virtual communication skills (verbal, non-verbal, active listening, respect), 2. Clinical reasoning and interpretation, and 3. Reflective skills facilitated by debrief.

Activity:

Simulation preparation including revision of musculoskeletal assessment and familiarization with virtual ground rules linked to HCPC Guidance on Conduct and Ethics [2].

42 students participated, split into groups of 14 for each virtual simulation session with a total of 5 service users briefed beforehand. Initial warm-up activities in breakout rooms were used to familiarize students with use of the online platform and to facilitate virtual communication skills. Groups of 4 students planned and undertook a virtual musculoskeletal case history with a service user.

The Diamond structure for simulation debrief [3] was facilitated by Faculty staff involving the service users and peers; enabling further development of the students’ clinical reasoning and interpretation. Students reflected on their own performance using a simulation checklist as a resource, closing the loop by creating an action plan prior to their first practice placement.

Findings:

25 students voluntarily completed an anonymous questionnaire linked to their virtual experiential learning activity. 75% strongly agreed and 21% agreed that the simulation was helpful in their development for placements (see Figure 1-A122).

Figure 1-A104:

Graph to show student response that virtual musculoskeletal simulation with service users was helpful in their development for placements

Thematic analysis of good aspects of the activity identified 4 main themes: 1.

Benefits and realism of service user involvement compared to actors or peers

Development of virtual communication and assessment skills

Richness of involvement of service users in the debrief

Usefulness of warm up activities using virtual technology

Suggestions for improvement showed 2 main themes around increasing planning time and more opportunities for simulation with service users.

Findings demonstrated the simulation aims and objectives were met with students positively reporting that the activity was helpful in their learning ahead of practice placements - enabling development of virtual communication, clinical reasoning/ interpretation and reflection through debrief.

Conclusion:

Approximation of a real environment for students to practice virtual case history assessment incorporating service users offers a rich educational example that aligns well with practice and sustainability in the current healthcare environment and is highly valued by 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.

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.

Electronic patient record (EPR) systems are increasingly prevalent in clinical settings, yet UK medical simulation training continues to use outdated paper-based methods for training healthcare staff. While published literature has highlighted the training benefits of incorporating EPRs into medical simulation training [1, 2], the transition has previously been hampered by a lack of bespoke software. To address this, a novel educational EPR (named SimEPR) was created, a bespoke training software designed to be used on a computer at the manikin’s bedside, which features customizable clinical scenarios (Figure 1-A102).

Figure 1-A102:

A preview of SimEPR, a novel educational electronic patient record system designed for UK medical simulation training

Aim:

This project aimed to incorporate SimEPR into routine medical simulation training in the South East of England, and report trainee experience using the software.

Activity:

Feedback data was collected from trainees who used SimEPR as part of their simulation training using an electronic feedback form. SimEPR was initially deployed in a medical school and two NHS trusts from 11th February 2021, before the project was scaled up to six additional educational centres (one university and five NHS trusts) from 3rd January 2023.

Findings:

Data from 209 trainees was collected, of which 16% were medical students, 82% were foundation doctors and 2% were post-foundation doctors. Out of these, 86% reported that, compared to using paper notes, the educational EPR created a more realistic training experience. Meanwhile, 83% reported that the use of SimEPR helped improve their clinical learning. Last, 87% reported that they would recommend the simulation department to continue using SimEPR.

Conclusion:

SimEPR is the first software of its kind designed specifically for UK medical education, and is the product of collaboration with a number of simulation leads and NHS-affiliated organizations. As well as data supporting a higher fidelity training experience, SimEPR incorporates digital skills into practical training, thus supporting the development of a digitally-ready workforce. In addition, by eliminating the use of paper, SimEPR contributes to the sustainable delivery of simulation-based education. Further evaluation work as part of this pioneering regional project aims to collect pre- and post-training feedback, feedback from medical educators and feedback from other healthcare disciplines.

In the longer term, SimEPR offers to transform the delivery of simulation training for the NHS workforce. The software’s ‘scenario-sharing’ function allows sharing of simulated patient records between institutions, supporting the standardization of training while saving staff time in building training scenarios. Furthermore, features such as performance analytics for trainee feedback, and AI technology to generate interactive scenarios, are being explored.

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.

Transfer medicine is evolving into a more visible, necessary sub-specialty, particularly since the COVID-19 pandemic, during which the need for proficiency in critical care transfers became apparent. As such, there exists a requirement for the provision of good training in this domain, especially for effective simulation-based learning given the dynamic nature of critical transfers, in tandem with the relative scarcity of experience of the average non-specialist practitioner.

The creation of meaningful simulation training is already well recognized as posing numerous challenges [1], often in balancing fidelity with practicality, for achieving engagement of learners and transfer of learning to practice [2]. When adding the dynamism involved in a transfer - such that simulation requires movement of a critically monitored patient from one point to another - this task becomes more complex. Importantly, the integrity of the exercise is lost when provided in a stationary environment, as with much simulation traditionally. This was the focus when designing the Adult Critical Transfer Simulation (ACTS) course - a multi-disciplinary team-based day with pre-course e-learning, focused around assorted simulated scenarios performed in motion across an education suite. Additionally, it incorporates reflexive debriefing, interactive workshops and group discussion sessions to support learning.

Activity:

The greatest technical challenge of ACTS - modified repeatedly now over two years - was the delivery of mobile, multi-environment scenarios that provide an equivocal experience to that of traditional, stationary lab-based simulation. This was addressed utilizing wireless, remotely controlled patient models and monitoring alongside a network of strategically placed cameras and microphones to provide immersive simulation for both active and observing participants. In addition, considerable attention was given to audio-visual cues at all points of transition for creating the ambience of a moving transfer, the efficacy of which is reflected in positive course feedback.

Results:

Feedback on ACTS was collated from all participants, with significantly favourable responses in every domain and 100% overall score of 5/5 for both enjoyment and recommendation, and 93.8% score of 5/5 for relevance to professional needs (Figure 1-A101). Positive comments were most numerous regarding realism and engagement of the experience, and faculty expertise, with additional commentary strongly supporting recommendation to other professionals and anticipation for continued provision.

Figure 1-A101:

Feedback from participants of the 2023 Winter run

Conclusion:

Although there is no substitute for real-life experience, ACTS has demonstrated multi-disciplinary need for critical transfer proficiency can be met successfully through the provision of dynamic simulation when facilitated by technology, with great scope for future development given the rapidly advancing nature of technological resources.

Ethics statement:

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

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

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

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

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

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

Activity:

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

Figure 1-A100:

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

Findings:

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

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

Conclusion:

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

Ethics statement:

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

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

Activity:

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

Findings:

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

Conclusion:

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

Ethics statement:

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

Following an investigation where ten times the amount of prescribed insulin was given to a patient during the administration of treatment for hyperkalaemia, learning needs were identified. It was from this incident outcome that the aim for this project arose.

Aim:

Create a hypokalaemia simulation that can be delivered trust wide with only one facilitator.

Activity:

The simulation was run on the medical wards that the staff were familiar with to allow us to identify policies and process gaps as well as learning needs.

The simulation only required two registered nurses and with the debriefing session usually took around 40 minutes. This limits the impact on busy wards allowing for safe staffing levels to be maintained. Simulation incident forms were completed for each session to highlight and raise awareness of identified learning points to both ward managers and local governance leads.

Findings:

The first error that impacted the simulation was the spelling effecting the access to treatment guidelines contained within a Trust policy. The Trust we work for is proud to be multinational, and we found that the majority of our colleagues that have received education oversees used the more widely recognized spelling in Europe of hyperkalemia. This was escalated and the second spelling was added as a keyword, after this change the problem was not repeated in subsequent simulations. It led to further reviews of Trust policies and has driven a change in keywords within the policy portfolio.

The second and third errors were around lack policy and treatment flowchart awareness and poor knowledge on how to navigate the intranet to find policies. Although the participants in the simulation left with a good awareness of the policy and practices accessing the policy and flowchart during the session, it had become apparent that this was a wider Trust issue. Therefore, communication posters were made to highlight the policy and treatment flowchart for hyperkalaemia. Using a QR code staff could play a short video showing how to access the Trust policies from the intranet page after the sessions.

Conclusion:

Future plans include collaboratively using simulation to test systems and highlight learning points for other incidents or errors that arise throughout the Trust. Also, we look to utilize Dynamic QR codes [1] that allow for the content connect to the QR code to be updated without the poster having to be reprinted and laminated allowing for a live document.

Ethics statement:

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

An assessment of mental capacity involves determining if a person can make a decision, or whether this needs to be done in their best interests [1]. The Mental Capacity Act (MCA) 2005, provides a legal framework that protects people who might not be able to make decisions for themselves and guides professionals during their practice. Research has shown inconsistencies on how the Mental Capacity Act is applied in health and social care settings [2], therefore ensuring that professionals have are provided with the right support to confidently apply the act should be a priority. Simulation has been effectively used in healthcare education [3] and could also be implemented to support this area of practice. The Homerton Healthcare NHS Foundation Trust’s Simulation Team and Adult Safeguarding Team, jointly worked in developing a simulation-based session which focused on mental capacity assessments in different situations. The aim of these sessions was to increase participants’ confidence to assess mental capacity and to manage challenging conversations during assessment.

Activity:

Scenarios were designed for hospital and community settings, the topics covered included consent to treatment, self-discharge, compliance with treatment, substance misuse, mental health problems, dementia and learning disability. The target audience was senior healthcare professionals that are regularly involved in making decisions related to mental capacity. Scenarios were designed to be flexible and adaptable according to the attendants’ needs, for example the learning disability scenarios involved the use of easy read information that was specifically provided or created. Actors were used for the role of patients or relatives, and members of the adult safeguarding team were part of the faculty to support or lead the debrief process.

Findings:

Between January 2023 and February 2023, the faculty delivered 3 sessions, with a total of 20 participants from different professional groups including doctors, nurses and allied health professionals. Anonymous feedback was collected at the end of each session, with 84.62% (n = 13) of respondents reporting their confidence in assessing mental capacity had increased. This led to gaining funding to continue delivering more sessions in 2023.

Conclusion:

Studies have shown that healthcare professionals’ confidence in applying the mental capacity act can vary [2]. Solely focusing on traditional forms of education might not be enough to prepare our workforce, in this case simulation-based training has provided a valuable tool to enhance participant’s abilities in relation to the mental capacity act and its application in healthcare 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.

Delayed discharges are a challenge in every hospital. The Scottish Government are ‘committed to significantly reducing the number of people who are waiting to move from hospital wards to more appropriate settings [1]. This transformative simulation has been designed for all multidisciplinary team members involved in a patient’s care to engage in discharge planning; and to ‘respond to health service needs [2]. This simulation was created to break down barriers between acute and community care, reduce silo mentality and share the decision-making and risk around discharge.

Aims:

Empower any member of staff to have discharge conversations.

Emphasis on early discharge conversations.

Join up acute and community staff involved in the discharge process.

Activity:

The simulation involves a three-hour session with three scenarios. The session has run in both acute and community hospitals. Participants are multidisciplinary, and have included doctors, nurses, allied-health professionals (AHP), flow team, carers representatives, social workers, social care staff, home care staff and NHS Education for Scotland (NES) staff. The participants, in pairs, have a simulated conversation with a patient’s relative about discharge. The learning objectives from the scenarios are around realistic medicine, managing risk and dealing with anxious families.

To assess the immediate impact of the simulation, participants complete a pre-simulation questionnaire on arrival and a post-simulation questionnaire at the end of the session.

Findings:

The results were from the pilot session pre and post simulation questionnaires in March 2023. Participants (n = 10) were asked ‘How would you rate your willingness to have discharge conversations with patients/family members?’ before the simulation the mean rating was 3.8 out of 5. Following the simulation, the participants were asked ‘To what extent does this training empower you to have discharge conversations?’ and the mean rating was 4.7 out of 5. This demonstrates that the simulation increased willingness and empowerment to have discharge conversations.

Prior to the simulation participants were asked ‘What makes it difficult to have these conversations?’ Themes from the qualitative answers were family expectations and managing uncertainty, both of which were learning objectives in the scenarios.

Conclusion:

Our participant feedback has shown that this Discharge without Delay Simulation has ‘made discharge everyone’s business.’ This simulation can provide transformative change to help healthcare professionals have early discharge conversations. This provides better patient-centred care by returning the patient to a homely environment, to reduce delayed discharges and increase patient safety.

Ethics statement:

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

It is well established that familiarization with the simulation environment is integral to the pre-brief [1]. This fosters psychological safety and creates optimal learning conditions for participants and faculty. We sought to enrich our visitors’ psychological safety by providing a digital preview of our simulated environment, prior to the face-to-face familiarization they receive when attending a course.

Activity:

Combining 360 and 2D video production techniques we have produced an online experience hosted on the CenarioVR platform. This gives visitors an opportunity to explore the simulated environment, patient and equipment, in their own time, while introducing aspects of the fiction contract. We believe accessibility is key to the utilization of this resource. So we have ensured it can be used on a range of devices including:

Virtual Reality Headsets (HTC/Meta)

Desktops/ Laptops

Mobiles/ Tablets (enhanced with accelerometer controls)

The content is cloud-based and accessed via an internet browser across all platforms, requiring no additional app. One limitation is that the experience requires a stable internet connection.

Findings:

A link to the tour was embedded in our pre-simulation communication to participants and faculty, and its usage and impact was evaluated over a period of 2 months using additional questions in our post-course questionnaire. 50 feedback responses to CenarioVR were received. 24 delegates viewed it 26 did not. Of the 24 that viewed 58.3% agreed virtual tour strengthened their experience, 12.5% strongly agreed, 20.8% neutral, 4.2% disagreed and 4.2% strongly disagreed.

Conclusion:

From our data we concluded that over 70% of delegates that viewed the virtual familiarization found it to be beneficial to their simulation experience. With simulation being used more in education it is imperative that those with less experience in this setting are provided with resources they need to feel psychologically safe.

Ethics statement:

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

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

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

Activity:

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

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

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

Findings:

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

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

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

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

Conclusion:

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

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

Ethics statement:

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

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

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

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

Address recent clinical incidents

Practice managing common medical emergencies as a multidisciplinary team

Build a greater sense of team between the ACU staff.

Activity:

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

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

Findings:

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

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

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

Conclusion:

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

Ethics statement:

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

Following the introduction of the ‘IMT3’ year as part of Internal Medicine Training in 2019, a ‘Step-Up’ simulation day was developed in 2021. Positive feedback from candidates reflected its usefulness in preparing to work as a medical registrar [1]. The scenarios were conducted with the subsequent cohort of IMT3 doctors and feedback assessed for sustained quality of training.

Simulation is recognized as an important tool in medical education [2]. It is now specified by the Royal College of Physicians that trainees participate in simulation inclusive of human factors and scenario training [3].

Activity:

The ‘Step-Up’ simulation day continues to consist of four progressive, high-fidelity scenarios that replicate a day in the life of a medical registrar. Each scenario occurs in the simulation lab for individual candidates, with peers observing via video-link in the debrief room.

Each scenario requires the candidate to perform a medical assessment of an acutely unwell patient, facilitated by use of the computerized manikin (SimMan Essential), whilst simultaneously tackling difficult conversations with a live actor and managing interruptions from a bleep. Participants also had the opportunity to lead simulated cardiac arrests with peers forming the cardiac arrest team.

Debrief and teaching continued to be provided by a qualified simulation facilitator alongside a specialist registrar or consultant. Feedback provision was moved to an online format and accessed via a QR code to be more environmentally conscious and to readily allow analysis and storage for future comparison. In order to assess sustained quality, the same five aspects of the day were assessed by participants on a ten-point Likert scale: relevance, pitch, clarity, usefulness and overall quality. Scores of 1 reflected strong disagreement and 10 of strong agreement. Free text feedback allowed candidates to suggest topics for future sessions or identify valuable learning points.

Findings:

Thirteen IMT3 or equivalent doctors participated in this round of ‘Step-Up’ simulation with 100% feedback rate. As in previous rounds median and modal scores were 10 in all 5 domains, ranging from 7 to 10. Free text feedback recorded multiple requests for further simulation sessions.

Conclusion:

‘Step-Up’ simulation was demonstrated previously to be a useful tool in progression to IMT3. Overall quality and usefulness were sustained year-on-year and simulated challenging discussions were highly valued by participants.

Therefore, this programme will continue for future cohorts, with ongoing monitoring of sustained quality and development of new scenarios to provide increased frequency of simulation training.

Ethics statement:

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

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.

The COVID-19 pandemic has undoubtedly served as a catalyst for adaptation of effective delivery of medical education, paving the way for the adoption of novel teaching methods [1]. Simulation based education (SBE) has been no exception, with increased delivery of SBE through immersive, virtual mediums such as head mounted displays (HMD) to create a three-dimensional (3D) environment.

Simulation is a vital part of the mandatory foundation programme (FP) learning requirement [2]. Our team incorporated synchronous in-person and online virtual reality simulation (VRS) sessions into the foundation doctor (FD) teaching programme at a single trust and supplemented this with additional, facilitated in-person small group 3D VRS sessions.

Methods:

Mixed quantitative and qualitative feedback was obtained from FD through online surveys, which included aspects of the SET-M tool [3]. Semi-structured interviews were then conducted with a purposeful group of FD attending facilitated small group VRS sessions. Interviews were conducted over a sixteen-week period at eight-weekly intervals, with a baseline interview conducted at week zero. Qualitative data obtained were analysed by thematic analysis.

Results:

Learners expressed that VRS sessions improved their confidence in clinical assessment, decision-making, and management of similar real-life scenarios as well as in the provision of interventions which foster patient safety. Moreover, feedback highlighted that the VRS modality fits well into their current teaching programme, is a format that they wanted more regularly incorporated into their learning and one which they would prioritize attendance at. Feedback also outlined some challenges with this modality; namely accessibility and technological troubleshooting.

Conclusion:

Our work highlights the value and associated challenges of using VRS in FP education. There is a strongly positive reception amongst learners in our cohort, a call for more exposure and, vitally, a transferability of learning into real-life 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.

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

Activity:

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

Findings:

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

Conclusion:

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

Ethics statement:

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

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

Activity:

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

Findings:

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

Conclusion:

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

Ethics statement:

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

The role of the paramedic is diversifying, and universities need to respond by developing curriculums that support paramedic graduates to meet future workforce needs. Placements are key to our students developing the necessary competencies to become qualified paramedics and the pressure is on universities to offer a wide range of placements to reflect professional diversification. In addition, Health and Care Professions Council’s new standards of proficiency acknowledge that paramedics of the future are likely to consult patients in the virtual world [1].

As universities strive to meet this demand, they are often faced with placement capacity issues. Rising student numbers, staff retention issues and competition for placements from other healthcare students can make it extremely challenging to secure placements, especially in desirable areas such as primary care.

Activity:

The author, with the support from colleagues, was successful in obtaining funding from Health Education England to pilot a series of live virtual placement experiences, the first of which was successfully delivered on 20th April. On this date, 30 learners from our paramedic degree apprenticeship programme, in a classroom on our Lancaster campus, virtually attended a live clinic in a primary care setting in the south of England. The clinic was rigged with various cameras and microphones, with real patients consenting to being filmed.

The experience comprised of 5 patients, with the lead clinician providing a brief to the learners before each patient arrived for their consultation. Afterwards, the clinician would complete their clinical documentation before engaging in a two-way conversation with our learners and academic staff via Microsoft teams. Following the clinic, our apprentices had the opportunity to consolidate their learning via case study driven seminars which linked to the mornings experience.

Findings:

Overall, student feedback was supportive, with the majority stating they found the experience enjoyable and engaging. The video stream of the placement was recorded for reuse in the programme’s curriculum, and we hope that future live virtual placements will see other professions, such as physiotherapy and nursing, take part. Eventually, we want to develop the model for other disciplines and placement settings

Conclusion:

The academic team are looking forward to the second of three experiences, in May, with the view to contributing to the growing evidence base in this area, to reflect the value that we believe ‘Live Virtual Placement’ experiences have in the development of our future workforce.

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.

The World Health Organization (WHO) Framework for Action on Interprofessional Education and Collaborative Practice (2010), states ‘Interprofessional education occurs when two or more professionals learn about, from and with each other to enable effective collaboration and improve health outcomes’ [1]. When healthcare students enter the practice workplace, they are required to work in an interprofessional team and make collaborative decisions to provide safe and effective patient care. With the increasing complexity of patient presentation, increase in life expectancy and disability years coupled with the challenges of resource and delivery within the healthcare system it is vital that practitioners have solid foundational skills in interprofessional working.

To facilitate this healthcare educators are being required to think of innovative, authentic and contemptuous pedagogical tools to demonstrate interprofessional working, collaboration and interdisciplinary role awareness.

Activity:

To provide healthcare students with meaningful exposure to interpersonal working educators at Birmingham City University embarked on the design and delivery of a live simulated patient case conference. To promote authenticity the case conference was designed (with consent) around a living patient (Jake) with complex medical and social needs. A team of healthcare educators each took the roles of clinicians from both health, social and tertiary care service. A round table discussion was held related to Jakes’s inpatient care and decisions regarding hospital discharge. Jake has quadriplegic cerebral palsy and substantial medical, social and occupational needs. Jake’s mum is also present, demonstrating the need to have patient and carer collaboration. The session was observed live by students but also filmed and edited into an ongoing simulation learning resource with both clinical and non-clinical learning objectives. A facilitated debrief was held after the session.

Findings:

Feedback and anecdotal analysis of the session showed greater student engagement and understanding of the needs for interprofessional collaboration when discussing patient care and decision-making. The use of a real and living patient meant students could immerse themselves in Jake’s story and feel true empathy with his clinical case. For some students’ knowledge of interprofessional working and the roles of other disciplines proves a challenging concept to master.

Conclusion:

It is feasible and effective to utilize simulation (live and virtual) as a method of teaching hard to grasp but vital concepts of healthcare practice including interprofessional working and interdisciplinary role awareness.

Ethics statement:

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

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

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

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

Activity:

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

Findings:

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

Conclusion:

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

Ethics statement:

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

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.

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

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

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

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

Activity:

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

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

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

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

Results:

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

Table 1-A82:

Summary of the student questionnaire results

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

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

Conclusion:

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

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

Ethics statement:

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

Advance Choice Documents (ACDs) are one of the important upcoming reforms to the Mental Health Act in the UK [1]. The aim of the document is to allow service users greater autonomy when they are well, to make decisions and guide what happens if they become unwell in the future. It is created by a service user and clinician in a shared decision-making process.

Maudsley Learning (ML) collaborated with an Institute of Psychiatry, Psychology and Neuroscience research team to provide a co-produced simulation day for service users, carers and clinicians. The aim was for participants to be able to gain a greater understanding of how to co-produce and implement ACDs.

Methods:

ML ran two separate simulation days, alongside, members of the research team including a lawyer and facilitator with lived experience.

The initial part of the day included didactic teaching; allowing participants to learn more about ACDs and have a space to ask questions from those with lived experience, clinicians and lawyers. This ensured participants gained a baseline level of knowledge to undertake the scenarios.

There were four simulation scenarios written, but only three took place on both days because of limited time. These revolved around one patient; the participants followed the patient through their ACD journey. The patient was played by an actor. All scenarios were designed to involve a clinician, often with the presence of a carer and service user as well.

The debrief consisted of a modified Pendleton model with feedback from service user, carers and clinicians to allow feedback and learning from all involved.

Results:

Participants were asked to complete a pre-course and post-course questionnaire. Paired samples t-tests were conducted to analyse the difference between pre- and post-course questionnaires. Results demonstrated a significant difference in scores for course-specific questions between the pre (M = 3.17, SD = 0.81) and post (M = 4.21, SD = 0.20), t(5) = -5.26, p <.05, 95% CI [-1.55, -0.53], with a large effect size of d = -2.15. 100% of participants would recommend this course.

Conclusion:

This was the first simulation that ML has run with a mixed group of learners that included not only clinicians, but also service users and carers taking part in the simulation and debrief. The feedback was positive and helped to improve the knowledge around ACD’s. It was also noticeable the positive difference it made having clinicians, service users and carers learning from one another.

Ethics statement:

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

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

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

Activity:

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

Findings:

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

Conclusion:

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

Ethics statement:

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

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.

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 gap between imagined and realized healthcare practice is indisputable. For trainees who rotate between departments, the challenges of navigating complex healthcare systems are unmet by standard induction programmes [1,2]. Our simulation centre and orthopaedic department collaborated to create an enhanced departmental induction using immersive simulation.

Activity:

Following a thorough needs assessment for new trainees rotating to trauma and orthopaedics. We looked at previous trainee feedback, adverse event data from our safeguarding reporting system, and expert opinion from orthopaedic staff. It became clear that at times of transition, the process of accessing timely and appropriate support was challenging. Furthermore, there were a myriad of clinical duties and patient cohorts covered by the trauma team. Working within this dynamic and complex structure was difficult for new trainees. We used team-informed process mapping to define the escalation systems in place, and the distinct roles within the team.

We identified key learning objectives for a simulation induction session. We used a case vignette of an unwell trauma patient and aligned the scenario design to the required learning objectives on clear escalation pathways and whole team working within a complex environment.

Findings:

Following a successful pilot run, this enhanced induction is routinely delivered four monthly for junior doctors rotating to the orthopaedic department. Current trainees, orthopaedic consultants, and senior managers also attend this trainee induction as an open forum for dialogue on service improvements. All participants have rated these sessions as good or excellent; they value the whole team approach and repeatedly ask for further simulation sessions. Feedback from other members of the trauma team following these sessions commented on increased connection within the team, which included junior trainees attending departmental meetings. The orthopaedic team also felt that, following the induction programme, new trainees had demonstrated improved handover skills when escalating unwell patients.

Conclusion:

This whole team simulation-enhanced approach to orthopaedic induction is novel, and in contrast to the majority of standardized induction programmes [3]. This work provides a template that can be applied to different healthcare systems. By delivering constructively aligned simulation sessions, we can improve team training and enable new trainees to flourish during periods of transition.

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.

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

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

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

Activity:

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

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

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

Findings:

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

Table 1-A74:

Evaluation themes with supporting examples

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

Conclusion:

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

Ethics statement:

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

Acknowledgements:

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

Uncertainty is a prevalent concept within medicine, intrinsic to clinical decision-making. Managing uncertainty can be challenging, especially in specialties (i.e. General Practice) where unclear diagnoses are common. This has resulted in curriculums for such specialities introducing teaching on managing uncertainty [1]. With poor tolerance of uncertainty associated with negative outcomes in medical students [2], there is a strong argument that medical schools need to prepare students to manage uncertainty. Uncertainty simulation cases have been utilized to achieve immersive teaching on uncertainty [3], however this is limited by the resources made available by simulation departments, restricting the potential reach of this transformative learning.

Aim: To deliver an immersive teaching programme for medical students that develops skills in managing uncertainty within a minimal resource environment.

Activity:

8 teaching sessions with 46 students were facilitated, which involved students rotating through a circuit of 5 simulated General Practice consultation stations. Students firstly performed the station and then acted as the patient for the next candidate in a continuous cycle (Figure 1-A73). Feedback was provided after each station. The station cases introduced elements of uncertainty ranging from diagnostic, management or closing/safety-netting. Feedback was collected after each session assessing confidence in managing uncertainty and GP scenarios.

Figure 1-A73:

Circuit Rotation Design – Students started the circuit acting as either the doctor or patient for stations 1-5. After each 10-minute station, there were two minutes for feedback. Students then rotated in a clockwise direction becoming the patient for the station they had previously performed or performing a new station. The students continued to rotate according to this carousel circuit design until they had performed and examined all five stations

Findings:

Students responded positively to the teaching programme, rating its provision of confidence in managing uncertainty and managing GP scenarios (real and OSCE) as >95%. Enjoyment of the sessions was rated at 97% with main aspects being: variety of stations and interactivity. Usefulness of the sessions was rated at 98% with main aspects being: chance to practice, range of cases, receiving feedback. Simulations of GP consultations were rated as highly representative; this was achieved with minimal resources.

Conclusion:

This teaching programme developed medical students’ confidence and skills in managing uncertainty. They also felt better prepared for managing patients in a GP setting. Critical to the success of this programme was the enjoyment and perceived usefulness of the teaching, as this improved engagement with the learning outcomes. With the cohort being final year students that were integrating knowledge from previous clinical years, we hypothesize that the usefulness was due to students wanting to focus more on revision and opportunities to develop skills in managing less commonly taught but clinically important abstract concepts, such as managing uncertainty. Further programmes should expand on the simulated environments (ED, medical/surgical on-calls) and managing other clinically important abstract concepts (confrontations, prioritization, errors).

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.

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

Activity:

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

Findings:

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

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

SEIPS based scenario design proforma

Course introduction with a human factors workshop

Incivility workshop

Technical teaching aid for debriefing

Human factors teaching tools

Pre- and post-course evaluation

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

Conclusion:

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

Ethics statement:

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

Simulation is integral to the recovery of surgical training in the UK after the COVID pandemic. Physical constraints on traditional simulation training can affect access. We sought to understand if cardiac and thoracic simulation training remotely is feasible and effective. It has been demonstrated in other settings and has potential in the surgical setting [1].

Methods:

We completed simulation training sessions using the Teams and Zoom online platforms with single one on one and group simulation training sessions covering Video-assisted-thoracoscopic-surgery wedge resections and lobectomy as well as coronary anastomosis.

Results:

We had 15 participants in the thoracic arm and 5 participants over 4 sessions in the cardiac arm. All participants found the remote simulation training useful and improved their confidence in surgical skill. We did not have any technical connection difficulties during sessions but challenges for simulation in this format included standardizing the equipment and setup pre-sessions. Participants found in 89% of cases that feedback on performance was superior to face to face simulation and/or surgical theatre experience.

Conclusion:

Remote simulation is feasible and effective in cardiothoracic surgery in our pilot study. Further studies are needed to better clarify who this resource should be targeted at included experience of trainees and level of competence.

Ethics statement:

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

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

Activity:

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

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

Resources:

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

Findings:

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

Conclusion:

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

Ethics statement:

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

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.

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.

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

Activity:

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

Findings:

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

Figure 1-A62:

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

Conclusion:

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

Ethics statement:

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

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

Methods:

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

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

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

Results:

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

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

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

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

Conclusion:

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

Ethics statement:

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

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.

Traditionally small pieces of equipment (e.g. Zimmer frame, commode, toilet frame and raise and walking sticks) required for frail older people in their home environment are ordered by Allied Health Professionals who are highly skilled in ensuring safety and functionality of the chosen item. However, the problem is that this process can sometimes take up to six months due to backlogs in the system. This means the person is living with unacceptable risk within their own home and losing the ability to perform activities of daily living (ADLs). This could also potentially result in falls and hospital admissions with the subsequent increase in morbidity and mortality.

The team working within social care are often the referrers into this service and we wondered if the use of simulation-based mastery learning which has been shown to allow safe successful dissemination of skills in other areas of health and social care could be used to enable home care teams to safely, timeously and appropriately order small pieces of equipment autonomously [1]?

Activity:

Using the 7-stage approach to SBML, Checklists allowing the safe acquisition of small pieces of equipment aiding ADLs were developed by our trained mastery learning facilitators (senior AHPs). Sessions were delivered to a wide range home care team members. The training was delivered using mastery-based learning approach.

We believe that this is the only example of the use of SBML in the social care environment and are really excited about the safety benefits and the way SBML enables a person-centred approach to social care [2]. The SBML training and the train the trainers will be continued to be disseminated and we will continue to evaluate the impact both on practitioners, the time it takes to get a piece of equipment and also rates of falls and admissions to hospital.

Findings:

The feedback from the sessions reflects the massive benefit perceived from the participants in the way their new ability will transform the way they can support people in their homes: •

We can’t believe this is happening it will make such a difference to our practice and the care we can deliver to our clients in their own home

I never thought the day would come

Conclusion:

We will continue to assess impact on home care teams especially whether this added enhanced role aids joy at work.

Ethics statement:

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

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

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

Aim:

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

Methods:

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

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

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

Results:

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

Table 1-A57:

Results of pre- and post-intervention knowledge assessment

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

Conclusion:

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

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

Ethics statement:

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

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

Activity:

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

Findings:

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

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

Conclusion:

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

Ethics statement:

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

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

Activity:

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

Findings:

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

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

Facilitators have been so kind and knowledgeable.

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

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

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

Immersive and interactive.

Conclusion:

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

Ethics statement:

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

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

Activity:

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

Results:

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

Conclusion:

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

Ethics statement:

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

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.

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

Activity:

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

Figure 1-A52:

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

Findings:

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

Conclusion:

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

Ethics statement:

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

High-consequence infectious diseases (HCID) are pathogens which spread easily between people, have high mortality rates, and lack effective treatment [1]. Examples include Ebola and Lassa fever. Most emerging pandemics, including COVID-19, are initially classified as HCID.

Assessment of patients with suspected HCID infection is an advanced procedural skill requiring application of enhanced infection control measures including patient isolation, personal protective equipment, and decontamination. There is a risk of healthcare worker infection if procedures are not followed [2]. HCID often present in non-specialist centres; there is a need for an accessible, educationally effective HCID course for NHS staff.

Activity:

We developed a course for clinicians in infectious disease and emergency medicine, in collaboration with the Health & Safety Executive and clinicians in the UK-HCID network. The course uses a blended approach; theoretical components are taught with online learning. Practical components are taught with high-fidelity, multidisciplinary simulation using VIOLET, a mannequin which coughs, vomits and sweats ultraviolet markers (Figure 1-A51) [3]. This simulates airborne, contact and fomite transmission, allowing visualization and debrief of contamination before and after PPE removal. Training culminates in summative assessment. Educational effectiveness was evaluated through curriculum-linked pre- and post-course tests, and self-rated confidence using Likert scales.

Figure 1-A51:

Ultraviolet tracers are used to replicate contact and airborne transmission of infectious pathogens in simulation scenarios

Findings:

Between 01/12/22 and 01/04/23, 57 specialized clinicians participated. All participants passed post-course competency-based practical assessments. Participants demonstrated significant gains in knowledge between pre- and post-course tests (mean score 61% vs. 83%, p = <0.0001). Pre-course, 36% (19/53) of learners reported feeling confident or very confident at PPE donning and doffing, rising to 97% (32/33) post-course. All participants rated their learning experience as high or very high quality.

Conclusion:

This is the first HCID simulation course internationally using ultraviolet markers to allow visualization of contamination. The course appears to be an effective educational intervention and improves learner confidence in PPE use.

Ethics statement:

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

As a human-factors focused simulation centre, we begin all our simulation courses with a human factors workshop introducing participants to the SEIPS model of human factors [1]. This enables them to explore systems-based impacts on clinical practice during post-scenario debriefs. However, we have noticed that some participants struggle to identify and discuss human factor themes which impact on them in their workplace. We aimed to develop an innovative teaching aid which would promote participant understanding and engagement.

Activity:

Previous experience has provided evidence that participants enjoy simulation games. Therefore, we chose to develop a table-top game to play with participants based on the SEIPS work system. We worked with interprofessional colleagues to identify factors that help and hinder processes in the work system and categorized them under SEIPS headings. We made a series of cards based on these factors which participants collect. The winner was the person who collected a helpful card for each SEIPS heading first.

Findings:

We have piloted our SEIPS game with interprofessional faculty, including those with specialist expertise in human factors in healthcare. We surveyed participants to obtain feedback. Survey results so far include data contained in Table 1-A50, and the following participant comments:

‘Play’ is a kinaesthetic way of learning and helps embed ideas and thinking. It also can create opportunities for discussion on different headings for human factors and systems thinking.

The examples are fun but are also realistic so helps you see how HF is relevant. With the examples of human factors in the game it could be useful for staff with little clinical experience.

Liked the competitive element and the examples helped expand on what SEIPS was and how it could be relevant to lots of areas.

Table 1-A50:

SEIPS game participant survey results

100% of participants enjoyed playing the SEIPS game.

100% of participants felt the SEIPS game could increase participants understanding of human factors in healthcare.

100% of participants felt the SEIPS game could help participants identify human factors impacts on their own work system.

Conclusion:

We have developed a SEIPS game to facilitate discussion of human factors in healthcare. This novel approach has received positive initial feedback following our pilot. We are confident we can now move forward to integrate our SEIPS game into our Foundation Doctor’s simulation programme from August 2023. Following this, we intend to continue the process of data collection and analysis, with the intention of incorporating our SEIPS game more widely across simulation courses within various clinical specialties in future.

Ethics statement:

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

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.

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

Activity:

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

Findings:

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

Conclusion:

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

Ethics statement:

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

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

Methods:

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

Results:

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

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

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

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

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

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

Conclusion:

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

Ethics statement:

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

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

Aims:

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

Methods:

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

Results:

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

Conclusion:

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

Ethics statement:

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

Climate change is considered one of the most pressing global concerns for the future and the single biggest health threat [1]. Healthcare delivery is a major contributor to the climate crisis, producing 4.4% of net carbon global emissions today [2]. One of the largest contributors to NHS carbon emissions is the use of equipment, consumables and clinical care itself [2]. Therefore, clinical staff have a significant part to play in reducing carbon emissions and achieving national carbon reduction targets. However, they must be carbon literate and understand the impact of personal practice on global carbon emissions and be able to identify ways to deliver low carbon models of care [3]. Simulation could play a significant role in educating and developing sustainable practice in healthcare students through a system thinking approach. Allowing students to examine the environmental impact of healthcare delivery and support innovative solutions to reduce carbon emissions without compromising care.

The aim was to firstly increase nursing students’ awareness of the carbon emissions from the delivery of patient care. Secondly to improve clinical decision-making in the selection and implementation of interventions to enable the delivery of low carbon care.

Activity:

Undergraduate nursing students took part in a specifically designed simulation scenario. Students completed the scenario of a patient presenting to the Emergency Department with exacerbation of Chronic Obstructive Pulmonary Disease (COPD), implementing care and interventions as clinically indicated. After completion of the simulation students then calculated the carbon emissions from the clinical resources they used, using the Centre for Sustainable Healthcare carbon emissions calculation.

Findings:

Debriefing identified that students did not consider sustainability and carbon emissions in their current clinical decision-making. Students were shocked by the amount of carbon emissions generated from interventions. Students identified areas where they could reduce carbon emissions without compromising care such as inappropriate use of gloves, using dry powdered inhalers, and reducing unnecessary cannulation.

Conclusion:

Simulation could play a pivotal role in developing sustainable clinical decision-making skills in healthcare students and staff. Actively calculating carbon emissions allows students to directly see the environmental impact of their practice, increasing carbon literacy and stimulating low carbon care practice. This use of simulation should be explored further by educators across professions to support both national and global climate change policies.

Ethics statement:

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

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

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

Activity:

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

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

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

Findings:

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

Conclusion:

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

Ethics statement:

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

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.

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

Methods:

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

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

Results:

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

Conclusion:

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

Ethics statement:

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

Severe disruptions have plagued Myanmar’s undergraduate and postgraduate medical education – firstly with the Covid-19 pandemic and later with a military coup d’état in February 2021. In the wake of the current humanitarian and political crisis, many medical students partaking in civil disobedience have been driven underground for fear of retribution. Foregoing bedside teaching and crucial clinical learning opportunities in hospitals – for online education through teleconferencing and live broadcast via social media. To scale up these efforts the Global Health Education Group’s (GHEG) novel XR platform was piloted to provide remote clinical experiences streamed to Myanmar students with the help of diaspora doctors and virtual patients in the UK [1].

Methods:

The pilot held over a 4-day period in February comprised 4 Virtual Clinical Experience (VCE) sessions each covering two simulated patient scenarios related to the following disciplines: Medicine, Surgery, Obstetrics and Gynaecology, and Paediatrics. Each session had an introductory, consultation, and debrief phase that ran for 1.5 – 2 hours altogether. This was held on GHEG’s newly developed Virtual CP platform [2], which enabled the students to view a live stream of the consultation with the patient-actor through the clinician’s smart glasses and provided the opportunity for real-time interaction.

Results:

The sessions were successfully delivered to 400 students from across 5 Myanmar Universities. The student’s satisfaction was assessed using an anonymous feedback form that was disseminated; a total of 38 responses was obtained which was overwhelmingly positive. 76.3% of the respondents rated the session to be ‘helpful’ or ‘extremely helpful’ and 68.4% rated the session to be representative of a real clinical experience. On a scale out of 10, 57.8% of respondents rated the VCE platform a 6 and above on ease of use. Technical difficulties did arise affecting 68.4% of respondents, although free text feedback purported they were promptly addressed in subsequent sessions.

Conclusion:

Synchronous remote learning through virtual clinical experiences can be used to address the dearth of clinical opportunities afforded to medical students in Myanmar.

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.

Traditionally the focus of simulation has been centred on clinical management. More recently there has been a drive to enhance training on ‘human factors’ [1]. In simulation, human factors can be challenging to replicate, particularly with regards to how individuals interact within a system.

At GSTT we introduced a concept known as ‘social GRACES’ into simulation training. Social GRACES, first described by John Burnham in 1992 [2], outline a framework to understand an individual’s personal and social identity.

An abundance of research into the development of human factors skills exists in the literature. Our aim was to integrate social GRACES into our simulation programme as a novel approach to engage trainees with human factors.

Methods:

Between October 2022- April 2023, there were 23 full-day simulation training days. The course started with an introduction on human factors and the social GRACES. This was followed by a ‘lost at sea’ activity where trainees worked individually and in teams to prioritize the items they would take if lost at sea. This was followed by 4 clinical scenarios with debriefs related to clinical management, human factors and social GRACES. Pre and post course questionnaires were disseminated, and delegates were consented for data being used for quality improvement. Unique identifiers allowed for paired data analysis.

Results:

101 pre-course and 138 post-course feedback forms were received. To allow for paired analysis, only completion of both questionnaires was included, leaving 83 responses. There was a statistically significant increase in the percentage of responders who strongly agreed they felt confident in recognizing (7.2%-35.2%), assessing (15.7%-43.4%), managing (3.6%-20.5%) and escalating care (15.7%-35%), in acutely unwell patients. Additionally, confidence improved in understanding the impact of human factors in delivering care (9.6%-35%) and the performance of healthcare professionals (9.6%-39.8%). We explored confidence with regards to the practical implementation of human factors in healthcare (Table 1-A40).

Table 1-A40:

10 questions were devised to assess confidence relating to practical aspects of human factors in healthcare with regards to teamwork, communication, and leadership. Following paired data analysis, we found a statistically significant improvement in confidence in all areas investigated.

Question – On a scale of 1-10 rate your confidence in: -	Pre course	Post course	p value
Constructively managing others’ negative emotions at work	6.1	7.8	<0.001
Requesting help from colleagues in other professions	8.0	8.6	<0.001
Communicating effectively with a colleague with whom you disagree	5.9	7.6	<0.001
Prioritizing when many things are happening at once	6.2	7.9	<0.001
Speaking up as part of a team to convey what you think is going on	6.2	8.2	<0.001
Involving colleagues in your decision-making process	7.4	8.3	<0.001
Dealing with uncertainty in your decision-making process	6.0	7.5	<0.001
Asking other team members for the information I need during a busy ward environment	6.8	8.0	<0.001
Recognizing when you should take on a leadership role	6.0	7.9	<0.001
Monitoring the ‘big picture’ during a complex clinical situation	5.8	7.7	<0.001
Anticipating what will happen next in clinical situations	5.7	7.6	<0.001
Working effectively with a new team in clinical situations	6.6	8.1	<0.001

Conclusion:

The results demonstrate that the interplay between managing acute clinical scenarios & human factors can effectively be taught through simulation and enhanced with an understanding of social GRACES.

An increased understanding of human factors and simulation training was useful in improving 3 crucial skills; teamwork, communication and leadership, which are instrumental in improving clinician confidence and patient outcomes.

Future direction should look to include awareness and implementation of human factors within mainstream simulation to effectively replicate real time clinical scenarios & pressures.

Ethics statement:

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

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

Methods:

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

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

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

Results:

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

Conclusion:

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

Ethics statement:

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

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

Methods:

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

Results:

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

Conclusion:

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

Ethics statement:

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

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

Methods:

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

Results:

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

Figure 1-A37:

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

Conclusion:

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

Ethics statement:

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

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

Activity:

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

Findings:

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

Conclusion:

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

Ethics statement:

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

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

Methods:

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

Results:

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

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

Figure 1-A35:

Summary of infographic for SUIT ward

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

Conclusion:

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

Ethics statement:

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

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.

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

Methods:

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

Session 1: Informal conversation, talking about yourself

Session 2: Voicing opinions and interpretations, acknowledging mistakes

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

Session 4: Public speaking, dealing with conflict

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

Results:

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

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

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

Conclusion:

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

Ethics statement:

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

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.

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

Methods:

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

Results:

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

Conclusion:

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

Ethics statement:

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

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.

UK-based doctors in training have faced major disruption, loss of training opportunities and increased risk of burnout due to covid-19 [1,2]. Furthermore, the intensified post-covid strain on services continues to hamper efforts to restore training. A bottom-up review across departments at both of our sites revealed demand across specialties and grades for increased simulated training opportunities. Further highlighting the need for additional simulation programmes, simulated training has recently been demonstrated to reduce risk of burnout [3]. To restore lost learning opportunities, improve morale and promote team cohesion, we began a project to embed simulated training at a departmental level. A key aim of this project was to give departments ownership of their simulation programmes, to promote autonomy, tutor upskilling and sustainability.

Methods:

We systematically reviewed the curricula for all specialties with doctors-in-training across our two sites in order to establish how training needs could be met with simulation. Consultant ‘simulation lead’ positions were offered to consultants in each department. Following this, we met with each assigned simulation lead to perform a scoping exercise - thus establishing specific training needs and opportunities within each department. The medical education team used this information to support each department to develop its own simulated training programme and support its delivery.

Crucially, unlike many simulated training opportunities, our programme is not tied to a particular training scheme nor does it incur any fees. This allows equal access to the programme for both locally employed doctors and Health Education England trainees.

Results:

We worked with 13 departments in developing simulation-based training programmes. Eight departments had a single lead identified, three shared lead positions and in two departments no consultants assumed the position of lead.

Experience and enthusiasm varied by department. In departments where a simulation lead was not identified, the education department has supported other team members such as Clinical Nurse Specialists and specialty registrars to devise and deliver sim-based training.

Anonymized Microsoft Forms based post-course questionnaire responses completed by 42 participants to date have been overwhelmingly positive (outlined in Figure 1-A29). Notably, learners have found the sessions improved both technical and non-technical skills, as well as providing learning not replicated elsewhere.

Fig 1-A29:

Percentage of attendees rating the following areas as ‘agree’ or ‘strongly agree’

Conclusion:

Our scheme has led to embedding of effective simulated training programmes across specialties at our sites, leading to sustainably improved training opportunities for post graduate doctors in the post covid era.

Ethics statement:

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

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

Methods:

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

Results:

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

Conclusion:

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

Ethics statement:

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

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.

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

Methods:

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

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

Results:

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

Figure 1-A26:

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

Conclusion:

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

Ethics statement:

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

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

Activity:

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

Findings:

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

Conclusion:

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

Ethics statement:

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

The cost of developing simulation-based education (SBE) facilities is high. However, the cost of sustaining SBE activities is often not considered in the initial outlay and facilities and centres can find themselves in financial difficulty early on. In addition to the cost of the initial capital and technology costs, there are many other costs incurred when running and sustaining SBE programmes. These are often not apparent or considered by simulationists when establishing new programmes. Research to date has focused on cost effectiveness and a return on investment [1]. However, the sustainability of a SBE programme is related to the ability to meet these costs. The aim of this work is to develop a simulation cost calculator that considered all costs incurred in skills programme development.

Methods:

Following consultation with experienced simulation faculty, the finance office, human resources and buildings office and equipment providers, a cost calculator template was devised to categorize the items required for SBE. The template allows for the calculation of the cost of teaching a procedural skill per person based on the total cost of all of the items in the template plus the number of attempts required for teaching and/or assessment.

Results:

The cost calculator categories for procedural skills teaching in a simulated environment included recurrent costs such as heating, light and cleaning of the simulation space/facility, consumables, single use simulators, fixed equipment/initial outlay, waste disposal, depreciation costs and staff costs. To illustrate, the calculated cost for a bowel anastomosis workshop using biological materials is approx. €235 per person while the equipment cost for a basic skill such as venepuncture is €161.17.

Conclusion:

Adequate resourcing is critical to establish, run and sustain SBE programmes. A cost calculator template will help new facilities to project their budget requirements and to decide what skills education they can support and sustain long term.

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.

COVID-19 created pressure on healthcare institutions to quickly prepare for maximum capacities. To meet the critical care capacity challenges, non-critical care nurses and overseas short-term temporary contracted nurses needed to be urgently deployed to the critical care units. That quick deployment and recruitment process raised concern about competence and patient safety; therefore, the deployed nurses were upskilled using fast track simulation-based education (SBE). SBE is an effective method to manage quick, focussed upskilling training, helping to improve patient care and safety ^[1].

Aim:

The aim of the study was to explore the effectiveness of the COVID-19 SBE upskilling program on perceived satisfaction, confidence and competence of deployed nurses.

Method:

Upskilling of 1200 non-critical care nurses was conducted using SBE between 14 March and 1 June 2021 during the country’s second wave of COVID-19. Training consisted of completing a mandatory 2-hour online critical care introductory module that included information on COVID-19 (the disease, pathophysiology), the critical care environment, critical care scope of service and infection control strategies. The online module was followed by 4 hours of in-person SBE using a demonstration and return demonstration approach. Considering the urgency of the situation and time constraints, skills were selected and prioritized according to patient safety and included care of the patient receiving mechanical ventilation, invasive line monitoring and care, recognition of deterioration, proning, and assessment of patient response to interventions. Post SBE, a survey was administered to collect data on the perceived satisfaction, confidence and competence of the nurses being deployed.

Results:

The majority of the nurses reported confidence in their new skills (97%), while 96% perceived themselves as competent after successful completion of SBEs. The nurses were highly satisfied with the training effectiveness (92%), and 99% believed that they were able to successfully achieve the learning objectives. Specifics about perceived competence and confidence per survey item will be reported in the presentation. The SBE upskilling programme was evaluated as an effective way to learn how to manage critically ill patients.

Implications for practice:

Nurses perceived themselves as confident and competent after participating in SBE. However, competence confirmation will be evaluated either in further SBE or through actual competency assessment in the clinical setting by trained competency validators. Nurses could perceive themselves as confident and competent but still perform incorrectly. Fast track SBEs should not be used to confirm full competence due to the inability to provide repetition of skills practice.

A medical negligence trial can be stressful for all involved and may be the first time in a courtroom for many health professionals. To provide students with the opportunity to learn from, with and about each other, the Mock Trial was established as an annual collaborative learning event between a local law school and our university-affiliated Office for IPE (Inter-professional Education). In 2021, Mock Trial was conducted virtually to continue high-quality IPE throughout the COVID-19 pandemic.

Aims:

The aims of the study were to establish the efficacy of translation of a large-scale inter-professional malpractice Mock Trial simulation to the virtual platform and to determine whether this will be a useful modality once social distancing restrictions ease.

Method:

The virtual simulation was structured using the brief-simulation-debrief model. Students participated as jury members via Zoom. A simulated courtroom held 11 participants of the trial (one judge, four law students [two defence, two prosecutions], five witnesses and one administrator) and was broadcast in real time to students. The learners first heard the case (opening statements, Plaintiff’s case, Defendant’s case, closing statements and jury instructions) before moving to IP jury break-out rooms with facilitator supervision to deliberate a verdict. Verdicts were delivered in the main room, followed by a debriefing. All students completed a pre-/post-questionnaire, including the Interprofessional Collaborative Competency Attainment Survey (ICCAS) and evaluation of simulation methodology, Mock Trial structure/content and overall impression. To assess efficacy, we compared student evaluations from 2018 and 2019 (in-person events) to those from 2021 (virtual).

Results:

A total of 179 learners participated in three in-person Mock Trials; 143 attended the virtual offering. The virtual event included learners from 19 professions from 4 institutions and 12 facilitators. Evaluations assessed IPEC competencies. For the virtual Mock Trial, learners (96%) strongly agreed/agreed that ‘this activity demonstrated the value of IP collaborative practice to prevent malpractice lawsuits’ and 97% felt that this was a valuable educational activity. Representative qualitative data include: ‘as a law student it was interesting to see what laypeople take away from evidence…’, ‘watching the process provided insight into the litigation process’, ‘the most valuable experience is hearing other people’s perspective’.

Implications for practice:

Large-scale virtual simulation events such as a Mock Trial are feasible and provide a valuable inter-professional learning experience. Student feedback demonstrates that gaining insight from different perspectives is a meaningful part of the experience. Incorporation of large-scale simulation events post-pandemic can increase accessibility to foster IP learning on a wider scale.

The COVID-19 vaccine hubs required rapid implantation. While organizations had plans as part of the emergency resilience response to the community, there were particular challenges for setting up and running vaccine hubs for COVID-19 that Human Factors and Ergonomic practices could help to identify and address prior to opening as a vaccine hub.

Aims:

The aim of the study was to assist with understanding the abilities of vaccinators and design of processes for the vaccine service at Dartford and Gravesham NHS Trust.

Method:

Simulation, observation, semi-structured interviews and Hierarchical Task Analysis (HTA) were used to understand the complexity of the vaccinator role and potential challenges for the implementation of the vaccine service. This was then used in identifying an area that could meet the capacity requirements identified and to help design the process and flow through the vaccine hub.

Results:

The work undertaken was used to identify and design the processes required to deliver the vaccine service. This in turn helped to identify the space required and, due to changes in practice following potential reactions to the Pfizer BioNTech vaccine ^[1], develop the process within the identified footprint. The process developed went into operation in late December and ran largely as designed throughout its operating life delivering first and second dose vaccines to trust staff and the wider keyworker community while community sites were identified and developed for mass vaccine hubs.

Implications for practice:

Using simulation and HFE processes as part of a collaborative process with staff trained with these skills can help to design safer, more effective processes in healthcare.

Human factors are essential to patient and staff safety, particularly during the COVID-19 pandemic with redeployment of staff to different roles in unfamiliar environments ^[1]. With concerns that the second pandemic wave would engender greater pressures on general medical wards, the simulation team at a London teaching hospital set out to create a multi-disciplinary educational programme for ward staff caring for COVID-19 patients. The course, planned for face-to-face delivery, was rapidly converted to online simulation at the height of the pandemic.

Aim:

The aim of the study was to ascertain the efficacy of converting face-to-face simulation and debriefing into online asynchronous video-based scenarios and debriefing, to enhance understanding of human factors skills.

Method:

In October 2020, a half-day simulation course commenced. Due to suspension of face-to-face teaching in December 2020 with COVID-19 cases rising, this was converted into a half-day online format through filming faculty participating in the existing scenarios. These films were shown to participants, followed by asynchronous online debriefing via Microsoft Teams. Both formats had e-learning as a pre-requisite. Data were collected using pre- and post-session questionnaires containing the Human Factors Skills for Healthcare Instrument (HuFSHI) ^[2]. Learners who attended both formats were excluded from quantitative analysis.

Results:

Post-training, staff demonstrated improvement in self-efficacy of human factors skills for healthcare. There was no statistical significance between mean improvements for both formats; the greatest improvement was split equally (Table 1). 100% found the face-to-face (N = 24) useful, versus 98% online (N = 54). Communication was the skill most learnt (face-to-face 58%, online 65%), with teamwork (face-to-face 50%, online 48%), escalation (face-to-face 42%, online 57%) and self-care (face-to-face 38%, online 19%) also frequently mentioned. Aspect’s learners’ thought were good included the discussion-based element (face-to-face 50%, online 37%), interactivity (face-to-face 13%, online 31%), multi-disciplinary team involvement (face-to-face 13%, online 20%) and videos for the online format (19%). 21% wanted the face-to-face longer, 15% wanted the online shorter. 9% would rather the online was face-to-face.

Implications for practice:

Online asynchronous debriefing produced similar outcomes to face-to-face for teaching human factors. We posit that this was because the videos were not ‘best practice’ – thus stimulating learning conversations, which accessed learners’ frames and past experiences. Challenges for faculty included: pace and volume of sessions, managing psychological safety, emotive discussions, screen fatigue, and technical aspects. A 6-month follow-up survey is planned and will be included in the presentation. Further work is required to understand why the results were similar.

As part of the national COVID-19 response, an NHS Nightingale Hospital was established for our region. An initial cohort of patients was admitted with resource allocation, demanding that limitation of care be clearly defined, including avoidance of invasive ventilation. Within weeks, an increasing bed capacity need drove preparation to admit patients who might require escalation to mechanical ventilation. This shift in admission criteria demanded significant change to the hospital’s service provision, including the ability to stabilize and transfer critically ill patients from this satellite location to an acute partner trust ^[1].

Aim:

The aim of this study was to perform a rapid, prospective analysis of the critical care patient pathway and surrounding environment at a novel Nightingale Hospital using high-fidelity simulation.

Method:

Following a need assessment and discussion with stakeholders, in situ simulation was undertaken using a Hal® (Gaumard) manikin with a multi-disciplinary team. The immersive scenario, requiring intubation of a deteriorating COVID-19 patient, was undertaken in real time, debriefed and then repeated to assess interventional safety improvements. A demonstration video narrative was produced as a learning aid for dissemination to all supporting staff who may be involved with this clinical scenario, potentially at short notice.

Results:

The internal environment and infrastructure were adequate to perform the task. A significant number of latent threats were identified and actioned during the simulation (Table 1). Qualitative feedback demonstrated that simulation was a useful and effective experience to increase confidence in performing this high-risk procedure in a remote location. Feedback on the video was positive and it was approved for dissemination to staff who may be involved in managing these patients.

Table 1:

Latent threats found at the Exeter Nightingale hospital during simulated intubation of a critically unwell COVID-19 patient

Domain	Latent threat	Action
Safety	Intubation checklist	Adopted and amended by members of the visiting teams. A video was created for demonstration purposes.
Equipment	Unfamiliar ventilators Breathing circuits incompatible Arterial lines Central lines Sterile packs Pressure bags Ultrasound probe covers Sterile gloves Theatre hats Tapered high-volume low-pressure endotracheal tubes, with integrated above cuff suction port Size 3 face masks Yanker suckers CPAP masks compatible with the ‘Jenny’ ventilator	A training video for use on the ventilator was made with information sought from the company representative. Boxes were unpacked and checked. Any additional equipment requested by the team was documented and ordered. Nightingale clinical lead informed of the extra requirements.
Drugs	Lack of critical care drugs	Intensivist involved with the investing team liaised with the Nightingale pharmacist to order any additional drugs.
General	Equipment unchecked and boxed identified.	The team unpacked and checked equipment and set it up for clinical use.
Staffing	Requirements for operation department practitioners, anaesthetists on near standby Transfer to the main hospital site	Transfer simulation planned with the ambulance service to test the multi-disciplinary components. The clinical lead was informed of the findings.
Resource planning	Ability to manage patients prone at the remote site	Staffing requirements were reported back to Nightingale lead consultant

Implications for practice:

In situ simulation with a high-fidelity manikin proved to be a useful and reproducible tool in developing and testing the systems involved in managing critical care patients at a novel hospital. In accurately simulating a real-time clinical scenario, the care pathway is experienced and contextualized within the team. It offers an opportunity to expose deficits in the system without causing harm (Kaba and Barnes, 2019). Evidence gathered can be easily and rapidly reported to operational leaders allowing timely decision-making, change implementation and mitigation of preventable risk. This makes simulation a cost- and resource-effective quality improvement method. In addition to patient safety process testing, in situ simulation offers a valuable individual and collective training opportunity, providing realistic orientation for clinicians and staff. In recording the simulation, educational tools have been created, extending their reach to both clinical and non-clinical staff.

The Clinical Skills and Simulation Centre (CSSC) at Edge Hill University (EHU) was opened in September 2019 to enhance and standardize simulation-based education across all programmes in the Faculty of Health, Social Care and Medicine. Before the CSSC opened, academic staff had not received any formal guidance in using simulation-based education. With the impact of the pandemic, a three-step blended simulation faculty development approach was created to assist and support faculty in their understanding and in the delivery of simulation ^[1,2].

Aim:

The aim of the study was to enhance, encourage and standardize the use of simulation-based education through the delivery of a three-step faculty development programme.

Method:

The following are the three-step approach to faculty development: Step 1:

The introduction of simulation sessions is specifically designed and focussed on the newly appointed academic faculty and is embedded in the staff induction programme.

Writing simulation scenarios, drop-in sessions are run once a month and are available to all academics from the faculty. They focus on designing and writing simulation scenarios.

Shadowing and feedback. At this stage, faculty are offered support during their simulation session. The experienced simulation facilitator leads the first part of the event with the faculty member running the second part supported by the facilitator observing and providing feedback after the session.

The evaluative methods included two approaches, quantitative incorporating Likert questionnaires, for evaluations, and qualitative focus groups, for faculty. Approximately 1700 student and faculty evaluations were obtained, and seven faculty members participated in the focus groups. These were obtained and conducted between June 2020 and August 2021.

Results:

Evaluations are obtained from students and from faculty who are involved in the sessions. In addition, ethical approval has been obtained to carry out focus groups to identify the challenges and benefits that faculty have found in delivering simulation. Feedback from the evaluations and the focus groups were very positive. Examples include:

The simulation team have been extremely supportive and always are. It makes my role so much easier and I appreciate all their hard work.

We had 450 students over a fortnight, everyone worked so hard and were very supportive, especially to staff who had not facilitated simulation for some time.

Data from June 2020 to August 2021

The session:

Was beneficial for my learning, 87.74%

Archived the learning outcomes, 91.37%

Did the session meet your expectations? 87.32%

Implications for practice:

We will continue to offer a blended approach and, from August 2021, a 1-day simulation facilitation programme will be offered to potential adjunct clinical faculty.

In situ simulation (ISS) has been shown to be an effective tool in delivering education to the inter-professional team in the Emergency Department (ED) ^[1]. ISS has also been utilized to drive quality improvement ^[2]. Using our local ISS programme, we provided a response to critical incidents involving patients within the ED. This has allowed identification and improvement of individual, team and system failures and has led to enhanced learning and departmental improvements to reduce risks of further incidents.

Aims:

The aim of the study was o describe how simulation has improved learning and development from critical incidents.

Method:

A simulated case is built around specific clinical incidents. Four were identified having occurred within the timeframe: missed abdominal aortic aneurysm, ischaemic limb, digoxin toxicity and ruptured ectopic pregnancy. The aim is to use ISS as a tool to educate colleagues about these presentations and as a way of checking that there are no system issues in managing such cases. Our ISS process involves either an ‘actor’ or a low-fidelity manikin with an ‘app’ providing a monitor. All equipment is sought and used in real time to attempt to simulate as close to real life as possible. The scenario utilizes junior doctors, nurses, healthcare assistants, trainee nurse associates and students. A senior team member is included if required. The participants are both briefed and debriefed, and learning points are disseminated via email placed on the ‘MYED’ Facebook group as well as the ‘MYEDSim’ ‘padlet’ page.

Results:

The ISS was run between October 2020 and May 2021. A total of 23 participants answered the nine questions on the post-ISS feedback form from the four incidents. Results are summarized in Figure 1. The participants were asked to record learning points from the sessions and suggestions for improvement. Key themes appear to be communication, team working and location of equipment in the department.

Figure 1:

Implications for practice:

By running simulations of critical incidents, we have identified deficiencies in areas within individual’s knowledge, factors shaping inter-professional team working and system failings from the wider trust which contribute to these events. This has led to wide dissemination of learning and knowledge sharing on various departmental social media/communication platforms and has allowed development and modification of clinical guidance and pathways within Mid-Yorkshire NHS Trust to reduce risks of further incidents occurring.

Offering high-quality and purposeful simulation-based educational (SBE) activities to learners requires careful planning ^[1]. To improve SBE practice across all healthcare professions and for learners at all levels of experience, the International Nursing Association for Clinical Simulation and Learning (INACSL) has outlined a set of standards recently rebranded as the Healthcare Simulation Standard of Best Practice Practice™ (HSSOBPTM) that were initially published in 2013 and recently revised in 2021. Involving individuals with a range of relevant expertise, revisions to these standards have occurred every few years, including expanding the topics covered as developments in this domain have occurred and the use of simulation has expanded.

Aim:

The aim of this abstract was to present the changes made to the Simulation Design Standard in comparison to its previously published version ^[2].

Method:

From 2019 to 2021, a group of simulation educators and researchers representing multiple specialities, simulation societies and geographic areas (the authors of this abstract) met regularly via a videoconferencing platform to review and revise the Simulation Design Standard based on their review of the latest literature and their individual experiences. The team identified several aspects that would benefit from being updated to make this key standard more explicit and applicable to all types of simulation modalities. Drafts of the standard were reviewed on multiple occasions by peer reviewers and the society’s leadership until the latest version was approved for publication.

Results:

An updated version of the Simulation Design HSSOBPTM will soon be published by INACSL in the journal Clinical Simulation in Nursing. It includes the same number of criteria, 11, most of which have retained the same title whereas a few others have been slightly redefined (Table 1). The new Simulation Design Standard provides clear information and guidance to the simulationists. The updated criteria can still be matched to those from the previous edition (see colour coding in Table 1) but are now more detailed and inclusive to be applicable to various simulation modalities and healthcare professions. Advances in virtual simulation experiences, new research and knowledge regarding pre-briefing, greater integration of simulation experiences throughout the curriculum both as a clinical replacement and in the classroom, as well as integration of multipatient and inter-professional teamwork experiences create excellent opportunities for learning if designed well using the HSSOBPTM.

Table 1:

Criteria of the 2016 and 2021 HSSOBPTM for simulation design

INACLS simulation design standard	2016	2021
Criterion 1	Perform a need assessment to provide the foundational evidence of the need for a well-designed simulation-based experience	Simulation experiences should be designed in consultation with content experts as well as simulationists who are knowledgeable and competent in best practices in simulation education, pedagogy and practice
Criterion 2	Construct measurable objectives	Perform a need assessment to provide the foundational evidence of the need for a well-designed simulation-based experience
Criterion 3	Structure the format of a simulation based on the purpose, theory and modality for the simulation-based experience	Construct measurable objectives that build upon the learner’s foundational knowledge
Criterion 4	Design a scenario or case to provide the context for the simulation-based experience	Build the simulation-based experience to align the modality with the objectives
Criterion 5	Use various types of fidelity to create the required perception of realism	Design a scenario, case or activity to provide the context for the simulation-based experience
Criterion 6	Maintain a facilitative approach that is participant-centred and driven by the objectives, participant’s knowledge or level of experience, and the expected outcomes	Use various types of fidelity to create the required perception of realism
Criterion 7	Begin simulation-based experiences with a pre-briefing	Plan a learner-centred facilitative approach driven by the objectives, learners’ knowledge and level of experience, and the expected outcomes
Criterion 8	Follow simulation-based experiences with a debriefing and/or feedback session	Create a pre-briefing plan that includes preparation materials and briefing to guide participant success in the simulation-based experience
Criterion 9	Include an evaluation of the participant(s), facilitator(s), the simulation-based experience, the facility and the support team	Create a debriefing or feedback session and/or a guided reflection exercise to follow the simulation-based experience
Criterion 10	Provide preparation materials and resources to promote participants’ ability to meet identified objectives and achieve expected outcomes of the simulation-based experience	Develop a plan for evaluation of the learner and of the simulation-based experience
Criterion 11	Pilot test simulation-based experiences before full implementation	Pilot test simulation-based experiences before full implementation

Implications for practice:

It is expected that the revised Simulation Design Standard of Best Practice will be welcomed by healthcare educators and simulation technology developers. It has been designed as a guide to help educators in all the key aspects of designing SBE activities, irrespective of the modality employed. It should ultimately benefit all learners but also promote the continuing professional development of the healthcare educator with an interest in SBE. It includes an updated list of useful references readers can consult to find additional information.

In situ simulation (ISS) is an effective educational tool that improves patient safety outcomes ^[1]. It has been trialled previously in this trust but not regularly and many staff members had never participated. Anticipated challenges included freeing staff from clinical duties, scepticism about simulation training and technical issues.

Aim:

The aim of the study was to establish a regular programme of inter-professional ISS delivered by a dedicated team in the emergency department (ED).

Method:

An ED simulation team was created, including consultants, a senior registrar and two newly appointed simulation junior clinical fellows. Sessions run monthly in both EDs in the trust, taking place in the ‘green’ resus area, in the morning when clinical demand is usually lowest. Participants include doctors and nursing staff of all grades, with cross-speciality involvement. Increasing participation required was influenced by senior management and clinical staff agreeing this was a necessary and valuable tool. Faculty include the ED simulation team and a simulation technician. Scenarios are developed by the team with specific intended learning outcomes, e.g. ALS in COVID-19, assessment of the acutely unwell pregnant patient. Intended learning outcomes are influenced by new guidelines, specific emergency cases or skills and suggestions by staff. The patient has been trialled as an actor and/or SimMan3G, depending on the scenario. Clinical equipment is mostly donated and expired. A structured debrief is led by a senior simulation team member. Key learning from each session is summarized in a ‘Sim News’ poster which is tweeted, disseminated via email to all staff and published on the departmental ‘EMBeds’ website. Participants fill in an anonymous feedback form online and receive a certificate of participation.

Results:

Fifty-nine participants from December 2020 to April 2021 gave feedback (see Table 1). Comments included ‘…helped me learn my anaphylaxis protocol’, ‘Teamwork and communication are vital’.

Table 1:

Feedback form results

This simulation session…	Average score (10 – strongly agree, 1 – strongly disagree)
…improved my clinical knowledge	9.63
…made me more familiar with my working environment	9.58
…taught me about current guidelines	9.68
…helped me improve my team working	9.84
…helped me improve my leadership skills	9.21
…helped me improve my communication skills	9.53
I enjoyed this simulation session	9.74
I would feel more confident managing a similar situation in the future	9.58
Simulation is a valuable tool in my training	9.74

Implications for practice:

The in situ programme has successfully educated staff; led to changes in guidelines published on ‘EMBeds’; and identified and corrected problems relating to the clinical environment. Staff have found it an enjoyable and valuable experience. The next steps are to increase the frequency of sessions, expand faculty to include a paid senior staff member and include further clinical teams such as blood bank, trauma team and other specialities.

This abstract looks at how we implemented physical health simulations within community hospitals in late 2020 and more recently physical health simulation in mental health units.

Aims:

The objectives of these simulations were to improve the recognition of deteriorating patients and the appropriate escalation and/or transfer of care as well as ‘identifying latent errors through simulation’ ^[1].

Method:

We have run simulations in the community since October 2020 and in the mental health units in February 2021. These sessions have covered four main themes:

Sepsis

Hypoglycaemia

Anaphylaxis

Opioid overdose

These sessions were taken from pre-existing incidents such as the hypoglycaemic relative and anaphylaxis. We also added opioid overdose as this topic is relevant to both mental health units and community hospitals. We delivered a package of four simulations across 1 month at each unit. This allowed for a different simulation each week, regular learning outcomes and wider opportunity of contact with the staff working within these areas. These sessions were always well attended with staff even committing to learning on days off. This level of commitment shows a real desire to improve not only their own knowledge but also patient safety. We engaged over 50 staff on 9 separate sites (five community hospitals, four mental health wards). Staff have been very engaging and have really got behind these simulation sessions as well as the ward managers. By engaging both mental and physical health, it has helped to provide a wider audience of staff and helped to gain a parity of esteem across the trust in the provision of safety training and simulation. We have also identified a number of latent errors such as non-standardized provision of anaphylaxis adrenalin across the trust, staff unfamiliar with resuscitation equipment bags and equipment location within and identifying the lack of Glucagon within a Hypo box.

Results:

The data collected from these sessions have shown a growth in confidence in identifying deteriorating patients and how to correctly implement and use escalation tools such as the sepsis pathway, electronic observations (E-Obs), anaphylaxis algorithms and the SBAR communication tool.

Implications for practice:

These simulations have really allowed us to bridge the gap between the acute and community site, allowing for a greater parity of esteem for all patients. Further steps in this program will be delivering mental health simulations to all mental health units and community hospitals to further bridge the learning between physical health and mental health.

The COVID-19 pandemic resulted in limited opportunities for medical students to assess patients in the Surgical Assessment Unit (SAU) at an acute teaching hospital. Inadequate exposure to acute surgical conditions affected student-reported confidence and preparedness for Objective Structured Clinical Examination (OSCE). We hypothesized that simulation-based teaching during the pandemic could supplement disrupted learning ^[1] and improve patient safety ^[2].

Aim:

The aim of the study was to address the quality dimension of patient safety. This Quality Improvement Project (QIP) was designed to increase student confidence by 50% in the assessment and management of acute surgical conditions, and preparedness for OSCE.

Method:

The educational intervention ‘Simulated SAU’, consisting of scenarios based on common acute surgical presentations, was co-designed with project champion, placement lead, teaching fellows and medical education department, utilizing transformational leadership. Model for improvement approach was utilized with Plan-Do-Study-Act (PDSA) cycles. During the first PDSA cycle, intervention was delivered over 3-hour sessions in March 2021 to 12 third-year medical students, through the use of simulated patients. The second cycle encompassed integration of learning points including amended scenario and debrief timings, and improved questionnaires, delivered in April 2021 to a further 11 third-year medical students. Students completed paired 14-item pre- and post-intervention paper questionnaires consisting of 5-point Likert scale questions on confidence and preparedness. The Wilcoxon signed-rank test was used for statistical analysis, with a p-value of <0.05 considered statistically significant.

Results:

During the first cycle, student-reported median confidence in assessment increased by 50% (p = 0.01), and in management by 66.7% (p = 0.02). Students felt 50% more prepared for OSCE assessment (p = 0.02). During second cycle, median confidence in assessment increased by 100% (p = 0.003), in management by 100% (p = 0.004), and students felt 50% more prepared for OSCE assessment (p = 0.015). 100% of students felt simulated SAU is useful and future sessions would further enhance surgical learning.

Implications for practice:

The QIP achieved its aim to increase student confidence with statistically significant differences, through a high-fidelity simulation intervention. Through QI methodology and leadership for improvement, this QIP has successfully bridged the educational gap resulting from the pandemic, with emphasis on delivering safe patient care. Next steps encompass integration of learning points over the following PDSA cycle, engagement of new staff and resource sharing for future implementation and sustainability. Simulated SAU intervention is low-cost, requires minimal staff and is simple to deliver, hence has the potential to become integrated within medical education across numerous educational settings and enhance patient safety.

Learning Together is a training model providing general practice (GP) and higher psychiatric trainees with peer learning opportunities across London in partnership with Health Education England. The initiative encompasses inter-speciality training days and joint clinics delivered by trainee pairs aiming to bridge the gap between mental healthcare in primary and secondary care. On the basis of this model, a full-day online simulation-based education (SBE) course for these groups was designed and delivered with a specific focus on inter-professional education and issues related to co-consulting ^[1].

Aims:

The aim of this study was to use SBE to enable sharing of knowledge, skills and approaches to clinical practice to improve inter-professional collaboration in the context of co-consulting in primary care.

Method:

A full-day online SBE course for GP (ST2/3) and higher psychiatric trainees (ST4 and above) was delivered to 64 participants over six deliveries. It included five live scenarios using professional actors depicting mental health presentations to reflect the overall learning objectives. Scenarios were followed by a structured psychologically informed debrief chaired by trained facilitators with support from an external senior GP. A mixed-methods evaluation was used. Participants completed the Human Factors Skills for Healthcare Instrument (HuFSHI) pre- and post-course, rating their level of self-efficacy in managing issues, such as ‘constructively managing others’ negative emotions at work’ and ‘working effectively with a new team in clinical situations’ (Cronbach’s alpha = 0.96) ^[2]. Participants rated aspects of course quality on a 5-item scale and provided additional course feedback via open-ended questions.

Results:

Responses from 51 participants were analysed (response rate = 79%). Median HuFSHI scores increased from 70 to 86 for the overall group (Z = 5.881, p < 0.001). Sub-group analysis between both trainee groups (i.e. GP and higher psychiatric trainees) showed no significant HuFSHI score differences. High scores were reported for scenario quality (90% of participants) and provision of a safe and constructive learning environment (91.7% of participants). Ninety per cent of respondents would recommend the course to colleagues. Emerging themes from the qualitative data were positive reflections on the importance of patient-centred care and appreciation of the value of inter-professional collaboration and joint clinics.

Implications for practice:

Findings demonstrated improvements in participants’ self-efficacy as measured by HuFSHI. Qualitative data suggest a deeper understanding and appreciation of patient-centred care and inter-professional collaboration. Considering the need for early intervention, prevention and delivery of mental healthcare in primary care, this early evidence supports the potential role of SBE in developing integrated care.

Cervical spine (C-spine) injuries are a significant cause of morbidity and mortality, particularly in the elderly population ^[1]. The Canadian C-spine Rule is sensitive in determining which patients require immobilization and radiological investigation ^[2]. Junior clinicians entering Emergency Medicine (EM) may not have had previous career exposure to trauma and may be uncomfortable approaching such injuries or using similar assessment tools. In situ simulation offers an opportunity to build confidence and learn from human interactions, typically only encountered during ‘real-life’ exposure.

Aims:

The aims of the study were to identify clinician knowledge gaps when starting EM, create a simulation-based teaching program to address these weaknesses and to improve multi-disciplinary systems relating to C-spine injury immobilization and management.

Methods:

A sample of 20 clinicians finishing their EM rotation in April 2021 at Queen Alexandra Hospital, Portsmouth, completed a survey listing conditions/procedures they would have appreciated simulation scenarios on as part of induction. A 30-minute C-spine simulation station was designed focussing on knowledge gaps identified, incorporating Canadian C-spine rules, immobilization, radiological investigation and treatment. Sessions were delivered in situ to groups of 5–10, including doctors, trainee acute care practitioners, nurses, healthcare assistants and physician associate students. Feedback was collected gauging enjoyment, confidence levels before and after the session as well as the likelihood of application of the topics covered soon. Data were collected from candidates at the end of their rotation to assess the lessons learnt.

Results:

About 70% of surveyed candidates included ‘C-spine’ within conditions/procedures they desired simulation teaching on. Candidate feedback suggested high levels of enjoyment with 100% of candidates scoring 7 or 8/8. The mean confidence of candidates before and after the session increased by 30.6% (52%–82.6%). 100% of candidates felt that the session was useful in improving day-to-day practice and 67.7% of candidates envisaged implementing teachings within the next week (96.8% within the next 3 months).

Implications for practice:

In a busy department, it is important to prioritize education and address workforce knowledge gaps. Trauma and C-spine injury appear to be an area of under-confidence in junior clinicians starting in EM. Short in situ simulation sessions were an effective and flexible way of improving confidence and multi-disciplinary systems, avoiding disruption during busy periods. We believe that repeating similar teaching programmes at the start of a new clinician intake can aid in identifying gaps in knowledge and effectively addressing these early and improved systems operation throughout the rotation.

In situ simulation (ISS) is an effective way to deliver inter-professional education in the Emergency Department (ED) ^[1]. Since October 2020, we have been running regular inter-professional ISS in both EDs in Mid-Yorkshire NHS Trust. We used personal experience, systems and processes from other EDs in West Yorkshire ^[2] and the literature to assist with initiating this.

Aim:

The aim of this study was to describe the process to set up an ED ISS programme and share our challenges and successes.

Method:

We run a variety of cases including paediatric and adult on a broad topic range (anything that can be seen in the ED), e.g. medical, surgical, trauma, psychiatric and maternity emergencies. We prepare the case beforehand and ensure that we have the appropriate staff and equipment. A vital aspect to ISS is ensuring the ED is safe. Embedding the attitude that this is ‘just another patient’ has been key. We use a low-fidelity manikin and a simulated monitor app. All participants are briefed, everything is in real-time to closely simulate real life. After the simulation, a debrief takes place. Feedback is sought from all and a certificate is provided. From 14 October 2020 to 5 May 2021, we have run 39 ISS with 138 inter-professional ED participants.

Results:

Figure 1 demonstrates feedback given by these participants (largely positive).

Figure 1:

Participant feedback

Implication for practice:

Although challenges exist, it is achievable and effective to run an ISS programme in a busy ED. While this was set up with the education of staff as the primary objective, it has become clear that ISS is also important in identifying system problems, testing new pathways and providing an educational response to incidents in the department.

Aspects of our programme that have worked for us include:

Picking a regular day weekly (early morning best for ED).

Having an inter-professional debriefing team helps to engage all professions.

Ensuring senior departmental support.

Build slowly to more complex simulations.

Challenges we have found are:

Changing culture/attitudes – most support simulation once they have taken part/seen it happen regularly – persevere with it!

The ED is busy – we cannot change this but can be flexible.

Too many observers put the learners off and reduce learning. We have reduced observer numbers and have a sim ‘uniform’.

Some participants have difficulty engaging with the manikin/low-grade technology – a good briefing can help.

The COVID-19 pandemic presented healthcare workers with a challenge to provide safe clinical care while protecting staff and coping with an evolving situation. The use of simulation to devise and test emergency pathways is well recognized in the literature ^[1]. However, this pandemic presented the world with a very tight timeline to deliver, let alone test potential pathways. This was further complicated in maternity units where workload remained the same during the preparatory phase.

Aim:

Recognizing the need to develop a safe pathway, with a limited evidence base, we sought to test the hypothesis that a combination of table-top and in situ simulation could be used to devise a protocol and train teams in a tertiary maternity unit during the first phase of the pandemic.

Methods:

This programme involved three phases: pathway development, safety testing and team training. The initial phase was a simulated table-top scenario of a parturient requiring a Category 1 Caesarean delivery under general anaesthetic. This pathway was then used to create a structured simulation scenario to test its suitability. The debrief sessions for each explored three themes: (1) pathway feasibility; (2) timing and (3) feedback.

Results:

The table-top simulation took place on 11 March. Team-specific outcomes highlighted the logistics of early senior escalation and the rationalization of staff and equipment in theatre. We also recognized deficits in the amount and correct use of personal protective equipment (PPE). Staffing levels and limitations in communication were also key findings. The subsequent in situ simulation took place 2 days later. The baby was delivered within the 30-min guideline (28 min) and overall, the pathway was safe to use. It was then modified and used to train teams over the subsequent weeks, reaching 151 staff. Feedback from candidates was powerful: ‘I feel safer coming to work’.

Implications for practice:

The initial phases of the COVID-19 pandemic provided a fertile ground for team consolidation and planning that promoted collaboration in one of the most multi-professional areas of any hospital: the maternity unit. Involvement of all teams meant that deficits in training could be identified early, and changes could be adapted rapidly. The simulations also demonstrated to staff that it was possible to safely deliver a baby within the timeframe. Recognizing that this was not an isolated problem, we shared our resources publicly helping teams in the USA, Laos, Australia and UK to develop their own protocols. Importantly, it improved our response to the second wave.

Critically ill patients require transfer within and between hospitals – a necessity amplified by ITU capacity pressures during the COVID-19 pandemic. This rising demand highlighted the need for dedicated transfer teams. Alongside establishing and expanding a cross-sector transfer team, we necessarily needed to meet growing training requirements. Transfer medicine is a core competency for intensivists, anaesthetists, ITU nurses and pre-hospital staff, with simulation recommended in the respective curricula. However, COVID-related restrictions alongside demands on staff’s time, limited opportunities for face-to-face training. We overcame these challenges by developing an online simulation-based course. Teleconferencing has previously been received favourably and rated highly for educational benefit ^[1]. Our innovative programme uses e-learning and interactive video teleconferencing to combine the requirements of distanced learning with the benefits of simulation.

Aim:

The aim of the study was to test the efficacy of and response to remote simulation-based training in transfer medicine.

Method:

Before attending the online simulation, multi-disciplinary participants completed 3 hours of interactive e-learning hosted online via the platform Rise. This incorporated case-based discussions, practical assignments and filmed presentations. Simulation utilized Zoom teleconferencing to immerse participants in clinical transfers. We used high-fidelity, pre-recorded scenarios made with a mannequin simulator and high-definition video. The participants observed the simulated transfer of critically ill patients (Figure 1). Scenarios paused at set intervals facilitating debriefing utilizing electronic whiteboards and interactional tools available in Zoom to elicit learning. The course was delivered twice. Each cohort completed a pre- and post-course test to assess learning of the intended learning objectives.

Figure 1:

Example screenshot of online simulated scenario with participants observing

Results:

A total of 21 multi-disciplinary participants completed training: 43% doctors and 57% nurses. 100% of respondents (18) rated the course 5/5 on the Likert scale when asked ‘how much did you enjoy the course’ and 100% would recommend the course to colleagues. All rated the course extremely relevant to their practice. Average assessment scores pre- versus post-course improved by approximately 20% (74.3% to 94.4%) (Figure 2).

Figure 2:

Results of pre- and post-course knowledge assessments

Implications for practice:

We developed an effective and well-received remote simulation transfer course to deliver training to a wide-reaching audience. Participants were enthusiastic about the innovative and interactive approach, finding the online course enjoyable and relevant to their clinical practice. Results suggest the course effectively increased learning. The flexible nature of online remote provision allows for delivery at scale, to meet a rising demand. Further evaluation will establish the extent at which this training translates to performance, such as a reduction in adverse events in transfer practice.

During the pandemic, several wards in our surgical wing became re-purposed for COVID patients. This resulted in patients who would usually be nursed in those wards being placed elsewhere. There were also many nurses and medical staff being redeployed to wards in unfamiliar specialities which required caring for patients outside their usual clinical areas. This resulted in some patients with chest drains being nursed outside the usual areas, and incidents being reported regarding their management.

Aims:

The hour-long workshop was designed to simulate the management and understanding of the terminology around chest drains. The hands-on aspect was achieved by modifying a manikin to be able to demonstrate these actions and troubleshoot when things go wrong.

What is meant by a swinging chest drain?

How much bubbling is expected?

Followed by the procedure of inserting a large-bore chest drain using immersive virtual reality

Methods:

Ward nursing staff, operating theatre staff and junior doctors were invited to attend the workshop. Six sessions each with five participants ran over the course of a month. The first part of the workshop was a hands-on session with a modified defunct manikin. We had the locally available kit for people to be able to interact with and understand the mechanics of chest drains Introducing people to the Royal Marsden manual of clinical nursing procedures ^[1] as a reference to be used in parallel with our trust protocols. Hands-on session covered the observations taken for safe management of a chest drain, demonstrating what a swinging and bubbling drain look like. Recognizing when and how to clamp a chest drain was simulated, with a short scenario requiring the attendees to troubleshoot a drain that had stopped swinging and the patient condition deteriorated. How the consumables are changed in the chest drain and its ultimate removal was also covered in the hands-on session as this had been a particular area of concern expressed prior to the workshop. The manikin (Frank) was limited in the ability to insert the chest drain in a realistic manner, so this component of the education was augmented by a virtual reality (VR) option. Pottle ^[2] asserts that VR allows participants to learn from experience as they would do in real life. VR is the use of software to create an immersive simulated environment, to experience VR, participants put on head-mounted display which places them inside an experience, where they can engage with the environment and virtual characters in a way that feels real. VR has a unique power, more than any other simulation technology, to make users believe they are in a different environment. The application used is available on the Oculus go format and is produced by the Royal College of Surgeons in Ireland, it takes the participants through the accident that results in the patient requiring the insertion of a chest drain. They are then faced with decisions regarding his care throughout the experience, following through decisions that may lead to a fatal result for the virtual patient. The VR simulation was in real time, with events unfolding at a realistic pace and included the various airway emergencies unfolding before you after the drain insertion

Results:

Questionnaires were completed before and after the workshop for attendees to evaluate their confidence to independently manage a chest drain. Every attendee reported an increase in confidence because of the session (Table 1).

Table 1:

How confident are you to…….	Pre-session, %	Post-session, %
Monitor vital signs	95	100
Assess chest drain function	60	90
Recognize/monitor swinging drain	60	90
Patient mobilizing with drain	55	90
Recognizing when/why/if to clamp	25	80
Clamp a chest drain	50	80
Wound management post-removal	35	75
Change chest drain bottle	25	65
Remove chest drain	25	55

Implications for practice:

As a result of this session, the ward areas created a ‘chest drain box’ which had everything needed to manage and replace a chest drain included as locating where kit was kept was identified as an issue. This box will be at the side of the patient being managed with the chest drain and will be checked for completeness regularly. This workshop would be useful to repeat because 50% of junior doctors have now rotated placements and many of the ward staff have been re-deployed to other areas.

Debriefing is a key component of all simulation-based educational (SBE) activities and is an activity for which a multitude of approaches and models have been developed and implemented (Oriot & Alinier, 2016). To improve SBE practice in general, the International Nursing Association for Clinical Simulation and Learning (INACSL) has outlined a set of Simulation Standards of Best Practice first published in 2013. Revisions to these standards have occurred every few years, including expanding the topics covered as developments in this domain have occurred and the use of simulation has expanded.

Aim:

The aim of this study was to present the changes in the Simulation Debriefing Standard in comparison to those last published (INACSL Standards Committee, 2016).

Method:

From 2019 to 2021, a group of simulation educators and researchers, the authors of this abstract, representing multiple specialities, simulation societies and geographic areas began meeting to review and revise the Simulation Debriefing Standard based on the latest literature. This group identified several items that would benefit from being updated, including expanding the terminology of this Standard to encompass Feedback, Debriefing and Guided reflection as distinct but integral components of this key phase of simulation-based experiences.

Results:

An updated version of the Simulation Debriefing Standard of Best Practice will soon be published by INACSL in Clinical Simulation in Nursing. Some of the updates include expansion to understand and allow electronic systems to be recognized as components of the debriefing process and emphasizing the need for practice and review of the skill of facilitators in the techniques of debriefing. The new Simulation Debriefing Standard provides clear information and guidance to the simulationists. It includes four as opposed to the five criteria in the 2016 version (INACSL Standards Committee, 2016). The updated criteria can still be matched to those from the previous edition (see colour coding in Table 1) but are now more detailed and inclusive to be applicable to various simulation modalities.

Table 1:

Criteria of the 2016 and 2021 INACSL debriefing standards of best practice

INACLS simulation debriefing standard	2016	2021
Criterion 1	The debrief is facilitated by a person(s) competent in the process of debriefing.	The debriefing process is planned and incorporated into the simulation-based experience in an appropriate manner to guide the learner(s) in achieving the desired learning outcomes.
Criterion 2	The debrief is conducted in an environment that is conducive to learning and supports confidentiality, trust, open communication, self-analysis, feedback and reflection.	The debriefing process is constructed, designed and/or facilitated by a person(s) or technology-enhanced system capable and/or competent in providing appropriate feedback, debriefing and/or guided reflection.
Criterion 3	The debrief is facilitated by a person(s) who can devote enough concentrated attention during the simulation to effectively debrief the simulation-based experience.	The debriefing process is conducted in a manner that promotes self, team and/or systems analysis. This process should encourage reflection, exploration of knowledge and resolution of performance/system gaps while maintaining psychological safety and confidentiality.
Criterion 4	The debrief is based on a theoretical framework for debriefing that is structured purposefully.	The debriefing process is planned and structured purposefully based on theoretical frameworks and/or evidenced-based concepts.
Criterion 5	The debrief is congruent with the objectives and outcomes of the simulation-based experience.

Implications for practice:

It is expected that the revised Simulation Debriefing Standard of Best Practice will be welcomed by the simulation community, which includes the healthcare educators and simulation technology developers, but also the learners. It has been designed as a guide to help educators in all the key aspects of debriefing, providing feedback and facilitating guided reflection conversations that will ultimately benefit learners. It includes an updated list of useful references readers can consult to find additional information.

Although commonly used in the clinical environment, insertion of peripherally inserted central catheters (PICC) is not routinely taught to clinical staff. As the procedure requires knowledge in relevant anatomy, sonography skills, and understanding of complications management, it requires dedicated time for teaching. In 2018 no PICC line insertion courses were found in London County.

Aims:

The Harefield educational team has therefore created a PICC line insertion course delivered by a multi-disciplinary faculty. This course aimed to increase understanding and confidence of PICC insertion.

Method:

Using Miller’s pyramid of clinical competence, the course was structured to provide learners with the knowledge and understanding of the procedure through interactive lectures and demonstrations, before progressing to hands-on practise in the workshops using high-fidelity models to increase dexterity and confidence ^[1]. Five editions of the course were delivered over 16 months with a total of 65 participants. Pre- and post-course questionnaires were conducted to assess the course’s effectiveness in achieving its purposes.

Results:

The results have shown the achievement of all the course objectives such as increased understanding of indications, relevant anatomy, equipment uses, complications and their management relating to the procedure. With increased confidence in the theoretical and practical aspects of PICC insertions, we hope the course attendees will have better performances in practicing the procedure, thus reaching the highest level of clinical competence on Miller’s pyramid.

Implications for practice:

As soon as face-to-face teaching will be allowed again, the PICC insertion course will be resumed as proven well-received and effective.

Previous research has described the importance of debriefing in Simulation-Based Medical Education; it is considered the most critical part of the teaching experience ^[1]. It is a skill requiring practice and poorly structured debriefs can harm candidates ^[1]. There are few formal debriefing courses available to aspiring faculty members; they are often oversubscribed.

Aim:

The aim of this work was to develop an inter-professional faculty with a variety of backgrounds to assist on an inter-professional nursing-medical simulation course in Emergency Medicine. A further aim was to develop a novel formal debrief for the debriefer to help improve confidence in this skill.

Method:

A variety of professionals were invited to attend the course as faculty. Following their debrief of the scenario, the debriefer was invited to discuss their opinion on how they managed the debrief, from room set up to structure used. Troubleshooting advice was offered and an action plan was put in place for next steps of development. Faculty members were asked to complete a formal feedback form at the end of the session.

Results:

Inter-professional faculty members included Emergency Medicine consultants, trainees and clinical fellows, simulation technicians, emergency medicine nursing staff and resuscitation officers. 75% of faculty members had attended <5 simulation courses as faculty prior to this session. 81% of faculty members scored 4 and 5/5 for feeling confident at debriefing as a result of the session. 100% scored 4 and 5/5 for feeling supported during their debrief. 100% felt that the session had improved their debriefing skills. 87.5% felt appropriately challenged as a faculty member. 100% were willing to attend the course again in the future. Free-text comments included the best part of the day was ‘Personally observing and practicing debrief, brief and debrief of my debrief’, ‘Supportive atmosphere for faculty’ and ‘Debrief learning points’.

Implications for practice:

Overall, faculty members from varying clinical and simulation backgrounds were supported throughout the day and as a result were more confident in their debriefing abilities following the session. Future work aims to continue this incremental learning to allow all faculty members to feel confident and able to ‘debrief the debriefer’. This will ensure the quality of the debrief for learners, maximizing the impact of simulation-based medical education.

In situ simulation, in the clinical environment, can help detect any issues with the systems, policies and practices within an organization that may not work. Many system errors go unnoticed until there is a real incident. Conducting simulation in situ is an innovative way of picking up these embedded problems ^[1]. Experiential learning theory suggests that, to truly understand a concept, you must experience it first-hand by doing it. Deliberate practice ^[2] recognizes that to gain expertise you must keep practicing a skill. Practicing tasks in a simulation environment helps to build performance levels and thus improves patient care and safety.

Aims:

This simulation exercise is designed to develop the skillset of foundation dental therapists in respect of Medical Emergency recognition and management in their own working environment. The parameters for assessment included teamwork, knowledge, communication, effectiveness of actions and situational awareness.

Methods:

Research methods for this project included a learning needs analysis, surveying and interviewing previous cohorts of hygiene therapists. The conclusions of which highlighted the need for further training in managing medical emergencies. The learning needs identified from stakeholders relating to this course have been used to develop the learning outcomes using Blooms’ taxonomy ^[3]. The faculty delivered a medical emergency in situ simulation training session for Dental Foundation Therapists across the Midlands and East region. The therapist and dental nurse were given information on the ‘patient’ before the interactive mannikin was positioned. Facilitators used an adjacent room from which to control the mannikin, including its vital signs and voice. A 360-degree camera along with iPads were used to monitor and record the session for safety and debrief purposes. The therapist worked with their dental nurse to react and respond to the emergency unfolding before them. They then watched back their performance, reflected and provided feedback.

Results:

Using GIBBs model of reflection, the 2021 delegates recognized personal learning needs including improvement in leadership and management skills, delivery of chest compressions and teamwork. Changes to practice were also recognized, for example, placing their emergency drugs in a more appropriate location. Using video, a ‘Hot Debrief’ method of evaluation was carried out whilst the experience was fresh. This proved to be powerful and enhanced personal reflection to support future learning and development. Later, an evaluation method in the form of a survey took place. Results of which showed that 50% of delegates had never partaken in simulation-based education before and 100% gave an excellent rating on the benefits to team and individual. One participant stated ‘this was such a good, real-life experience! I hope this can either be introduced into undergraduate training or as part of the practice annual BLS CPD!!’.

Implications for practice:

A successful session needed prior communications with the practice staff to free up a surgery for use, inform present patients of the activity and understand where the emergency equipment was during the session for patient safety. The benefits of conducting in situ simulation were staggering, the delegates reviewed their current practices and made changes as appropriate.

The full impact of working in the COVID-19 pandemic surge on NHS staff is yet to be understood. Simulations were run to explore the staff experience following the second COVID surge. From these, it was clear that the staff had powerful stories to tell. A series of further simulation sessions were then delivered, designed to allow staff to explore their experiences and assist with organizational learning within the trust debrief strategy.

Aims:

Firstly, to use simulation to recreate working with uncertainty and unfamiliar staff as a platform within the debrief to explore their experiences of working during the pandemic surges. Secondly, to employ a human factors framework, SEIPS model ^[1], within a simulation debrief to build a system picture of work-as-done ^[2] by staff throughout the organization. This was then used to feed back to leadership to influence care processes and staff and patient well-being for potential future surges.

Method:

Simulation sessions, open to all staff, were advertised throughout the organization. In total, 8 sessions were delivered for 38 staff. Multi-disciplinary attendance was encouraged, and a wide range of staff groups participated. During the session, staff were given a brief presentation on human factors, a simulation pre-brief and a pre- and post-simulation questionnaire. A simple patient deterioration scenario unrelated to COVID-19 was used to maintain psychological safety. A system-focussed debrief using the PEARLS model took place after the scenario. Insights shared by candidates were captured by a facilitator and anonymously grouped into the six SEIPS themes.

Results:

Pre- and post-questionnaires show a general theme of improved confidence post-simulation. Findings were reviewed and the impact on care processes and staff, patient and organizational outcomes were summarized. Information captured within the SEIPS framework showed recurring themes that were condensed into four main categories: psychological trauma and burnout, communication, re-deployment and training, and infection control and PPE.

Implications for practice:

It was clear from facilitating sessions that staff were concerned about patient experience but were also suffering their own trauma from working through the surge. Feedback from participants was positive, emphasizing their sense of validation in sharing their experiences and of feeling part of the hospital community. Staff also had experiences to share about what had helped them and where things could be improved. These insights were synthesized into practical recommendations for managing future pandemic surges that were fed back to the wider organization.

In November 2020, the first COVID-19 vaccine for the UK had been approved. We were subsequently tasked with the rapid development of vaccination clinics. Two COVID-19 vaccination clinics in suitable spaces within the University Hospitals Bristol and Weston NHS Ft were planned, across two different hospital sites (25 miles apart), to be operational within 7 days. Changes to both pharmaceutical and national guidelines were altering by the hour.

Aims:

The key driver for this fast-paced change was to ensure vaccines were delivered as soon as available to Bristol-based health and social care staff.

Methods:

A process map outlining the vaccination journey established in the local public vaccination site was the starting point to understand how to efficiently, effectively and safely deliver vaccines. Hospital sites for both clinics were identified, and work began immediately to vacate those rooms and establish both the infrastructure and personnel to run the large-scale clinics. Simulation Lead Educator involvement during the first days of planning was essential and at each stage of the process mapping.

Simulation Round 1:

full-scale simulated vaccine clinic in the newly designed rooms on one site

standardized patients (actors) briefed as receiving the simulated vaccine

key staff in roles – administrators, pharmacy, vaccinators

debrief focussed on latent threats, agreeing immediate changes to be tested in the next round

patient experience feedback from the standardized patients

Simulation round 2:

immediate re-run of the simulated clinic

solutions identified in Round 1 were applied and tested

rapid improvements to the process mapping, ergonomics, clarity of roles and timings for clinic appointments were able to be made

Simulation round 3:

Round 3 took place on the second site a few days later

lessons learnt from the first two stages being shared and translated within the new site

essential safety and efficiency issues were explored and lessons learnt applied to the clinic

Results:

The three rounds of simulation systems testing identified a number of latent threats and process mapping alterations which were implemented immediately, with solutions being tested on the spot. The vaccination clinics opened, administering over 500 vaccines per day across a 4-month period. The team involved continued to adapt processes and environment to suit the constantly changing guidelines and ensure safe practice.

Implications for practice:

Simulation is an adaptive and responsive tool in systems testing, process mapping and implementing solutions within a high-pressured and time-restricted environment.

Annually, approximately 80 undergraduate physiotherapy and occupational therapy students participate in simulation-based learning, as part of a second-year module. The experience provides opportunities for students to achieve core module outcomes, such as developing communication skills, inter-professional practice and clinical reasoning. The simulation is supported by a small team of academic faculty and a professional actor, all trained in simulation and debriefing. The students are required to assess an older person at home as part of an emergency response team. They work in groups of up to eight students, are pre-briefed and given a profession-specific written brief of their role in the scenario. A two-pronged approach to debriefing is used; the origami approach, utilizes pauses to capture teachable moments ^[1], and the advocacy-inquiry approach, used to reflect on the experience ^[2]. The simulation itself is not assessed; the students write a reflective assignment through the simulation lens, discussing the concepts of effective collaborative practice.

Aim:

The aim of the study was to identify the mechanisms used in simulation-based education that support development of collaborative practice skills of undergraduate students.

Method:

The simulation-based learning scenario was iteratively developed, delivered and evaluated over 3 years. Staff reflection and content analysis of 3 years of feedback from anonymous evaluation questionnaires, and a sample of student assignments, were used to identify aspects of simulation delivery that supported students’ development of collaborative practice.

Results:

Although students consistently report anxiety about participating in the simulation, they also identify it as one of the most intense but helpful learning experiences of their on-campus degree programme. The use of trained, experienced actors, indistinguishable from service users maximizes student engagement. Effective pre-briefing reduces student anxiety and provides an opportunity to add complexity via the written brief. The student roles as observers and/or participants (in a familiar role) improve students’ experience and support students with diverse needs. Assigning clear staff roles improves delivery and cost-effectiveness. Combining the two approaches to debriefing students was necessary to allow reflection-in-action and -on-action. Thorough debriefing is essential, challenging and requires planning and practice.

Implications for practice:

Simulation is an effective pre-qualifying education tool. Adequate pre-briefing, effective debriefing styles, and clear assignment of staff roles aid in effective delivery. Simulation scenarios need to be carefully constructed and delivered to ensure that all students remain within their optimal learning zone and to support students with diverse needs.

The COVID-19 pandemic has necessitated pedagogical change with many events virtual or hybrid in nature. Simulation events are particularly affected due to their hands-on quality. In addition, requirement for virtual facilitators may be increased compared with in-person counterparts. Virtual simulation education must be as high quality as in-person efforts and facilitator training is key. Some principles of virtual facilitation differ from in-person, for example, in relation to debriefing ^[1]. Effective education should be tailored to address these differences.

Aims:

The aim of the study was to deliver virtual facilitator education addressing the format, objectives, expectations and strategies for virtual IP simulations.

Method:

The traditional in-person Facilitator Training and Inter-professional Education (IPE) Event Training Design course our university-affiliated program delivers was adapted based on a local needs assessment to the virtual Facilitating Virtual Simulations Crash Course. This was delivered as required as small-group Zoom-based teaching, outlining educational theory, practice and principles of virtual simulation facilitation.

Results:

Sixteen virtual inter-professional simulations have been delivered for students in 19 professions within our Office of IPE since September 2020 with 33 inter-professional facilitators from 4 institutions. To determine the efficacy of our novel virtual facilitation, training facilitators were surveyed. The majority had facilitated one to five simulations (in-person 58%, virtual 70%). In addition to the Office of IPE training, 30% of facilitators had received external education on in-person simulation facilitation compared with 6% for virtual facilitation. The majority of facilitators strongly agreed/agreed that they were as effective a facilitator in virtual simulations (80%), as confident facilitating virtually (70%), as psychologically safe in virtual debriefings (75%), and that virtual simulations will continue in their practice after the pandemic (100%). Most (95%) facilitators strongly agreed/agreed that students were as engaged with virtual simulations as with in-person and 80% felt virtual simulations were a good learning experience for students. The majority (88%) of facilitators strongly agreed/agreed that the virtual crash course provided the knowledge and practice to help them effectively facilitate virtually, and 75% strongly agreed/agreed that the crash course made them appreciate and foster IP relationships in their daily work. These results are comparable to evaluation of in-person training delivered before the pandemic.

Implications for practice:

Virtual simulation events require specific facilitation strategies, and virtual education is useful to improve the knowledge and confidence of facilitators. Facilitators value the virtual simulation experience for themselves and their students, and they believe that this will be an important pedagogy post-pandemic.

A human factor-based simulation course is run for foundation doctors and nurses annually at a London teaching hospital. Simulation helps to improve technical and non-technical skills in a supportive environment ^[1]. The course was adapted in response to the COVID-19 pandemic. We analysed feedback from participants to understand whether the educational value of the course was maintained and to identify potential areas of improvement.

Aim:

The aim of the study was to evaluate the impact of the course adaptations on the participants’ learning experience, delivery of learning objectives and quality of teaching.

Method:

The course comprises simulated scenarios with facilitated debrief sessions. Post-COVID-19 changes comprised: moving to a half-day format, reducing the number of scenarios from five to three, reducing the number of participants per session, running multiple courses on 1 day and reducing debriefing time. Feedback was gathered pre- and post-course using SurveyMonkey. The questionnaires utilized free-text answers and Likert scales based on the Human Factors Skills for Healthcare Instrument ^[2]. Two cohorts, before and after the changes were introduced, were analysed. There were 175 participants in cohort 1 (3 October 2019–11 March 2020) and 105 in cohort 2 (1 October 2020–12 April 2021).

Results:

Despite changes made, participants reported an improvement in clinical skills (Table 1) and human factors (Table 2). 67.6% of cohort 2 reported that personal protective equipment (PPE) had no impact on simulation; however, 7.6% felt masks hindered communication. Common themes reported in feedback are shown in Table 2. Both cohorts reported the course as useful (38% in cohort 1 and 36% in cohort 2). 7% of cohort 1 felt that the debrief needed shortening, compared with 4% in cohort 2 where shorter debrief models were used, conversely 6% of cohort 1 suggested more scenarios were needed compared with 8% in cohort 2 (Table 3).

Table 1:

Percentage of participants who reported feeling confident in clinical skills

	% of participants who felt confident in the following scenarios
	Pre-course 19–20	Post-course 19–20	Difference	Pre-course 20–21	Post-course 20–21	Difference
Managing acutely deteriorating patients	64.32	94.1	29.78	65.39	92.93	27.54
Assessing patients using ABCDE	93.1	100	6.9	92.32	97.98	5.66
Escalating patient care	93.03	98.84	5.81	92.23	96.96	4.73
Using SBAR to handover information to colleagues	79.89	98.84	18.95	86.54	97.98	11.44
Accessing and using clinical guidance and policies	80.46	90.14	9.68	85.58	96.97	11.39

Table 2:

Percentage of participants who reported that they could adequately do the following Human Factors Skills for Healthcare Instrument skills

	% of participants who felt they could do the following
	Pre-course 19–20	Post-course 19–20	Difference	Pre-course 20–21	Post-course 20–21	Difference
Constructively managing others’ negative emotions at work	50.68	79.78	29.1	53.4	83.83	30.43
Requesting help from colleagues in other professions	86.13	97.11	10.98	80.59	96.96	16.37
Communicating effectively with a colleague with whom you disagree	63.01	85.55	22.54	53.39	87.87	34.48
Prioritizing when many things are happening at once	69.37	87.28	17.91	62.14	85.85	23.71
Speaking up as part of a team to convey what you think is going on	69.36	90.17	20.81	67	90.9	23.9
Involving colleagues in your decision-making process	86.13	94.79	8.66	80.58	98.98	18.4
Dealing with uncertainty in your decision-making process	65.31	87.28	21.97	58.25	88.89	30.64
Asking other team members for the information I need during a busy ward environment	80.92	95.95	15.03	77.67	96.96	19.29
Recognizing when you should take on a leadership role	67.05	90.76	23.71	66.98	88.88	21.9
Monitoring the ‘big picture’ during a complex clinical situation	56.65	89.02	32.37	56.31	85.85	29.54
Anticipating what will happen next in clinical situations	60.11	89.02	28.91	51.46	86.87	35.41
Working effectively with a new team in clinical situations	75.73	92.48	16.75	67.97	89.9	21.93

Table 3:

Common themes arising from participants’ feedback

	19–20	20–21
	% of participants	% of participants
Good/useful course	38	36
Improved confidence/knowledge	11	16
Useful inclusion of human factors	5	7
Good range of scenarios	9	12
Useful debrief/reflection	21	44
Supportive/non-judgmental environment	9	10.40
Supportive facilitators	18.90	9.50
More focus needed on clinical skills	5	4
Shorter debrief needed	7	4
More scenarios needed	6	8

Implications for practice:

This course demonstrates that simulation can be delivered safely throughout a pandemic while maintaining education value. Participants continued to find simulation useful; the use of PPE did not affect debriefing and learning processes. Changes did arise as a result of the changes: increased workload on staff (multiple sessions), timing issues, repetition in scenarios delivered and ward pressures on participants. Moving forwards, some adaptations such as the use of PPE will remain, but the course will return to a full day. To further evaluate the impact of the changes made. We are currently obtaining feedback from faculty.

The physician associate (PAs) profession is a relatively new profession to the NHS. As such, there is no official national or regionally agreed further training to support PAs transitioning from PA school into clinical practice once they have graduated. Simulation training has proved to be an effective tool for developing clinical and non-clinical skills in other groups of clinicians ^[1,2]. We have adapted an already implemented simulation programme for junior doctors to make it suitable for the PA profession with the aim of improving the confidence and skills of PAs working in primary and secondary care. We have evaluated the perceived beneficence of our initial work and have so far observed a perceived positive impact.

Aim:

We aimed to describe the development and implementation of a novel PA-specific simulation training programme and present the evaluation of our initial work.

Method:

We designed and implemented a bespoke simulation training programme based on existing training for junior doctors. This model has three separate simulation sessions, spaced over 2 years, each session has three different clinical scenarios. Seventeen PAs have undergone the first two sessions. The first session contained three scenarios that highlighted important local protocols such as the major haemorrhage protocol and the sepsis ^[6]. The second session contained three clinical scenarios which followed the same patient’s journey: diagnosis of myocardial infarction, cardiac arrest scenario and breaking bad news. We then collected feedback from candidates’ written feedback and Likert-scale questions.

Results:

At this point in time, we have feedback from 16 candidates from session 1 and 11 from session 2. The results are overwhelmingly positive showing improved confidence, better team-working skills and a perceived perception of improved patient safety following the simulation training, as shown in graphs 1 and 2. The majority of candidates partaking in the session found the simulation training beneficial to their practise. The main negative feedback given was the lack of ‘senior support’ (i.e. from a senior doctor) in the scenarios that were unrealistic to actual practice.

Implication for practice:

The introduction of a novel PA simulation training programme has demonstrated improvements in clinical and non-clinical skills. This supports our aim of improving post-graduate PA training. Work continues to further develop our PA simulation programme and further evaluate its effectiveness with the aim of making this as a regional simulation programme that PAs can undertake when joining the healthcare workforce.

Between November 2020 and May 2021, 61 simulation sessions were run either face-to-face or remotely for foundation-level doctors and pre-registration pharmacists. A total of 346 participants attended. Thirty-three sessions were face-to-face (185 participants) and 28 were remotely via Microsoft Teams (161 participants). The content was the same for both modalities.

Aims:

The aim of the study was to discern whether there was a difference in learning points and confidence scores between face-to-face and remote participants.

Methods:

Participants were asked to rate their confidence (see Table 1) before and after the course. They were asked to provide their main learning points and what they gained from the course. Confidence scores were compared and assessed for change. Responses were compared between face-to-face and remote.

Table 1:

Confidence score change on Likert scale 1–5.

Q. no.	How confident do you feel…	Change
		F2F	REM
1	…that your clinical knowledge is appropriate for your role	+0.67	+0.89
2	… to manage a patient who is peri-arrest	+1.03	+1.27
3	…to manage a patient with a NEWS2 >7 and/or is deteriorating	+0.93	+1.23
4	…that you possess the skills required to communicate information to the rest of the MPT	+0.81	+0.83
5	… that you possess sufficient strategies to raise concerns when necessary	+0.51	+0.64

Results:

All participants reported increased confidence. Table 1 shows that the changes were comparable, with the changes in the remote participants all being marginally higher than in face-to-face. The distribution of learning points for remote and face-to-face participants was identical. For both modalities, the top two points were communication and escalation. The dominant theme in remote was escalation and communication in face-to-face. Remote participants were positive about the course, in their free-text responses, ‘most innovative use of technology I have seen during COVID’ and ‘My hands are sweating, I can’t believe how real that felt’ a common theme in the comments was that they would rather do the course face-to-face.

Implications for practice:

While not preferred, remote simulation appears to deliver equivalent learning and is a suitable alternative when face-to-face is impossible. The main difference seen was in communication skills, which is concurrent with Cheng et al. ^[1] related to the difficulties of communication in a virtual debriefing.

It is well established that simulation can help individuals and teams improve their clinical skills and confidence in managing medical emergencies ^[1]. In our region, a full-day simulation course on common neonatal emergencies was established in 2018 for paediatric trainees. It consists of four scenarios and two workshops. It is designed for eight candidates who are split into two groups so that each has an opportunity to ‘lead’ a simulation. The Diamond Model is used for debriefing. The course has been running 3–4 times per year and receives consistently excellent feedback. During the COVID-19 pandemic, the course was suspended.

Aims:

The aim of the study was to adapt the SHINE course for virtual delivery.

Method:

We replaced live simulations for pre-recorded scenarios. We filmed these on the labour ward and our simulation room with members of our Neonatal Unit, instructing ‘candidates’ to act in specific ways which would bring out learning objectives. The videos were edited to optimize quality. We delivered the course via Zoom, playing the videos followed by a live debrief. The workshops remained the same. We increased participants to 12, split them into two break-out rooms. We ran the course twice during the peak of the pandemic. We evaluated self-rated confidence pre-attending and post-attending the course.

Results:

We ran the course with four members of faculty instead of eight required face-to-face. We encountered minor technical difficulties which were easily resolved. Twenty-four paediatric trainees of various grades attended. Candidates rated their confidence managing scenarios from 1 (very low) to 5 (very high). The average score before the course was 2.8 and improved to 3.9 after the course. 81% (22) candidates agreed/strongly agreed that the workshops were well structured and educational, 96% (23) agreed/strongly agreed that they had enough opportunities to interact and 81% (22) agreed/strongly agreed that the virtual environment worked well. All candidates agreed/strongly agreed that the video debrief sessions were well structured and educational and that the virtual learning environment was safe and supportive. All trainees would recommend the course to colleagues.

Implications for practice:

SHINE is a well-established sought-after course. We were able to continue this training virtually during the COVID-19 pandemic Whist we recognize that there is no replacement for hands-on experiential learning, we have demonstrated that virtual simulation is possible, effective, highly valued by trainees and has the advantage of being less resources intense and accessible to more candidates. We propose that virtual simulation training should be offered where face-to-face teaching is not possible.

COVID-19 required many simulation faculties to provide online alternatives to in-person training. Over this period, our organization pivoted fully to online delivery of mental health simulation-based education (SBE), defined as delivery entirely via a videoconferencing platform to participants remote from one another and the simulation team. SBE can help early-stage psychiatric doctors to bridge educational and clinical practice by providing exposure to a variety of presentations and a safe space to hone communication and de-escalation techniques while encouraging reflective practice ^[1,2]. There is, however, limited research comparing the efficacy of in-person and online mental health SBE.

Aim:

We assessed for any significant differences across several course evaluation measures in a comparison between groups attending in-person and online versions of a simulation course for early-stage psychiatric doctors.

Method:

An existing full-day course was adapted for online delivery over a half-day period. It focuses on developing confidence and skills in psychiatric history-taking, mental state examination, risk assessment and formulation, meeting the relevant learning outcomes set by the Royal College of Psychiatrists. It encourages participants to explore consultation dynamics with a key emphasis on communication and human factors skills. Participants for in-person (n = 228) and online deliveries (n = 90) comprised of early-stage psychiatric doctors (core psychiatric trainee, or GP trainee level) based in mental health trusts in South London. Pre- and post-course quantitative data (assessing learners’ confidence, situational awareness, and course satisfaction) using the Human Factors Skills for Healthcare Instrument (HuFSHI) and Course-specific Questions (CSQ) measures were collected and compared across the two delivery formats, that is, in-person and online. Data previously collected from participants attending in-person deliveries were used in the comparison.

Results:

Paired-samples t-tests were conducted to determine whether there were any changes in HuFSHI and CSQ scores pre- and post-course. Results indicated that there were significant improvements in HuFSHI scores as well as CSQ scores for both digital delivery and in-person delivery. Large and very large effect sizes were also observed for HuFSHI and CSQ scores, respectively, in both delivery formats. Our data suggest that participants benefited more from in-person delivery across CSQ measures and from digital delivery across HuFSHI measures.

Implications for practice:

Our understanding of the educational differences between in-person and online mental health SBE is at an early stage. Our data suggest that online mental health SBE potentially represents an effective alternative to in-person delivery. Further research is required to better understand these differences.

Following a rise in COVID-19 cases and hospitalizations in autumn 2020, the resultant pressures on general medical wards galvanized the simulation education team at a London teaching hospital to create a multi-disciplinary educational programme aimed at ward staff caring for the surge in COVID-19 patients. This was especially important in the context of rapidly evolving clinical guidance and recognition of the importance of human factors in re-deployment of staff, thus a multimodal educational project was initiated to develop ward staff knowledge and human factors skills.

Aim:

The aim of the study was to ascertain the effectiveness of the multimodal COVID-19 educational project in improving ward staff knowledge and human factors skills.

Method:

In October 2020, the team began creating the project – comprising e-learning to improve staff knowledge, in situ simulation training and an in-centre human factor course, all based around the care of patients with COVID-19. With rising COVID-19 cases and subsequent suspension of face-to-face teaching, an online format for the human factors training was created incorporating scenarios from the in situ simulation. Data were collected via SurveyMonkey with pre- and post-surveys for each facet – six key learning outcomes for e-learning and the Human Factors Skills for Healthcare Instrument (HuFSHI) for the other elements – with free-text boxes for qualitative feedback.

Results:

e-Learning surveys were completed by 108 learners with a significant difference (p < 0.01) in self-reported pre- and post-survey scores across the six domains. Learners demonstrated mean improvements across all areas of the HuFSHI for the in situ (N = 9), human factors course (N = 15) and online format (N=46). Results were comparable between face-to-face and online formats. Learners found all formats useful (e-learning 99%, in situ 100%, human factors 100%, online 98%).

Implications for practice:

In a limited time frame, the simulation education team implemented a multimodal educational project that improved both ward staff knowledge and human factors skills amidst the second wave of the COVID-19 pandemic. Moreover, following restriction of face-to-face delivery, the project was successfully converted into a purely online format. This ability to be flexible and adapt accordingly is one that needs to be widely adopted going forwards, especially during these unpredictable times. Further challenges included staff release for training, time pressures, managing emotive discussions using the online modality and COVID-19 safety measures. A 6-month follow-up survey is planned to evaluate the benefit to staff’s clinical work and will be included at the presentation.

The GOSH Clinical Simulation Centre (CSC) delivers an established paediatric in situ simulation programme at Great Ormond Street Hospital. Prioritizing advancement of the patient safety agenda, we work closely with our quality and safety teams to embed key safety themes within our trust-wide in situ curriculum. A fundamental objective of in situ simulation is to identify and remove risks or ‘latent safety threats’ in the clinical environment, which could cause unintended harm to patients or staff ^[1]. Fitting with the safety II approach advocated in the National Patient Safety Strategy ^[2]; another emerging application of in situ simulation is its use to evaluate clinical systems and processes ^[3].

Aim:

The aim of the study was to expand the applications of our pan-trust in situ programme to adopt a prospective approach to simulation delivery via ‘Systems Safety’ exercises.

Method:

Over the course of 18 months, simulation exercises were designed to focus on rehearsal and refinement of processes and systems, towards uncovering latent safety threats or gaps in practice. A reporting tool was developed; to capture risks and identify mitigating actions. In addition to this, an established reporting structure enabled faculty to share findings and escalate risks to the local patient safety team. The COVID-19 pandemic presented healthcare workers with many new or unfamiliar working practices. This context further shifted our focus towards systems safety simulations (SSS) with the aim of enabling teams to focus on rehearsing and preparing for new ways of working.

Results:

Ten different exercises were delivered with clinical teams across the trust: successfully informing the development of five new clinical guidelines relating to COVID-19-specific practices. In one exercise alone, 11 latent safety threats (LSTs) were captured and managed with the appropriate teams (Figure 1). A system-based approach to simulation has since been used to inform equipment location and fire evacuation processes in two new clinical environments (Figures 2 and 3).

Figure 1:

Themes from LSTs captured during COVID-19 CT transfer simulation

Figure 2:

SSS fire evacuation exercise in the IMRI suite

Figure 3:

SSS fire evacuation exercise in the new sight and sound building

Implications for practice:

These exercises demonstrate the potential applications of simulation to support process and system improvement. Beyond the pandemic, we aim to continue to deliver SSS exercises to help make clinical systems and spaces safer for patients and teams. Following in the footsteps of successful simulation teams in the USA, we aim to advance this work to deliver SSS at the preconstruction level in future to inform the design of new clinical spaces.

In response to COVID-19, our organization expanded the critical care beds capacity; however, the number of critical care nurses was insufficient to meet expansion demands. Therefore, non-critical care nurses were deployed to COVID-19 critical care units. The deployed nurses lacked experience and training in critical care. To ensure patient safety, the nurses were assigned to assessors who evaluated their fitness to practice after receiving upskilling training through simulation-based education (SBE). However, due to the massive expansion and rapid deployment process, there was a shortage of competency assessors, highlighting an urgent need to use SBE to develop more assessors. We developed additional competency assessors through simulation embedding deliberate practice and rigorous assessment. Deliberate practice in simulation is described as progressive learning, which includes repetitive performance and rigorous assessment ^[1].

Aims:

The aim of the study was to explore the effectiveness of simulation embedding deliberate practice in developing nurse competency assessors.

Method:

Eleven assessor candidates were asked to perform competency assessments under simulated conditions. During the simulation, simulated participant (SP) roles were assigned as a bedside nurse and patient relative; the patient was a high-fidelity patient simulator. The assessor candidates were asked to perform a competency assessment of the bedside nurse who should perform the required critical care skills on the patient in the presence of the patient’s relative. The candidates used a valid observation rubric to complete the assessment. Using deliberate practice strategies, after each competency assessment, a debriefing session was conducted in which the SPs provided constructive feedback on the assessor’s performance. The assessor repeated the competency assessment under the same simulation conditions and attended debriefing sessions until they mastered the competency assessment process. Post simulation evaluation collected data to evaluate the candidates’ perception of the training.

Results:

Eleven nurses completed the simulation developmental programme and were assessed as competent to become assessors. The questionnaire findings revealed that all nurses perceived themselves as competent assessors; however, 90% reported the need for frequent exposure to the competency assessment process over time, in the clinical setting, to enhance their competence and confidence levels.

Implications for practice:

The hybrid simulation modality of SP and patient simulator embedding deliberate practice method was deemed to be an effective fast track method to develop competency assessors. However, practice of competency assessment in real clinical settings is essential to confirm competence.

Enhanced recovery after surgery (ERAS) is an evidence-based approach in perioperative care allowing patients to recover more quickly after surgery. The ultimate aim of this programme is to optimize organ function pre-operatively and reduce the stress response from major surgery to aid in early recovery ^[1]. The multimodal pathways utilize a wide range of staff from the multi-disciplinary healthcare team. Although medical staff such as senior anaesthetists and surgeons may be confident in implementing ERAS protocols and troubleshooting post-operative problems, this may not be the case for more junior medical, theatre and nursing staff. This is of particular relevance in smaller surgical units across the UK.

Aims:

We aimed to provide structured and interactive simulation (SIM) training for staff involved in the management of colorectal surgery patients on the ERAS programme. Staff included operating department practitioners (ODPs), surgical staff nurses and anaesthetics senior house officers (SHOs). This was based at a small district general hospital (DGH) in the West Midlands.

Method:

Staff were given hypothetical post-operative scenarios of commonly encountered surgical problems on the ward. These included hypotensive patients and the management of regional analgesic techniques such as epidurals. Sessions were commenced with a brief and targeted outline of relevant physiology, followed by a series of SIM moulages. A longer period of time was made available at the end of each SIM for debrief.

Results:

Staff were more confident after SIM sessions in managing the acutely ill ERAS surgical patient. The multi-disciplinary nature of the scenarios was highly commended. Feedback from staff was encouraging, in particular, about how ‘real’ the scenarios felt. There was also increased awareness about the rationale behind the principles of the ERAS programme and healthcare staff felt it would change their practice. Feedback was measured through a series of pre- and post-SIM questionnaires.

Implications for practice:

Through a series of SIM sessions and theatre shadowing, we aim to create an ERAS team and ERAS unit at the hospital. SIM will play a major role in addressing the learning objectives of junior medical staff, ODPs and nurses. The long-term goal is to safely manage these patients on a dedicated unit. We aim to create a safe environment where invasive monitoring can be used, and treatments such as vasopressors prescribed under the supervision of anaesthetists. This will ultimately improve patient care and help fulfil the core objectives of the ERAS approach.

Accurate assessment of potential hazards and challenges within a home environment is essential to ensure the safety of our patients both post-discharge from hospital and within the community. Inter-professional education in this area allows students to learn from, with and about each other to provide more effective patient care. COVID-19 challenged the Arkansas Interprofessional Education Consortium (ARIPEC) to develop meaningful inter-professional activities while minimizing COVID-19 risk ^[1].

Aims:

The aim of the study was to create and deliver a novel virtual home assessment simulation for inter-professional learners to improve the performance of home assessments state-wide.

Method:

Faculty from three universities created rooms within a simulated home assessment environment illustrating patient characteristics, hazards, habits and interpersonal considerations. Each university created and video recorded one simulated room (kitchen, bedroom and living room) which were combined in one video to represent a home. Students received pre-course material including education on the INHOMES tool and learning objectives before the virtual learning event. The brief included education on the importance of home assessment and the INHOMEs tool. The simulated home video was played to all students who subsequently were split into break-out rooms with facilitators. In inter-professional groups, students created action plans for immediate needs and for when weight-bearing status allowed increased mobility and identified professionals required to meet needs. Following this debriefs occurred in break-out rooms and then as a large group to summarize and identify take-aways. All students completed a pre-/post-questionnaire including the Interprofessional Collaborative Competency Attainment Survey (ICCAS) and evaluation of simulation methodology, home assessment and overall impression. Mean scores for 5-point Likert scores are reported.

Results:

In total, 400 students participated in the 2021 event, including medical, pharmacy, physician assistant, dental hygiene, communication science disorders, physical and occupational therapy, addiction studies, respiratory care, radiography, public health, sonography and nursing. All ICCAS metrics increased pre- to post-evaluation. See Table 1.

Table 1:

Student evaluation data from the simulated home environment assessment activity

Quality assessed	Mean Likert score (1 – strongly disagree, 5 – strongly agree)
Improve confidence	4.32
Improve communication skills	4.34
Improve reasoning skills	4.41
Improve decision-making skills	4.41
Helpful for professional development	4.46
More comfortable in completing home assessment to identify safety hazards and concerns	4.48
More comfortable to identify team members to meet the immediate and long-term needs of a patient with pain and limited mobility	4.48
The activity demonstrated the value of providing team-based home assessment education	4.54
Overall was a valuable educational activity	4.48
Simulation video portrayed the simulated environment well	4.5
Simulation video gave constructive indicators to identify patient characteristics and behaviours	4.53
Simulation provided an effective mechanism to learn home assessment using the INHOMES tool	4.52

Implications for practice:

Our results demonstrate that a video-recorded simulated home environment event is successful in supporting the development of an inter-professional action plan for a home assessment using the INHOMES assessment tool. The collaborative creation of this event was essential due to the COVID-19 pandemic, but the efficacy for learning demonstrates the utility of this approach in the post-pandemic area. Virtual simulations increase accessibility for inter-professional learners to learn from, with and about each other for the benefit of our patients.

During the second wave of the coronavirus pandemic, Day Surgery had been stopped for 6 months at Aintree University Hospital to respond to an influx of COVID patients. Day Surgery theatre staff had been redeployed to other areas of the hospital, including A&E and Intensive Care. The Day Surgery recovery had been repurposed as a ventilatory inpatient unit for coronavirus patients. We felt that this potentially jeopardized the confidence and competence of returning elective care staff. We hypothesized that the theatres themselves had become unsafe to accept patients for elective procedures having been used for a different purpose for such a long time. We used in situ simulation to re-skill the staff and test the safety of the clinical area ^[1].

Aim:

We aimed to improve the confidence and capability of theatre staff returning to work in elective theatres and to perform a systems test of the Day Surgery Unit to identify and rectify any latent errors.

Methods:

The refresher day was split into morning and afternoon sessions. The morning session comprised of two simulation sessions: cardiac arrest in recovery and a difficult airway in theatre. The afternoon comprised of sessions focussing on five anaesthetic emergencies: malignant hyperthermia, local anaesthetic toxicity, massive haemorrhage, anaphylaxis and sepsis. These sessions included locating and studying standard operating procedure (SOP) folders and locating vital equipment in the treatment of these emergencies. Participants then evaluated their confidence in managing emergencies before and after the refresher day using pre- and post-questionnaires. We also encouraged participants to raise concerns and make suggestions in a free-text section.

Results:

Forty participants took part in the refresher day. Pre- and post-questionnaires indicated that participants had much-improved confidence in dealing with anaesthetic emergencies post-session. We identified several latent errors within the unit including missing and out-of-date SOP folders, missing anaphylaxis bag, no fibrescope available for the difficult airway, no key available for the malignant hyperthermia cupboard and a poorly stocked and unsealed difficult airway trolley.

Implication for practice:

The results show that participants felt more confident to restart work in the Day Surgery Unit, hopefully improving their performance in critical incidents. By running in situ emergency simulations, we identified several latent errors in the elective care centre which allowed us to rectify these in preparation for its re-opening, improving the safety of our unit. Participants expressed a desire to engage in more simulation sessions. Latent environmental errors revealed: using in situ simulation to check the safety of returning theatres to operating after being repurposed as a ventilator inpatient unit.

Point-of-care ultrasound (PoCUS) is a bedside imaging modality that provides the operator with instant clinical patient information. PoCUS is a low-cost, radiation-free, portable diagnostic tool that is utilized in many specialities ^[1]. To the best of our knowledge, no Irish medical schools have a formalized ultrasound curriculum in place for undergraduate students. Hands-on ultrasound teaching has the potential to enhance medical students’ basic understanding of human anatomy and confidence in diagnostic ability ^[2].

Aims:

The aim of the study was to assess undergraduate medical students’ attitudes towards PoCUS through the implementation of a rudimentary proctored PoCUS workshop.

Methodology:

Third-year medical students at the Royal College of Surgeons in Ireland participated in a 1-hour PoCUS workshop as part of their fundamental clinical skills training. Medical students attended the in-person workshop repeated over 8 weeks. Students were exposed to three ultrasound stations. The first was a CAE Vimedix ultrasound simulator utilizing augmented reality colourization and 3D modelling. The second station was learning and performing an extended FAST scan with a focus on bright mode image acquisition and free fluid recognition. The third station was the practical placement of peripheral/central IV-line insertion helping students to identify vasculature while also manipulating the ultrasound transducer as a procedural adjunct. Students were asked to complete a post-workshop survey to investigate their attitudes towards ultrasound teaching in undergraduate medical education. The survey consisted of 10 questions to assess attendee’s prior ultrasound knowledge, to provide constructive feedback regarding the workshop and how ultrasound can be incorporated into future undergraduate medical education.

Results:

A total of 121 students completed the post-workshop survey. Of those who completed the survey, 94.2% of students had never used an ultrasound machine before and 100% had never performed PoCUS previously. Collectively, participants strongly agreed 100% that PoCUS should be incorporated into the undergraduate medical student curriculum at RCSI. In particular, 89.3% and 45.5% of students indicated that POTUS should be included in the third- and fourth-year medicine curriculum, respectively. 85.1% of students indicated that PoCUS education would be most valuable to supplement clinical placement followed by anatomy (62.8%), pathology (59.9%) and physiology (23.1%). 86.8% of the students were interested in learning more about PoCUS through an online format.

Implications for practice:

PoCUS appears to be an additional valuable learning resource for undergraduate medical students. Of the students surveyed, it is apparent that there is strong support in favour of early ultrasound integration into the future medical school curriculum.

The transition to a foundation doctor is often a daunting process for medical students and, to prepare for this, students attend an assistantship placement in the final months of medical school. The transition to foundation year 1 (TTF1) programme is an 8-week placement where students shadow a junior doctor, taking on a vocational role, and attend various teaching activities including high-fidelity simulation. Evidence suggests that medical students transitioning to clinical practice feel unprepared for working on-call, managing acutely unwell patients and task prioritization, and are often unprepared for scenarios requiring expert communication techniques ^[1]. As such, we redesigned a simulation programme for TTF1 students using novel scenarios designed to focus on these key areas that students often struggle with.

Aim:

We aimed to evaluate the effectiveness of a redesigned simulation programme for TTF1 students, focussing on student satisfaction, confidence and attitudes across key domains.

Methods:

Fifty-three TTF1 students attended a 1-day high-fidelity simulation training day, separated into cohorts of 10 students. Students completed a pre-course (n = 53) and post-course online evaluation form (n = 49) using Likert scales (0–5) and qualitative data. Students participated in at least one clinical scenario, while observers viewed the scenarios in a separate room. Scenarios were created to reflect likely clinical on-call tasks such as falls assessment, recognizing and managing the acutely unwell patient, bleep prioritization, and de-escalation of an agitated patient-actor. Debrief was undertaken using the Diamond Debrief model.

Results:

In terms of confidence, there was an improvement across all core domains, namely diagnosing and managing acute medical emergencies (2.8 vs. 3.8), performing cardiopulmonary resuscitation (3.0 vs. 3.6) and working effectively with colleagues in the interests of the patient (3.3 vs. 4.2). 96% of students found that simulation was a valuable learning experience, allowing them to integrate theory with practice. 94% of students felt that the simulation allowed them to analyse their behaviours and actions and 88% found that scenarios resembled real-world situations. Attitudes towards simulation were positive, with 92% of students agreeing that simulation is a good way of learning technical and non-technical skills. Qualitative themes focussed on the real-world applicability of the scenarios, increased confidence in task prioritization, closed-loop communication and early escalation.

Implications for practice:

We have demonstrated the benefit of integrating simulation training within the assistantship period and the value of creating novel scenarios directly related to future practice as a junior doctor.

The difficult airway society states that emergency front of neck access skills should be recapped every 6 months amongst those practitioners expected to perform the skill. Furthermore, the national audit states that, of the 25 emergency cricothyroidotomy cases, 9 failed. These were largely due to incorrect identification of the midline and tube misplacement. There is a convincing argument for training practitioners in ultrasound identification of the cricothyroid membrane, mitigating the risks of incorrect midline identification and blood vessel damage ^[1].

Aim:

Our aim was two-fold: introduce and embed the skill of ultrasound identification of the cricothyroid membrane for use in emergency front of neck access and encourage regular recap of these skills through a training package of blended learning, consisting of videos, ‘tea trolley’ style theatre training and a more formal simulation-based course that focuses on the ultrasound and front of neck access skill and human factors as we know this is a key factor in the success or failure of this scenario.

Methods:

A pilot course was rolled out amongst anaesthetic trainees to assess relative comfort with performing emergency front of neck access. The course consisted of a short lecture on the background and anatomy, teaching of the ultrasound skill using live subjects, practising of ultrasound-guided front of neck access on animal necks and finally a simulation with debrief surrounding implementation of the skill itself and human factors. This course is now being rolled out regionally and aims to teach all trainees in the region. We encourage trainees to generate their own informal logbook of ultrasound cases, whereby they consent patients to undergo a short ultrasound scan in the anaesthetic room prior to intubation, have their neck marked and then are rescanned after intubation to confirm correct identification. This should be done with ‘normal’ airways, not just those expected to be difficult, as this practice embeds the skill. Our ‘tea trolley’ style teaching is yet to be commenced but will involve ad hoc teaching within the theatre suite including the multi-disciplinary team who would be involved in such an event – the anaesthetist, operating department practitioner and theatre team. Finally, we are generating a video bank, which can be accessed in users’ own time to recap and review the process and troubleshooting of ultrasound identification of the cricothyroid membrane and ensuing cricothyroidotomy.

Results:

An improvement was reported in trainees’ comfort levels to perform ultrasound-guided cricothyroidotomy and all trainees felt that this was a worthwhile skill to embed into their practice. These improvements were tested via a pre- and post-course questionnaire. The same we hope will be true for the tea trolley training and we aim to address the human factors involved during these sessions too.

Implications in practice:

The aspiration is that ultimately ultrasound identification of the cricothyroid membrane for emergency front of neck access will at the very least become a skill that all trainees are formally taught and encouraged to practice and at the most will become the new standard for plan D airway access in the difficult airway society guidelines.

Infant abductions are rare distressing events. The Care Quality Commission recently highlighted inadequate protective measures in other trusts as a cause of major concern ^[1]. In April 2020, the security system in our Neonatal Intensive Care Unit (NICU) was updated, with a new baby tag system. A tag is placed onto each baby in NICU, and if this tag is within close proximity of an exit door, an alarm sounds and the door locks.

Aim:

The aim of the study was to test our existing patient safety system in a real-life situation looking at human factors and equipment functionality.

Method:

An activated baby tag was placed on a mannequin which was then put into a pram. A member of staff in disguise (the ‘abductor’) pushed the pram out of the neonatal unit by ‘tailgating’ another member of staff so that the doors would not automatically lock, replicating a potential real-life scenario that exploited a known risk. The aim was to see whether the mannequin could leave the hospital. The ‘abductor’ was eventually stopped from leaving. A detailed timeline of events was recorded and analysed. Safety was ensured and participants were individually debriefed as emotions were high.

Results:

Our simulation highlighted points of excellence including a quick and calm response, the use of the panic button and appropriate persistent challenge of the ‘abductor’ without aggression. Important human factors were highlighted. There is no security staff in the hospital. The ward clerks called the porters directly, rather than dialling 2222 and saying ‘lockdown’, which triggers a lock of all doors out of the hospital. There were several system failures. The baby tag system did not alert the front of house. The panic button was broken, and a set of doors out of the hospital did not lock.

Implications for practice:

Simulation is an effective tool to identify system failures and patient safety risks. This scenario highlighted deficiencies in our system and a lack of established procedures and training. A detailed action plan has been put in place. The panic alarm, door locking mechanism and system linking the baby alarm system to the front of house are being addressed. The option of an automatic lockdown on activation of the baby tag alarm system is being explored. Finally, a standard operating procedure is being written and learning disseminated in the department. We are planning to run this simulation in other areas of the hospital to optimize patient safety.

During a single patient journey from admission to hospital discharge, multiple clinical handovers may occur between health professionals from different specialist inpatient teams and between staff at shift changes. Each handover carries a degree of risk for the patient. It is well recognized that poor communication during handovers has resulted in a significant proportion of preventable deaths ^[1]. The World Health Organisation (WHO) has therefore included clinical handover in the 2020 Global Patient Safety Action Plan as one of the key areas of patient care that requires robust processes and policy to ensure and improve patient safety ^[2]. Although handover involves risk, it is a vital part of patient care. It is often the primary source of information for health professionals taking over patient care. However, handover in resus could often feel stressful and chaotic with multiple distractions and variability in the information conveyed. It was also apparent that staff from both ED and SAS were not satisfied with the handover process. During debrief sessions, handover was often mentioned as an area of practice that required change.

Aims:

The aim of our quality improvement (QI) project was to improve the handover process between Scottish Ambulance Service (SAS) staff and Emergency Department (ED) staff for critically unwell and injured patients arriving into resus. In addition, we aimed to improve communication and staff satisfaction with the handover process.

Methods:

By utilizing QI tools such as the model for improvement, process mapping and driver diagrams, change ideas were identified and trialled using inter-professional simulation as part of PDSA (Plan, Do, Study, Act) cycles. This project involved engagement with ED and SAS staff members via online surveys, simulation sessions and staff education.

Results:

We increased staff satisfaction with the handover process from 24% to 88% and no adverse events relating to our changes were reported.

Implication for practice:

From the information gathered during PDSA cycles, a new standard operating procedure (SOP) for handover in resus was created.

Practical procedures are integral to neonatal care. All first-year paediatric specialist trainees (ST1s) are expected to develop essential skills from their first neonatal placement. However, many trainees join the speciality with minimal prior exposure. With recent changes in junior doctors’ contracts, reduced working hours and evolving clinical practices, trainees may not get enough clinical exposure to acquire required skills. Simulation is recognized as essential to bridge this training gap ^[1]. A practical skills course developed in 2018 has been running with consistently good feedback. However, during the COVID-19 pandemic, it was suspended.

Aims:

The aim of the study was to adapt neonatal skills training to virtual delivery.

Methods:

In September 2020, we trialled a half-day virtual training course for new trainees on core topics. The first part included ‘Human Factors’ followed by ‘Stabilization of the premature infant’ using a pre-recorded simulation followed by a live debrief. The second part covered ‘intubation and difficult airway’ followed by ‘vascular access’. We used interactive lectures and pre-recorded demonstrations. A full-day course was then organized for new trainees in March 2021. We included additional sessions on ‘Newborn Infant Physical Examination’ (NIPE), ‘chest drain insertion’ and ‘journal club’, including sign posting to the Critical Appraisal Skills Programme (CASP). Interaction was encouraged to facilitate peer bonding. A Paediatric Trainee Committee representative also joined to outline the support available for trainees. We followed a similar structure to the first course but added live simulation demonstrations of equipment and techniques.

Results:

Seventeen trainees attended the full-day course. A number of candidates rating the sessions as extremely useful were 16 for ‘Stabilization of the premature infant’ and ‘intubation and difficult airway’, 14 for ‘Human Factors’ and ‘NIPE’, 12 for ‘vascular access’ and ‘chest drain insertion’ and 11 for Journal club. Trainees commented positively on the videos, equipment demonstration, level of interactivity and overall usefulness of the course. Nine trainees commented on desire for additional face-to-face training.

Implications for practice:

After balancing the safety and learning needs of trainees, we adapted an established face-to-face skills day for virtual delivery during the COVID-19 pandemic. Whilst we recognize that virtual training is not a substitute for doing, we were able to maintain essential education during highly pressured times. Feedback demonstrates that our virtual teaching programme was well received and useful. It also emphasizes the value of actual practice and the urgency to restore hands-on training as soon as possible.

Simulation is a technique employed to produce an experience without going through a real event ^[1], with different methods used to do this within a medical simulation. Virtual reality (VR) is the simulation of the world through a computer or device. VR has been used for procedural training and within medical education for a number of years ^[2].

Aim:

We had used 360 videos for remote simulation and debrief for over 3 years but as face-to-face sessions started to reoccur, we wondered whether we could use these videos to engage learners using VR headsets for short immersive sessions with a targeted debrief.

Methods:

We used unscripted 360-degree scenarios of Paediatric emergency simulations, loaded onto Occulus-Go VR headsets. Between November 2020 and May 2020, we ran sessions for the paediatric and obstetric teams in North Devon district hospital, where groups of up to five learners watched a scenario, followed by a debrief led by a facilitator. We explored its acceptability, immersion and whether the debrief enriched the session through collecting feedback.

Results:

We engaged 50 participants over 14 sessions. The majority of sessions occurred on night shifts. Twenty-nine staff including doctors, midwives, healthcare assistants and nurses gave feedback. All participants enjoyed the experience and wanted to do it again: 90% felt immersed and 97% enjoyed the debrief. A small minority found the experience strange and one had to stop watching because of motion sickness.

Implications for practice:

Virtual sim with headsets is time-efficient, requires no bedspace and was engaging enough to be requested during out of hours shifts. Feedback proved it to be immersive, safe and enjoyable. It is cost-effective (not needing large numbers of staff or expensive manikins) and the experience reproducible. It was accessible for those who had previously been scared of simulation as they did not feel ‘judged’ and therefore may be a valuable adjunct to engaging those who have not in the past. Debrief was vital and allowed active discussion of learners’ own experiences as well as an exploration of the medicine prompted by being immersed in the scenario. Virtual simulation using headsets and 360 videos gives learners an experience without going through the real event and we feel that it is a valuable tool for engaging teams in simulation education. Through this project have established standards that could help others engage in projects such as this.

We wanted to use simulation teaching to improve our multi-disciplinary team’s (MDT) management of children who presented to our Children and Young People’s ED (CYPED) with fever.

Aims:

The aims of the study were: first, to use simulation teaching to train the MDT in our CYPED, to improve the care delivered to children presenting with fever, measured as an improvement in our compliance with the Royal College of Emergency Medicine’s (RCEM) standards ^[1]. Secondly, to carry out the simulation teaching in a ‘pop-up’ style that can be delivered to staff within their clinical shifts on the shopfloor, without disturbing their work or the functioning of the CYPED.

Method:

For cycle one of our audits, we looked at a sample of 136 children who presented to our CYPED with fever; 61 patients met the inclusion criteria and were included. To improve compliance to the RCEM standards ^[1], we designed a 10-min, low-fidelity, simulation-based teaching session, requiring minimal resources. When staffing and acuity in the department allowed, we carried out ‘pop-up’ teaching in a spare CYPED cubicle. We ran four sessions, each lasting 1 to 3 h. Within these sessions, we ran the simulation 20 times, to 40 members of the MDT. To aid flexibility, we started each teaching session as and when staff attended. Following the teaching, staff self-rated their knowledge and ability to adhere to the RCEM standards on a 10-point Likert scale. To complete our PDSA cycle ^[2], we repeated the audit. We looked at a sample of 192 children, 87 met the inclusion criteria and were included.

Results:

Staff’s self-rated knowledge of the RCEM standards ^[1] improved from 4.4 to 9.3 and their self-rated adherence to the standards improved from 5.4 to 9.3, on a 10-point Likert scale. This was reflected in improved compliance to the RCEM standards 1–6 ^[1] in the second audit cycle. The compliance with RCEM standards (1) from cycle 1 to cycle 2 was as follows: standard 1; 71% to 79%, standard 2; 59% to 78%, standard 3; 38% to 92%, standard 4; 74% to 66% and standard 5; 100% both cycles. Standard 6 is that the CYPED should provide training in sepsis recognition, which was achieved through our simulation sessions.

Implications for practice:

‘Pop-up’ style simulation teaching can be used to improve the care that we offer our patients, as reflected by an improvement in staff’s confidence and in the department’s compliance with RCEM standards ^[1]. We endeavour to continue to use pop-up style simulation sessions within clinical shifts to continue to learn and strengthen as an MDT. In turn, we hope that this will improve the care that we offer our patients.

In early 2020, medical teams globally faced the challenge of preparing for an unprecedented clinical situation. As well as the predicated scale and severity of the COVID-19 pandemic clinical teams were generally inexperienced in dealing with an infectious agent of this nature. Simulation, particularly high-fidelity, plays an important role in preparing for novel, high-stakes situations. However, at this time, all clinical departments were simultaneously occupied with such preparation. This placed unprecedented demand on resource-dependant, high-fidelity simulation. Here we share our use of multiple simulation modalities, ranging from low- to high-fidelity, to prepare our multi-disciplinary obstetric theatre team for the arrival of the COVID-19 pandemic.

Aims:

The aim of the study was to prepare the local team to manage COVID obstetric patients within the theatre environment, particularly in the context of obstetric emergencies. This preparation must take the form of both institutional learning (the creation of a standardized protocol specifically adapted for obstetric theatres) and individual learning (familiarity by individual team members with guidelines and their roles within them).

Method:

Multiple modalities of simulation were utilized (Table 1), ranging from ‘talk-through’ – table-top discussion utilizing paper prompts, such as a map of the theatre complex (Figure 1) – to high-fidelity in situ simulation. Whilst only a single high-fidelity simulation was performed, the other modalities were employed numerous times.

Table 1:

Figure 1:

Results:

This programme of multiple interlinked simulation modalities allowed the creation of a coherent, comprehensive and practical protocol for the management of COVID patients in obstetric theatres in advance of encountering such patients in reality. This protocol was found to be satisfactory to a group of local subject matter experts prior to the arrival of the pandemic. As management of COVID obstetric patients became more familiar, this protocol was reviewed. It was found that no significant alterations were required, indicating that, despite utilizing only a single, high-fidelity simulation session, the original programme of development had pre-empted many of the practical issues that would otherwise only have been discovered later through real-world practice. Individual learning is more challenging to define, but feedback suggested both a greater familiarity with guidelines by individual learners and was able to identify targets for more specific training (e.g. donning/doffing, definitions of aerosol-generating procedures).

Implications for practice:

High-fidelity is often viewed as the highest form of simulation for effective learning. However, its undertaking has a high resource cost. Our experience demonstrated that low-fidelity, less resource-demanding modalities provide significant benefits to both individual and institutional learning.

As part of their Healthcare of Later Life placement medical students take part in a simulation-based learning (SBL) programme delivered by the Nottinghamshire Healthcare Simulation Centre. Since face-to-face teaching was not possible during the COVID-19 pandemic the programme was instead delivered online.

Aim:

The aim of the study was to compare the feasibility and acceptability of delivering an SBL programme for medical students virtually versus face to face.

Method:

The existing SBL programme was delivered online while largely keeping the same content and format as for prior, face to face, cohorts. Feedback questionnaires from 136 face-to-face participants (F2F) from the 2019–2020 cohort and 131 virtual participants (V) from the 2020–2021 cohort were compared.

Results:

Overall, the virtual course was still acceptable to most participants with 99% agreeing or strongly agreeing that the learning objectives were met and 98% indicating they would recommend it to a colleague. However, there was a decrease in Likert scale ratings across all domains in the V group. This was most apparent when examining the ‘strongly agree’ responses: the venue/remote format was suitable for the session 34% decrease, the course length was appropriate 30% decrease, the pace of the course was appropriate 20% decrease, the trainers were well-prepared 15% decrease, the presenters were engaging 10% decrease, the simulation was helpful and relevant 10% decrease, the content of the course was organized and easy to follow 5% decrease, the learning objectives were met 4% decrease. There was a small increase in responses in the strongly disagree and disagree categories.

Implication for practice:

Providing the SBL programme using an online format was feasible while also being acceptable to most participants. However, participants did not rate this experience as highly as face-to-face teaching. An interesting finding is that participants rated the pace and length of the online course as less agreeable, despite the content and scheduling is the same as for the face-to-face group. Analysis of qualitative responses indicated that participants in the V group found it difficult to sustain concentration for the duration of the virtual session. This may relate to a newly emerging phenomenon dubbed ‘Zoom Fatigue’ (Lee, December 2020) which is related to the greater cognitive load required when participating in social interactions in a virtual environment. Based on these findings, face-to-face teaching should resume when practicable. The virtual delivery may be improved if the course length was reduced.

Departmental induction is essential for trainee well-being and patient safety, particularly for doctors in the early stages of their careers. Studies have shown that junior doctors often feel underprepared and without sufficient knowledge for safe and efficient practice in surgical rotations ^[1]. Simulation has been suggested as a tool to improve preparedness. Simulation training in acute surgical presentations, surgical ward rounds, for theatre teams and for practical surgical skills is well established. However, much of junior doctors’ work involves assessing patients who have deteriorated following admission ^[2], including post-operatively. There is little in the literature exploring the use of simulation in preparing junior doctors to manage ward-based surgical emergencies.

Aim:

This pilot project aimed to create an immersive simulation-based course for junior doctors, focussing on the technical and non-technical skills required to deal with common post-operative and post-procedural emergencies, to improve the departmental induction process.

Methods:

Junior doctors completed a questionnaire to identify their learning needs. On the basis of this, six high-fidelity immersive simulation scenarios were designed: post-operative bleeding, post-ERCP pancreatitis, post-NG tube insertion aspiration pneumonia, anastomotic leak, post-operative wound dehiscence and post-operative cardiac arrest. The scenarios were constructively aligned to both technical and non-technical learning objectives. Scenario participation was followed by a facilitated debrief. Participants completed a pre- and post-course questionnaire exploring their experience on surgical wards, confidence managing surgical ward emergencies and evaluation of the course.

Results:

Two pilot sessions have been facilitated, involving seven junior doctors. Highlighted challenges of surgical ward work include the need for independent decision-making, obtaining senior support and ensuring review of post-operative patients. Pre-course, confidence was particularly low in identifying and managing post-operative emergencies, identifying patients who need to return to theatre and making escalation decisions for surgical patients. Confidence was higher in escalating to surgical seniors and recognizing own limitations. Post-course, confidence had improved in all technical and non-technical skill domains. Participants found the scenarios and subsequent debriefs relevant and educationally valuable. The main suggestion for improvement was to include the course earlier in the rotation. Data collection is ongoing.

Implications for practice:

Our results show that junior doctors find specific simulation-based training in surgical ward and post-operative emergencies extremely valuable, with improved confidence in technical and non-technical skills. We hope to embed this training as part of the departmental induction within our health board and suggest that simulation training for junior doctors on post-procedural emergencies would be of widespread benefit.

During the COVID-19 pandemic, most face-to-face courses were cancelled in line with government and trust guidelines reducing the risk of virus transmission and, if possible, delivered virtually. Given that this is not feasible for all courses, cancellation would have resulted in suspension of essential training for healthcare staff subsequently impacting on career progression.

Aim:

We aimed to deliver Internal Medical training skills and simulations course, face-to-face with measures taken to minimize virus transmission as well as maintain good-quality teaching.

Method:

COVID-19 measures:

Fewer delegates per course to accommodate social distancing – infection control guided

Temperature check on registration

Wearing appropriate Personal Protective Equipment (PPE) whilst inside the teaching centre

Email instructing to notify if exhibiting symptoms of COVID-19, and advise not to attend

Maintain social distancing during course

Increase ventilation of rooms

Cleaning of equipment after each use and encouraged regular use of hand sanitizer

Use of register for track and trace purposes

Data collection:

Feedback forms of courses that were run pre-pandemic (2019/20) and during pandemic (2020/21) were collated and compared.

Results:

Four editions of the course were run over a period of 3 months and a total of 19 participants in 2019/2020. Four editions of the course were run over a period of 7 months with a total of 17 participants in 2020–2021. Feedback response was on a Likert scale ranging from ‘strongly agree’ to ‘strongly disagree’. For ease of comparison, Figure 1 shows ‘strongly agree’ and ‘agree’ responses only. The pre- and post-SARS-COVID-19 results from the feedback are similar across the board.

Implications for practice:

The results from the feedback forms are very similar for both courses run pre- and post-SARS-COVID-19. Free-text feedback and feedback on the day from the delegates were positive. The results suggest that the changes made to the course during the pandemic to allow for social distancing and to ensure that the courses were run COVID secure have not affected the quality of the teaching and the learning opportunities for delegates. Furthermore, written feedback showed that most candidates appreciated the opportunity to practice new skills and gain confidence and work fatigue did not dampen their motivation to learn. This highlights the importance of continuing to run face-to-face courses during the pandemic.

Gynaecologic Teaching Associate (GTA) and Male Urogenital Teaching Associate (MUTA) methodology have been utilized for decades in effective breast, pelvic and urogenital examination clinical skill instruction. This methodology is recognized as the gold standard of instruction when educating learners on the sensitive, invasive clinical skills techniques associated with a genital examination. While research shows it is the most effective way to learn these procedures, outside of the USA and Canada, there are few GTA/MUTA programmes at medical learning institutions.

Aims:

This methodology aims to provide hands-on, standardized instruction in an anxiety-free environment where learners safely practice the clinical skills techniques of breast, pelvic and urogenital examinations and have the unique experience of learning these techniques from the patient’s perspective.

Method:

The GTA/MUTA is both instructor and live simulated patient, using their own bodies as teaching tools, guiding learners through examination techniques and providing instant feedback. With this unique opportunity for skills acquisition, learners receive step-by-step instruction on an actual person in a quality-controlled environment. In addition to correct palpation techniques, this patient-centred form of instruction addresses the emotional reaction patients may have to these examinations. GTA/MUTA instruction also includes patient education and communication and relaxation techniques. The GTA/MUTA patient empowerment methodology is designed to provide an anxiety-free atmosphere for the learner so that the sensitive nature of the genital examination and the embarrassment often accompanying the examination do not become an obstacle to acquiring safe, effective clinical technique.

Results:

Decades of research prove that this method lowers learner anxiety and provides exceptional outcomes for learners in a multiplicity of learning criteria, including higher overall scores; superior communication skills; better ability to identify pathology; ‘better interpersonal skills than physician trained with lasting effects that can be demonstrated after clinical exposure’ ^[1]; ability to conduct safe, genital examination techniques on patients after exposure to a GTA/MUTA instructor ^[2].

Implications for practice:

The methodology has far-reaching implications. The specialized skills of these individuals mean that the teaching method can be brought outside of the well-patient experience; sexual assault providers can practice the trauma examination on live simulated patients; remediation can be provided to practitioners who must relearn techniques to maintain licensure; learners are more empathetic to their patients and more inclined to include their patients in the examination process thus improving patient care. This methodology can be utilized in any setting where invasive examination procedures, patient education and communication must be mastered.

It was a recognized challenge of lack of ventilators needed to face COVID-19 worldwide. Although ventilators are sparse, self-inflating manual resuscitators are widely available in-hospital services, providing a rapid response to respiratory depression. Based on this, a device (PNEUMA) ^[1] was designed to be a temporary solution for emergency use, allowing positive pressure ventilation through a standard self-inflating manual resuscitator, without the need for healthcare personal manually operating the resuscitator. In the first stage, the device underwent functionality and performance testing, using a calibrated lung tester. In the second stage, the usability of the device was assessed, using a clinical simulation environment, an effective method to test usability ^[2].

Aim:

This work describes the use of a simulation environment to test the usability of a novel device to automate self-inflating manual resuscitators.

Method:

The usability study was divided into two parts: (1) participants followed a protocol with instructions for assembling and using the system in a non-clinical context (Figure 1, left panel) and (2) participants used the system in an immersive simulation environment with a clinical case scenario (Figure 1, right panel). Participants received information on how to assemble/use the system through a 4-page user manual. To monitor participants’ interaction with the system, both parts were video-recorded and questionnaires on key aspects of usability were filled out.

Figure 1:

Usability testing. Left panel – assembly of the system (part I); right panel – use of the system in an immersive clinical simulation environment (part II).

Results:

A convenience sample (two MDs and six RNs) from an intensive care unit of a tertiary Portuguese hospital participated in the test. Usability testing showed that the system was easy and timely assembled, with low complexity of use (e.g. not requiring external help). The clinical scenario tested the transition between spontaneous and mechanical ventilation, and ventilatory parameters’ control, using PNEUMA. All participants reported that the controllable parameters (I:E, RR, Vol, PIP, Plat, and PEEP) were relevant and easy to change. Participants suggested the inclusion of patient parameters such as the tidal volume and lung compliance. Participants also suggested improvements, such as the inclusion of pressure alarms and a more user-friendly interface. All participants reported that they would be willing to use the device for emergency use.

Implications for practice:

The reported study resulted in recommendations and ameliorations of the device, before its use in real settings, in the context of the COVID-19 pandemic. The use of simulation environments for device/systems’ testing provides a timely and standardized approach, enabling a safer clinical practice.

As COVID-19 hospital admissions rose in 2020, there was a requirement to prepare wards and staff to care for COVID-19 patients, especially given the rapidly emerging and frequently evolving guidance, and high levels of re-deployment (GMC, 2020). In one London Trust, this need for educational material geared towards ward staff resulted in a multi-disciplinary simulation education team being commissioned to produce an e-learning resource. We measured the effectiveness of the resource for ward staff as well as any improvement in learners’ COVID-19 knowledge.

Aim:

The aim of the study was to quantify the effectiveness of an e-learning package in improving learners’ COVID-19 knowledge.

Method:

In November 2020, an e-learning package was created, comprising a video series documenting the journey of a patient with COVID-19 covering admission to discharge (filmed from the patient perspective). This was integrated with content highlighting key aspects of COVID-19 care, ending with a mandatory assessment with an 80% pass mark. The e-learning was disseminated to hospital staff (doctors, nurses and allied healthcare professionals) with data collection via SurveyMonkey® from November 2020 for 3 months. Pre- and post-surveys were included to investigate the average improvement of learners and the impact of the resource on learner self-efficacy through self-rating on six learning outcomes. Free-text options in the post-survey allowed qualitative feedback, aiding continual resource development.

Results:

In total, 108 learners, about half of whom were doctors, completed both surveys, with a significant difference (p < 0.01) between the pre- and post-learning results and an overall improvement in learners’ knowledge after completion of the e-learning (Table 1). The greatest improvement was in ‘Discharge requirements’ (94%) and 100% of learners passed the assessment. The majority found the resource useful, and none reported finding the resource difficult to use. Most positive feedback referred to the format, resources, content and audio-visual aspects.

Table 1:

Average pre- and post-learning scores of learners’ self-reported knowledge and percentage improvement

Key learning outcome	Pre-learning mean (out of 10)	Post-learning mean (out of 10)	p-value	Percent improved
Recognize symptoms	7.2	9.0	<0.01	73
Understand TEPs*	6.7	8.8	<0.01	73
Treatment options	5.8	8.7	<0.01	89
Features of deterioration	6.3	8.7	<0.01	83
Escalation protocol	5.0	8.6	<0.01	93
Discharge requirements	4.6	8.2	<0.01	94

*Treatment escalation plans.

Implications for practice:

E-learning can rapidly disseminate learning, at a time when most feel the pandemic has had a mixed or negative impact on learning opportunities (Dean E, 2020; GMC, 2020). The e-learning is continually updated with new evidence, with plans to expand access across London. An iterative process was undertaken with updates in response to learner feedback due to the speed at which the resource needed to be developed, for example, turning resources into PDFs for home access. The e-learning remains live given rising COVID-19 cases. Further work is required to investigate the effectiveness of this resource across London and how beneficial it has been for clinical work.

Child abduction is poorly defined in the UK. Legislation varies, defining offences of child abduction, kidnapping and child stealing/plagium. Rabun ^[1] reports that 45% of infant abductions occur from healthcare facilities and the remainder occur from homes (40%) and other places (15%). The rise in child abduction in recent years may be related to easier access to hospital units, previously open only to fathers during strict visiting hours ^[2]. Modern, family-centred units allow many visitors, posing further concerns around abduction.

Aims:

Proactive planning, security and staff training are required to reduce this risk, and a live simulation was utilized to test these elements, identify risks and provide solutions.

Method:

A staff member, unknown to the maternity team, was admitted to the ward and gave birth (simulated to a baby girl). Ward staff were informed that there was a restraining order on her partner who was not permitted to visit. An educator from the Clinical Simulation team was tasked with gaining access to the maternity unit, abduct the baby and make their way to a hospital exit and to the car. With the support of Clinical and Governance Midwives, an unannounced live drill was conducted to analyse:

Security of the unit

Staff adherence to local policy – proactive planning

Conflict management and challenge

Results:

Observation analysis identified:

Access to the maternal unit was gained through tailgating with no challenge from staff.

Access to the mother’s room, despite being in close proximity to the midwives’ station, went unchallenged.

Staff did not engage or challenge abductor despite a team member identifying concern.

Activation of local policy was slowed due to handover time. Lack of awareness of who has called who.

Communications between staff members occurred through non-secure social media applications.

Security cameras ineffective due to relay of images to a different location

Escape from the unit made easy by unlocked corridors.

Certain staff groups unsure of their role.

Implications for practice:

The identification of latent risks in resources and staffing alongside having confidence with protocols and decision-making has illustrated potential serious risks to both mother and baby. This clinical simulation has allowed us to address and provide recommendations to resolve these by highlighting urgent reassessments of security, proactive planning and staff development to ensure the reality of abduction is minimized.

Stroke remains the second leading cause of death worldwide and an important diagnosis requiring early recognition and action for optimal clinical outcomes which are time dependent ^[1]. With heterogeneity in healthcare systems according to trust and resources, it is key that healthcare workers are aware of the local pathways for time-critical conditions such as stroke. Delayed recognition and management of an inpatient stroke prompted the development of an acute neurology simulation course at a London district general hospital aimed at junior doctors.

Aims:

The aim of the course was to inform about the local stroke pathways, ensure juniors are comfortable with recognition of stroke and to develop the non-technical skills required in stroke management, thus enabling skill acquisition in a safe environment.

Method:

An innovative course was created using SimMan 3G with a focus on ensuring high fidelity to overcome the limitations associated with the practical aspect of stroke assessment in a mannequin. Five scenarios were created to last 15 minutes: three of which involved acute stroke diagnosis and two about stroke ‘mimics’. These scenarios included the involvement of a junior doctor, an acting nurse and acting members of the multi-disciplinary team as required. The debrief following each scenario would cover the technical aspects of management and self and group reflections. To add to the fidelity when assessing a mannequin for neurological conditions, we ensured that slurred speech could be mimicked, weakness in the limbs was showcased and facial asymmetry represented with innovative techniques using the mannequin.

Results:

Two sessions have been delivered involving nine junior doctors and this has been implemented as a regular course for junior doctors and nurses. All attendees felt more confident with stroke recognition, awareness of stroke mimics and of the local pathways when managing patients with acute stroke.

Implications for practice:

The positive feedback received and the outcome that all attendees felt more confident following the course suggest that stroke recognition and management can be learnt using simulation with a focus on the human factors required to optimize patient care. We hope to continue delivering this course to junior doctors rotating through the hospital and hope to open it up to the wider multi-disciplinary team including nursing staff, healthcare assistants and therapists with a focus on recognition and escalation. Dissemination of learning on local pathways and management using simulation is effective and can impact patient care.

Paediatric vascular access can be notoriously difficult due to small vessels and patient cooperation. Studies have shown ultrasound (US) guided technique to be a more successful method in experienced hands, especially in children with difficult access ^[1]. US-guided vascular access is well established within adult medicine; however, at present there is no standardized practice in paediatrics with many clinicians not gaining any US experience, unless undertaking acute sub- specialist placements ^[2]. In some cases, children are transferred to tertiary centres where there is more US expertise ^[2]. To enable the best patient care within their local setting, US skills should be routinely taught to all paediatricians.

Aims:

To date, there have been no studies exploring the experience and significance of US-guided vascular access training amongst district general hospital (DGH)-based UK paediatricians. We aimed to evaluate this within our DGH.

Methods:

Small-group US vascular access simulation sessions were led by our accredited and experienced paediatric advanced nurse practitioner (ANP). Participants learned to map veins and practiced US cannulation technique on the gelatinous ‘phantom’ model. A questionnaire asked attendees to evaluate confidence levels before and after sessions, and open-space for qualitative comments.

Results:

Thirty-eight paediatricians attended sessions; of whom, 75% had never conducted US vascular access and 96% did not feel confident. Following sessions, 100% of participants felt significantly more confident and would attempt this on real patients (Figure 1). Qualitative comments showed that they valued sessions: ‘good opportunity to practice vein mapping and cannulation on gel model’. All participants felt that this should be taught routinely within paediatric training. Five participants used this new skill in real patients, following the sessions.

Figure 1:

Confidence level pre- and post-sessions, n = 38

Implications for practice:

This study demonstrates the effectiveness and usefulness of delivering US-guided vascular access training to DGH paediatricians. It enabled improved self-reported confidence, which translated into improved patient care in real-life scenarios. Following its success, we intend on running this as an ongoing session. For clinicians wanting to utilize their skill on real patients, this will be supervised by our ANP. We recommend that all UK paediatricians train in US vascular access to enable optimal care for paediatric patients in all hospital settings. However, further research in a larger cohort of participants is required. We also recognize the variability in available expertise and equipment in all units to undertake the training. The importance and role of US-guided paediatric vascular access are still lacking in recognition and demands wider acceptance.

In situ simulation (ISS) has previously been shown to be an effective tool for identifying system issues in healthcare ^[1]. Since the commencement of weekly inter-professional ISS in the Emergency Department (ED) at Mid-Yorkshire NHS Trust in October 2020, we have run 50 ISS sessions involving 225 participants and identified several system issues. These have subsequently been addressed through debriefing, feeding learning points back to the wider department and working with the management team to resolve practical issues.

Aim:

The aim of the present study was to describe how ISS has been used to identify and address system issues in an ED setting.

Method:

Each week a simulated case is selected to address specific clinical presentations and to bring out a range of clinical and non-clinical learning points. The scenarios are run in the ED using a low-fidelity mannequin and a monitor ‘app’. The scenario is run in real time, participants are required to locate and identify real kit; medications are required to be collected and additional help/senior advice is to be sought in the way that the participants would do in normal practice. After each scenario, there is a debrief, facilitated by the ISS team, in which the participants discuss and identify learning points as well as errors and systemic issues drawing both on the scenario and wider clinical experience. These points are collated and written up in the ‘MYSIM’ (an infographic sharing learning points) and distributed through a range of channels to all ED staff. Where practical solutions are required, the team feeds these back to the relevant senior nursing staff or management team to address these issues.

Results:

Table 1 demonstrates the system issues that we have identified and addressed so far through ISS.

Table 1:

System issues identified and addressed so far through ISS

Theme	Issue	Solution
Medication	Idaricizumab unavailable in ED	Pharmacy restocked ED
Equipment	Lack of infusion pumps	ED pumps electronically tagged and returned to department
Environment	Lack of familiarity with Resus	Simulation familiarizes with environment and participants encouraged to take time to familiarize with the environment following the session
Culture	Reluctance to push the emergency buzzer	Encouraged in debriefing over several sessions’ behaviour change noted in subsequent sessions

Implications for practice:

By running ISS, we have identified and addressed a number of system issues, which, through shared learning, has seen changes within the ED and ISS continues to be a valuable tool for improving patient safety.

Many medical students feel unprepared for starting as FY1 doctors, and often report low confidence in taking responsibility for patients and working independently, and lack self-assurance in common FY1 skills, including assessing unwell patients and initiating management, task prioritization, referrals, documentation, ordering imaging and on-call shifts. These skills are developed during clinical placements; however, access to these opportunities during placements has diminished due to COVID-19 and concerns around patient safety. Simulation‐based teaching allows students to take responsibility and work within complex clinical environments without posing a risk to patients ^[1]. Previous studies have shown that simulated ward rounds improve students’ clinical skills ^[2]. This study aimed to evaluate whether a new simulated mock ward round with tasks would improve final-year students’ general preparedness for FY1 and confidence across common FY1 tasks.

Aims:

The aim of the study was to evaluate whether simulated mock ward rounds increase final-year medical students’ overall confidence and feeling of preparedness for starting as FY1 doctors.

Method:

In total, 20 final-year medical students took part in the programme in two whole-day sessions. This was comprised of a simulated ward round of 10 patients. Students acted as FY1 doctors on the ward and carried out jobs, reviewed patients who deteriorated and had a number of tasks such as updating families, ordering radiology, initiating management and discharge summaries. Students’ confidence and preparedness was measured using pre- and post-course questionnaires. The questionnaires consisted of a 10‐point Likert scale for students to rate their confidence in key skills and overall preparedness for FY1 (1 = not at all confident, 10 = completely confident). These scores were matched and analysed using the Wilcoxon signed‐rank test. Additionally, there was blank spaces for feedback on the course which were analysed thematically.

Results:

Pre- and post-course questionnaires demonstrated that students felt significantly more prepared for FY1 after the course (p < 0.001). There was also a significant improvement in nine other domains deemed important for FY1 that students had reported low confidence in (see Figure 1). Qualitative data revealed that students appreciated the programme. They stated its superiority to other educational methods such as shadowing or didactic teaching sessions.

Figure 1:

Students mean confidence score in overall preparedness and key skills before and after the programme. P < 0.001 for all domains.

Implications for practice:

Simulated mock ward rounds can be used as an adjunct to clinical placements to increase medical students’ confidence about starting work, and to teach them valuable skills regularly utilized by FY1 doctors.

Awareness of symptoms associated with frailty is uneven across acute hospital staff ^[1]. Frail patients are more likely to suffer adverse outcomes; managing frailty requires an inter-professional, multi-disciplinary approach – for which simulation has been identified as beneficial in delivering education ^[2]. Given this, in addition to multiple incidents on wards highlighting a deficiency in both technical and human factors skills, an in situ frailty simulation project was undertaken at a London teaching hospital.

Aim:

The aim of the study was to evaluate the efficacy of in situ frailty simulation in improving both technical and human factors skills for ward staff.

Method:

In situ simulation was selected to increase accessibility for staff and promote ward team learning. Sessions started in October 2020 on one ward, before moving across other wards. These 1-hour sessions have been delivered weekly with a hiatus due to the second wave of the COVID-19 pandemic. A bank of frailty-based scenarios has been created, ranging from acutely unwell patients to communication with families. Participants have been from across the multi-disciplinary team. Data were collected using pre- and post-session questionnaires – containing the Human Factors Skills for Healthcare Instrument (HuFSHI) and frailty-based knowledge questions with Likert scales. Learning has been disseminated through the department via newsletters.

Results:

Thirteen sessions have been delivered with 59 participants (23 nurses, 20 doctors, 9 physiotherapists, 6 nursing assistants, 1 occupational therapist). Forty-nine surveys were completed – 100% of participants found the sessions useful. Post-training, staff demonstrated improvement of self-efficacy in 11/12 HuFSHI questions and all frailty questions (Table 1). The most common learning themes were communication (51%), teamwork (43%) and escalation (24%), as well as management of frail patients (35%). Working with the team (47%), the scenarios (18%) and debriefing (12%) were aspects learners most liked about the sessions.

Implications for practice:

An in situ frailty simulation programme has been successfully implemented, leading to improved learner self-efficacy in both technical and human factors skills when managing frail patients. This has been well received amongst staff. In particular, the sessions have promoted interaction and teamwork within the multi-disciplinary team, which was liked by participants. The in situ delivery has allowed learning to occur without the need for staff release, widening access. Latent threats – such as missing airway equipment – have been identified during sessions and addressed. Moving forwards, funding has been secured for a departmental manikin alongside expanding our multi-disciplinary faculty.

The use of in situ simulation (ISS) within the Emergency Department (ED) has been widely accepted and has shown to be a valuable teaching tool ^[1]. At Mid-Yorkshire NHS Trust, we have been running weekly ISS since October 2020. Within the ED, systems and protocols are frequently audited, guidelines often change, and it can be challenging to disseminate this information. After identifying a clinical need for a cardiac arrest proforma, we considered how best to introduce it. We decided to utilize our weekly ISS to provide a valuable learning opportunity.

Aims:

The aim of the study was to evaluate the effectiveness of using ISS as a learning opportunity to disseminate and trial the introduction of a new cardiac arrest proforma.

Method:

We ran the scenario on two separate occasions involving 11 participants. The simulation involved a low-fidelity manikin and a simulated monitor app. Real equipment is used and the simulation is run in real-time – learners were encouraged to manage the patient as they would in real life. Learners include doctors, nurses, healthcare assistants and student nurses/doctors. Learners are briefed prior to the simulation; in this particular case, the learners were informed that we would be utilizing a cardiac arrest proforma and encouraged to use this. The learners are then debriefed using a promoting excellence and reflective learning (PEARLs) framework and discussion amongst themselves is central to the debrief framework ^[2]. The purpose of this simulation was multi-faceted; firstly, to discuss the team’s management of cardiac arrest and learning around this and, secondly, to discuss the use of the proforma to improve teamwork and patient care. Learners were asked to complete a feedback form.

Results:

Feedback obtained from this simulation concluded that it was a valuable learning opportunity. Figure 1 shows the results of learner responses (n = 11). The scale included was 5 (strongly agree) to 1 (strongly disagree) – an average of responses is included within the graph.

Implications for practice:

Using ISS to trial our proforma allowed us to implement it within the ED. Collating feedback allowed us to make amendments to our proforma based on multi-disciplinary opinions. As well as recognizing that ISS can be used to achieve this purpose, it also provided a valuable learning opportunity. ISS can be used in future to introduce new guidelines, distribute vital information and provide learning.

The national lockdowns due to COVID-19 have caused significant disruption to schools and colleges. As well as interruption to their studies, pupils work-experience placements have been cancelled, particularly those based in healthcare. Despite this, the BMA continues to recommend all aspiring doctors undertake placements within healthcare to aid their application to medical school and give them an insight into being a doctor ^[1]. Additionally, for students from low-income families or those with no ties to healthcare, voluntary placements are often the only opportunity to learn about the various roles of doctors.

Aims:

Creating a ‘virtual work experience’ using simulated video demonstrations in order for students to gain an understanding of what working as a doctor encompasses. This course was offered free of charge to help encourage students, particularly from low-income households.

Method:

Invitation letters were sent to all public and private schools in Merseyside. Contact details and school information were obtained through the Office for Standards in Education, Children’s Services and Skills (OFSTED) Government website. Students were asked to fill out a pre- and post-course questionnaire.

Results:

Seventy-five schools and colleges were invited. A total of 326 students registered for the course and 220 participated in the virtual conference. All participants were from 18 schools and colleges. Students, where at least one parent had attended university, felt more confident in applying to medical school and securing a place, this was significantly higher when a parent was in the medical profession. Students from private or schools rated as above average by OFSTED felt that they were more likely to apply to medicine than those in schools who were rated average or below-average. Overall, students felt that they had an improved understanding of the different roles of doctors following the course and the simulated scenarios were most useful in encouraging them to apply to medicine.

Implication for practice:

Up to 20% of secondary schools provide 80% of all applicants to medicine, with half of the schools in the UK not providing any applicants to medicine at all. The selection alliance 2019 report on widening participation in UK medical schools suggested that there continues to be a discrepancy in underprivileged students applying to study medicine with barriers including limitations to securing work-experience placements ^[2]. Virtual work experience and the use of simulation may be useful in providing work experience and encouraging those from low-income households to apply to medicine.

In situ simulation is an emerging tool used to test systems, improve patient safety outcomes and prepare staff working in new clinical environments ^[1,2]. Our department opened a new Paediatric Assessment Unit (PAU) in April 2021, which sees an average of 470 patients each month.

Aim:

The aim of the study was to use simulated learning events (SLEs) to assess the effect of a new environment on performance, interpersonal skills and system-based practice. As part of the wider paediatric improvement plan, the simulation programme has been used to enhance teamwork and implement a change to maximize patient safety.

Method:

Five multi-disciplinary SLEs based on paediatric and neonatal emergencies were held over a month following the opening of the new PAU. The simulations were low fidelity and in situ, using static models and facilitator feedback, and were held in the new PAU. Observations were displayed on tablets using the REALITi simulation app by iSimulate. A ‘description, analysis, application’ diamond debrief was held following each SLE, and feedback was collected via an online questionnaire. Latent strengths and safety errors were identified and shared with the wider working group to implement a change. Safety errors were then re-assessed at subsequent SLEs to demonstrate resolution.

Results:

Ten latent errors were identified pertaining to the availability of equipment and medications; all were rectified within 2 weeks. Operational errors were also identified, including unfamiliarity with the new PAU location within the wider emergency team, leading to delayed attendance to the simulation. The time taken to attend the PAU by the anaesthetic team decreased by 69% once the emergency bleep message was amended with location instructions. We observed that, with each SLE, there were successive improvements in teamwork and operational behaviours. The teams were able to familiarize themselves with each other and the new working environment, consequently leading to reduced times on acquiring equipment for the emergency. There were a total of 20 participants from paediatric, anaesthetic and nursing backgrounds. Feedback was received from 55% of participants, of which all agreed or strongly agreed that the SLEs and debriefs contributed to their learning and helped develop their team-working and leadership skills.

Implications for practice:

SLE is an effective tool for systems testing in a new clinical environment and helps to identify potential critical and non-critical safety risks. We will continue to develop our simulation programme to assess a variety of clinical environments and share learning from the latent strengths and errors with the multi-disciplinary team, to improve clinical processes, team working and patient safety outcomes.

Major haemorrhage causes systemic shock with resultant coagulopathy. The Belmont Rapid Infuser© (BRI) is one example of a rapid infuser device to deliver intravenous fluids and blood products to patients as part of emergency resuscitation. We are a simulation team based in a busy trauma unit and anecdotally our staff did not feel confident in using our BRI.

Aims:

We aimed to quantify how confident our nursing staff were in using the BRI, before and after delivering a simulated patient scenario asking them to transfuse blood products using the BRI. We also aimed to quantify whether a simulated scenario could reduce the time taken to use the BRI. We aimed to create an enjoyable environment and use aspects of gamification² within the training.

Method:

A self-evaluation questionnaire was circulated to establish pre-scenario confidence. Candidates observed a demonstration of the set-up and use of the BRI. Candidates were read a scenario brief and asked to use the BRI to infuse 500 ml of simulated blood product at 200 ml/minute. Once they had completed the scenario, their time was recorded, they were asked to again self-evaluate their confidence and were invited to attend again at a later date to ‘compete’ against their previous time.

Results:

Pre-scenario data confirmed what was suspected; there was a wide variation in confidence in using the BRI across the sample. Early data suggest that the simulation was able to significantly increase staff confidence in safely using the BRI and repeated attempts led to a significant reduction in time to safely transfuse.

Implications for practice:

Positive participant feedback included recommendations for further hands-on deliberate practice. We hope the training can be expanded to also include members of the medical team. Further research is needed to explore the use of gamification to support simulation-based medical education within urgent care.