Introduction:

University Hospitals Dorset (UHD) relocated maternity services into a newly constructed building. Transformational simulation is an effective method for identifying safety threats and driving healthcare improvements [1]. Research is limited on transformative simulation for maternity relocations. This project aimed to use simulation to identify latent safety threats in a new maternity unit and explore the impact on staff.

Introduction:

In February 2025 Newcastle Hospitals Trust ran a multi-disciplinary, multi-stage simulated exercise demonstrating care for a patient with a viral haemorrhagic fever (VHF). The exercise, entitled ‘Moulin Rouge’, followed on from work at the Royal Free Hospital, London (Exercise ‘Mamma Mia’), which conducted an exercise using a Trexler-based method of isolation and care in 2024 [1]. The Infectious Diseases (ID) team at Newcastle simulated a PPE-based care model to explore the relative challenges and benefits compared against the Trexler model.

Supporting Documents – Figure 1-A108

Figure 1:

Evaluation from observers stating whether the objectives of the exercise had been met.

Introduction:

Simulation plays a crucial role in healthcare by providing a controlled and risk-free environment for training, education, quality improvement, innovation and research. Funding is often required to support the resources needed including; faculty, equipment and/or technology, venues, scenarios and administrative support, amongst others to develop, establish and sustain the delivery of simulation activity. There is a need to clearly articulate the requirements, benefits and cost effectiveness of simulation to justify and secure investment. Additionally, there is a need to foster organisational ownership and buy in to help sustain simulation. Yet funding for this type of learning activity is finite and understanding and justifying costs can be challenging [1].

Introduction:

Provision of safe perioperative care in remote theatre locations has many challenges. NAP 4 identified airway management in remote sites is associated with increased risk of morbidity and mortality [1]. Simulation training can aid preparedness to manage infrequent but highly critical events. Simulation training is often recommended following a critical events [2]. Insitu Simulation (ISS) undertaken in a clinical team’s own workplace provides a safe learning environment, improves team work and performance and identifies latent safety threats [3]. We organised ISS training in our dental DPU for the clinical team after review of learning needs and following recommendations from a critical event.

Introduction:

Patient safety is a cornerstone of healthcare, and this principle extends to simulated patients/participants (SPs) who contribute to healthcare education. Ensuring their well-being is an ethical obligation that requires careful consideration of recruitment, role allocation, emotional impact, and ongoing support [1]. This innovation explores an ethical framework, produced with SPs, that prioritises their safety and well-being while maintaining the integrity of the educational event. Originally conceived in 2016 [2], this framework has since been refined, with multiple supportive tools, to enhance its effectiveness and applicability.

Supporting Documents – Figure 1-A105

Introduction:

When opening a new healthcare space, simulation based clinical systems testing allows for potential patient safety threats to be identified [1]. Translational simulation can be used in this context due to the focus on improving patient care and healthcare systems through diagnosing safety and performance issues and delivering simulation-based intervention [2].

The creation of a new paediatric day surgery centre required an interdisciplinary simulation programme designed to familiarise staff with the new environment and equipment, test systems and processes, and enhance team working both within and between departments. Clinical scenarios added focus on human factors and non-technical skills alongside strategies for improvement [3].

Introduction:

Following funding from the Morgan Advanced Studies Institute (MASI) a pilot study was conducted with expertise from the SUSIM Simulation and Immersive Learning Centre at Swansea University.

Healthcare professionals often lack the training and confidence to communicate effectively with d/Deaf patients, leading to miscommunication, reduced trust, and poorer health outcomes. Traditional simulation-based education (SBE) programmes rarely reflect the lived experiences of d/Deaf individuals or include British Sign Language (BSL) and deaf culture [1,2]. This project aimed to address this gap through the co-creation of immersive Virtual Reality (VR) learning modules with the d/Deaf community. The research question was: How can immersive simulation technologies be co-designed with the d/ Deaf community to enhance student understanding and inclusive communication in healthcare?

Supporting Documents – Table 1-A103

Table 1.

Data from Deaf club focus group.

Lack of healthcare staff awareness about interpreter provision	Poor communication	Stereotypes of deaf people	Impact of poor health staff Deaf awareness	Discrimination (specific acts)	Positive suggestions to improve care for Deaf patients
Wi-Fi is a big issue when using remote interpreters	Call name? reception call name, assume not present	Assuming I won’t complain or answer back	Being a patient (in-patient), very lonely and isolating	Refusal to wear a clear mask. Told me to ‘watch my behaviour’	Ask patient what works well for them
Assumption of not needing an interpreter without clarification or communication	I prefer to have it all written down, but their handwriting is terrible and not as detailed	Assumption – when you can talk	Lip reading is hard, when you are ill it’s worse	Interpreter being asked to wait outside as too many people in the room	Male interpreter for male patients, female for female especially if treatment is sensitive
No clue about how to book interpreter	If they shout room number, then I don’t know		Patients feel that staff can revert to shouting, banging, poking instead of the medical notes being clear that the patient is Deaf and seeking an interpreter	Issues of informed consent	Need a screen with name and room number and estimated wait times

Introduction:

A sense of belonging within the National Health Service (NHS) workforce is imperative in establishing a safe and effective working environment, as outlined in the NHS People Plan (2020) [1], ‘The NHS must welcome all, with a culture of belonging and trust. We must understand, encourage and celebrate diversity in all its forms’ (p.24). It can be challenging to establish a sense of belonging within the NHS where large teams are working under high pressures in inconsistent shift patterns. Incorporating lived experiences, a simulation workshop was designed to enhance participants’ knowledge and understanding of how to foster workplace belonging when interacting with colleagues with protected characteristics.

Introduction:

Workplace incivility is a pervasive issue in healthcare, negatively impacting staff well-being, teamworking, cognitive load and patient safety [1]. Traditional training may not capture specific human factor or patient safety elements related to incivility. This project aims to evaluate the effectiveness of an innovative, multidisciplinary simulation-based intervention designed to increase awareness of incivility and its impact on patient safety within the NICU.

Introduction:

A quality improvement (QI) project using in-situ simulation (ISS) was undertaken at a Cardiac catheterisation laboratory (CCL) in a London teaching hospital. The CCL provides 24-hour primary percutaneous coronary intervention (PPCI) for patients having a heart attack and is a lifesaving treatment. Cardiac arrest can happen during the procedure as a heart attack complication.

Guidance released in 2021 [1] advocates early use of a mechanical cardiopulmonary resuscitation (M-CPR) device after the first cycle of CPR meaning PPCI can continue as it is safe to deliver fluoroscopy, which may facilitate treatment intervention for the potential cardiac arrest reversible cause. A baseline audit showed this was not happening.

Introduction:

The provision of major trauma resuscitation in the emergency department (ED) is a life-saving, time-critical multidisciplinary (MDT) process that is susceptible to latent safety threats (LSTs). Testing the system response using simulation can yield valuable lessons for improving patient safety [1]. No ‘blueprint’ currently exists to guide planning and delivery of this quality improvement (QI) process within NHS acute EDs that form part of major trauma networks (MTNs). This project aimed to develop and pilot a replicable strategy for delivering in-situ simulation to test and improve trauma resuscitation systems.

Introduction:

The introduction of the Patient Safety Incident Response Framework (PSIRF) marked a shift in how patient safety incidents are reviewed. Although external training opportunities are available, staff feedback highlighted a need for more practical understanding of PSIRF and human factors. To address this, we developed a bespoke, financially sustainable course, enabling staff to engage interactively with the changes in PSIRF. A key focus was on preparing staff to carry out swarm huddles, as the new learning response with the most local ownership.

Introduction:

Opioid analgesia remains a key pharmacological option for the management of post-operative pain [1]. Preventing and recognising adverse events associated with opioid analgesia is vital, due to the risk of life-threatening sedation and respiratory depression. Nurses play an important role in the recognition and initial management of these patients.

Simulation-based education (SBE) has been shown to have a significant positive effect as a training strategy for nurses [2]. Here, we aim to determine whether SBE, delivered in a ward environment, can increase nurses’ knowledge and confidence in managing patients with opioid toxicity with respiratory compromise.

Supporting Documents – Table 1-A97

Table 1.

Table of results. (* p<0.05 = statistical significance)

	Number of responses	Mean (range)	Standard deviation	z-value (compared to before)	p-value* (compared to before)
1) Knowledge
Before	7	3.57 (3–5)	0.787	---	---
After	7	4.57 (4–5)	0.535	2.377	0.0174
Follow-up	6	4.17 (4–5)	0.408	2.236	0.0253
2) Recognition
Before	7	3.57 (2–4)	0.787	---	---
After	7	4.71 (4–5)	0.488	2.53	0.0114
Follow-up	6	4.16 (3–5)	0.753	1.41	0.1585
3) Airway management
Before	7	3.71 (2–5)	0.951	---	---
After	7	4.71 (4–5)	0.488	2.377	0.0174
Follow-up	6	4.33 (4–5)	0.516	1.964	0.0495
4) Management
Before	7	3.71 (2–5)	0.951	---	---
After	7	4.42 (3–5)	0.787	1.673	0.0944
Follow-up	6	4.50 (4–5)	0.548	2.169	0.0301
5) Naloxone
Before	7	3.86 (1–5)	1.345	---	---
After	7	4.86 (4–5)	0.378	1.976	0.0482
Follow-up	6	4.83 (4–5)	0.408	1.732	0.0833

Introduction:

Analysis of patient safety incidents and complaints is an essential form of learning for healthcare institutions, with harm to patients having major human, moral, ethical and financial implications¹. In response to common and repeated incidents, weekly in-situ simulation-based education has been implemented on the Older Persons’ Medicine (OPM) ward to enhance learning amongst the multidisciplinary team. The team included Doctors, Nurses, Healthcare Assistants and Advanced Nurse Practitioners.

Supporting Documents – Table 1-A96

Location	Participants	Feedback
Both wards on older persons’ medicine.	90% Nursing, Health Care Nursing, and Doctors.	“I feel that having the training on the actual ward where I work was very beneficial as it added to the atmosphere of trying to work in a busy clinical environment.”“Really good session as difficult to access some training due to ward pressures. Also the session being catered to our specialty is better for staff to increase their knowledge and skill set”“Do more!”

Introduction:

Managing anticoagulation in emergencies requires swift decisions, collaboration, and precision. Despite existing guidelines, real-world practice often suffers from delays and inconsistencies. This Quality Improvement Project (QIP) at the Royal Victoria Hospital (RVH) used in situ simulation combined with a novel debriefing model integrating, Figure 1:

•Scottish Debrief Model – for emotional processing and team reflection.

•SEIPS framework – to analyse system-level safety factors.

•i-SOG – to highlight gaps between intended and actual workflows.

This structured debriefing enabled identification of performance and system issues while aligning with the four Meta-Debriefing pillars:

1. Theory-based – rooted in established models.

2. Psychologically safe – fostering open discussion.

3. Context-dependent – focusing on ED-specific anticoagulation challenges.

4. Formative – driving practical improvements and learning.

Supporting Documents – Figure 1-A94

Introduction:

Increasingly adopted in healthcare education for their ability to engage learners, develop teamwork and critical thinking skills, escape rooms are defined as ‘live-action, team-based games where players discover clues, solve puzzles, and accomplish tasks in one or more rooms in order to accomplish a specific goal’ [1]. The literature suggests that escape rooms have the potential to engage learners[2,3]. Our simulation team, consisting of academic and simulation technicians, created a virtual escape room using IntuifaceTM software for our immersive learning environment. This interactive touchscreen experience allowed nursing students to practice critical thinking, communication, and teamwork as they navigated a virtual patient’s home, consisting of a linear storyline of puzzles within a 40-minute limit. These were focused on wound assessment and management.

Supporting Documents – Figure 1-A92

Introduction:

Nursing and Midwifery Council (NMC) approved institutions can deliver up to 600 hours of Simulated Practice Learning (SPL) within the 2,300 practice hours, pre-registration nursing students are required to register [1]. Many approved Higher Education Institutions (HEIs) are using immersive technology-enhanced learning as part of a blended approach in their SPL delivery. Virtual Reality (VR) is commonly used to simulate immersive environments where learners can practise decision-making skills within different clinical contexts. Alongside this, there is a need for 3rd year nursing students to develop peer supervision and coaching skills in preparation for registration [2]. The purpose of this work is to report on an evaluation of a teaching intervention, utilising both VR and peer-to-peer learning.

Supporting Document – Table 1-A89

Table 1.

Results of scenario peer 1 vs peer 2.

Introduction:

It is known that for approximately 70% of tertiary level burns referrals, total body surface area (TBSA) calculations are largely overestimated. Furthermore, patients at the point of arrival often are inadequately fluid resuscitated. A learning need to address these factors for multi-disciplinary emergency and surgical care teams was identified, simulation is recommended as a useful tool to prepare health care workers for such cases and address skills gaps amongst teams [1]. A study conducted in 2016 [2] emphasized the affirmative impact of employing moulage based simulation of burns injuries on the overall learning process. In answer to this we have developed an innovative methodology for creating representations of full thickness burns on simulation manikins.

Supporting Documents – Figure 1-A87

Introduction:

Simulation-based training has been shown to significantly improve clinician performance in emergency front of neck access (eFONA), particularly among professionals in high-acuity settings [1]. However, traditional simulation options—including animal tissue models and commercially available part-task trainers—present notable limitations. Ethical concerns, unpleasant sensory experiences, high costs, and environmental impacts restrict their accessibility and scalability. In response to ongoing budget constraints within the NHS, we aimed to develop a low-cost, sustainable, and easily reproducible model for eFONA training using readily available materials.

Supporting Documents – Figure 1-A85

Introduction:

Public satisfaction with General Practice (GP) services has reached an all-time low, amid increasing demand for appointments and strain on resources. In response, the UK government launched the “Delivery Plan for Recovering Access to Primary Care,” which includes a commitment to modernise primary care and improve patient access through digital innovation. A key component of this transformation is the implementation of Total Patient Triage (TPT), a model that assesses all patient contacts to determine the most appropriate clinical pathway. Widely adopted during the COVID-19 pandemic, TPT facilitates remote consultations, reduces reliance on traditional telephone booking systems, and aims to optimise time for both patients and clinicians.

Supporting Document – Table 1-A84

Table 1.

Average scores for four statements evaluating the tabletop simulation session on total patient triage. Likert scale from 1 to 5 (with 5 being “strongly agree”).

On a scale of 1-5 (5 being ‘strongly agree’ and 1 being ‘strongly disagree’), how much do you agree with the following statements?	Average score
I felt that today was interactive and stimulating.	4.92
I felt that today was relevant to my development needs.	4.82
I found today’s tabletop simulation useful.	4.78
My awareness of the total patient triage process has increased because of today’s session.	4.68

Introduction:

Empathy and effective communication are critical to safe, patient-centered healthcare, yet these ‘softer’ skills are often underdeveloped in traditional training when compared to ‘harder’ skills [1, 2]. Simulation tools exploring immersive and XR technologies can often prioritise clinical tasks over emotional engagement. Emerging from an arts-led collaboration between disabled-led arts organisation ZU-UK and researchers at the University of Greenwich, SIMFONIK is an app-based, audio-led XR simulation platform that uses storytelling, immersive audio, and scaffolded role-play to enhance healthcare students’ empathy [3], communication resilience, and emotional awareness. Drawing from techniques in serious games, LARP, and immersive theatre, SIMFONIK places students directly into the patient’s perspective through progressive and accessible instruction-led experiences.

Introduction:

Due to an everchanging healthcare environment and reduced placement availability, the NMC [1] has proposed the adoption of simulated practice learning (SPL). This has encouraged many higher education institutions (HEIs) across the country to bolster the simulation provision, preparing nursing students to face the challenges of the future in a safe environment without the risks associated with clinical practice [2].

During SPL planning for a last year undergraduate adult nursing masters programme, a learning need was identified through learners’ feedback, which highlighted their keenness to explore critical care before graduating. As the placement capacity could not be increased to accommodate large number of learners, the intensive care unit (ICU) environment was recreated digitally through projector-based interactive technology. Medical equipment, sounds, AI generated people, interactive touch-points and bed spaces were developed to increase immersion.

This paper focuses on the team’s own learning journey in adopting the technology, whilst sharing with the simulation community challenges and lessons learnt.

Supporting Documents – Table 1-A82

Table 1.

Findings and solutions after 4 iterations.

Findings		Solution
Lack of standardised practice	Unlike the tried and tested VR-based simulation, no established framework or model existed for designing and delivering an immersive room experience, leading to uncertainty and apprehension.	Produce an ad-hoc template to capture, LOs; Sequence flow (what happens at this stage); Resources needed (images, videos, sounds etc.); Interactive activity, (quizzes, drag and drop etc.)
Software inexperience	The team was unfamiliar with immersive room technology.	Regular catchups and training workshops were introduced, fostering progressive skills development.
Competing priorities	Balancing simulation development with teaching responsibilities proved challenging.	Using one version of a shared live document to identify critical steps, responsible person and obstacles, enabled asynchronous collaboration.
Educational effectiveness	Due to lack of prior experience, there were no metrics that could be used as benchmark.	A dry run, for faculty only, was conducted to test functionality and check timings. A lesson plan (LP) and a narrated video for faculty were instrumental to align LOs to delivery.The LP contained navigation of the scenes, layout of the room, duration of each scene, specific activities to run like quizzes and videos, discussion points, pre-brief, brief and debrief.
Learning and engagement	Long videos and long text caused engagement to drop.	Limit passive learning. Videos were shortened, whilst discussion points and dynamic activities were encouraged.
Future iterations	Further developments and activities stemmed from this experience.	The learning technologist adopted the template used for this experience as a starting block for a different session, resulting in a much quicker and streamlined development.

Introduction:

Swarm debrief is one of the Patient Safety Incident Response Framework (PSIRF) learning response methods [1]. It is a group debrief aimed at fostering collective, system-based learning, used immediately after any event where there is something new to learn. During the implementation of PSIRF in our trust, a gap in Swarm debriefing skills was identified, and the simulation and human factors team was asked to provide educational support. In collaboration with the patient safety team and input from the NHS England PSIRF team, we developed a systems-based Swarm guide and an accessible, engaging audio-visual (AV) Swarm simulation to illustrate a more realistic ‘work-as-done’ example [2].

Supporting Documents – Figure 1-A80

Introduction:

Human factors are essential to patient safety and effective clinical practice, yet traditional teaching methods often struggle to engage multidisciplinary teams in a practical and collaborative manner. Escape rooms are increasingly recognised as a didactic tool that supports active learning, problem-solving, and the development of key skills such as teamwork and communication [1]. As part of the Skills and Simulation Team’s Open Days at University Hospitals Birmingham (Heartlands, Queen Elizabeth, and Good Hope), an interprofessional escape room was developed as a novel, recreational learning activity. It aimed to bring together clinical and non-clinical staff in a high-pressure, team-based environment to reflect on human factors concepts through immersive gameplay.

Introduction:

Ultrasound (US) guided, or Point of Care Ultrasound (POCUS) procedures are increasingly commonplace in healthcare. These procedures improve accuracy and benefit patient safety [1]. Simulation provides a safe environment for healthcare providers to learn how to use the US probe and carry out different surgical or medical interventions such as a kidney biopsy. An innovative US compatible model for kidney biopsies was created out of mixed materials using Aqueous Dietary fibre and Antifreeze Mix (ADAM) Gel [2], a porcine kidney and porcine muscle and skin.

Introduction:

Uterine inversion is a rare but life-threatening obstetric emergency, with its precise incidence remaining unclear [1]. A Canadian case series by Baskett suggests an incidence of 1 in 3,127 deliveries [2]. Associated with considerable morbidity and mortality, prompt recognition and management are essential to improving maternal outcomes [1]. Given its rarity, exposure to this emergency may not occur until later stages of clinical training. We aimed to develop a skills-based session using low-cost simulation models to support obstetric trainees in managing acute uterine inversion and associated postpartum haemorrhage (PPH).

Introduction:

Effectively training healthcare professionals for complex elderly care is vital but often hindered by simulation costs. This project demonstrates a high-impact, low-fidelity simulation escape room designed for interprofessional groups of urgent care practitioners (nurses, paramedics). We aimed to enhance critical thinking, teamwork, and problem-solving by focusing on accessible, engaging pedagogical design incorporating gamification [1] and Visual, Aural, Read/Write, Kinesthetic (VARK) principles, demonstrating impact and creativity within resource constraints.

Introduction:

Working with People with Lived Experience (PLE) can provide a powerful learning experience, and services can be improved by including the expertise of PLE [1]. Motivated by a North East and North Cumbria Integrated Care Board patient safety alert [2], a training session collaborating with PLE of Learning Disability (LD) was developed. The primary objective was to evaluate inclusion of PLE in simulation training, and to explore viability for future expansion. Other objectives were to expand our repertoire of acute care scenarios to include people with existing long-term conditions (including mental health conditions and/ or neuro-developmental conditions), and to develop scenarios requiring professionals to individualise their communication approaches to the person.

Supporting Documents – Figure 1-A74

Introduction:

Healthcare professionals need to recognise when someone is approaching the final days or hours of life and be confident to talk about death and dying. Undergraduate training in end-of-life care is inconsistent and students need more support [1]. In the UK, people are experiencing inequitable and suboptimal care before death, with delayed recognition of dying and poor communication resulting in inadequate support for symptoms [2]. Many students will not have a supported experience of caring for someone who is dying, whilst others will experience death frequently. Student nurses report fear, anxiety, and overwhelm about death on placement, feeling vulnerable and unprepared. This can lead to emotional trauma and dropping out before registration [3]. Simulation is used to specifically focus on increasing resilience and decreasing fear of death. A partnership simulation was designed to prepare student nurses for talking about death and dying, to improve end-of-life care experiences.

Introduction:

On-call respiratory physiotherapy is provided by NHS Trusts for acutely unwell patients outside of normal working hours [1]. Training is provided before undertaking on-call duties. However, many physiotherapists find on-call situations stressful and report a lack of confidence to undertake these duties. Simulation provides a safe learning environment to develop on-call skills, when supported by trained faculty [2]. Access to faculty training is needed [3]. Therefore, a national course was developed for experienced physiotherapists looking to develop their skills as simulation faculty. It was aimed at participants with limited experience as simulation faculty, wanting to develop an on-call simulation provision at their institution.

Supporting Documents – Figure 1-A72

Figure 1:

Chart to show regional distribution of course participants across the UK.

Introduction:

The 2021 document “Modern ward rounds: Good practice for multidisciplinary patient review” recommends simulation as a useful strategy for training relating to ward rounds [1]. Existing ward round simulation predominantly targets undergraduates, or foundation doctors during induction, with limited integration across different grades of medical training. We hoped to take this opportunity to engage multi-disciplinary and cross-grade teams in a more authentic, collaborative learning experience around open communication and building positive working culture.

Introduction:

LLEAP (Laerdal Learning Application) by Laerdal Medical is the software used to control our interactive manikins during simulation. External courses are not specific to our technology, so the need for training and opportunities for practice in this area were evident. Since the COVID-19 pandemic, much training has moved online. The use of the cognitive apprenticeship model described by Collins, Brown and Newman [1] has proven to be effective in the delivery of online faculty development programs [2]. The aim of this blended learning approach was to increase the confidence of new faculty, using the same model to provide online software training followed by hands-on practice.

Introduction:

This teaching simulation aims to improve the team working and leadership skills of different members of the medical team in an acute scenario and allows them to understand the direct roles of each individual team member.

Introduction:

Medical students repeatedly report a lack of confidence in their paediatric knowledge and clinical skills, which can adversely affect their learning experience [1]. Given the complexity and nuances of Paediatrics, coupled with limited placement exposure, creative and accessible teaching interventions are imperative [2]. This service evaluation aimed to assess whether delivering a dedicated Paediatric Knowledge and Skills Session (PKSS) early in training could improve student confidence and knowledge, while remaining sustainable and easily replicable.

Introduction:

The UK Foundation Programme Curriculum [1] requires understanding of patient safety and incident management. While the NHS Patient Safety Incident Response Framework [2] advocates a systems-based approach, training often emphasises non-technical skills without deeper exploration of system-wide factors. To address this gap, the Simulation Team at University Hospitals of North Midlands (UHNM) integrated human factors teaching into one of the three simulation sessions they provide for Foundation doctors. The goal was to equip trainees with the tools to analyse incidents and appreciate how changes to the wider work system can affect patient safety.

Introduction:

Patient involvement in medical education has traditionally been passive, often limited to experiential learning in clinical settings or illustrating clinical conditions, limiting the potential for impactful learning experiences [1]. Thus, research to date on their involvement in simulation education is sparse, with greater emphasis placed on the role of the simulated patient, a professionalised role subject to detachment from authentic patient experiences. In conditions such as obesity, where stigma and communication challenges often exist [2], a deeper understanding of the lived experience of our patients is vital to patient-centred care. Our Bariatric Emergencies Simulation Training (BEST) course reimagines patients not as passive subjects but as active partners in simulation education. Through co-production, we sought to authentically integrate the patient voice and demonstrate its value in shaping effective healthcare education.

Introduction:

Elective withdrawal of non-invasive ventilation (NIV) in motor neurone disease (MND) is recognised as impactful on clinician’s mental health and well-being, presenting complex ethical, legal, and emotional challenges [1,2]. To reduce the emotional burden on staff, we designed and delivered an immersive simulation-based training day aimed at improving clinical confidence in managing elective NIV withdrawal and its holistic challenges.

Supporting Documents – Figure 1-A63

Introduction:

In high-pressure clinical environments, fostering a culture that encourages reflection, learning, and emotional wellbeing is essential. Hot debriefing offers an immediate, structured opportunity for teams to reflect on critical events, strengthen communication, and embed psychological safety into regular practice [1]. This teaching session aimed to educate resident paediatric doctors on the importance of a hot debrief and introduce relevant models that supports cultural transformation by normalising reflective practice.

Introduction:

Peripheral venous cannulation is an essential practical skill for undergraduate medical students. The journey towards procedural competence can be challenging and stressful due to infrequent opportunity for practice and fear of failure on real patients. In clinical practice ultrasonography can aid clinicians performing difficult peripheral venous cannulation. Teaching on ultrasound has not previously been widely incorporated into UK medical undergraduate education with cost cited as a significant barrier [1]. The increasingly widespread availability of ultrasound equipment provides an opportunity to give students an introduction to ultrasound whilst simultaneously developing competence and confidence with peripheral venous cannulation. We aimed to develop a cost-effective ultrasound guided intravenous access course for medical students to bring together these two learning requirements.

Introduction:

Our busy children’s emergency department sees a high turnover of Resident Doctors from a range of training pathways, many of whom have had limited exposure to paediatrics in their careers to date. In addition, there has been a growing nursing team over recent years and the department hosts a number of student nurses from local universities. Simulation has an ever-growing presence in many aspects of medical education, providing a safe environment for learners to build confidence and competence, particularly in high-stakes emergency scenarios [1]. Short, low fidelity simulation sessions were already regularly used in our department and we therefore elected to build on this premise to create a bespoke simulation-based study day aimed at junior colleagues to further enhance clinical practice.

Introduction:

Faculty development is imperative to delivering and maintaining high quality, impactful simulation-based education (SBE). The ASPiH guidelines outline key attributes of simulation faculty and encourage a culture of shared knowledge and expertise. [1] At The Royal Wolverhampton NHS Trust (RWT), we designed and implemented an innovative educational experience aimed at the novice SBE facilitator to ensure development of simulation faculty in keeping with ASPiH standards. The course is free and available to all RWT employees with an interest in becoming involved in SBE - from those hoping to develop their own departmental in-situ simulation programmes to those already having established roles within existing SBE. The full-day course includes workshops and simulated scenarios, with planned debriefs and meta-debriefs to optimise participant reflection and learning. The culture of the course is such that anyone from the wider multidisciplinary team (MDT) can attend, and peer observation and reflection is encouraged and facilitated.

Introduction:

Over 500 interdisciplinary healthcare students from Bournemouth University’s Faculty of Health & Social Sciences took part in a two-day interprofessional simulation event, simulating a major incident: an alien invasion causing organised chaos in an underground car park. Students from multiple healthcare disciplines (Adult, Mental Health, and Children’s and Young People’s Nursing, Paramedic Science, Physician Associates, and Physiotherapy) collaborated with makeup artists from Arts University Bournemouth to create high-fidelity injuries, practicing triage, emergency care and teamwork in a controlled, immersive setting.

The NHS Long Term Workforce Plan highlights simulation as a key strategy to modernize healthcare education, supporting interprofessional education (IPE) and exposure to rare and complex scenarios [1]. Higher Education Institutions (HEI) play a vital role in preparing students to deliver safe, effective and innovative care.

Simulation fosters essential communication, collaboration and decision-making skills, while major incident simulations enhance both technical and non-technical abilities to improve emergency readiness [2]. By promoting IPE, these experiences help build a resilient healthcare workforce equipped to handle major incident events and deliver high-quality patient care [3].

Supporting Documents – Figure 1-A57

Introduction:

The Nursing & Midwifery Council (NMC) now mandates nursing students to replace 600 clinical hours with simulated practice learning (SPL) [1]. While Higher Education Institutions (HEIs) are incorporating this shift into curricula, aligning simulation with clinical competencies remains a challenge. Traditional skills training is often hands-on but lacks realism and practical transferability [2].

To bridge the gap between theoretical knowledge and clinical application, we developed a procedural simulation model that embeds clinical skills training within structured simulation scenarios. This model aligns with NMC standards and best practice guidelines, supporting the development of core nursing competencies in realistic settings that are replicable in practice.

This study evaluates the model’s effectiveness in enhancing students’ clinical competence, knowledge, and skills while meeting SPL requirements.

Supporting Documents – Figure 1-A56

Introduction:

It was identified in our hospital trust that emergency paediatric intubations were infrequently encountered by staff across the year, resulting in low levels of confidence in management. With winter approaching, it felt pertinent to design and deliver teaching on this topic, simulating the preparation for intubating a bronchiolitic baby. The learning objectives were to increase confidence and knowledge, and also signpost candidates to relevant guidelines [1]. The aim was to capture as many anaesthetic and theatre staff as possible, utilising tea-trolley simulation to allow for multi-disciplinary (MDT) candidates to attend each session.

Supporting Documents – Table 1-A55

Table 1

	% Confident/Very confident in airway equipment preparation	% Confident/Very confident in drug preparation	% Confident/Very confident in ventilator setup	% Download of correct guidelines
Pre-session questionnaire	41.1%	32.9%	19.1%	63%
Post-session questionnaire	84.8%	73.8%	67.7%	97%
Verbal feedback	“Great exposure to small paeds, all of session was massive learning experience”	“Very helpful to drill through the scenario and practise the calculations that we don’t do frequently”	“Walking through the kit. De-mystified elements”	“Having a variety of people with different skill level to give opinions”

Introduction:

The IMT Stage 2 curriculum, introduced in 2022, emphasised simulation-based education with a focus on human factors to progress at ARCP [1]. Existing simulation for Medical Registrars remains limited and rarely integrates these elements [2,3].

We developed a one-day simulation course for ST4-5 registrars, embedding human factors into each scenario to meet curriculum needs. To enhance realism and observer engagement, we also created a web-based patient record enabling faculty-controlled access to documentation and results.

Supporting Documents – Figure 1-A54

Introduction:

Virtual Reality (VR) has emerged as a promising tool in healthcare education, offering immersive experiences to support learning and professional development. At Sheffield Hallam University, VR was integrated into the BSc Physiotherapy curriculum to enrich simulated placement experiences. The initiative targeted key educational domains such as Equality, Diversity, and Inclusion (EDI), human anatomy, and soft skills. This study investigates the impact of VR on student engagement, learning, and skill application using the Kirkpatrick Evaluation Model [1].

Introduction:

IMG (International Medicine Graduate) doctors play a key role in the NHS and in Children’s Services they account for approximately one third of the medical workforce [1]. Despite this, the support they receive when starting to work in the United Kingdom is often suboptimal, making the transition extremely challenging [2]. This is often reflected in the higher number of referrals to the GMC (General Medical Council) compared to UK trained colleagues [3]. We explored the feelings of IMGs around the time they were newly employed in the NHS and the option of tailored simulation scenarios as a key tool to help them integrate.

Introduction:

Virtual reality (VR) immersive technologies are an emerging area in healthcare education involving a digital representation of a 3D environment and a head-set to “block out the real world” [1]. They allow for controlled, standardised and repeatable interactions [2] promoting equitable access to high-fidelity learning. Successful implementation necessitates collaboration with learners, to inform development of the product. The session aim was to create a platform for Occupational Therapy (OT) students to develop skills and knowledge with people experiencing suicidal ideation. This module was new for the OT programme.

Introduction:

The role of the surgical multidisciplinary team (MDT), particularly surgical resident doctors and nurses, extends far beyond the confines of the operating theatre. The peri-operative ward environment presents unique clinical and communication challenges that demand a distinct skillset to manage complications in unpredictable, high-pressure situations. Formal team training in peri-operative complication management can lead to increased confidence among healthcare professionals, improved team cohesiveness, and positively impact on patient care [1]. Despite this, structured training for MDT members in managing such scenarios is limited. Simulation-based education provides a safe, reflective environment for healthcare professionals to develop these skills without compromising patient safety [2]. Recognising a gap in peri-operative simulation training for surgical MDTs, we developed a targeted programme to address this need.

Introduction:

Identification and prevention of cardiovascular disease (CVD) was identified as the single biggest area where the NHS can save lives in the NHS Long-term plan [1]. The NHS Health Check screening aims to assess a person’s risk of developing CVD, type 2 diabetes and dementia and offer advice to help people maintain or improve their health [2]. Student-led health check clinics have been implemented in other universities, proving to be a viable mechanism to deliver Experiential Learning, while providing health services to an underserved population [3]. A robust training programme was required, ensuring students to develop skills whilst also demonstrating competence to deliver the service.

Introduction:

Effective communication remains a cornerstone of compassionate healthcare, closely linked to patient experience and care outcomes [1]. In 2022, the Comprehensive Communication Skills Training (CCST) course was developed at a medium-sized trust, in response to feedback from bereaved families and frontline staff, aiming to improve communication in emotionally complex scenarios [2]. Preceding the creation of the course, the facilitators attended a two-day training in experiential learning. Since its inception, the course has been refined; a Patient Advice and Liaison Service (PALS) component, produced through a listen-create-reconnect exercise with relatives with lived experience, has been added. This development helps attendees understand how to respond to complaints in the moment and highlights the function of PALS as a key support service for patients and families.

Introduction:

Resident doctors are expected to have the knowledge and skills required to manage common medical emergencies. Medical students report anxiety and under-preparedness for such situations [1]. There is a lack of understanding as to why this is and how students could be better prepared for this transition. This study aims to evaluate the educational impact of a simulation-based educational curriculum in a novel cohort of medical students from multiple year groups and two universities.

Introduction:

Empathy enhances healthcare professionals’ understanding of the experiences, perspectives, needs and feelings of patients and colleagues [1]. It is fundamental to professionalism, therapeutic relationships and person-centred care. Empathy improves patient wellbeing, satisfaction and clinical outcomes [1] and reduces the risk of healthcare staff experiencing stress and burn-out. Importantly, empathy is an antecedent to cultural competence and enables caregivers to respond appropriately, and without prejudice to the needs and expectations of patients and colleagues, several of whom will come from diverse backgrounds and/or vulnerable and groups. Approximately 15% of patients admitted to hospital have a communication disability that affects their ability to speak with and/or understand the staff who care for them [2].

A review of 27 studies identified that ‘…vulnerable patients with communication disabilities (i.e. impairments of body structure or function that impact upon speech, language, or communication function) face a three-fold increased risk of sustaining preventable and harmful patient safety incidents’ [2, p502]. Some of the most commonly reported factors include i) ‘being in hospital with no way to gain the attention of or communicate with hospital staff’; ii) ‘…staff who are not always attentive even when patients raised the alarm’; iii) ‘advocacy failure’; and iv) ‘failing to listen, or to recognise complaints of pain or symptoms of distress’ [2, p509].

Introduction:

Effective management of critically unwell children demands seamless interprofessional collaboration, rapid clinical decision-making, and a high degree of confidence among healthcare providers. However, many professionals across disciplines report low self-efficacy in paediatric emergencies, due to limited exposure and lack of interprofessional training opportunities outside paediatric tertiary centres [1].

Introduction:

Honour-based abuse (HBA) is a form of domestic abuse motivated by perceived ‘dishonour’ to family or community. Often involving multiple perpetrators from family networks, HBA centres around controlling behaviours and beliefs. Healthcare professionals frequently miss identifying victims. Simulation-based education offers an effective training method for sensitive topics but requires careful design to avoid stereotyping cultural contexts [1]. This project aimed to develop authentic simulation scenarios through co-production with survivors.

Introduction:

This initiative aims to address the critical training gap in paediatric mental health services by implementing simulation-based education (SBE), with a focus on equipping healthcare professionals to respond effectively to mental and physical health emergencies. Simulation-based education is well-established in acute and physical healthcare settings but remains underutilised in mental health services, particularly in paediatrics [1]. This gap persists despite evidence that simulation can enhance clinical confidence, interprofessional collaboration, and patient safety [2]. Within the new Simulation Strategy launched at BWCFT, the recognition of the need for both physical and mental health simulation support was paramount. The goal was also to begin growing expert faculty trained to deliver simulation-based education within our mental health setting.

Introduction:

Ambulance services are seeing an increase in PEoLC patients electing to remain at home, with a focus on supportive care [1]. A challenge exists in how to suitably equip and empower ambulance services to adapt their culture, shifting from survival focussed care to supportive care for this patient group. Addressing this need through the implementation and development of simulation workshops, which are proven to be effective [2], aims to explore the impact on clinicians and consider the potential for further programme development.

Supporting Documents – Figure 1-A37

Introduction:

Recent reforms in undergraduate pharmacy education [1] mandate increased clinical exposure in primary care to support the development of prescribing competencies and consultation skills. However, capacity constraints in community care, driven by workforce shortages and service pressures challenge traditional placement models [2]. Observed simulation-based education offers a scalable and innovative solution. This pilot project explored the design and implementation of a virtual clinical experience (VCE) for third-year pharmacy students, using simulation to deliver standardised, high-fidelity, experiential learning. The aim was to implement and evaluate a hybrid simulation model that addresses placement shortages, reduces clinician burden, enhances student engagement, and supports interprofessional education.

Introduction:

Final-year medical students often report feeling unprepared for managing the responsibilities of on-call shifts as foundation doctors, particularly in prioritisation, escalation, communication, and prescribing tasks [1]. Responding to bleeps has been identified as a particularly anxiety-inducing element of starting clinical practice [2]. Addressing this gap in preparedness is crucial for ensuring a safer transition to postgraduate training. The Virtual On-Call (VOC) simulation was developed to provide a realistic, low-fidelity, psychologically safe environment for final-year students to practice core on-call competencies. We aimed to evaluate whether participation in VOC improved students’ self-reported confidence across key clinical domains and to explore student perceptions of the simulation’s realism and educational value.

Supporting Documents – Figure 1-A34

Introduction:

Birmingham Children’s Hospital (BCH) Emergency Department (ED) serves as the paediatric major trauma centre (MTC) for the West Midlands and Central England, managing the region’s most severely injured children. Due to the high acuity but low frequency of such cases, clinician experience and confidence are often limited [1].

This project aimed to design and implement a paediatric trauma simulation curriculum and assess whether this intervention can strengthen clinical skills, improve teamwork, promote adherence to guidelines, and improve clinician confidence [1,2].

Introduction:

Ultrasound-guided cannulation shown to be safer and more efficient than landmark-guided cannulation [1]. But it is a skill many resident doctors lack confidence in. We developed an ultrasound-guided cannulation course which aimed to give healthcare workers an opportunity to learn this skill in a safe simulated environment. We evaluated its impact on confidence ratings immediately and 3 months after the course.

Supporting Documents – Figure 1-A32

Introduction:

Across the globe, healthcare systems are experiencing rapid transformation, driven by advances in technology, increasing patient acuity, and evolving professional standards [1]. These shifts have elevated the expectations placed on newly graduated nurses, particularly in their ability to demonstrate critical thinking and clinical judgment. This shift has highlighted the need for innovation in clinical education. Recognizing these challenges, a Faculty of Nursing in Canada saw the opportunity to fundamentally reimagine its approach to clinical education through the intentional development and implementation of an innovative simulation program. The goal was to transition from sparse, ad hoc use of simulation to the comprehensive use of high-quality multimodal simulation to promote clinical judgment and critical thinking.

Introduction:

The number of knife crime-related serious injuries is growing across the UK [1]. Our questionnaires demonstrated that even senior clinicians lack confidence in managing chest wall trauma and making a time-critical decision to perform a resuscitative thoracotomy. We have piloted the Resuscitative Thoracotomy course designed by C.A.R.E. (Cardiac Advanced Resuscitation Education LLC), to train the frontline multidisciplinary team of ED doctors, surgeons, intensivists, anaesthetists and senior nursing staff. Candidates learn to perform bilateral thoracotomy, resuscitative thoracotomy, pericardiotomy, internal cardiac massage, internal defibrillation, and to manage underlying injuries.

Supporting Documents – Table 1-A30

Table 1-A30:

Average confidence rating of technical skills/knowledge of candidates (scale 1=poor, 5=excellent)

	October 2024 (pilot)N=8		April 2025N=16
Skill	Pre-course	Post-course	Pre-course	Post-course
Knowledge of existing guidance for chest wall trauma (blunt/penetrating)	2.75	4.5	2.69	4.56
Performing chest wall thoracostomy	3	4.25	2.56	4.44
Performing clamshell thoracotomy	2.13	x	2.19	4.38
Performing pericardiotomy	2.13	4	1.94	4.25
Performing internal cardiac massage	2.88	4.13	2.38	4.43
Dealing with underlying heart/vascular injury	2.38	4.13	1.88	4.06
Performing internal defibrillation	2.88	4.13	2.06	4.31
Ability to team lead			2.69	4.25
Act as a resource coordinator			2.31	4.38
Ability to work in a team to expedite the time-critical transfer of an unstable patient			3.5	4.6
Ability to work collaboratively to facilitate opening a chest within 5 minutes of an arrest			3.19	4.75

Introduction:

In situ simulation improves participants’ ability to respond to high-stress situations, increases confidence, and enhances interprofessional communication [1]. Simulation has increasingly been recognised by senior medical leadership as a valuable tool in enhancing patient safety. However, our experiential understanding showed that ad hoc simulation sessions across wards were often subject to cancellations and last-minute changes. Additionally the use of generic scenarios did not always reflect the specific clinical challenges faced by individual teams. These issues prompted a reassessment of our approach. We aimed to explore whether embedding a collaborative, ward-specific in situ simulation course would improve engagement, reduce cancellations, and better meet learning needs.

Supporting Documents – Figure 1-A29

Introduction:

Simulation training is a teaching method which uses a controlled environment to “recreate a clinical experience without exposing patients to the associated risks” and allows students to practise skills and gain confidence in clinical scenarios [1]. Simulation training is highly effective at enhancing the learning and clinical competency of individuals working in a healthcare setting [2]. Over the past year we, a group of FY2 doctors, delivered “virtual on-call” sessions for final year medical students and foundation doctors, providing them with bleeps and a simulation of an on-call shift.

Supporting Documents – Figure 1-A27

Figure 1:

Graph showing percentage increase in number of students feeling confident for on-calls from pre- to post-session, in each 'block' of sessions and overall.

Introduction:

Point-of-care ultrasound (POCUS) is increasingly becoming an integral component of healthcare due to its capability for swift diagnosis, aiding management plans and improving accuracy and decreasing complications of bedside procedures. POCUS training has advanced over recent years with many centres now offering accredited courses and implementing structured training to improve clinician’s ultrasound skills. According to the literature, frequent barriers to accreditation include lack of supervisors and lack of time to complete supervised scans [1], by running a “Introduction to POCUS” course it was our aim to reduce these barriers.

Introduction:

Early and appropriate use of Non-Invasive Ventilation (NIV) reduces patient mortality [1]. Simulation-based multidisciplinary education enhances realism, teamwork, and clinical preparedness in acute care settings [2]. Embedding Critical Care Outreach (CCOT) teams into simulation training mirrors real-world escalation pathways and strengthens clinical decision-making. However, resident doctors often report low confidence and high anxiety when managing NIV, primarily due to limited formal training - a pattern seen in the UK [2]. Addressing this gap is essential to optimise acute patient care. We collaborated with CCOT and peer-led teaching initiatives to deliver simulation-based sessions focused on recognising suitable patients, setting up, and initiating NIV [3]. We aimed to evaluate the benefits of interdisciplinary, CCOT-integrated simulation in developing skills for managing respiratory failure.

Supporting Documents – Table 1-A23

Table 1

Outcome Measure	Pre-Simulation	Post-Simulation	Change
Confidence Score (mean,/5)	2.7	4.2	+56% increase
Anxiety Score (mean,/24)	16.0	11.7	-27% reduction
Participants with prior formal NIV training (%)	8.3%	—	91.7% without prior training
Participants finding CCOT input beneficial (%)	—	93.75%

Introduction:

Medical students at University Hospitals Dorset have an 8-week placement in Paediatrics, where they are expected to develop their skills in history taking and examination of children. Previously these skills were introduced through lectures, prior to students commencing placement, where they would be expected to practice their new skills on patients. Informal feedback showed that students found this daunting. Literature on this topic shows that students find an abrupt transition from theory to practice with real patients to be challenging [1]. To address this, we designed a simulation session to occur prior to clinical placements, where we gave students the opportunity to practice their skills in a safe and low-pressure setting.

Introduction:

Ultrasound (USS) guided regional anaesthesia is a core skill in anaesthetic training. However, access to high-fidelity phantoms is often restricted by cost. Simulation-based training is well recognised for improving clinical performance [1] and low-cost phantoms offer significant educational value [2]. We developed an affordable, realistic, and reusable gelatine-based phantom in collaboration with the simulation team at our hospital. We evaluated its effectiveness through user feedback across different training levels.

Supporting Documents – Figure 1-A17

Introduction:

Simulation is a widely acknowledged method of training for healthcare practitioners often with a focus on improving safety and awareness of human factors [1]. Low fidelity in-situ simulation is an efficient way of improving performance [2] and is well established within our NHS trust, with a 30-minute session delivered fortnightly for resident paediatric doctors. Feedback identifies the majority of resident paediatric doctors across the deanery have some, but limited, opportunity to participate in simulation, with a learning gap regarding how to deliver these sessions themselves.

Introduction:

WingFactors, a collaboration between aviation professionals and NHS educators, has been working with healthcare simulation faculties since 2020 and with Frimley Park’s Emergency Department (ED) since 2022. Drawing on aviation’s established use of Crew Resource Management (CRM) [1], CRM-trained airline pilots contribute to medical simulation debriefs – an approach that has supported a clearer focus on non-technical skills (NTS). This exposed a lack in NTS-specific training within Emergency Medicine (EM) and positive feedback from clinicians informed the development of a dedicated NTS curriculum and a bespoke training programme.

Introduction:

Foundation Year 1 (FY1) doctors are unlikely to have firsthand experience of navigating the unique chaos of a Medical Emergency Team (MET) call before joining the team. Experiential learning through simulation could help to bridge this gap between theory and practice [1].

The aim of this simulation project was to provide a realistic view of a MET call from the FY1 perspective. The simulation scenarios progressed in real-time, to uncover hidden internal pressures caused by delayed access to crucial information. They also replicated some logistical challenges commonly encountered by MET members, such as locating necessary equipment in an unfamiliar environment.

Introduction:

All anaesthetic and Acute Care Common Stem (ACCS) trainees are expected to undergo an Initial Assessment of Competence (IAC) during the first 3 to 6 months of their anaesthetic training. The umbrella term ‘novice anaesthetist’ is used to describe an anaesthetist in training yet to achieve their IAC.

As per the Royal College of Anaesthetists, one of the two core learning outcomes of the IAC is to provide general anaesthesia for American Society of Anesthesiologists (ASA) I/II patients having uncomplicated surgery [1,2].

A new regional two-day simulation course was developed to enhance novice anaesthetists’ preparedness and confidence during their IAC period. The broader aims of the course were to improve equity of access to and ensure sustainability of simulation training for novice anaesthetists across the region.

Supporting Documents – Figure 1-A9

Graph 1:

Bar Chart Showing Pre- and Post-course Scores for the Novice Anaesthetic Simulation Course

Introduction:

38% of LGBTQIA+ individuals report negative experiences within healthcare in the United Kingdom [1], yet no mandatory LGBTQIA+ training exists for NHS staff post-qualification. Simulation-based training can provide a platform to promote culturally competent LGBTQIA+ care [2]. University Hospitals Dorset developed a livestream simulation to increase healthcare staff access to LGBTQIA+ education, with the aim of improving staff confidence in communicating with LGBTQIA+ people.

Introduction:

There is limited research providing guidance on deliverance of in-situ simulation (ISS) in ambulances, within the transport setting. Previous studies have shown that only 67% of UK neonatal transport teams provide ISS and this takes place less than weekly in 60% of teams surveyed [1]. Simulation-based education (SBE) is well established in enhancing team-work, communication and awareness of human factors, all of which are significantly more challenging in transport, due to clinical isolation, scarcity of resources and physical and sound barriers.

KIDSNTS is a joint paediatric and neonatal transport service, covering the West-Midlands region. Many staff members are dually trained in paediatric and neonatal retrieval allowing speciality collaboration. St Johns Ambulance technicians additionally contribute to the multi-disciplinary team (MDT) care. Many team members have limited or no experience of SBE previously. Joint ISS delivery literature is scarce.

Introduction:

Haemorrhagic shock is the one of the leading causes of death in trauma patients and early recognition of blood loss, haemorrhage control and rapid massive transfusion is lifesaving [1]. Efficient delivery of blood products is essential to the care of trauma patients [2] and is dependent on excellent multi-disciplinary teamwork and communication.

In our institution, a Dublin based designated Trauma Unit, we sought to investigate the effect of multi-disciplinary simulation based medical education on time to delivery of blood products in a massive transfusion.

As a collaborative quality improvement project between the Acute General Medicine team (AGM) and the Resuscitation Service, the REsuS project’s primary aim is to enhance resuscitation team leadership skills, alongside developing non-technical skills throughout the responding multi-disciplinary team (MDT).

Initiated in response to a qualitative evaluation of leadership and team dynamics during 2222 calls across the Trust. Informed by Anderson et al.‘s [1] 2021 paper on ‘Best practices for educating and training resuscitation teams for in-hospital cardiac arrest’, the program aligns with themes identified for improving resuscitation management, such as promoting training engagement, clear communication, and responsive leadership.

Methods:

Unanticipated, ‘real-time’ simulations were conducted in 2 acute medical units. The scenarios comprised of a peri-arrest assessment to full cardiopulmonary arrest, prompting emergency-alarm activation and Registrar-led Advanced Life Support response. The ‘in-situ’ and ‘without prior-warning’ approach, integral to this initiative, elicits a genuine response to a medical emergency, utilising the clinical environment, available equipment, and actual clinical staff. Facilitated by an experienced Resuscitation Practitioner and a Critical Care Registrar, using Cooper et al.’s Team Tool©[2], the participants are evaluated for leadership and teamwork. Post-simulation debriefings serve as the pivotal learning phase, highlighting effective practice and areas for improvement in non-technical skills, through feedback and critical self-reflection.

Results:

The ongoing project has a further 8 planned simulations. From the determined power calculation, current projected outcomes aim for a minimum 10% increase in overall Team Tool scores, indicating enhanced leadership and team effectiveness. This current project operates as a pilot study, employing Plan-Do-Study-Act cycles to refine facilitation methods within resource constraints. Concluding by July 2024, documentation of results, the positive impacts, and the challenges, will be highlighted in the presentation.

Discussion:

Engagement with Ward Managers, Consultants, and Service Leads, ensuring pro-active support is vital for the project’s future success. An important component is the proposal of a sustainable version of this leadership programme. Aligning with the NHS’s commitment to continual learning, outlined in the Patient Safety Incident Response Framework [3]. The presentation will highlight the strategies to achieve ongoing sustainability and the proposed integration to the mandatory training pathway for both resuscitation and human factors education.

The REsuS project is a significant undertaking, particularly working within clinical settings with ongoing patient care. Barriers to project implementation include staff availability, time-constraints, and bed-space considerations, exacerbated by the 2023-2024 industrial action. Despite these obstacles, leading this project is highly motivating, with positive feedback and optimistic outcomes.

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.

References

1. Anderson TM, Secrest K, Krein SL, Schildhouse R, Guetterman TC, Harrod M, et al. Best practices for education and training of resuscitation teams for in-hospital cardiac arrest. Circulation: Cardiovascular Quality and Outcomes [Internet]. 2021;14(12). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8759032/.

2. Cooper S, Cant R, Porter J, Sellick K, Somers G, Kinsman L, Nestel D. Rating medical emergency teamwork performance: Development of the Team Emergency Assessment Measure (TEAM). Resuscitation: Simulation and Education [Internet]. 2010;81(4). Available from: https://www.sciencedirect.com/science/article/abs/pii/S0300957209006339?via%3Dihub.

3. NHS England. Patient Safety Incident Response Framework [Internet]. Available from: https://www.england.nhs.uk/patient-safety/patient-safety-insight/incident-response-framework/. [Accessed 5 March 2024].

Health Education England have recently endorsed the use of simulation activity as a crucial mechanism through which new policies and procedures can be tested to identify latent patient safety threats [1].

Our tertiary neonatal intensive care unit (NICU) has, in response to national requirements and recent safety incidents, developed a new Neonatal Major Haemorrhage Protocol (NMHP). This is a complex, dual-site protocol which requires action from staff in multiple departments over both sites. To aid development of the protocol, we utilised simulation to stress test the guideline and to identify gaps in the roll out of its use.

Methods:

We designed a two-part simulation to test the NMHP. The key priorities of these simulations were in Identification and Innovation [2].

1. A ‘Table-Top’ Simulation in which knowledge of staff in each department was tested through simulation of principal phone calls within the NMHP.

2. An In-Situ Simulation of the NMHP within the NICU. This involved five nursing staff, three medical staff and four facilitators.

In lieu of a traditional debrief, participants and facilitators engaged in a modified debrief with the purpose of identifying problems that arose during the simulation and developing action points for improvement of the protocol and reduction in patient safety threats.

Results:

The ‘Table-Top’ Simulation uncovered lack of dissemination of the new protocol to one key department. Following this, education of this team was completed.

The In-Situ Simulation identified 16 primary issues, from which 28 separate action points were developed. The primary issues identified related to equipment, process and educational needs for both nursing and medical staff, as well as inaccuracies and/or omissions within the new written protocol.

The action points developed included amendments to the protocol, need for additional staff training, changes to processes in ordering blood and sending blood samples to a second site and development of a “Neonatal Major Haemorrhage Box” which would provide staff swift access to the protocol, key drug guidelines, key equipment, tabards for role allocation and a newly designed record sheet.

Discussion:

Simulation is a valuable tool in the development of new clinical protocols. Our experience demonstrates that, when utilised effectively, latent patient safety threats not recognised earlier in the protocol development stage, can be identified and minimised.

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.

References

1. Health Education England Technology Enhanced Learning. Enhancing education, clinical practice and staff wellbeing. A national vision for the role of simulation and immersive technologies in health and care [Internet]. 2020. Available from https://www.hee.nhs.uk/sites/default/files/documents/National%20Strategic%20Vision%20of%20Sim%20in%20Health%20and%20Care.pdf. [Accessed 10 April 2024].

2. Weldon SM, Buttery AG, Spearpoint K, Kneebone R. Transformative forms of simulation in health care – the seven simulation-based ‘I’s: a concept taxonomy review of the literature. International Journal of Healthcare Simulation. 2023. Open Access. Available from: https://ijohs.com/article/doi/10.54531/TZFD6375. [Accessed 10 April 2024].

The introduction of virtual reality within healthcare and specifically within simulation-based education, is a novel opportunity to enhance the care of our complex airway patients. ENT and anaesthetic teams frequently manage airway emergencies out-of-hours, yet our airway teaching programs have historically been delivered separately. There is a recognised need for both specialties to train together to develop team-working skills and share knowledge when managing difficult airways [1].

Methods:

We present our first regional collaborative airway teaching course delivered in February 2024 aimed at both ENT and anaesthetic trainees. This extensive high-fidelity full day program utilised a variety of teaching modalities including virtual reality (VR) oculus 3 headsets, Orsim bronchoscopy simulators, a simulated emergency cricothyroidotomy station and collaborative paediatric inhaled foreign body moulages. Our VR headsets have both adult and paediatric tracheostomy simulations and emergency ‘front of neck access’ scenarios in-built. An additional multi-player function allowed cross-specialty team working. Orsim delivered a pioneering flexible nasendoscopy technology to recreate difficult endotracheal intubation. Our emergency ‘front of neck access’ simulation utilised a bespoke mannikin to recreate the real-time tactile feedback. The paediatric inhaled foreign body moulage put our delegates through a comprehensive scenario from A&E to our own ENT theatre suite.

Results:

Regarding formal feedback, those participants that felt ‘very confident’ or ‘extremely confident’ in managing a paediatric inhaled airway foreign body improved from 0% to 83%. With regards to skills acquisition, those participants that felt ‘very confident’ or ‘extremely confident’ in performing flexible bronchoscopy improved from 50% to 92%. ENT trainees’ confidence in discussing difficult airway cases with an anaesthetic colleague improved from 20% to 80% and for anaesthetic trainees improved from 45% to 100%. All participants found the teaching day useful and 100% agreed that there should be more formal collaborative teaching between ENT and anaesthetic trainees.

With respect to the VR simulation, 50% agreed that VR simulated scenarios mimicked a real-life scenario better than conventional mannikin-based sim. 100% found it useful to perform the simulation with a trainee from a different specialty. 100% felt that VR simulation allowed a safe environment to learn, highlighting the psychologically safe learning environment that often limits conventional sim teaching.

Discussion:

This study has demonstrated that the incorporation of novel virtual reality teaching methods into our regional collaborative ENT & anaesthetics airway teaching, improved outcomes in trainees ability to manage tracheostomy and paediatric emergencies.

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

References

1. Coyle M, Martin D, McCutcheon K. Interprofessional simulation training in difficult airway management: a narrative review. The British Journal of Nursing. 2020;29(1):36–43.

Acknowledgments:

Funding was provided by our own local ENT department to purchase two VR oculus 3 headsets from ‘goggleminds’ company on a running annual basis.

Simulation in medical education is a well-established tool that produces a realistic experience in a safe learning environment and is used frequently in later years of medical training. Many medical students report immense apprehension and lack of confidence prior to commencing Foundation Year 1 (FY1) [1]. To address this, we undertook a quality improvement project that incorporated game-based [2] and experiential learning [3] principles. The aim was to promote student reflection on common clinical and non-clinical challenges they may face as a Foundation Doctor.

Methods:

The escape room design encompassed a pre-existing simulation setup, incorporating key simulation equipment including a Laerdal SimMan manikin.

Twenty final-year medical students from the University of Birmingham Medical School participated in the escape room activity, working in groups of three or four. Before and after the escape room, students rated their confidence levels on a Likert scale (1-5) regarding various clinical tasks and non-technical skills relevant to FY1: conducting an A-E assessment; formulating differential diagnoses; initiating management plans; making referrals; teamwork; leadership; task delegation and dealing with uncertainty. Mean confidence ratings were calculated for each statement pre- and post-escape room. The data was analysed using the paired-sample Student t-test with statistical significance determined by a p-value of <0.01.

Qualitative data was obtained through student self-evaluation on the skills demonstrated in the escape room and how these assisted, or hindered, their escape. Students participated in an in-person reflective debrief after the escape room.

Results:

Nine students succeeded in escaping the challenge. Analysis revealed a statistically significant increase in mean confidence ratings across six of the nine statements for all students.

Seventeen students reported identification of areas of practice to improve prior to commencement of FY1. Of these, common themes included conducting a thorough patient examination, management of sepsis, clear task delegation within a team, and medication prescribing. Common reflective discussions from the debriefs included working efficiently in a time-pressured environment and focusing amidst distraction.

Discussion:

The escape room has showcased an innovative and effective tool to help students identify their learning needs prior to FY1 and improve their confidence in common tasks in anticipation of their future clinical work. We recognise the limitations of qualitative data gathering and feedback bias from the students that successfully escaped. Overall, we believe that the gamified experience facilitated a greater student appreciation for the impact of non-technical skills in comparison to other simulation learning they have previously received.

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

References

1. Monrouxe LV, Grundy L, Mann M, John Z, Panagoulas E, Bullock A, et al. How prepared are UK Medical Graduates for practice? A Rapid Review of the literature 2009–2014. BMJ Open. 2017;7(1).

2. Xu M, Luo Y, Xia R, Qian H, Zou X. Game-base learning in medical education. Front Public Health. 2023;11:1113682.

3. Kolb D. Experiential Learning: Experience As The Source Of Learning And Development. Englewood Cliffs, NJ: Prentice-Hall. 1984.

There is increasing demand to demonstrate cost-effectiveness in simulation-based education (SBE) [1]. This challenging truth is one our department has been forced to reckon with. Consequently, this initiative aimed to provide SBE to core trainees (CTs) and operating department practitioners (ODPs) to ASPIH standards [2] without additional funding, a simulation suite, protected teaching time, or more than one faculty member.

Figure 1-A129.

These objectives suggested use of in-situ simulation. However, challenges of this format are well described. Examples include prolonged set-up, risk to expensive equipment, high facilitator candidate ratio, high facilitator workload, vulnerability to service requirements and low stakeholder buy-in [3].

Methods:

To address these challenges, an unused airway trainer head was selected. It was modified using regularly discarded anaesthetic equipment to simulate chest rise, mechanically mimic physiological and pathological positive pressure ventilation both on monitors and bagging. This was combined with a similarly assembled mechanism to simulate regurgitation and arms with cannulae connected to reservoirs. It was covered with padding, a gown and bedsheet, and secured to a canvas creating an en-bloc unit foldable into a case (Figure 1-A129).

These modifications enable one facilitator to transport all their equipment on a single airway trolley and set up in-situ simulation alone in 20 minutes. This allows exploitation of the otherwise unavailable “downtime” of CTs who have exhausted all learning opportunities on their lists and ODPs on Merit or obstetric duties. Sessions have consisted of a standardised 10-minute pre-brief, 20-minute simulation of an anaesthetic critical incident and a 20-minute debrief.

Simulated patient monitor outputs were pre-programmed in stages to anticipate the progression of the incident and the candidate’s responses. Simple controls alter the manikin’s respiratory mechanics or cause regurgitation. This permits a single facilitator to lead, conduct, monitor and debrief simulations.

Results:

Written candidate feedback has demonstrated high reported immersion, psychological safety, applicability, specific personal learning outcomes, and elicited systems issues on a local and national level. Theatre co-ordinators have accepted the minimally intrusive nature of this design. The total value of equipment and software is estimated to be less than £5000.

Discussion:

This initiative may be useful in departments with few resources for SBE or to demonstrate SBE’s merits when there is low buy-in from stakeholders. Sadly, this mannikin cannot be fully exposed, undergo CPR or defibrillation. It cannot spontaneously breathe and collapses on circuit disconnection. The vulnerabilities of in-situ simulation to service requirements and facilitator workload remain only partially addressed by this 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

References

1. Hippe DS, Umoren RA, McGee A, Bucher SL, Bresnahan BW. 2020. A targeted systematic review of cost analyses for implementation of simulation-based education in healthcare. SAGE Open Medicine [online]. 8:205031212091345.

2. Purva M, Baxendale B, Scales E. et al. Simulation-Based Education in Healthcare. [online] 2016. Available from: https://aspih.org.uk/wp-content/uploads/2017/07/standards-framework.pdf.

3. Patterson MD, Blike GT, Nadkarni VM. In Situ Simulation: Challenges and Results. In: Advances in Patient Safety: New Directions and Alternative Approaches (Vol 3: Performance and Tools) [Internet]. US: Agency for Healthcare Research and Quality; 2008. Available from: https://www.ncbi.nlm.nih.gov/books/NBK43682/.

Addressing the challenge of providing authentic simulated practice learning (SPL) experiences for 750 first-year student nurses across multiple campuses, this presentation explores the implementation of Ruskin Row, a community simulated practice learning initiative. The aim of the SPL was for student nurses to develop competence in proficiencies identified in the UK Nursing and Midwifery Council (NMC) Future Nurse Standards of Proficiency (2018) [1], the case study seeks to investigate the effectiveness of integrating AI software to create immersive learning scenarios.

Methods:

Ruskin Row was created through collaborative efforts involving the nursing simulation team, service users, and practice partners to develop tailored scenarios. AI-generated content, facilitated by Veed.io and Chat GPT, was integrated to enhance scenario realism. Diverse AI avatars, reflective of inclusivity. Additionally, the incorporation of diverse media elements, including videos captured using an iPhone and Gimbal, and immersive 360-degree videos filmed with an Insta X3 camera further enhance the learning experience.

The AI scenarios, developed in VEED.io, are stored in ARU’s media repository, Yuja and linked into Canvas learning management system. Students received support throughout the Simulated Placement learning from a team of academic practice supervisors, led by the placement Charge Nurse.

Results:

Student engagement was high, with positive feedback on content quality and relevance. Notably, students exhibited growth in professionalism, particularly in areas such as avoiding stereotypes and embracing empathy in patient care, aligning well with the principles of patient-centred care. However, staffing shortages posed challenges, highlighting the importance of consistent support for optimal learning experiences.

Discussion:

The experience of the development team underscores the value of collaborative input in integrating AI-generated scenarios into nursing education. By prioritising inclusivity, cultural diversity, and ethical considerations, Ruskin Row fosters innovation in educational practices. Addressing staffing concerns is pivotal for maximising the impact of simulated learning experiences, emphasising the need for sustained support mechanisms.

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

References

1. Nursing and Midwifery Council. Future Nurse: Standards of Proficiency for Registered Nurses. 2018. Available from: https://www.nmc.org.uk/globalassets/sitedocuments/education-standards/future-nurse-proficiencies.pdf.

Management of cardiac arrests are a vital part of a doctor’s job. Although there is no data on the percentage of UK medical students who will witness an arrest, a study of Norwegian students found that 72% had witnessed defibrillation, and 47% had participated in CPR [1]. Anecdotally, UK medical students may never witness a cardiac arrest and subsequently the first arrest they attend is as a qualified doctor. It has been shown that simulation can improve the quality of care during a cardiac arrest [2]. This lesson aimed to utilise the immersive technology of the Gener8 room (interactive, immersive room designed to enhance medical education and simulation) to create a high-fidelity experience of a cardiac arrest situation, The outcome was to improve confidence and competence in management of cardiac arrest.

Methods:

Final year medical students were informed that they would be undertaking a simple lesson. It appeared to them that the lesson was going badly, with the interactive technology failing. They were sent out of the room temporarily so the tutor could ‘fix the technology’. However, after 30 seconds, an emergency buzzer was activated, the students re-entered the room and were faced with a cardiac arrest situation. The tutor played the role of arrest leader. Following the simulation, students underwent Hot Debrief’ discussing the cardiac arrest simulation and then the entire simulation.

Students were asked to rate their confidence around the management of cardiac arrests before and after the simulation and share free text comments including their enjoyment of the session. This was done on a voluntary basis.

Results:

There were 49 responses. The mean confidence rating before the session was 3.59 with a standard deviation of 2 and a variance of 4. This rose to a mean confidence score of 7.71 with a standard deviation of 1.47 and a variance of 2.16 after the session. 100% of the participants stated that they enjoyed the session. The feedback was overwhelmingly positive with the students particularly enjoying the realism and surprise element of the simulation.

Discussion:

The results strongly suggest that immersive technology is an effective tool in improving education and experience of cardiac arrests. An effective debrief to re-enforce learning outcomes and support students is essential, especially simulation featuring a surprise, as it could prove traumatic without it. Future simulations re planned for the fourth-year medical 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

References

1. Freund Y, Duchateau FX, Baker EC, et al. Self-perception of knowledge and confidence in performing basic life support among medical students. European Journal of Emergency Medicine 2013;20:193–196.

2. Wayne DB, Didwania A, Feinglass J, Fudala MJ, Barsuk JH, McGaghie WC. Simulation-based education improves quality of care during cardiac arrest team responses at an academic teaching hospital: a case-control study. Chest. 2008;133(1):56–61.

Maternal cardiac arrest is rare, with an incidence of 2.78 per 100 000 maternities in the UK [1]. RCOG guidelines state that if there is no response to CPR after 4 minutes, a perimortem caesarean section (PMCS) should be performed [2]. As part of University Hospitals Sussex NHS Foundation Trust’s (UHSx) new approach to patient safety, local instances of PMCS have prompted the development of a new, simulation-based, multi-disciplinary, transformative learning package [3]. “The ADAMgel Group” in collaboration with the local, pan-UHSx simulation, emergency medicine and obstetrics departments are developing a low-cost, procedurally accurate, and sustainable PMCS simulation model.

Methods:

ADAMgel (Aqueous Dietary fibre Antifreeze Mix gel) was infused in a large stockinette and layered with chamois leather and velcro tape to reproduce the anatomical layers encountered when performing PMCS. This was fastened to a simple clothes mannikin frame in which we excised a fluid retaining cavity for our uterus model. A plastic doll in a watertight bag was used to simulate the foetus and amniotic sac. Foam pads were attached to the chest to allow simultaneous CPR, and a rocker bottom to enable a lateral decubitus position. This aims to add situational realism, and replicate known ergonomic issues and human factors.

Results:

Initial feedback from senior clinicians, experienced in the techniques, has been excellent. The procedural accuracy, fidelity to biological tissue and the capacity to simulate CPR were highlighted as particular successes (Figure 1-A120).

The ADAMgel layers can be recycled and re-used, in line with the UHSx “Planet First” sustainability policy. The fabric layers were either stitched back together for reuse or new Velcro tape was applied to reset the manikin. All the materials were low cost and readily available, and assembly was straightforward.

Discussion:

ADAMgel in combination with other readily available materials can produce an effective, low-cost, sustainable, and procedurally accurate PMCS model. This model, paired with appropriate speciality-specific learning resources and more generalised multi-disciplinary team centred learning outcomes, will enable high-acuity-low-occurrence (HALO) training in this procedure. Collaboration between different departments to share mental models, decision-restricting barriers and how an MDT can support decision-makers in this high-stress situation will be incorporated into the regular UHSx patient-safety based simulation program, ensuring our trust is prepared for these events. Further work to limit usage of non-recyclable materials will be needed to bring the model fully in-line with the ethical principles of the ADAMgel group.

Figure 1-A120.

Model in 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.

References

1. Beckett V, Knight M, Sharpe P. The <scp>CAPS</scp> Study: incidence, management and outcomes of cardiac arrest in pregnancy in the <scp>UK</scp>: a prospective, descriptive study. BJOG: An International Journal of Obstetrics & Gynaecology. 2017;124(9):1374–1381.

2. Chu J, Johnston T, Geoghegan J. Maternal collapse in pregnancy and the puerperium. BJOG: An International Journal of Obstetrics & Gynaecology. 2020;127(5).

3. Weldon SM, Buttery AG, Spearpoint K, Kneebone R. Transformative forms of simulation in health care – the seven simulation-based ‘I’s: a concept taxonomy review of the literature. International Journal of Healthcare Simulation. 2023.

Simulation has become a ISCP mandated component of surgical training, and the challenge remains to develop ‘close-to-real’ training [1]. Management of paediatric elbow fractures is an obligatory competence for completion of training in Trauma and Orthopaedics. Current methods using saw bones teach the concepts of wire configuration, but the limitations include an absence of soft tissues, and intra-operative X-ray interpretation is not possible. Research question was if suitable models could be designed to maximise the realism of training and allow radiographic assessment during the simulated scenario.

Methods:

In conjunction with Axial 3D Printing (Belfast, N. Ireland) a child’s elbow model was produced with radiopaque ‘bone’ and flexible radiolucent ‘soft tissues’ technology to produce a high-fidelity paediatric elbow, suitable to be used under radiological guidance, as an adjunct to teaching Kirschner wiring of a supracondylar fracture. Simulation training of 19 Orthopaedic Trainees (ST3-8) was undertaken.

Results:

Participant feedback was collected with positive responses regarding the model’s usefulness for simulation training within a theatre environment, particularly for trainees with less experience. There was a trend towards decreased screening time and duration of the procedure between junior and senior trainees. Junior trainees had a greater increase in self-reported confidence in performing the procedure. This was measured using a 5-point Likert score with improvement of 1.8 in the ST3-4 cohort compared to 0.44 in the trainees ST5+ (p = 0.003).

Each trainee was dual marked for their performance of the simulated K-wiring procedure using the Objective Structured Assessment of Technical Skills (OSATS) Global Rating Scale [2]. Senior trainees had an average OSATS score of 31.8 compared to the junior trainees who averaged 27.9 (p = 0.015) which mirrors real-life expectations. This proficiency in utilising the simulation model among more experienced surgeons reflects its realism and usefulness as an educational tool.

Discussion:

This new 3D printing technique demonstrates development in modern surgical training. Saw-bones have numerous limitations, while the costs and practicalities of cadaveric training remains prohibitive. By combining realism and low risk these 3D printed models may offer a solution to these challenges and contribute to enhanced patient 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

References

1. So HY, Chen PP, Wong GKC, Chan TTN. Simulation in medical education. J R Coll Physicians Edinb. 2019;49(1):52–57.

2. van Hove PD, Tuijthof GJM, Verdaasdonk EGG, Stassen LPS, Dankelman J. Objective assessment of technical surgical skills. British Journal of Surgery. 2010;97(7):972–987.

Successful management of trauma patients is perhaps more reliant on optimal non-technical skills (NTS) than any other area of patient care. We believe that to be able to achieve this there is a requirement for inter-specialty immersive simulation training which is not currently offered routinely [1].

Using this form of shared training and reflection we hypothesise that we would see generation of new mental models and categorisation of knowledge which would supplement the skill, fact and protocol-based learning that is delivered by existing international trauma courses.

Methods:

We created 5 trauma scenarios aimed at meeting learning outcomes based around vital NTS. Consultants or senior trainees in emergency medicine, anaesthetics, intensive care medicine and surgical specialties attended along with trauma nurses.

Scenarios were managed in teams of 5 with the remaining attendees observing. The participants and observers were varied for each scenario allowing adequate opportunity for both observation and participation as well as experience in always working with different team members as would occur in clinical practice. All scenarios were recorded to allow reflection using video analysis in the debrief.

We aimed to determine if the perceived educational need was met by this course using a post course evaluation.

Results:

Based on 29 responses, 93% reported that this course met their educational requirement ‘well’ or ‘very well’.

Comments from participants included:

● ‘Learning the different point of views of different specialities when dealing with a trauma. Very enriching discussions’

● ‘Wide mdt, ability to talk through scenarios with multiple individuals’

● ‘Great to work/ learn together with other specialties/members of the MDT’

● ‘Great mix of specialties on the course was an excellent source of learning.’

● ‘Multidisciplinary aspect is its strength, working with colleagues and seeing their approach’

● ‘Demonstrated the value of the role each person has in resus during trauma calls’

Discussion:

The opportunity to be part of an authentic trauma team, observe other trauma teams in action and reflect with an inter-specialty group is powerful for developing NTS via the cognitive transformation theory. It appears that our learners recognised this as an important part of their educational development.

We conclude that this method of training meets the needs of the learners and therefore the trauma system.

In the future we would like to integrate this training into all relevant specialties curriculum and study its effect on the learners’ performance level within a trauma team.

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.

References

1. Barleycorn D, Lee GA. How effective is trauma simulation as an educational process for healthcare providers within the trauma networks? A systematic review. International Emergency Nursing. 2018;40:37–45.

Initial contact for trauma and paediatric patients can be from junior doctors. However, medical students receive limited teaching in trauma skills and courses teaching intraosseous access (IO) are postgraduate. Obtaining emergency intravenous access in an unwell child can be time consuming and has a high failure rate. IO access provides a quick method of access that has a low failure rate. Our aim was to teach medical students IO access in a single session, assess their success and confidence and determine if these attributes are retained over time.

Methods:

Small groups of fourth year medical students completed a pre session questionnaire assessing their knowledge and experience of IO access. A short lecture was delivered followed by a practical session taught using the Peyton’s four step approach. Students were assessed using a clinically validated scale. At the end of the session a further questionnaire was undertaken to assess knowledge and confidence following the session. Students were then invited back for reassessment to see if the skill had been retained and a repeat questionnaire assessing knowledge and confidence was performed.

Results:

A-hundred-and-one students undertook training with 100% gaining successful IO access. 91.9% of participants agreed or strongly agreed they would be confident to attempt IO access in a clinical setting immediately after training. 100% of participants either agreed or strongly agreed that the teaching was appropriate for their level of training. 49 participants were reassessed over a range of 16 to 347 days. Our aim had been to test after a minimum of 6 weeks. 100% of reassessed participants successfully gained IO access and 95.9% of participants agreed or strongly agreed they would be confident to attempt IO access in a clinical setting. Knowledge depreciated slightly with time.

Discussion:

There have been limited studies [1] looking at teaching medical students IO access. Remote and rural hospitals are often staffed primarily by junior doctors who may have limited knowledge and experience of this procedure yet be expected to undertake IO access in an emergency. This study has shown that the skill can be taught to senior medical students and retained. Further re-assessment over a longer time period would be beneficial.

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.

References

1. Kwon OY, Park SY, Yoon TY. Educational effect of intraosseous access for medical students. Korean Journal of Medical Education. 2014;26(2):117-124.

Clinical reasoning is an essential skill for doctors to reduce the risk of diagnostic error [1]. Diagnoses typically stem from a thorough patient history and physical examination; however, an increasing dependence on laboratory testing may suggest a compensatory measure for poor history taking and examination skills [2] and therefore, diminished clinical reasoning. Clinicians can learn diagnostic reasoning effectively if “teachers provide guidance on the cognitive processes involved in making diagnostic decisions” [3] and “competence in clinical reasoning is acquired by supervised practice with effective feedback” [3].

Methods:

In Withybush General Hospital, the medical education team have developed a simulation programme to promote diagnostic reasoning. The simulation scenarios centre around a common presenting complaint e.g., chest pain, with a specific learning objective to identify a list of differential diagnoses using a focussed history. During the simulation, the learners only have access to “immediate” diagnostic tests such as observations, ECG, ABG and portable CXR. The simulation is facilitated for foundation doctors with an advocacy-enquiry style debrief discussing diagnostic reasoning and post-simulation feedback from the learners.

Results:

Quantitative ratings out of 5 for educational value and written comments were collected for results. 100% of the foundation doctors who attended the simulations and completed the feedback rated the educational value of the sessions as 5 out of 5 (excellent). Written comments include the following: “it was good exposure for clinical judgement and decision making for complex patient presentations” and “made me increase my list of differentials”.

Discussion:

This simulation programme illustrates the potential to use simulation as a tool to develop diagnostic reasoning through specific cases that encourage the learner to develop a list of differential diagnoses without relying on laboratory testing.

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.

References

1. Murray H, Savage T, Rang L, Messenger D. Teaching diagnostic reasoning: using simulation and mixed practice to build competence. Canadian Journal of Emergency Medicine. 2018;20(1):142–145.

2. Epner PL, Gans JE, Graber ML. When diagnostic testing leads to harm: a new outcomes-based approach for laboratory medicine. BMJ Quality & Safety. 2013;22(suppl 2):ii6–ii10.

3. Pinnock R, Welch P. Learning clinical reasoning. Journal of Paediatrics and Child Health. 2014;50(4):253–257.

The principles of human factors aim to understand the “fit” between staff members and their environment. Human factors include equipment design, processes, communication, teamworking, leadership and organisational culture. Understanding these principles can result in reduced human error and therefore beneficial results on quality of care and patient safety [1]. The NHS Patient Safety Syllabus highlight human factors as a core theme of its training for every member of staff across the NHS. Despite this, we were unable to identify any interprofessional human factors training courses in Wales when establishing this concept [2].

Methods:

In Cardiff & Vale University Health Board, we created an interprofessional, multi-speciality human factors course. The course was one full day consisting of a “The Basics” lecture, interactive workshops around the main themes of Human Factors and then discussion about the practical application of Human Factors based around pre-filmed simulations. A pre-course handbook and post-course online platform was also created to allow attendees to consolidate their learning. Content was delivered by a multi-professional multi-speciality faculty.

Results:

The first course, run in January 2024, was attended by 11 doctors, 13 nurses and one physician associate in attendance. All attendees were requested to complete pre- and post-course questionnaires.

The pre-course questionnaire found that only 12% (3/25) of attendees felt confident about human factors and 48% (11/23) of attendees were aware of human factors effects on their clinical work. 74% (17/23) reported having had minimal or no human factors teaching prior to this course. The post-course questionnaire found that 80% (20/25) felt confident about human factors and 88% (22/25) felt aware or very aware of human factors effects on clinical work following attending the course.

Qualitative feedback suggested that the participants found the course engaging, interesting and useful and felt that their learning would help them to improve their clinical areas and share their learning with their colleagues.

Discussion:

This interprofessional multi-speciality human factors course has proven its usefulness and value for all healthcare professionals working within the Health Board. It’s inter-professional nature, has strengthened the learning that attendees gained and proved that human factors really are everyone’s problem. Detailed feedback will be analysed in order to improve upon the courses foundations and further courses will open this education to more Health Board staff.

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.

References

1. Health Education England. Human Factors [online]. No Date. Available from: https://www.hee.nhs.uk/our-work/human-factors. [Accessed 19 December 2023].

2. Academy of Medical Royal Colleges. National Patient Safety Syllabus [online]. Version 2.1. 2022. Available from: https://www.hee.nhs.uk/our-work/patient-safety. [Accessed 5 February 2024].

Acknowledgments:

Thank you to the Cardiff & Vale University Health Board Medical Education team for their help and support with this course.

The UK has become increasingly diverse, and educators must prepare health professionals to address social and structural determinants of health, inequity, and care for diverse population groups. Promoting EDI in simulation creates safe learning environments and broadens the training of healthcare professionals to meet the dynamic demands of patient-centred care for different patient populations.

The ideal simulation focuses on creating structured Intended Learning Objectives (ILOs), Pre-briefing, Scenario design & Implementation with professional facilitation, Debriefing, and/or Performance evaluation [1]. Incorporating EDI into these processes would foster an inclusive environment that cherishes differences, addresses root causes of unfair disparities among population groups, and creates exposure to patients from various backgrounds and healthcare needs [2]. This will improve participant’s awareness and overall clinical competency in upholding EDI principles.

This study aims to highlight the practical measures taken to promote EDI in simulation at our district general hospital. It focuses on Scenario design and Physical fidelity in line with EDI thus identifying any potential biases or missed opportunities and proffers recommendations for further improvements in the context of EDI in simulation.

Methods:

EDI for this paper would focus on five of the nine protected characteristics listed in the ‘Equality Act 2010’ (Gender reassignment, Sexual orientation, Race, Disability, Religion or belief) [3].

This study evaluated our post-graduate simulation training for incorporation of these EDI elements in Scenario design and Scenario Fidelity (Equipment).

Gaps were enumerated and recommendations were outlined.

Results:

For Scenario design, a total of 11 scenarios featured one or more EDI elements in its design with 5 of those scenarios being EDI-specific scenarios (ILOs strictly focused on EDI) such as Learning disabilities and LGBTQ representation.

For Scenario Fidelity, some equipment has been purchased including specialized task trainers and contemporary mannikins. We have furnished the suite with a variety of dark-skin task trainers targeted for lumbar puncture, chest drain insertion, and other invasive procedures. The paediatric department appeared well vast in EDI promotion with the development of an entire simulation study day focusing on sexual health in children and young people with EDI-specific ILOs.

Discussion:

Overall, there is evidence of deliberate efforts to increase the scope of EDI in simulation within the Trust. Further recommendations included creating more EDI-specific scenarios, incorporating EDI into debrief sessions where possible, and developing more faculty training for EDI debriefs.

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.

References

1. Alrimawi I. et al. Integrating diversity, equity, and inclusion in nursing simulation and clinical. Teaching and Learning in Nursing. 2024;19(2).

2. Watts PI. et al. Onward and upward: Introducing the healthcare simulation standards of Best PRACTICETM. Clinical Simulation in Nursing. 2021;58:1–4.

3. GOV.UK. Equality act 2010, Legislation.gov.uk. 2010. Available from: https://www.legislation.gov.uk/ukpga/2010/15/contents. [Accessed 30 April 2024].

The provision of optimal, high-quality healthcare relies upon effective interprofessional teamwork, wherein each discipline contributes unique skills to enhance person-centred care. However, teamwork in itself is complex, dynamic, and multifaceted [1]. Wherein success relies on multiple factors (effective communication, cohesive dynamics, collaborative working, etc.) aligning to enable optimal care deliverance. Consequently, ineffective teamworking has been evidenced to increase patient morbidity and mortality to service wide failures in obstetric care [2-3]. Despite the clear need to improve teamworking within healthcare, the prioritisation of communication and teamworking skills within medical education remains insufficient [4].

Methods:

Interprofessional education involving midwifery and medical students at undergraduate level is uncommon in Scotland. An initiative has commenced to integrate midwifery students into the current NHS/GGC undergraduate medical obstetric and gynaecology simulation course. Within the framework of the existing program, a high-fidelity, multi-scenario, acute in-patient simulation, third-year midwifery students have been invited to participate on a voluntary basis. Scheduled between March-June 2024 across six sessions, 50 medical and 22 midwifery students will participate. The objective of this scoping exercise is to assess the feasibility of incorporating midwives into the course. Additionally, analysing post-course surveys will allow future changes to be influenced from student feedback.

Results:

Incorporating midwifery students into the existing program posed several challenges: adherence to regulations set forth by universities and professional bodies as well as recruitment of voluntary midwifery participants. Additionally, course adaption had to equally provide a meaningful learning event for midwifes while not compromising the existing medical student learning. Retaining the course content while adapting the structure (a), deliverance (b) and resources (c) allowed the above to be achieved while additionally improving fidelity. For example, but not limited to;

(a) Staggering candidate entrance into the scenario allowed the midwife to complete an initial A-E assessment assessment while ensuring an interprofessional handover as the medic arrived. Dually creating key learning moments for both parties while replicating clinical practice.

(b) The embedded professional role changed from a qualified practitioner to a senior support worker, maintaining psychological safety while enabling the midwifery student to take responsibility.

(c) Resourcing fetal heart monitoring and medication administration equipment created practical work while increasing fidelity.

Discussion:

This is aimed at simulation educators working within or wishing to commence interprofessional simulation courses, particularly at undergraduate level. Aiming to foster collaborative learning by presenting a detailed overview of the scoping exercise, course feedback and key insights gained from the evaluators.

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.

References

1. Angouri J, Mesinioti P, Siassakos D. Let’s talk about it: Reframing communication in medical teams. Best Practice & Research Clinical Obstetrics & Gynaecology. 2022;80:75–91. Available from: https://pubmed.ncbi.nlm.nih.gov/35177327/. [Accessed 15 April 2024].

2. Kirkup B. The Report of the Morecambe Bay Investigation. UK Government; 2015. Available from: https://assets.publishing.service.gov.uk/media/5a7f3d7240f0b62305b85efb/47487_MBI_Accessible_v0.1.pdf. [Accessed 15 April 2024].

3. Ockenden International. The Independent Review of Maternity Services at The Shrewsbury and Telford Hospital NHS Trust. UK Government; 2021. Available from: https://assets.publishing.service.gov.uk/media/624332fe8fa8f527744f0615/Final-OckendenReport-web-accessible.pdf. [Accessed 15 April 2024].

4. Royal College of Physicians. Improving teams in healthcare: Resource 3: Team communication [Internet]. Royal College of Physicians. Available from: https://www.rcplondon.ac.uk/projects/outputs/improvingteams-healthcare-resource-3-team-communication. [Accessed 15 April 2024].

Return to work courses exist for those on maternity/paternity leave but not for those Out of Program electively for other reasons. For those wishing to maintain clinical contact and knowledge the Paediatric UPDATES (pUPDATES) course provides that opportunity which is funded by Health Education England [1]. Paediatrics has faced many challenges in the last few years with new evolving conditions such as PIMS-TS, this has been a challenge to many clinicians with constantly developing guidelines, adapting the care as new information becomes available. Paediatric medicine is developing quickly and often time out of training results in lack of updated knowledge of these evolving guidelines. This course was developed to cover a communication scenario, journal club discussion, case discussion and an update on a new guideline.

Methods:

The two pilot sessions had 10 candidates across the two days. Feedback from these pilot sessions helped develop a training program and formally roll out the pUPDATES course in 2023. From the initial questionnaire it was decided the course suited being virtual as opposed to face to face as it made it easier for candidates to attend around other commitments. The course is self-directed in the morning and then virtually in the afternoon. HEE have funded 3 courses a year for paediatric trainees. Feedback is collected via survey after each course.

Results:

Eighty percent of those attending were out of training for parental leave. 50% had been out of training for 6-12 months and 50% were out of training for over 12 months. The main concerns of candidates were the updated guidelines, and de-skilling in procedures. The three most useful sessions were the communication scenario, journal club and guideline update. The best things about the course reported by candidates were the guidelines update, communication station, group discussions and the opportunity to use the morning to read through the supporting material and prepare at home.

Discussion:

There has been positive feedback from all the candidates who have attended the course. Specifically, the guideline update on the measles pandemic as a lot of doctors have no experience of measles in clinical practice. Multiple candidates suggested attending the course more than once. As a consequence of the positive feedback there has been funding on the back of this for an UPDATES course funded for adult trainees in the West Midlands, the paediatric simulation lead has supported and helped set up their pilot simulation day.

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.

References

1. Wade L, Mehta F, Keane M. Do trainees value remote access return to training courses? Archives of Disease in Childhood. 2022.

To ensure that all new West Midlands Paediatric Trainees are equipped with the skills and confidence to start their new role as a paediatrician, the Wolverhampton Paediatric Simulation Team designed the Paediatric ST1 Skills and Drills Day with support of the deanery. The day has been hugely successful since it began in 2017, consisting of both practical procedures as well as simulation scenarios, including a relay scenario, that allows the development and discussion of non-technical skills. Trainees attending the course will have varying previous experiences in paediatrics with some having never worked in this field before, therefore, this day equips trainees with vital technical and non-technical skills and has shown to have greatly improved confidence levels in those candidates participating on the course [1].

Methods:

A retrospective review of pre- and post-course questionnaire answers. A total of 120 candidates were surveyed over 6 years with regards to their confidence levels with each skill before and after undertaking the course by ranking their confidence on a Likert scale. The specific skills for the day include 12-lead ECGs, lumbar punctures, urinary catheters, long lines and intraosseous (IO) insertion. We also have many free-text comments from candidates stating how valuable the sessions are and what a fantastic day it is.

Results:

There was, overall, a vast improvement in confidence levels across all skills with the largest improvement seen in IO insertion with confidence levels at ‘agree’ or ‘strongly agree’ increasing from 10% to 81%. The other skills showed a total average combined improvement in confidence levels of 52%, ranging from a 48% increase in lumbar punctures and 55% for long line insertion. Examples of specific comments we received include “Fantastic sessions, would love more simulation as it is invaluable as a learning tool”, “Most useful teaching day I’ve had to date!” and “Lovely Sim Team. Very useful topics for a paed rotation”.

Discussion:

It is vital that we support and equip new paediatric doctors with the skills and confidence to commence their new role. Having the opportunity to practise both technical and non-technical skills in a safe environment has proven to be invaluable to those undertaking the course and has shown to greatly improve candidate’s confidence and preparedness for life as a paediatrician. Going forward, we would like to contact those who have attended this course over the past 6 years to see how it may have influenced or improved their 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.

References

1. NHS West Midlands Workforce Deanery (2010): Applications of simulation in health professional education and beyond.

Junior doctors are frequently tasked with undertaking medical procedures despite studies demonstrating a lack of formalised training [1] and low confidence in procedural skills [2]. Commonly, they are taught using the outdated approach of ‘see one, do one’ [3]. “Learning by doing” is the sine qua non of medical education thus we aimed to create an innovative structured procedural skills workshop for junior medical colleagues. Our objective was to enhance the confidence of our learners in performing these procedures within an immersive and safe learning environment.

Methods:

Two courses were developed guided by simulation-based educational theory:

1. Basic procedures: lumbar puncture, ascitic drain, USS-guided cannulation and knee aspiration.

2. Advanced procedures: non-invasive ventilation, central line, chest drain and arterial line.

Both courses ran as four stations each following a similar format:

● Discussion covering indications/contraindications/consent

● Simulated practice using part-task trainers and a modified Peyton’s approach

● Feedback delivered as a ‘learning conversation’

A flipped classroom model was utilised to maximise time for ‘hands-on’ practice. Learners were not formally assessed but use of peer feedback checklists was encouraged.

Experienced faculty were recruited; medical/ICU/ED registrars and HDU nurses. Faculty development was delivered to ensure uniformity of the sessions and to aid timekeeping. The learner to faculty ratio was 3:1.

On completion of the course, learners completed feedback forms to assess prior experience and confidence levels.

Results:

Our participants encompassed a range of grades including foundation trainees, clinical fellows and internal medical trainees. 8 courses were delivered in total. 75 of the total 84 participants completed the feedback.

Learners rated their confidence levels before and after the course (Figure 1-A107). The results revealed a marked improvement in confidence across all procedures, independent of trainee grade or prior experience.

Figure 1-A107.

Qualitative feedback highlighted the “interactive” and “friendly atmosphere” which made the sessions more “engaging” with all participants recommending the courses to a colleague, suggesting that the courses were well liked.

Discussion:

The results indicate a significant improvement in trainee confidence as a result of our courses, independent of trainee experience or grade. Both courses also demonstrated high levels of satisfaction. This suggests that the course effectively addressed a potential training gap. The course provided an opportunity for faculty to develop as teachers and achieve training portfolio requirements. Future developments include offering a follow-up session for competency assessment at skills-lab level and assessing the longer-term impact of the session on confidence through follow-up surveys at 6 months post-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.

References

1. Manthey D, Fitch M. Stages of competency for medical procedures. The Clinical Teacher. 2012;9(5):317–319.

2. Lim CT, Gibbs V, Lim CS. Invasive medical procedure skills amongst Foundation Year Doctors - a questionnaire study. JRSM Open. 2014;5(5):2054270414527934.

3. Giacomino K, Caliesch R, Sattelmayer KM. The effectiveness of the Peyton’s 4-step teaching approach on skill acquisition of procedures in health professions education: A systematic review and meta-analysis with integrated meta-regression. Peer Journal (San Francisco, CA). 2020;8:e10129-e.

Simulation-based education (SBE) has been shown to be an effective training tool within clinical medicine, conferring ‘real-world’ benefit within trauma & orthopaedics (T&O) [1]. A recent survey of T&O trainees demonstrated that 100% felt SBE was important for their training [2]. Within the regional T&O training programme in Northern Ireland, the implementation of novel SBE events has been piloted to help address curriculum deficits, allow safe skill acquisition, and make T&O training more attractive to junior doctors with excellent outcomes [3].

Methods:

A hybrid-model Upper Limb simulation course was developed by simulation and education leads targeting shoulder arthroscopy and humeral fracture fixation. This was delivered in November 2023 using a group simulation framework model with pre-brief and introductory lecture, followed by groupwork, and completed with debrief and feedback.

The groupwork comprised of four stations through which the candidates rotated: passive haptic feedback virtual reality (VR) trainer and three consultant-led sawbone procedural stations (Proximal Humerus Fixation, Distal Humerus Fixation, and Humerus Intramedullary Nailing). The course was facilitated by shoulder fellowship trained faculty. Feedback was collated pre- and post-course using Likert-scale questionnaires to identify learner needs and outcomes.

Results:

Pre-course, learners reported confidence levels in four domains: Shoulder Arthroscopy, Proximal Humerus Fixation, Distal Humerus Fixation and Humerus Fracture Intramedullary Nailing. Confidence was reported as ‘Not Confident’ or ‘Minimally Confident’ in 71% of responses across all domains. The learning requests were technical tips and increased confidence and practice.

Post-course, there was a significant improvement in confidence across all four areas, with the biggest improvement seen in junior trainees. Fifty-eight percent of trainees selected ‘Somewhat Confident’ or ‘Very Confident’ across all the domains. ‘Not Confident’ or ‘Minimally Confident’ was only selected in 17% of responses (Figure 1-A106). Positive feedback included the fidelity of the VR trainer and consultant teaching. Suggestions for improvement included more demonstrators and time for each station.

Figure 1-A106.

Discussion:

We have further demonstrated that SBE is a powerful tool in regional T&O training, building on the work of lead educator focus groups. High and low-fidelity scenarios empowered trainees to acquire new skills and develop existing ones in a psychologically and clinically safe environment. Due to its success locally and within the literature, SBE will be used to augment regional T&O training. We aim to make it a staple feature of the regional teaching programme to drive development of new, validated learning methods for trainees.

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.

References

1. Bartlett JD, Lawrence JE, Stewart ME, Nakano N, Khanduja V. Does virtual reality simulation have a role in training trauma and orthopaedic surgeons? The Bone & Joint Journal. 2018;100-B(5):559–565.

2. Seil R, Hoeltgen C, Thomazeau H, Anetzberger H, Becker R. Surgical simulation training should become a mandatory part of orthopaedic education. Journal of Experimental Orthopaedics. 2022;9(1):22.

3. Moffatt R, Napier R. Integrating simulation based education to trauma & orthopaedic training: a regional experience. International Journal of Healthcare Simulation. 2023;3(suppl 1):A63–A63.

Acknowledgments:

The authors would like to thank Dr Nicola Weatherup and Dr Bronagh McCarragher for their input and advice in applying simulation teaching models.

Ultrasound-guided vascular access is a useful skill for foundation year (FY) doctors, however, FY doctors receive little instruction on how to use ultrasound (US) [1]. This study evaluated the utility of a 1.5-hour workshop using venous phantoms to train FY doctors to perform US-guided cannulation independently.

Methods:

The course was advertised to all FY doctors at a single hospital site. The teaching was delivered by two anaesthetic core trainees. The focus of the session was on visualising venous structures using ultrasound. We used Butterfly IQ+ ultrasound probes (Butterfly Network Inc., Burlington, MA, USA) connected to iPads as monitors (Apple Inc., Cupertino, CA, USA) and VATA venous access phantoms (VATA Inc., Canby, OR, USA). Pre- and post-session questionnaires using 5-point Likert scales were taken using Google Forms. Statistical significance was calculated using the paired samples t-test.

Results:

Eighteen participants attended across 3 sessions. Before the course, the mean confidence at attempting US-guided cannulation was 1.67 out of 5. After the course, the mean confidence rose to 4.56 out of 5 (increased by 2.89, p < 0.00001). Free text comments showed that participants valued being taught the theory of cannulation by anaesthetic trainees and enjoyed the opportunity to gain practical skills in a simulated environment using realistic phantoms.

Discussion:

This study demonstrates that a 1.5-hour phantom simulation-based teaching session led to a significant improvement in FY doctors’ confidence at attempting US-guided vascular access (e.g., cannulation) on the ward. The course could be rolled out on a Trust-wide basis to upskill the 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.

References

1. McKay GFM, Weerasinghe A. Can we successfully teach novice junior doctors basic interventional ultrasound in a single focused training session. Postgraduate Medical Journal. 2018;94(1111):259–262.

Within the Emergency Department (ED) 67% of healthcare professionals are experiencing violence and aggression (V&A) from patients and relatives [1]. Additionally, 32% of staff in ED feel unsafe on a weekly basis [2]. Conventional training methodologies often fall short in capturing the nuanced interplay and rapid evolution of circumstances that may precipitate violent confrontations. These outdated methods lack the emotional response element of human behaviour when confronted with V&A. This study employs simulation-based training in a live ED to fortify the readiness of ED personnel in navigating instances of V&A within a controlled and secure setting.

Methods:

Three actor-based simulations were devised to stimulate interactions among the multidisciplinary team within the ED, including reception staff, non-clinical navigators, nursing staff, doctors, radiographers, and security. This model focuses on a patients journey throughout their ED encounter, with increasing complexity dependent on participants experience and skill set. The utilisation of a trained actor to enact lifelike scenarios heightens the immersive quality of the training session for the staff members. Furthermore, collaboration with security personal and the radiology team, enabled cross-departmental working.

Results:

These simulations unveiled intricate patterns underlying V&A. Feedback from the MDT in indicated notable enhancements in situational awareness, communication proficiency, and preparedness to de-escalate volatile situations. Debriefs facilitated discussions which frequently covered the staff’s feelings of responsibility to de-escalate the situation, despite their personal safety, and the availability of security team in the department. Additionally, the participants reported that the experience was overall a positive exposure and had no negative impact on their mental health as well as increased team cohesion.

Discussion:

Debrief sessions proved instrumental in learning, highlighting the underutilisation of early involvement of the security team. Additionally, the security team was enabled to discuss within the MDT the usefulness of their early involvement to be able to monitor and evaluate the V&A scenario t time appropriately their intervention. Furthermore, the participants agreed that the simulations were a positive impact on their feelings of safety in their working environment.

The ability to demonstrate and review de-escalation techniques and review departmental processors for escalation were greatly received. The outcomes underscore the significance of integrating simulation-based training into preparedness initiatives addressing V&A within the ED 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.

References:

1. Donald N, Lindsay T. Incidence and trends in workplace violence within emergency departments in the United Kingdom 2017-2022: an observational time series analysis. Frontiers in Public Health. 2023;11. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10336324/. [Accessed 29 April 2024].

2. RCEM National Survey on Security and Restraint in the Emergency Department [online]. Royal College of Emergency Medicine. London; 2022. Available from: https://rcem.ac.uk/wp-content/uploads/2022/02/Security_and_Restraint_Survey_Report_FINAL_100321.pdf. [Accessed 28 April 2024].

The population of NHS doctors who have received their medical education outside of the United Kingdom is growing. 29% of General Practitioners (GPs) are International Medical Graduates (IMGs) and in the Midlands this increases to 37% [1]. IMGs make up a large proportion of the workforce, therefore, at Royal Wolverhampton Trust (RWT) we have designed the paediatric IMG simulation day involving workshops and scenarios with a large focus on non-technical skills and debrief. Other topics include the NHS structure, training in paediatrics in the UK, common abbreviations, colloquialisms, and roles within healthcare.

One of the biggest challenges IMGs face when joining the UK workforce is adjusting to the NHS systems. In addition, any simulation-based education (SBE) opportunities available to IMGs would have been specific to their previous country’s healthcare system. In response to this and previous IMG training needs analysis conducted with Clinical Fellows at RWT, the SimWard RWT simulation team piloted an IMG-specific simulation-based education programme to tackle some of the challenges IMGs may experience and, therefore, assist transition into the NHS.

Methods:

We undertook a retrospective review of pre- and post-course questionnaire answers with regards to confidence in communicating with patients and colleagues, handover skills, delivering unexpected news and how to escalate to seniors. We also asked about previous experience with simulation and their understanding of the role of debrief.

Results:

A total of 9 candidates were surveyed. 6 had worked in the UK for <1 year, 2 for 1-2 years and 1 for 2-3 years. Confidence levels improved in all areas after participating in the course with free-text comments such as:

“This session was very informative with regards to breaking bad news, communicating with parents and colleagues”, “It was worthwhile” and “Wonderful simulation”.

Discussion:

This course provides an excellent opportunity for paediatric IMGs to build on their confidence early in their career in the NHS. Feedback received has been consistently positive and meets the training needs of those attending the course. Due to the positive feedback of this course, further courses have been scheduled to align with regional paediatric starting dates, with the aim to improve candidates’ confidence in several essential non-technical skills and, consequently, lead to improved safety and retention of doctors in the NHS. This course has also been used as a blueprint for the adult acute simulation fellows to design an IMG course for their 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.

References

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

Workplace conflict incurs a substantial cost to employers [1]. Research indicates that the primary cause of workplace conflict is differences in personality styles. Poor communication emerges as the most prevalent behaviour associated with workplace conflict, including the healthcare sector. Its repercussions can vary from decreased motivation to employee stress and turnover.

Although traditional conflict resolution (CR) courses offer valuable insights to theoretical frameworks, they often lack equipping practitioners with the necessary behavioural skills for navigating such challenging conversations and managing their emotions. To this end, we devised an innovative course that integrated theoretical perspectives with experiential, immersive learning.

Methods:

We designed a pilot 3-day program: a 2-day theoretical programme on CR and a 1-day immersive session using simulation. Delegates, including leaders and managers, co-created simulation cases based on real experiences. A drama professional trained delegates to embody roles. Delegates rotated simulation roles in triads, practicing conflict resolution and mediation skills while also experiencing being facilitated. Simulations included pre-brief, simulation, and debrief, with a focus on de-rolling following such emotionally ladened simulations.

Results:

The impact of this course surpassed expectations. Delegates were able to suspend disbelief and immerse themselves in their roles, and were comfortable with this transition. Within simulations, participants were able to experience important principles: 1) Drawing upon CR cognitive tools ‘in-the moment’; 2) Being aware and learning from the emotional responses 3) Gaining a heightened awareness of the importance of communication skills especially micro-gestures; 4) Gaining deeper insights to what it is like to be informally mediated and learning from this empathic position. Guided debriefing helped delegates to learn from these experiences and provide a strong stimulus to take these new skills to the future.

Delegates rated the course highly in terms of enhancing their CR skills, managing emotional responses and confidence in handling such situations; this was echoed in qualitive evaluation feedback: ‘Looking forward to going back and working on how to apply my learning into my own practice’; ‘Great to have the opportunity to learn new skills and go out of my comfort zone’; ‘The simulation provided some incredibly invaluable insights to my own practice’.

Discussion:

In this innovative course, we were able to harness the power of simulation to develop CR skills. Not only enhancing confidence in applying CR skills into the workplace, but their emotional responses too; this signals a strong need to further research this important learning concept in conflict intervention.

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.

References

1. Saundry R, Urwin P. Estimating the Costs of Workplace Conflict, Acas. 2021. Available from: https://www.acas.org.uk/costs-of-conflict; Saundry, R. and Urwin, P. (2021) Estimating the Costs ofWorkplace Conflict in Northern Ireland, Labour Relations Agency. This research was funded by the Advisory Conciliation and Arbitration Service (Acas) and the Labour Relations Agency (LRA).

Acknowledgments:

We would like to thank QUB and Mediation NI for their partnership in this immersive workshop training and the delegates of the course.

In response to the new requirement for 12 hours of simulation training in the GIM (General Internal Medicine) stage 2 curriculum, GIMME (General Internal Medicine Medical Emergencies) is a novel simulation course for GIM registrars [1]. Whilst managing acutely unwell patients, GIM registrars are also expected to co-ordinate and supervise other junior doctors, offer advice to other specialities, and deal with bed states. This course covers these more nuanced aspects of the role and improves confidence in what is the most daunting and unsupervised part of the job.

Methods:

The objective measures for this pilot were to evaluate confidence in managing various aspects of the role before and after undergoing the GIMME course. The course lasts one day, offering up to 6 complex medical emergency scenarios. The course is treated as a continuous night shift, commencing with a handover detailing unwell patients from the outgoing day team, a list of staff they will be leading (complete with obligatory staff absences), and the resources available to them in this particular hospital. Although each scenario is led by a different learner, patients from prior scenarios and handover may be referenced, and team members engaged with previous scenarios may not be available. Each scenario has an acute patient to manage directly and at least one complicating factor, ranging from managing bed capacity on coronary care, to consideration and preparation for transfer of a sick patient between hospitals.

Results:

After two pilot courses for eight learners, the results showed that 7/8 felt more confident in managing the acutely unwell patient, 7/8 felt more confident in risk assessment and prioritisation; 6/8 felt more confident with medical leadership; 8/8 had a better understanding of human factors. Overall, 8/8 would recommend this course to other medical registrars.

Discussion:

It is well known that simulation improves patient outcomes [2] but this high-fidelity simulation fulfils the dual purpose of improving confidence of medical registrars performing this demanding role, as well as satisfying part of the mandatory 12 hours of simulation required by the curriculum. Learners found the most rewarding part of the course was debriefing, where more ambiguous areas of medical decision-making could be discussed. Learners commented that prior to the introduction of this course, sufficient opportunities for this type of training were unavailable. Learners suggested the introduction of further complicating factors such as rising counters for “numbers of patients to be clerked” and more persistent bleep interruptions.

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.

References

1. Joint Royal Colleges of Physicians’ Training Board; IMS2 ARCP Decision Aid 2022 150921.pdf (thefederation.uk) [Internet]. [updated 15 September 2021, cited; 22/04/2024]. Available from https://www.thefederation.uk/document/internal-medicine-stage-2-arcp-decision-aid-2022.

2. Zendejas B, Brydges R, Wang AT, Cook DA. Patient outcomes in simulation-based medical education: a systematic review. Journal of General Internal Medicine. 2013;28(8):1078–1089.

International Medical Graduates (IMGs) comprise 50% of all new doctors joining the UK medical workforce [1]. IMG doctors joining the foundation programme or working as Locally Employed Doctors, or Clinical Fellows, bring a wealth of knowledge and experience. Tailoring educational courses to address non-technical skills related to adapting to the NHS and understanding different cultures can help to maximise individuals’ potential and performance, and reduce differential attainment [2].

Methods:

Following incident report and learning needs analyses, which highlighted issues concerning IMGs, a bespoke simulation-based education (SBE) course aimed at FY1 doctors and Clinical Fellows was developed by an experienced faculty. Qualitative and quantitative data was collected in the form of pre and post courses surveys, in order to assess impact and inform future courses. Qualitative data underwent thematic analysis by two individuals. Quantitative Ordinal Likert scale data was converted into continuous data and analysed using non-parametric statistical tests. Further data was collected ‘1 year on’ to assess longer term educational benefit and was analysed in the same way.

Results:

A total of 44 IMG’s participated in our bespoke courses. Having recently moved to the UK to work in the NHS, these doctors’ primary medical qualifications were from a variety of countries, with very little exposure to SBE in their previous training. A significant difference in pre and post course ratings of knowledge of the human factors, non-technical skills and the role of debriefing was demonstrated, as well as confidence ratings across a range of skills (Table 1-A97). Key themes identified via thematic analysis include ‘I learned a lot’ and ‘extremely useful’. The participants themselves have recommended that all IMGs new to the NHS should be offered such SBE training. And some suggest it should, in fact, be mandatory. Data collected to assess longer term educational benefit is a work in progress, however initial data is positive.

Table 1-A97.

	Pre course average score FY1	Post course average score FY1	P-value	Pre course average score CF	Post course average score CF	P-Value
Assessing the acutely unwell patient	3.67	4.33	0.064	3.93	4.36	0.046
Structured handover	3.83	4.67	0.023	3.79	4.64	0.007
Being assertive	3.67	4.5	0.033	3.64	4.21	0.046
Communicating with patients and relatives	4	4.5	0.087	3.79	4.29	0.064
Communicating with colleagues	4.17	4.67	0.087	4.07	4.5	0.078
Breaking bad news	3.5	4.33	0.033	3.36	4.29	0.007
Escalation of treatment	3.5	4.17	0.055	3.79	4.64	0.007
Mental Capacity	3.17	4	0.055	3.56	4.36	0.011

Discussion:

IMG doctors have a unique training need, in that they have many years of clinical experience, but have translocated to a new healthcare system, posing them with human factors and non-technical challenges that they have not previously experienced. These issues can be readily explored through a bespoke SBE programme that provides a physically and psychologically safe environment. This research will inform future development of our courses aimed at IMG’s and we hope to share with other centres to develop best practice guidance.

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.

References

1. GMC. The Workforce Report. 2022. Available from: https://www.gmc-uk.org/-/media/documents/workforce-report-2022---full-report_pdf-94540077.pdf. [Accessed 27 November 2023].

2. Differential Attainment Toolkit | London (hee.nhs.uk) [Accessed 27 November 2023].

In 2022, the Joint Royal Colleges of Physicians Training Board introduced a new General Internal Medicine curriculum for medical registrars. This specified that “Simulation teaching involving human factors and scenarios training should be carried out in IM (Internal Medicine) Stage 2” (Joint Royal Colleges of Physicians Training Board) [1]. Despite this addition, no guidance was released regarding which scenarios to include or what “simulation teaching involving human factors” would specifically entail. With this background, the Postgraduate Medical Education Department at a large, tertiary hospital trust, designed and delivered a one-day course, aiming to meet the needs of medical registrars faced with this new curriculum requirement.

Methods:

Local stakeholders were consulted, in the form of the trust’s Chief Registrar and the Acute Medicine educational leads, to ensure scenarios and course structure were appropriate to senior medical registrar requirements. Entitled, “A series of unfortunate medical events”, the one-day course has been run twice to date and attended in each case by six learners. Each day incorporated a specific human factors session, before six simulations of a range of medical emergencies were carried out. Simulations incorporated managing disagreement with colleagues, working alongside a clinician in distress and communication failures, to promote discussion and consideration of the impact of human factors in medical emergencies. Faculty included an Acute Medicine consultant, two Medical Registrars, an Emergency Department registrar and Postgraduate Medical Education Fellows.

Results:

Quantitative feedback found learners strongly agreed the course was relevant to their level and needs, was of a high quality, given at the right pace, that their participation and interaction was encouraged and that the trainers appeared enthusiastic and well informed about the subject (Table 1-A96). Learners specifically enjoyed the “variety of clinical scenarios and combining SIM with human factors”, the use of “appropriate level simulation for senior trainees” and the “group exercise to think about human factors”. Constructive suggestions for improvements included, “involving trainees from other specialties (e.g., ICU)” and including a scenario where there is “conflict in treatment escalation decision making”.

Table 1-A96.

Learners asked to what extent they agreed with the following comments (1 = Strongly Disagree, 5 = Strongly Agree).

Comment	Average Rating (n=9)
Appropriate Content Level	4.8
Relevant Content to Need	4.9
Clear introduction	4.9
Course Aims Clearly Stated	4.9
Well Organized	4.9
Clear Summary of Learning Points	4.7
Well Informed Trainers	4.8
Enthusiastic Trainers	4.9
Candidate Participation Encouraged	4.9
Right Pace	4.9
Overall this course was of a high quality	5.0

Discussion:

A novel, tailored course, to meet the needs of senior medical registrars was designed and delivered with extremely positive subjective feedback from learners. The course design and content can be used as a template for other NHS trusts aiming to meet the needs of a nationally newly implemented curriculum.

Ethics statement:

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

References

1. Joint Royal Colleges of Physicians Training Board, Curriculum for General Internal Medicine (Internal Medicine Stage 2) Training. 2022.

Simulation has emerged as a cornerstone in healthcare education, bridging the gap between theory and practice in both academic and clinical settings. It provides a safe environment for learners to engage in real-life scenarios, fostering effective professional development [1].

Flipped or reversed teaching is recognised as a valuable pedagogical approach to facilitate learning [2]. Flipped teaching embraces the concept of student-led learning, encouraging active engagement. This approach seamlessly integrates with simulation, as students take on active roles while lecturers guide the learning process [3]. However, despite its potential benefits, there is limited research exploring its application in simulated education, particularly within higher education contexts.

In response to this gap, a pedagogic innovation was introduced, prompting students to write simulation scenarios where their lecturers assume the role of learners, thereby facilitating the learning process. This innovative approach aligns with the skills and competencies essential for registered Operating Department Practitioners (ODP). By engaging in the creation and execution of simulation scenarios, students not only reinforce theoretical knowledge but also hone practical skills crucial for professional practice.

This research addresses the question: “What are the experiences and perceptions of flipped simulation teaching for third-year Operating Department Practice (ODP) students from the perspective of both students and instructors?”

Methods:

Four cohorts of Third-year BSc ODP students were tasked with writing a simulation scenario in small groups (between 6-8 students) during a clinical skills week at the University. Guidance and support were provided in the form of an information booklet, tutor and technical support for simulation setup. Qualitative data was obtained from student and instructor feedback through discussions during debriefing and anonymised student surveys.

Results:

Out of 74 third-year ODP students who engaged in flipped simulation teaching, a subset responded to the survey, yielding a total of 52 responses for analysis. Thematic analysis revealed insights into student engagement and participation, perceived benefits and challenges, and best practices and recommendations. Overall, feedback was predominantly positive, with students expressing appreciation for the learning experience and its value in their education.

Discussion:

Flipped simulation teaching shows promise in healthcare education. This study adds to the literature on its effectiveness. Despite challenges, feedback was predominately positive, emphasising its value for active student engagement. Incorporating this pedagogic approach has provided valuable insight in optimising learning and building confidence, providing students with transferable skills relevant to clinical practice. Further research is needed to explore long-term benefits and 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.

References

1. Martin A, Cross S, Attoe C. The use of in situ simulation in healthcare education: Current perspectives. Advances in Medical Education and Practice. 2020;11:893–903. Available from: doi:10.2147/AMEP.S188258.

2. Advance HE. Flipped Learning [Internet]. 2021 [cited 14th April 2024]. Available from: https://www.advance-he.ac.uk/knowledge-hub/flipped-learning-0#:~:text=Flipped%20learning%20has%20not%20been%20rigorously%20evaluated%20as.

3. Dong C, Szarek JL, Reed T. The Flipped Classroom and Simulation: a Primer for Simulation Educators. Medical Science Educator. 2020;30:1627–1632. Available from: doi:10.1007/s40670-020-01041-9.

Rising mental health-related emergency calls and inconsistent, under-confident application of mental health frameworks by paramedics underscore the need for improved training and practical experience [1]. However, shortages in mental health nursing and high vacancy rates in mental health settings impact the availability, quality, and consistency of practical placements for paramedic students and ambulance employees. Consequently, newly qualified paramedics often feel underprepared for managing mental health issues. This quality improvement study investigated whether simulated mental health placements can enhance practical learning and confidence among both students studying to become paramedics and professionals already working in the field.

Methods:

Between June and September 2023, a series of one-day simulated placements using a novel hybrid approach, took place in a university classroom. The placements involved a total of 42 participants, which included 32 final year undergraduate students who were studying to become paramedics and 10 practitioners who specialise in mental health and work for an emergency ambulance service. The placement included live scenarios, delivered remotely by actors via conferencing software. The content of the scenarios was co-produced with paramedic students, university faculty responsible for delivering the undergraduate BSc Paramedic Science programme, ambulance service Learning and Development officers, and mental health and simulation experts from Maudsley Learning. The co-production element was important for ensuring that scenarios addressed student needs, met course outcomes, and were sensitive to both common and unusual mental health presentations found in the prehospital emergency ambulance context. The scenarios were followed by expert-led, trauma-informed debriefs. During the study we iteratively refined the placement using the Plan, Do, Study, Act (PDSA) Quality Improvement cycle, incorporating feedback from After-Action Reviews and participant surveys.

Results:

Participants were asked to complete questionnaires before and after they participated in the placement. Participants reported increased confidence and knowledge in understanding and managing mental health conditions, including psychosis and suicidal ideation. Based on the feedback received, an optimised model for delivering the placement was developed (Figure 1-A94).

Figure 1-A94.

Discussion:

Simulated mental health placements appear to be effective and well-received, offering a practical solution to geographical and resource barriers often associated with traditional placements [2]. Moreover, this approach plays a crucial role in standardising care and enhancing student experiences. Maintaining a psychologically safe learning environment with tailored debriefing methods is key.

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.

References

1. Green A, Pound A. Undergraduate paramedics’ understanding of mental health insight placements. Journal of Paramedic Practice [Internet]. 2020 [cited 2024 Mar 25]; Available from: https://www.paramedicpractice.com/features/article/undergraduate-paramedics-understanding-of-mental-health-insight-placements.

2. Sim JJM, Rusli KD Bin, Seah B, Levett-Jones T, Lau Y, Liaw SY. Virtual simulation to enhance clinical reasoning in nursing: a systematic review and meta-analysis. Clinical Simulation in Nursing [Internet]. 2022 Aug 1 [cited 2024 Mar 25];69:26. Available from: /pmc/articles/PMC9212904/.

Acknowledgments:

This project was funded by the Health Education England/NHS England’s (South West) Mental Health Programme, as part Sasha Johnston’s NHSE Allied Health Professions Clinical Fellowship. We would like to acknowledge the important contribution of the undergraduate students who participated in this placement and their involvement with the co-production of the content of the scenarios to ensure that the placement was sensitive to the unique prehospital emergency ambulance context.

The General Medical Council in its document ‘Promoting Excellence’ [1] states that ‘learners must have access to technology enhanced and simulation-based learning opportunities within their training programme as required by their curriculum’. Prior to 2016, the Royal Aberdeen Children’s Hospital (RACH) had no formal simulation programme. Sporadic sessions were offered to paediatric trainees with no opportunity to undertake multidisciplinary team (MDT) training. Our aim was to introduce a regular simulation programme which was accessible to all those working within the hospital.

Methods:

A pre-programme questionnaire established what our workforce felt about simulation. 89% wished to participate in simulation with 91% feeling that simulation would give them more confidence when encountering a sick patient. 93% felt simulation training was important in promoting good teamwork. Following this fortnightly MDT sessions were established. These were run by a team of facilitators comprising nurse educators, paediatricians and paediatric surgeons. Feedback was obtained from participants and we continually looked to improve our setup.

Results:

Five-hundred and forty-four participants attended. This comprises 256 doctors, 170 trained nurses, 82 student nurses, 20 medical students and 16 allied health professionals including pharmacists and psychologists. 100% of participants found the session useful. 96% felt more confident in dealing with the condition in real life with 98% feeling that the material covered in the scenario was relevant to them. All participants asked for further sessions. Since conception we have run a total of 117 sessions covering burns, sepsis, cardiac arrest etc. We have increased our pool of scenarios and have now four high fidelity mannequins. A booking system and varying the day and timings of our sessions has helped the ongoing success of the program.

Discussion:

We have successfully managed to sustain a MDT simulation program in RACH. Our feedback has been exceptionally positive. Due to clinical pressures our faculty members now consist of one paediatric surgeon and two nurse educators. Nurse staffing issues mean simulation is often not a priority. Attendance by paediatric trainees has been variable despite the recommendation of attendance within their educational agreement. However, with the change in the paediatric curriculum [2], trainees have asked to attend in order to have aspects of the curriculum signed off. Going forward we will look to create a specific simulation program for paediatric trainees to ensure competencies are being met but continue to run our fortnightly MDT sessions to ensure the learning needs of each team member are met.

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.

References

1. General Medical Council. Promoting excellence: standards for medical education and training. 2015.

2. Paediatric Specialty Postgraduate training Curriculum. RCPCH Progress+. 1st August 2023. Available from: https://www.rcpch.ac.uk/sites/default/files/2023-07/ProgressPlus-curriculum.pdf.

Failed cannulation is an issue for patients and clinicians and means patients will not receive medications needed. Depending on staffing levels, it can be difficult to find a suitably trained colleague to attempt the skill, resulting in a telephone call to ITU for help. This adds to the ITU registrar on calls workload. Ultrasound guidance can improve patient outcomes and skill success [1]. Physicians Associates (PA’s) and Advanced Care Practitioners (ACP’s) are expected to cannulate patients, but are rarely taught advanced skills for cannulation. We sought to teach ultrasound cannulation using simulation to this population.

Methods:

Simulation was utilised to teach ultrasound cannulation techniques. Upper limb vasculature was recapped, and ultrasound was used to look at the vasculature of the candidates and instructors, noting the anatomical differences between people and the look of different structures (veins, arteries, muscles, etc) under ultrasound. Venepuncture arms compatible with ultrasound were used to practise cannulation of vessels. Peyton’s 4-step approach was used to teach the skill itself, comprising 4 steps of: demonstration; deconstruction; comprehension; and execution [2]. Confidence levels before and after the session were recorded, and followed up 2 weeks after the teaching session.

Results:

Twelve students attended the course, 8 of which had never used ultrasound before. 80% felt their confidence levels were a 1 on a scale of 1-10 (1 being the lowest possible score). During the course, participants appeared to increase in confidence throughout the day. Following the session, 60% rated their confidence as 9/10 with the remaining 40% being above 6/10. After 2 weeks, 1 participant was lost to follow up, but the remaining 11 still felt confident at ultrasound cannulation having had a chance to practise on real patients (with supervision at first). Confidence levels remained above 7/10 for all 11.

Discussion:

Traditionally, ultrasound cannula teaching has been self-motivated and in the clinician’s own time/when opportunities arose on the job. Teaching the skill has been shown to improve success rates amongst notices and experienced operators1. The use of simulation reduced the risk to patients and allowed for trial and error [3]. We stated that the first-time using ultrasound guidance on a patient must be supervised, and all 11 used ultrasound on a patient under supervision in the 2 weeks that followed with confidence levels remaining high. The course appeared to be a success and may reduce the need for escalation to ITU 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.

References

1. Stolz LA, Stolz U, Howe C, Farrell IJ, Adhikari S. Ultrasound-guided peripheral venous access: a meta-analysis and systematic review. The Journal of Vascular Access. 2015;16(4):321–326.

2. Peyton. Teaching in the Theatre. In: J. W. R. Peyton. editor. Teaching and Learning in Medical Practice, Manticore Publishers Europe. Rickmansworth. 1998.

3. Greene AK, Zurakowski D, Puder M, Thompson K. Determining the need for simulated training of invasive procedures. Advances in Health Sciences Education. 2006;11:41–49.

Chest radiograph (CXR) interpretation is an important skill expected at the foundation doctor level. CXR teaching provided by medical schools is often insufficient to prepare medical graduates [1]. This study’s aim was to evaluate whether CXR interpretation could be taught via an engaging, simulation-based approach.

Methods:

We recruited third year medical students on their medicine and surgery clinical rotations. The programme consisted of three 15-minute simulation scenarios (tension pneumothorax, pleural effusion and pneumonia) on a simulated ward (Figure 1-A91). Low-fidelity mannequins were used and students were expected to use an ABCDE approach and to request appropriate imaging to aid their diagnosis and management. At each scenario, a CXR was provided upon request of the student participant. Students rotated through each scenario sequentially in pairs and were debriefed on CXR interpretation and acute illness management at the end of the session. Pre- and post-session questionnaires using 5-point Likert scales were taken using Google Forms. Statistical significance was calculated using the paired samples t-test.

Figure 1-A91.

Results:

Twenty participants attended the sessions. Before the session, the mean confidence at interpreting CXRs was 2.55 out of 5. After the session, mean confidence rose to 4.25 out of 5 (increased by 1.70, p < 0.00001). In terms of usefulness, participants rated the session 4.8 out of 5 on average. Free text comments mentioned the case mix, integration of radiographs into the ABCDE assessment and teaching on systematic methods to interpret radiographs as being assets of the programme.

Discussion:

Simulation can improve student confidence in CXR interpretation. Students find simulation-based scenarios to be an engaging and interactive way to learn about imaging. To improve student confidence and ability further, we could introduce multiple radiology-based sessions throughout their rotation.

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.

References

1. Chew C, O’Dwyer PJ, Sandilands E. Radiology for medical students: Do we teach enough? A national study. The British Journal of Radiology 2021;94(1119):20201308.

Effective trauma teams have been shown to improve care for trauma patients [1]. Effective team leadership is critical to providing high quality patient care. Managing major trauma in DGHs in Northern Ireland is uniquely challenging. EM higher specialty trainees are expected to take on the role of TTL and manage trauma teams within this setting. A regional training need was identified. Simulation provided a psychologically safe and effective method to address this.

Methods:

We surveyed EM Higher Specialty Trainees prior to development of the training to ascertain confidence levels and specific training needs. These surveys used mainly rating scale and limited questions with free text boxes. A focus group of EM Consultants was used to identify training needs through incident reports and their experience. Based on the survey results and focus group findings learning objectives were created and a full day of trauma simulation training was designed around these. The faculty included EM consultants, senior nurses from six emergency departments and specialty trainees from orthopaedics and anaesthetics. This interprofessional faculty increased the range of experience and perspectives and also provided an opportunity to enhance interprofessional relations.

The simulation training was delivered with two simulation and debrief rooms running simultaneously covering a range of technical and non-technical topics identified in the pre-course surveys. There were six immersive simulation scenarios with each trainee getting at least one opportunity to act as TTL. The formal debriefs were facilitated by EM consultants and included relevant micro-teaching based on the Royal College of Emergency Medicine curriculum and signposts to regional and national resources and guidelines. Trainees completed post-course questionnaires using mainly rating scale and Likert scale questions with free text boxes.

Results:

The analysis of pre- and post-course surveys showed that trainee confidence in leading major trauma in a DGH setting increased from a mean score of 7/10 to 9/10. Their confidence level in leading paediatric major trauma in a DGH setting increased from a mean score of 5/10 to 8/10. The mean confidence score for leading traumatic cardiac arrest increased from 5/10 to 7/10. 100% of trainees ‘strongly agreed’ or ‘agreed’ that the day was relevant to their training needs and that they would recommend this training day to their colleagues.

Discussion:

This simulation training day addressed regional training needs and significantly increased trainee confidence when leading trauma teams in DGHs in Northern Ireland.

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.

References

1. Georgiou A, Lockey DJ. The performance and assessment of hospital trauma teams. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2010;18:66.

Acknowledgments:

I would like to acknowledge all of the support and encouragement I received from Dr Nicola Weatherup and Dr Julie Rankin with the development and delivery of this course. I would also like to thank the incredible faculty whose expertise and enthusiasm were invaluable.

In 2019 the Royal College of Emergency Medicine released a SL0 6 curriculum requirements outlining several procedural skills required for emergency medicine [1]. This key emergency skills are recognised as time critical and/or life or limb saving. The skill set for these tasks is appropriate for a simulated environment and exposure to task via a mastery learning simulation and repeated deliberate practice throughout training and after. These skills include resuscitative hysterotomy, lateral canthotomy, pericardiocentesis and front of neck access.

Methods:

The Acute School in the North East runs a dedicated HALO simulation training day as part of the regional teaching programme day has a region wide faculty including emergency medicine consultants and speciality consultants. There are 8 procedural skill and 2 simulation scenario stations. To meet the large classroom capacity and the two simulation suites/staff required, the day utilises the MELISSA (Mobile Education Learning Improving Simulation Safety Activity) bus [2]. The skills stations use a combination of procedure specific task trainers, a haptic perimortem C-section trainer (C- Celia) and 3d printed task trainers for lateral canthotomy. Surveys are sent to trainees prior to the course to ascertain training years for group allocations and an evaluation survey containing Likert and qualitative statements conducted after the session.

Results:

There were 32 trainees in attendance in 1st year, 49 in the 2nd year, representing 60% of trainees in the programme in the first year with 75% in the second year of running (trainees on full 24 hours rotas so not required to attend on night shift and annual leave commitments). The overall course evaluated highly with all stations receiving >90% good or very good scores. The maternal cardiac arrest simulation averaged 4.88/5 scores and the front of neck access facial trauma simulation 4.90/5 score. The stations with specialists received more very good evaluations.

Discussion:

The HALO training day is now a fixed training day within the emergency medicine training programme in the northeast and north Cumbria. The attendees and faculty evaluate the day highly, with repeat requests to participate from faculty. Anecdotally, the maxillary-facial seniors have reported more lateral canthotomies being performed by Emergency Department doctors rather than referral since the first course. The success of the course has resulting in an expansion to training days for locally employed doctors and emergency medicine consultants in the region for 2025.

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.

References

1. SLO 6 - Proficiently deliver key procedural skills needed in Emergency Medicine [Internet]. RCEMCurriculum. 2019. Available from: https://rcemcurriculum.co.uk/deliver-key-procedural-skills/.

2. MELISSA | The NHS Training and Simulation Bus [Internet]. NE Learning Trust. Available from: https://www.melissabus.co.uk/.

Acknowledgments:

Funding was received via Covid 19 Recovery Funding from NHS England NENC. Acknowledgement to the MELISSA team, Faculty of Patient Safety at NHS England NENC and Dr Olly Moore, Emergency Medicine Consultant, CDDFT NHS Foundation Trust.

Physiotherapy students must complete 1000 hours of practice placement experience during a pre-registration programme. It is essential that academic practice aids in preparing students for practice placements. A reduced level of confidence regarding the ‘unknown’ of working within a clinical environment can be challenging, especially for international students. Simulation-based learning could be a tool to aid the transition from the classroom environment to practice placement, through improving student confidence [1]. The purpose, within the curriculum provision, was to design, implement and formally evaluate a developmental simulation-based learning experience.

The aim of the research was to explore the effectiveness of simulation-based learning for physiotherapy placement preparation, from the students’ perspective.

The objectives of this study included:

● To understand whether the simulation experience was authentic, in relation to the possible practice placement environment.

● To understand factors impacting on confidence and feelings of preparedness for placement and whether simulation has an impact.

● To understand, from the student’s perspective, the strengths and areas for improvement within simulation design in the physiotherapy curriculum.

Methods:

The scenario’s used were developmental in nature and the physiotherapy students were required to assess and treat the ‘simulated patient’ on day 1 of a hospital admission, on day 2 and then the home setting follow-up after discharge. Two scenarios used the ‘observer-participant’ format and the other was active participation from all students. The learning outcomes, content and debrief were aligned to the objectives of the practice placement module and the Chartered Society of Physiotherapy (CSP) Common Placement Assessment Form (which is the assessment criteria for a practice placement).

Semi-structured interviews were conducted with physiotherapy students after completion of their first practice placement to gain an understanding as to whether, on reflection, the simulation-based learning experience aided their preparation for practice placement.

Results:

A total of 6 Physiotherapy students who met the inclusion criteria were interviewed. An inductive thematic analysis was completed, which identified three themes and respective sub-themes. Firstly, the feeling of preparedness, which was accounted to the application of clinical reasoning strategies during SBL and the replication to ‘real-life’ scenarios which students encountered on practice placement. The second theme was the consensus of SBL being a positive experience. The concept of reflection, filtered through the debrief process, was the main sub-theme and an identified factor that contributed to the request of further opportunities for SBL to be embedded within the physiotherapy curriculum. The last theme related to the structure, which included the sub-themes of managing the complexity, service-user involvement and the operational format.

Discussion:

Simulation-based learning was found to be beneficial for students and aids the preparation for practice placement experience. This was achieved through realism of scenario design, involvement of service users as the simulated patients and the practice of key skills such as clinical reasoning and communication, which are transferable to placement. The ‘observer-participant’ format was well received and a suggested area for improvement was to increase the environmental complexity.

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.

References

1. Wright A, Moss P, Dennis DM, Harrold M, Levy S, Furness AL, Reubenson A. The influence of a full-time, immersive simulation-based clinical placement on physiotherapy student confidence during the transition to clinical placement. Advances in simulation (London). 2018;3:3.

Working in co-production is a relatively new aspect of healthcare simulation, but evidence shows that participatory learning alongside Experts with Lived Experience has a positive impact on the learning of healthcare students [1]. Co-production enhances knowledge, safety, empathy, appreciation of disciplines, and recognition of lived experience’s value. [2]. As homeless people are statistically much more likely to experience ill health, improving staff training is a key way to ensure their needs are safely and holistically met [3].

A week of simulation was designed and delivered for 70 second year nursing students from Adult, Child and Mental Health branches at the University of Greenwich. The outcomes for this week included working across disciplines to learn from each other, to carry out in depth social histories for a variety of patients, recognise the nuances involved with caring for homeless patients and to exercise good communication skills when discussing sensitive information.

Methods:

Students engaged in four days of in-person simulation scenarios spanning various nursing disciplines to achieve their learning goals. Each day focused on a different aspect of nursing, complemented by contextualising activities. The week emphasised homelessness, with three experts contributing insights: two with personal experience of homelessness and one, a nurse leading a homelessness charity. Their input shaped scenario design and activities. They also participated in talks with students and staff on the final day, sharing their backgrounds and stories. Feedback was gathered using Google Forms at the end of the week.

Results:

Of the 70 students who took part in the simulation week, 41 provided feedback (58% response rate). The students were asked to rate their learning for the simulation sessions and activities, using a Likert scale from 1-5. They were also asked more specific text-based questions regarding their experiences. The results are presented in Table 1-A86, with the number of responses and in brackets, the percentage.

Table 1-A86.

Question:		Answers:Yes	No	I was not in attendance
Did you find the simulation sessions interesting?		40 (98%)	0	1 (2%)
Did you learn from the simulation sessions?		40 (98%)	0	1 (2%)
Were the simulation sessions relevant to your learning?		38 (93%)	2 (5%)	1 (2%)
Did you find the activities interesting?		34 (83%)	5 (12%)	2 (5%)
Did you learn from the activities?		34 (83%)	5 (12%)	2 (5%)
Were the activities relevant to your learning?		34 (83%)	5 (12%)	2 (5%)
Did you find the talks from Experts with Lived Experience interesting?		38 (93%)	0	3 (7%)
Did you learn from the talks?		38 (93%)	0	3 (7%)
Were the talks relevant to your learning?		38 (93%)	0	3 (7%)
Question:		Answers:Fair	Good	Excellent
How would you rate the Interdisciplinary aspect of the week?		4 (10%)	12 (29%)	25 (61%)
Free text responses:
Please provide further comments regarding the talks from experts with lived experience.	“It was good seeing people who has experienced such situations sharing their stories and helping others” “Fantastic and insightful” “It was useful getting information from someone that has had experience” “Really opened my eyes and makes me want to do more to help” “I didn’t know nurses could get jobs working with homeless people so it was good learning about how I can apply this when I finish uni” “I learned a lot from them.” “These people are amazing and so strong” “I loved hearing their experiences and asking questions because it’s not something we get to do often” “I found it educational, interesting and challenging”
Do you have any further comments or feedback around the week as a whole?	“It was interactive and I learned a lot” “Learnt new information and gave me an insight to how people are affected when it comes to being homeless” “Very informative week, however, straight after a 6 weeks placement was too much for me personally to take in.” “Thank you for all of your hard work in organising this week, it has been very fun and informative. I appreciate the effort it must of taken to organise. I especially liked the talks this afternoon which really touched me.” “I just wanted to personally thank you guys for orchestrating this wonderful simulation it has really helped open my eyes to the homeless situation and it has helped me how I can help them whilst they are in hospital as I didn’t really know about all these kind of support pathways for homeless people in terms of my role as a student adult nurse. I enjoyed interviewing the patients within the different discipline’s and understanding different interview techniques and the external expert speakers it was really refreshing to hear their stories and it helped me to put things in perspective especially with understanding that some people just don’t want any help.”

Discussion:

The simulation sessions, activities and talks received overwhelmingly positive feedback, with at least 83% of students reporting that they learned from these sessions and that they were able to build a better understanding of how they can support and work with homeless people in practice. Working in co-production allowed the scenarios and activities to relate to the real-life experiences of the patients that our students might encounter, and the talks from the Experts at the end of the week enabled the students to consolidate this learning and view their patients holistically.

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.

References

1. O’Connor S, Zhang M, Trout KK, Snibsoer AK. Co-production in Nursing and Midwifery Education: A systematic review of the literature. Nurse Education Today. 2021;102:104900.

2. Clarke I, Philpott L, Buttery A. Pilot study: Design, delivery and evaluation of a co-produced multi-agency Mental Health Simulation-Based Education Programme. International Journal of Healthcare Simulation. 2023.

3. McNeill S, O’Donovan D, Hart N. Access to healthcare for people experiencing homelessness in the UK and Ireland: A scoping review. BMC Health Services Research. 2022;22(1).

The Royal College of Anaesthetists (RCoA) require Core Level Trainees to be able recognise and manage critical incidents. As many of these critical incidents may not be encountered in clinical practice, the RCoA advise the use of simulation to assist teaching and assessment [1]. The RCoA expects anaesthetic trainees to have an awareness of human factors and understand the importance of non-technical skills to ensure consistent high performance [2].

Methods:

Anaesthetic and acute core stem emergency medicine novice trainees attended four training days in the simulation suite and theatre department over a four-month period. The simulation strategy was structured so the trainees progressed from clinical skills teaching on part task trainers and low-fidelity simulations to challenging high-fidelity anaesthetic and critical incident simulations, building on gaining deeper insight about human factors/ergonomics and non-technical skills. After each simulation, a debrief was held and at the end of each day evaluation forms were given to the trainees to complete.

Results:

Primarily, the training focused on exploring essential skills required for the management of clinical anaesthetic emergencies. This included both technical and non-technical skills such as, situational awareness, effective communication, navigating uncertainty, and fostering self-awareness. Trainees found the debrief discussions particularly beneficial, as they shed light on the significant impact of human factors, shared lessons learned from peers and heard the reflections of real-life experiences from the faculty. Feedback showed increased learners’ confidence in managing these cases especially developing a greater awareness of human factors/ergonomics, non-technical skills, and methods to decrease cognitive load during emergencies e.g. Association of Anaesthetists Quick Reference Handbook [3]. They also appreciated the progressive approach as it provided a structured method for learning and contributed to building a sense of psychological safety during simulation-based learning.

Discussion:

The structured and progressively challenging approach of the simulation strategy ensured the trainees were led through their zone of proximal development with the support and guidance of experienced faculty to promote confidence and skill development across a spectrum of scenarios. This simulation strategy enhanced the adaptability, preparedness and fostered a proactive approach to handling challenges and uncertainty of the trainees. Additionally, there was a noticeable improvement in confidence levels in not only the trainees but also in the faculty. Overall, the crucial aspect of the training days was the simulation strategy that allowed the trainees to progress from skill training to high-fidelity and challenging scenarios with guidance and support.

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.

References

1. Royal College of Anaesthetists. 2010 Curriculum. Royal College of Anaesthetists. September 9th, 2020. Available from: https://www.rcoa.ac.uk/documents/2010-curriculum/annex-b-core-level-training. [Accessed 3 October 2023].

2. Kelly EF, Frerk C, Bailey CR, et al. Human Factors in anaesthesia: a narrative review. Anaesthesia. 2023;78:479–490.

3. Anaesthesia Emergencies. Quick Reference Handbook. Association of Anaesthesia, Updated June, 2023. Available from: https://anaesthetists.org/Portals/0/PDFs/QRH/QRH_complete_June_2023.pdf?ver=2023-06-23-141011-603. [Accessed 19 April 2024].

The number of patients posing challenges to conventional peripheral venous cannulation techniques is ever increasing with rising rates of obesity, chronic illness and long-term IV therapies including chemotherapy [1]. The use of Ultrasound Guided Venous Cannulation (USGVC) has enabled venous cannulation to be carried out at the bedside by a wide range of professionals [2]. Teaching this skill was originally a postgraduate proficiency, often specific to certain specialities such as anaesthesia and intensive care. Increasingly this technique is being taught to doctors earlier in their careers and indeed at undergraduate level [1,2]. Our aim was to assess the effects of a teaching session on final year medical students.

Methods:

Students attended a 90-minute teaching session including a 30-minute lecture covering the basics of medical ultrasonography, anatomy of the upper limb and a video demonstration of USGVC, followed by a small group practical session lasting 60 minutes. During the practical session they were shown the principles of ultrasound machine controls, identifying arteries and veins on human volunteers and USGVC on a phantom limb. All students had the opportunity to practice these skills during the session with guidance from faculty. Self-reported confidence, knowledge and skills in USGVC were assessed Pre and Post teaching session via electronic questionnaires.

Results:

Questionnaires were returned by 241 students across two teaching sessions in November 2023 and January 2024. Pre teaching session Median values (IQ range) were: confidence 1(1-2), knowledge 2(2-3) and skill 1(1-1). Post session Median scores were 4(3-4) for confidence, 4(4-5) for knowledge and 4(3-4) for perceived skill showing a statistically significant self-reported improvement following the 90-minute teaching session (p<0.001 Independent-Samples Median T Test SPPS V29). Figure 1-A83 shows a comparison of self-reported skill levels pre and post teaching session.

Figure 1-A83.

Discussion:

We have shown a statistically significant increase in students’ confidence, knowledge and perceived skill in USGVC. We suggest introducing USGVC to undergraduate education would provide a platform for practice and clinical skill acquisition during the remaining undergraduate phase and moving on into their Foundation training. The likely outcome is not only an increased confidence in USGVC amongst clinicians earlier in training, but also increased competence. Once USGVC training is embedded in undergraduate and early post-graduate curricula, this would be an important area of research.

Ethics statement:

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

References

1. McMenamin L, Brown FE, Arora M, Barnard J, Smith LE, Stockell DJ, Tung P, Wakefield RJ, Weerasinghe A, Wolstenhulme S. Twelve tips for integrating ultrasound guided peripheral intravenous access clinical skills teaching into undergraduate medical education. Medical Teacher 2021;43(9):1010–1018.

2. Breslin R, Collins K, Cupitt J. The use of ultrasound as an adjunct to peripheral venous cannulation by junior doctors in clinical practice. Medical Teacher. 2018;40(12):1275–1280.

There is an increasing awareness amongst the medical profession as to the importance of simulation and strong engagement of care providers in healthcare leadership across our system [1]. Faculty Development Guidelines for the use of simulation in healthcare published in 2021 championed colleague mentoring in the delivery of simulation education [2]. To uphold best practice, Horton General Hospital (HGH) Emergency Department (ED) – Oxford University Hospitals NHS Foundation Trust, has focused efforts on creating unique, and valuable leadership opportunities for juniors passionate about simulation. As a requirement of this juniors must now also have training in the national programme; Becoming Simulation Faculty [3].

Methods:

HGH ED has committed to broadening its simulation faculty. Our simulation programme continued to ensure interprofessional consultant expertise to deliver two hours of impactful teaching to medical and nursing students, doctors, nurses and healthcare assistants. HGH ED has gone further to create the role of simulation coordinators delegating responsibility to junior healthcare professionals. The role offers the opportunity to execute programme delivery under the support and mentorship of the established simulation faculty.

Results:

The simulation training programme was established four years ago and has benefited patients and allied healthcare professionals. Participation in simulation training and its organisation has provided valuable opportunities to build Simulation champions and bring diversity to simulation faculty. HGH ED has achieved junior professional development, experience in leadership and management, interdisciplinary networking, and opportunities for understanding how to establish sustainable simulation.

Discussion:

Introducing the coordinator role is a high-impact intervention providing opportunities to water the passion for simulation training amongst junior colleagues. Through participation, coordinators engage in interprofessional networking to enable a diverse teaching programme. They gain an essential understanding of resourcing simulation equipment to facilitate high-impact teaching and marketing to champion training across the department. Participants will learn how human factors influence cohesive output to deliver, relevant and educational Simulation training. The role equips juniors with the skill to organise the delivery of simulation and contribute to the diversity of simulation faculty as hthose interested will have the strategies to resource sustainable simulation training as they progress in their careers across the NHS.

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.

References

1. Doherty R, Lawson S, Mc Laughlin L, Donaghy G, Courtney J, Gardiner K. Developing leadership as a trainee- opportunities, barriers and potential improvements.The Ulster medical journal. U.S. National Library of Medicine; [cited 2024 Apr 30]. Available from: https://pubmed.ncbi.nlm.nih.gov/29867267/.

2. Lofton L, Winnett G, Fores M, Fullwood D, Taylor C, Thomas A, et al. National toolkit to support the use of simulation in health and care Faculty development guidance [Internet]. hee.nhs.uk. Health Education England; 2021 [cited 2024 Apr 30]. Available from: https://www.hee.nhs.uk/sites/default/files/documents/Faculty%20Development%20Guidance%20FINAL.pdf.

3. Becoming simulation faculty [Internet]. Elearning for Healthcare. NHS England; 2023 [cited 2024 Apr 30]. Available from: https://www.e-lfh.org.uk/programmes/becoming-simulation-faculty/.

Securing first year placements has been an ongoing challenge. Current research [1] highlights that there are multiple barriers to offering placements such as time and student capability which may explain the challenges securing these placements.

A new placement model was designed with the following aims: reduce the time per student in clinical practice, offset this with simulation, reduce the assessment burden for clinical educators, whilst providing a valuable learning experience which can be classified as placement hours.

Methods:

The total duration of placement required was 3.8 weeks. Historically, this had all been in one clinical setting, with a Level 4 assessment form.

For this iteration, all students attended an introductory week at university. The cohort was then divided into three rotating groups, with one third being on an observational experience, and two thirds at the university per week (see Table 1 for example student timetable).

Table 1-A80.

Monday	Tuesday	Wednesday	Thursday	Friday
• Overview of placement• Introduction to professionalism• Understanding the different healthcare roles• Understanding the NHS and social care system in England	• Infection control• Safeguarding adults• Safeguarding children• Understanding dementia, mental health and learning disabilities	• Moving and handling of people• Basic life support	Introduction to healthcare environment:• Orientation to a ward environment• Use of a call bell/emergency bell• Identifying common ward objects• Familiarisation with resus trolley	Care Certificate workbook and e-learning
Clinical Observation Week
Monday	Tuesday	Wednesday	Thursday	Friday
• Escape room task focused on person-centred care• Community visits simulation activities: stairs assessment, physical observations, observing ADLs, environmental assessment• Breaking bad news – role play	• Cultural conversations – Discussions relating to EDIB in healthcare• Analyse fitness & balance class• Simulated fitness to practice hearing with adapted HCPC cases	• Design and deliver a group exercise class to peers & peer feedback• Activities related to resilience, mental health and wellbeing and completing as peer sessions	• Subjective and objective assessment on a simulated patient (MSK, Neuro, CVR• Personal care• Recordkeeping & SOAP notes• Handover simulation (nurses to physios)	Care Certificate workbook and e-learning
Monday	Tuesday	Wednesday	Thursday	Friday
• MDT discharge planning meeting simulation• Use of mytherappy website• Researching common conditions and medications and teaching each other	• Challenging communication scenarios:• Disorientated patient• Frustrated patient• Low mood patientApplied safeguarding scenarios:• Suspected child neglect• Suspected domestic violence• Suspected self-harm• Suspected financial abuse	• MECC training and considering application to role• Importance of hydration, nutrition and movement• Sustainability in healthcare	Disability awareness:• Hearing impairment simulation• Visual impairment simulation• Reduced dexterity simulation• Reduced mobility simulation• Wheelchair user simulation• Supported feeding• Supported drinking• Supported dressing• Supported oral care	END OF PLACEMENT

The observational experiences were in a variety of settings and were assessed with a feedback form which included total number of hours and feedback on professionalism.

For the simulated weeks there was feedback on professionalism and a record of hours. In addition, the students had to complete the Care Certificate workbooks [2].

Feedback from students about their placement experience was collated through evaluation forms (as per module requirements).

Results:

All students were able to attend a clinical observation period and participate in the simulated activities. The time in a clinical environment per student was reduced by 74%, yet the total number of placement hours for the student remained the same. In addition, the marking burden for the clinician educator was reduced from approximately two hours to five minutes (96% decrease). Students’ perceptions on the simulated activities were mixed – with an average score of 3.3 out of 5.

Discussion:

There was a significant decrease in the demand for clinical educators through this placement model and it enabled all students to complete a placement in the allocated time. However, the review of the Care Certificate workbooks is lengthy (240 pages) and a major challenge of this placement.

The evaluation response rate from students was very low (less than 10%) and therefore may not be representative. From the feedback, that higher fidelity and more immersive simulations were rated higher.

Further evaluation is recommended to identify simulations of higher value to students, staff and educators and long-term evaluation on preparedness of practice would be advantageous.

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.

References

1. Smith B, Robson K, Robinson C, Patton N. Factors influencing provision of clinical placements for health students: A scoping review. Focus on Health Professional Education: A Multi-Professional Journal. 2023;24(2): 63–103.

2. Skills for Care. Care Certificate Workbook. Available from: https://www.skillsforcare.org.uk/Developing-your-workforce/Care-Certificate/Care-Certificate-workbook.aspx. [Accessed 30 April 2024].

An accelerated training programme to address the shortage of qualified Anaesthetic Practitioners (APs) in Scotland was commissioned by Scottish Government. The aim was to accelerate successful completion of the existing NHS Education for Scotland, Core Competency Framework for Anaesthetic Practitioners [1], reducing time to capability from an estimated 2 years to the 24 weeks of the programme. This is achieved by targeting ‘high-risk, low exposure’ clinical experiences identified as rate limiting and difficult to achieve in clinical practice. Clinical exposure is substituted by providing experiential learning through high-fidelity, simulated practice to facilitate competency completion.

Methods:

Extensive initial stake holder consultation identified rate-limiting competencies, flagged as barriers to timely competency completion within anaesthetic departments across Scotland.

These were grouped into 8 themed face-to-face workshops mapped to competency requirements, combining skills training sessions and high-fidelity simulation, delivered to cohorts of up to 12 learners. High-fidelity simulation is used as a substitute for difficult to achieve clinical experiences for the purposes of competency completion. Hybrid, online and face-to-face delivery patterns allow preparation for workshops through engagement with bespoke, contextualised online learning resources.

Acceleration is achieved through capitalisation of prior knowledge, skills and experience in learners who are not subject naïve, application of constructivist educational principles to focus on clinical skills acquisition, and simulated clinical experience to remove redundancy from the programme curriculum. Competency sign-off remains with the employing NHS Boards.

Results:

Since 2022 the programme is currently in its 6th iteration, having successfully trained 37 Anaesthetic Practitioners with 12 more enrolled. Significant acceleration of skill and competency acquisition to full qualification has been demonstrated with 100% (37/37) of learners completing within an accelerated timeframe (< 2 years), 89% (33/37) completing within the 24-week programme. Feedback for the programme has been sought both constructively and at 0, 6 and 12-months post-programme. Evaluations have been overwhelmingly positive with 100% of Service Manager respondents reporting an increase in AP confidence, competence and skill in the workplace, and all respondents reporting an increase in overall workforce capability, flexibility and resilience.

Discussion:

Evaluation indicates that as simulation is a substitute for clinical experience as part of a simulated practice model it is essential that fidelity is as high as possible. Well-structured and leaner accessible debrief is important to maximise learning opportunities afforded by each simulation and improve learner experience.

A programme of high-fidelity, simulated practice experience is being successfully used to accelerate clinical competency completion for workforce development without compromising clinical or educational outcomes and has significantly reduced time to qualification for APs in Scotland.

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.

References

1. NHS Education for Scotland, Core Competency Framework for Anaesthetic Practitioners. 2003. Available from: https://nesvleprdstore.blob.core.windows.net/nesndpvlecmsprdblob/201e47e8-809b-4e3d-a246-9a70792c6875_NESD1900%20Core%20Competency%20Framework%20for%20Anaesthetic%20Practitioners%202024.pdf?sv=2018-03-28&sr=b&sig=WDUSDl9crj1po%2Bnd%2BaMjU4HcUiA5Ocxt8i7FgzqjF9Y%3D&st=2024-04-30T17%3A11%3A56Z&se=2024-04-30T18%3A16%3A56Z&sp=r.

The joint Royal College of Paediatric and Child Health (RCPCH) and Royal College of Emergency Medicine (RCEM) curriculum for paediatric emergency medicine (PEM) outlines illustrations whereby trainees should be competent in dealing with ear, nose and throat (ENT) and ophthalmological emergencies including dealing with obstructed airways. Particularly for lateral canthotomy, the lack of confidence in performing this skill [1] is associated with few real-life experiences and little training [2]. The aim of this simulation day was to provide a multidisciplinary simulation-based teaching day to address these gaps in training across both ENT and ophthalmology.

Methods:

A group of PEM, ENT and ophthalmology clinicians collectively developed educational material for the simulation day. Topics included two low fidelity simulations on post tonsillectomy bleed and blocked tracheostomies, interactive case-based discussion on orbital cellulitis and part task trainers to simulate retrieving foreign bodies from the ears and nose, using a slit lamp, removing foreign bodies from the eye, irrigation of the eye after chemical exposure and lateral canthotomies.

Invitations to attend were sent to both RCPCH and RCEM trainees in the West Midlands. Educational material was uploaded on to the postgraduate virtual learning environment for trainees to access. Questionnaires were sent to the participants to rate their confidence in these skills pre and post course.

Results:

Nine participants (6 RCPCH and 3 RCEM trainees) attended the course. Confidence in their ENT/ophthalmology skills were self-evaluated using a Likert scale, where 1 represented no confidence and 5 represented being very confident. Of the 9 attendees, 8 completed the pre-course questionnaire and 8 completed the post course questionnaire (Table 1-A78).

All trainees reported improved confidence in all of the skills taught on the simulation course. Feedback was overwhelmingly positive, with trainees appreciating the mixed faculty and mixed modalities of delivering the teaching material.

Discussion:

This novel course clearly addresses the learning needs for trainees working in PEM who are both RCPCH or RCEM trained. The profoundly positive feedback demonstrates the demand for simulation-based education for these practical skills and we will be delivering the course again in late April 2024 (biannual).

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.

References

1. Wilde C, Memon S, Ah-Kye L, Milligan A, Pederson M, Timlin H. A novel simulation model significantly improves confidence in canthotomy and cantholysis amongst ophthalmology and emergency medicine trainees. The Journal of Emergency Medicine. 2023.

2. Edmunds, Haridas AS, Morris DS, Jamalapuram K. Management of acute retrobulbar haemorrhage: a survey of non-ophthalmic emergency department physicians. Emergency Medicine Journal. 2019;36(4):245–247.

Table 1-A78.

Delivering A Novel Paediatric ENT And Ophthalmology Emergency Medicine Simulation Day

Skill	Pre course average (n=8)	Post course average (n=7)	Difference
Managing blocked tracheostomy	2.88	4.75	+1.87
Managing a post-tonsillectomy bleed	3.13	4.75	+1.74
Removal of foreign body from eyes, ears or nose	3.75	5.00	+1.25
Managing orbital cellulitis	4.13	4.88	+0.75
Using a slit lamp	2.38	4.25	+1.67
Irrigating the eye	3.63	5.00	+1.37
Lateral Canthotomy	1.63	4.00	+2.37

On-call ward cover is one of the most daunting prospects for final year medical students approaching their first foundation year one (FY1) post. Final year students have spent years developing their knowledge, assessment, and clinical decision-making skills, but many feel unprepared for the on-call aspect [1]. 93% of the 46 students in this research felt “not so confident” or “not confident at all” for their first shift on-call. It is therefore essential to deliver specific teaching in order to prepare them [2]. As simulation provides a “risk-free” environment for learning critical aspects of medicine [3], it is an ideal technique for a task such as this.

Aim: The aim of this research was to design and deliver a teaching session to prepare final year medical students for their first FY1 medical on-call using simulation. The aim was to unmask the hidden curriculum of how to practise as an FY1 doctor on-call and build attitudes, skills, and behaviours beyond that of the classic curriculum.

Methods:

Forty-six final year medical students from Cardiff and Swansea University took part in an optional on-call ward cover simulation session. The simulation consisted of 10 – 12 scenarios carried out during a 90 – 105-minute session in a simulated ward environment. The scenarios included data interpretation, prescribing, escalation to a senior colleague, practical clinical skills and an ABCDE assessment of an acutely unwell patient. Throughout the simulation, the medical students were expected to answer bleeps, prioritise tasks and formulate a management plan for each case. At the end of the simulation, a group debrief was conducted discussing each case and common themes such as phone etiquette, prioritisation and senior escalation.

Results:

Results were collected in the form of an online feedback form assessing student opinions on how helpful the session was, confidence before and after the session, and general comments about the simulation. 100% of the students who attended the session reported that it was helpful and after the session, 72% felt “confident” for their first medical on-call. Comments regarding the simulation included positive thoughts about the session and specific mention to the fact that the “scenarios were interesting” and the “feedback was really useful at the end”.

Discussion:

On-call ward cover simulation can help final year medical students to feel more confident for their first shift out of hours and help to unlock the hidden curriculum of skills associated with an on-call.

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.

References

1. Cripps F, Roberts N, Lau D. P79 Preparing for life on-call: developing on-call simulation training for final year medical students. BMJ Simulation & Technology Enhanced Learning. 2019;5(suppl 2):A95.

2. Hawkins N, Younan H-C, Fyfe M, Parekh R, McKeown A. Exploring why medical students still feel underprepared for clinical practice: a qualitative analysis of an authentic on‐call simulation. BMC Medical Education. 2021;21:1–11.

3. Bradley P. The history of simulation in medical education and possible future directions. Medical Education. 2006;40(3):254–262.

Interprofessional education (IPE) has been advocated on a global scale as an approach to improve collaborative practice and health care delivery [1]. A central tenet of IPE is if professions learn interactively together, they will develop the skills and knowledge to work more effectively with each other in clinical practice. Simulation-based education (SBE) is a rapidly evolving pedagogy within IPE. SBE offers participants the opportunity to learn in a controlled, psychologically safe environment. An indispensable component of all SBE is a structured debrief; to consolidate reflective interprofessional learning [1]. An emergent branch of SBE is In Situ Simulation (ISS). Literature included in a systematic review by Fent et al. (2015) [2] suggests the technique; which involves interprofessional teams managing simulated patient care scenarios in the actual clinical settings in which they work, improves clinical skills and interprofessional teamwork.

Methods:

An interprofessional faculty was established across two Emergency Departments in our Trust by a small, multidisciplinary team with a special interest in the benefits of SBE. All faculty members were trained in a debriefing tool; ensuring our simulation delivery, including pre-briefs and debriefs were standardized. A bi-monthly simulation program (Table 1-A75) was devised and advertised across both departments. Participation was welcomed from all ED specialties. Simulations were delivered in either a protected simulation environment or, when department acuity permitted, in-situ. Additionally, relevant disciplines were invited to participate in specific simulations, augmenting learning and collaborative practices. Staff were incentivized with certificates’ detailing CPD hours for portfolios. Nursing staff were given time in lieu for attendance.

Table 1-A75.

Schedule

24/03/2022	Status Epilepticus
07/04/2022	Traumatic Cardiac Arrest
21/04/2022	Complete Heart Block
05/05/2022	Unstable Tachyarrhythmia
19/05/2022	Emergency Delivery/Neonatal Resuscitation
06/06/2022	Obstetric Emergency (Eclampsia)
16/06/2022	Rapid Tranquilisation Of Psychotic Patient
30/06/2022	Massive Transfusion Protocol (GI Bleeding)
14/07/2022	Congestive Cardiac Failure – Unstable
28/07/2022	Life-threatening Asthma
11/08/2022	Silver Trauma
25/08/2022	Eye Emergency
08/09/2022	Difficult Interactions With Colleagues, Patients Or Relatives
22/09/2022	Hypertensive Emergency
06/10/2022	Vertebral Artery Dissection
20/10/2022	Procedural Sedation And Adverse Outcomes
03/11/2022	Pneumothorax
17/11/2022	Paediatric Sepsis
01/12/2022	Elderly Abdominal Pain/ AKI/ Hyperkalaemia
15/12/2022	Perimortem C-Section (Resuscitative Hysterotomy)
05/01/2023	Massive P.E.
19/01/2023	Hypothermic Emergencies
02/02/2023	Ectopic Pregnancy
16/02/2023	Seizures Due To Electrolyte Disturbances
02/03/2023	Red-Flag Headache
16/03/2023	Toxicology And Refusing Treatment
30/03/2023	Aortic Dissection/ Aneurysm
13/04/2023	Head Injury

Results:

Pre-and-post simulation feedback evidenced improved confidence with management of the clinical conditions being demonstrated. Over the course of the program, feedback was received from 239 participants. Of those, 238 would recommend attendance of a simulated scenario to a colleague.

Learning from the delivered simulations was amalgamated by one of the ED consultants and disseminated through safety briefings and short learning videos via our ‘My Emergency App’ platform.

Discussion:

A patient safety culture shift was observed as multi-disciplinary staff increasingly engaged with the simulation events across both sites. A myriad of safety improvements was introduced from key themes and latent safety threats identified by learners through debrief processes. Circulation of salient learning points enabled staff who were unable to attend the simulation events to tangibly share learning [3], with the primary aim of delivering high quality, safe and effective clinical care to our patients.

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.

References

1. Reeves S, Fletcher S, Barr H, Birch I, Boet S, Davies N, McFadyen A, Rivera J, Kitto S. A BMBE systematic review of the effects of interprofessional education: BMBE Guide No. 39. Medical Teacher. 2016;38(7):656–668.

2. Fent J, Blythe J, Farooq O, Purva M. In situ simulation as a tool for patient safety: a systematic review identifying how it is used and its effectiveness. British Medical Journal STEL. 2016;1:103–110.

3. Purdy E, Borchert L, El-Bitar A, Isaacson W, Bills L, Brazil V. Taking simulation out of its “safe container” – exploring the bidirectional impacts of psychological safety and simulation in an emergency department. Advances in Simulation. 2022;7(5):1–9.

The Nursing and Midwifery Council (NMC), the General Medical Council (GMC), and the Health and Care Professions Council (HCPC) all stipulate within their standards of education the requirement for students to be trained and prepared to work collaboratively within multidisciplinary teams. Despite this, the integration of meaningful Interprofessional Education (IPE) remains a significant challenge within the higher education sector. Barriers to success have been cited as a lack of skills and experience, staff commitment, logistics of collaboration, organisation, and sustainability [1-3].

In November 2023 and March 2024, a total of 650 undergraduate students from various healthcare disciplines actively engaged in an extensive IPE initiative. The participants included those studying medicine, physician associate, midwifery, nursing, nutrition, counselling & psychotherapy, social work, paramedicine, and operating department practice. Implementing an IPE day on this scale required students to rotate through multiple concurrent activities, making use of both the clinical skills and simulation centre and the entire faculty teaching building. The activities included six multifaceted interprofessional simulations, a virtual escape room experience, an AI-generated problem-based learning exercise, team-building activities, and a large-group virtual simulation employing Oxford Medical Simulation® technology.

Methods:

Within the context of a broader nursing study titled ‘Evaluating, Developing, and Generating Evidence for Quality (EDGE Q),’ ethical approval was obtained to conduct exploratory evaluative research involving student nurse and midwifery participating in the IPE day. Participants were invited to complete a validated evaluative questionnaire (Interprofessional Collaborative Competency Attainment Scale) and answer some free-text questions about their experiences of the day. As such, quantitative and qualitative data were collected and subjected to descriptive statistical analysis and thematic analysis.

Results:

Forty nursing students and 9 midwifery students completed the questionnaires. Results identified that students benefited from their participation in the day, specifically in relation to promoting communication, teamwork, and collaboration. Students enjoyed the interactive, varied, and innovative teaching approaches and working with students from other programmes.

Discussion:

Implementation of a large-scale IPE day required strategic planning and leadership, and investment from all staff across the faculty. Creating large group activities assisted in managing the significant student numbers, whilst engagement in the smaller activities ensured that learning remained relevant and meaningful.

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.

References

1. Bogossian F, New K, George K. The implementation of interprofessional education: a scoping review. Advances in Health Sciences Education. 2023;28:243–277.

2. Lawlis TR, Anson J, Greenfield D. Barriers and enablers that influence sustainable interprofessional education: a literature review. Journal of Interprofessional Care. 2014;28(4):305e310.

3. O’Keefe M, Henderson A, Chick R. Defining a set of common interprofessional learning competencies for health profession students. Medical Teacher. 2017;39(5):463–468.

The development and implementation of simulated placements based in higher education settings has grown, partly compensating for limited availability of allied health placements [1]. Simulation can offer students high-fidelity experiences in protected learning environments where there are specific opportunities for reflection and performance evaluation. Evaluative judgment (EJ) is the ability of the learner to evaluate their own work and their peers [2]. Simulation can support students to develop EJ through feedback and assessment of performance.

Methods:

A simulated occupational therapy placement was created, implemented and evaluated using a design-based research approach. Within the programme, students worked in groups, each with a designated academic facilitator from the teaching team. Simulated clients were portrayed by volunteer retired professionals. After each session, students self-evaluated their performance, provided peer feedback, and received verbal and written feedback from the academic facilitator. At the end of simulation, students reflected and graded their own performance based on the cumulative feedback in preparation for their next practice placement. Facilitators also completed the same evaluation with grades and comments on students’ overall performance.

Results:

The simulated placement enabled novice students to develop their practice skills and build confidence. Further, it also supported them to develop EJ. Specifically, post-session reflection time allowed students to identify areas of improvement. The post-session feedback discussion also provided peer feedback, engaging students in actively evaluating their observations of peer performance. Lastly, individualised feedback from the academic facilitators provided these novices with guidance for their future actions. At the end of simulated placement, having both students and academic facilitators completing the Evaluation of Foundational Placement Competencies (EFPC) assessment, enabled explicit comparison of the similarities and differences in their formal judgements of performance.

Discussion:

When developing EJ, it is important that students can transfer their learning experience to a comparable situation to promote validation of their self-evaluation [3]. After this simulated placement, students undertook in-person, clinician-led placements. They prepared by creating action plans, providing a meaningful purpose for developing their EJ through reflection and assessment within the simulation programme. Students require useful constructive feedback to facilitate improvements in future performance and thus support their development of EJ [2]. The simulation context was particularly amenable to embedding authentic opportunities for students to receive quality feedback in both verbal and written formats. Overall, this model of simulation addresses student learning through self, peer and facilitator feedback, all of which are required elements within the development of EJ.

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.

References

1. Rossiter L, Turk R, Judd B, et al. Preparing allied health students for placement: a contrast of learning modalities for foundational skill development. BMC Medical Education. 2023;23(1):161.

2. Tai J, Ajjawi R, Boud D, Dawson P, Panadero E. Developing evaluative judgement: Enabling students to make decisions about the quality of work. Higher Education. 2018;76(3):467–481.

3. Sadler. Transforming Holistic Assessment and Grading into a Vehicle for Complex Learning. In: Joughin G, editor. Assessment, Learning and Judgement in Higher Education. 1st edition. Springer; 2009. p. 45–63.

In response to the growing demand for effective training methodologies within healthcare settings [1], organisations are increasingly working with simulated patients (SPs). However, there exists a need for structured training programmes to ensure the proficiency of trainers in involving SPs in simulated-based education sessions. An established 14 hour Train the Trainer in Experiential Learning (TtTiEL) programme was reported to be effective in arming attendees with experiential learning facilitation skills, however data analysis revealed that peer support after TtTiEL is an essential component ensuring attendees actualise their acquired skills.

Methods:

A peer review process mirroring all practical elements covered in TtTiEL was created. This was reviewed by both experienced and novice experiential learning facilitators, by administrating teams, and by a self-selected group of experienced and novice SPs. Early drafts were built on and piloted, with changes made, then retested. A total of 65 points are reviewed in the key areas of pre-session preparation, facilitation techniques, session management, co-facilitation, and debriefing strategies.

Results:

The implementation of the TtTiEL programme coupled with peer review has resulted in notable advancements in participant proficiency, which leads to learner proficiency and safety, SP safety, and ultimately leads to improvements in patient care and safety. Peer review sessions provide essential feedback, enabling trainers to refine their skills and enhance the overall quality of experiential learning sessions. The pivotal role of peer review post TtTiEL optimises the effectiveness of experiential learning in healthcare education. By providing experiential learning facilitators with tailored feedback and opportunities for improvement after peer review one, they are then able to actualise the feedback and hone their skills, during the second peer review.

Discussion:

The peer review process serves as a catalyst for quality enhancement and innovation. A key finding is that training trainers, does not stand alone, it is a dynamic process [2]. Organisations’ attempts at budget control, by leaving out peer review post TtTiEL are counterproductive in creating safe, effective experiential learning facilitators. Peer-reviewing post TtTiEL represents a paradigm shift in experiential learning, with emphasis on continuous improvement aligning with the ASPiH standards of practice, making it a valuable asset for education deliverers. As healthcare landscapes evolve and we strive to meet the aims of the NHS workforce plan [3], the transformative approach of peer-reviewed experiential learning remains indispensable in shaping the future of patient-centred 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.

References

1. Simulation in Nursing Education: An Evidence Base for the Future [Internet]. 2024. Available from: https://www.councilofdeans.org.uk/wp-content/uploads/2024/01/CoDH-ARU-Simulation-in-Nursing-Education-Report-Jan-2024.pdf.

2. Lane AJ, Mitchell CG. Using a Train-the-Trainer Model to Prepare Educators for Simulation Instruction. The Journal of Continuing Education in Nursing. 2013;44(7):313–317.

3. NHS Long Term Workforce Plan [Internet]. 2023. Available from: https://www.england.nhs.uk/wp-content/uploads/2023/06/nhs-long-term-workforce-plan-v1.1.pdf.

In the NHS staff survey 2022, 27.8% of staff reported that they had experienced bullying, harassment or abuse in the last 12 months [1].

On a local level, over 75% of staff who attended in-situ simulation sessions reported that they encountered violence and aggression at work ‘often’ or ‘most shifts.’ 24% of staff reported feeling unconfident in managing violent and aggressive behaviour prior to training, with 52% feeling somewhat confident and the remaining 24% feeling confident.

We set out to design a training session to help staff to de-escalate violent/aggressive behaviour, as well as to improve confidence in being able to escalate or stand up to unacceptable behaviour.

Methods:

A program of in-situ simulations was carried out over a 2-month period, across clinical areas in the hospital. Key themes addressed using these scenarios were personal safety, de-escalation, involving security and post-event debrief. Scenarios were adapted to fit in with the location and patient group that staff were likely to encounter.

The full multidisciplinary team were invited to these simulations with attendance from security, doctors, nurses, students, therapists, healthcare assistants, and ward clerks.

Scenarios were run in side rooms or staff rooms to protect the wellbeing of other patients nearby. Professional actors were used when available to increase fidelity.

Post-simulation feedback questionnaires were given to staff and then analysed.

Results:

A-hundred percent of staff felt the session was ‘very useful’/‘useful’ in improving confidence in managing violence and aggression, and 100% said that they would recommend the training session to a colleague.

Specific learning points from staff included:

● Phrases to use/not to use, supporting verbal de-escalation

● What a panic alarm was and how to use it

● Consideration of positioning and environment for personal safety

● Team support: how best to help with an ongoing or completed incident

Discussion:

During these sessions we identified that staff often felt patients had a right to be upset or angry about their care and subsequently tolerated the behaviour. This was fed back to the local violence and aggression working group, to emphasise the need for trust wide communications about behaviour that is not tolerated. Having senior staff and security present at training sessions allowed feedback of what had been done in response to specific situations.

Staff commented on the need for ongoing training, and therefore the aim is to run this session on each ward in the hospital on an annual basis.

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.

References

1. NHS England, Violence Prevention and Reduction. Available from: https://www.england.nhs.uk/supporting-our-nhs-people/health-and-wellbeing-programmes/violence-prevention-and-safety/. [Accessed 5 January 2024].

Simulation has been a mandatory part of internal medicine training (IMT) since 2019 [1] and is a useful tool to improve ability to manage acute medical emergencies and recognise human factors [2]. A ‘Step-Up’ to medical registrar course has been ongoing since 2021, with scenarios simulating the experience of being the medical registrar on call which has received positive feedback [3]. This includes running two simultaneous scenarios with unwell patients, ethical dilemmas requiring senior input and phone interruptions.

The aim of the ‘Step-Up’ programme is to aid the difficult transition from senior house officer to medical registrar incorporating both the senior clinical role this entails and the wider managerial aspects.

Methods:

The ‘Step-Up’ course is a one-day course with four scenarios with one candidate per scenario. The scenarios take place in the simulation lab with the other candidates observing via video link in a debrief room.

Each scenario comprises of two high-fidelity situations commonly encountered by the medical registrar on call. This includes one difficult communication skills (using live actors) and one medical emergency (using a computerised mannikin, SimMan Essential) running simultaneously. Throughout the scenario candidates are interrupted by the bleep which, when answered, requires candidates to give telephone advice or appropriately redirect the caller.

Debrief is then carried out by qualified simulation faculty along with an expert facilitator in the form of a consultant or specialist registrar. Feedback was collected immediately post simulation via a QR code. This allowed easy collection of data and ongoing analysis. Three months post course a further survey was conducted via online link on the course’s usefulness, relevancy to work, and influence on working practices (including stress management). The candidates were specifically asked about the role of simulation in helping the transition to medical registrar.

Results:

Eighteen candidates attended simulation sessions and thirteen responded to the three-month survey, a 72.22% response rate. All surveyed candidates found the training useful, had encountered similar scenarios on call and thought the course had helped with the transition to medical registrar, with 100% responding with agree or strongly agree to all three questions.

Discussion:

Simulation was relevant to candidates’ experience of being the on call medical registrar allowing it to be incorporated into practice post-course. It helped with the transition from senior house officer (SHO) to registrar as demonstrated with an ongoing improvement in confidence three months later.

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.

References

1. Available from: www.jrcptb.org.uk/training-certification/arcp-decision-aids.

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

3. Roy E, William G, Hannah P, Megan R, Benjamin G, Benjamin S. ‘Step up’: utilising simulation to assist in the transition from medical senior house officer to registrar. International Journal of Healthcare Simulation. 2022;2(suppl 1):A52–A52.

The use of simulated practice-based learning to compliment clinical practice has led to the opportunity to deliver novel approaches to placement experiences where students are able to take on the role of the registered practitioner in areas of practice with limited access for students, and with other branches of the profession that they may not necessarily collaborate with in clinical practice. One approach is the use of a virtual placement to allow students to work collaboratively over a week-long placement across three branches of nursing.

Methods:

A week-long placement was designed to be delivered using existing virtual learning platforms (VLP). A virtual environment called Greenbrook was created, developed from the work of Wright et al [1]. Within this, the participants would be responding to the needs of a family with a mixture of clinical presentations. The interactions with the family had been pre-recorded by the faculty along the lines of common nursing assessments and turned into vignettes for the participants to view and pull off the necessary information to assess, plan and implement/ suggest care for each person within the family. Time was allocated for students to research the conditions and formulate plans of care. Collaborative approaches were required by the teams so that they could complete tasks and all work was a tracked through attendance at meetings on teams and through interaction with the VLP.

Results:

Ninety-seven students from the three branches undertook the placement over the week and provided care for patients with Sickle Cell crisis, Autism, Bi Polar disorder and Diarrhoea & Vomiting. Anecdotal feedback from the placement was that the students enjoyed the ability to work with and learn about areas of practice outside their branch with one participant saying it was the first time they had felt that they were acting as a practitioner with their contribution having consequences for the patient and their family.

Discussion:

The delivery of online/ virtual simulation can be challenging [2] however it can be undertaken without the use of expensive platforms using resources that are at hand within the average higher education institute. The ability to track the interaction and provide access to resources through the VLP help to encourage engagement but there is still a need for faculty to facilitate catch up debriefs and end of day debriefs as well as technical support.

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.

References

1. Wright DJ, Greene L, Jack K, Hannan E, Hamshire C. Birley Place: A virtual community for the delivery of health and social care education. BMJ Simulation and Technology Enhanced Learning. 2021;7:627–630. [Accessed 14 February 2024].

2. Cheng A, Kolbe M, Grant V, Eller S, Hales R, Symon B, Griswold S, Eppich W. A practical guide to virtual debriefings: Communities of inquiry perspective. Advances in Simulation. 2020;5:18. [Accessed 14 February 2024].

Healthcare simulation has the potential for learners to suffer psychological distress and anxiety causing “amygdala highjack” thus the potential for learning drastically dissipates as learners enter fight, flight or freeze, where cognition can be impaired [1]. An obvious solution is to remove stress from the simulation, however a variety of factors can contribute to the emergence of anxiety including external stressors, social discomfort [1] simulation design and extraneous cognitive load [2]. The complete removal of anxiety or stress is improbable yet promoting psychological safety and providing a learner centred environment in which anxiety can be alleviated is essential.

Methods:

Utilising the neuroscience of education concept, brain breaks [1], a space set away from the simulation, was used. Learners removed themselves from the simulation, stepped into the space and were coached through cyclical sighing which has been shown to reduce stress and anxiety [3]. Following this, physical and cognitive activities designed to activate neural pathways and release neurotransmitters such as dopamine, oxytocin and acetylcholine were carried out to promote the learning process and higher order thinking [1]. The combination of these elements aimed to reduce anxiety and have the learner return to the simulation should they feel able to do so.

Results:

The brain break spaces were implemented in two high fidelity major incident simulations in April 2023 in which 120 healthcare students participated. Of the 120 students, 46 provided anonymous feedback. 83% of students who used the space indicated a reduction in anxiety and stress, 72% of the respondents reported that knowing it was available for them reduced their baseline stress and anxiety prior to the simulation. Whilst some did not return to the simulation a small number of students were able to complete the simulation after using the space.

Discussion:

Initial positive results indicated from student feedback showed that the presence of a brain break space had positive outcomes on students undertaking simulation. For those who suffer ‘amygdala highjack’ and anxiety the space offers refuge for cognitive re-focus and relief from anxiety. The presence of the safe space also appears to reduce the likelihood of learners suffering psychological distress by reducing their baseline levels of anxiety and stress. Further development of these spaces is ongoing and continual student feedback will guide any future implementation of the initiative with the aim of improving psychological safety during 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.

References

1. O’Mahony K. The brain-based classroom: accessing every child’s potential through educational neuroscience. New York, NY: Routledge, Taylor & Francis Group. 2021.

2. Fredericks S, ElSayed M, Hammad M, Abumiddain O, Istwani L, Rabeea A, et al. Anxiety is associated with extraneous cognitive load during teaching using high-fidelity clinical simulation. Medical Education. 2021;26(1).

3. Balban MY, Neri E, Kogon MM, Weed L, Nouriani B, Jo B, et al. Brief structured respiration practices enhance mood and reduce physiological arousal. Cell Reports Medicine [Internet]. 2023;4(1). Available from: https://www.cell.com/cell-reports-medicine/fulltext/S2666-3791(22)00474-8?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS2666379122004748%3Fshowall%3Dtrue.

As an educational modality, simulation “can improve the quality and impact of training provided to doctors now and in the future” [1] but is labour and time intensive due to the small group sizes required to achieve maximum efficacy [2]. Foundation doctors currently undertake two and a half days of multidisciplinary simulation, with scenarios constructively aligned to their curriculum [3]. The need for additional simulation opportunities that are accessible to larger groups of doctors was identified. These sessions would require a more efficient style of delivery to ensure the engagement of all participants, not just those selected to enter the simulation environment. Could the use of multi-modal teaching transform observing learners into active participants to reach a larger audience?

Methods:

The three-part session was designed as an immersive simulation with an integrated interactive prescribing tutorial. This targeted the acute management of a patient with diabetic ketoacidosis and the following twelve hours of their care. The tutorial tasked all attendees (not just those involved in the simulation) with using the Trust protocol to prescribe appropriate treatment at various intervals in response to simulated clinical findings.

Pre- and post-intervention questionnaires explored participants’ views on styles of teaching and examined any changes in clinical confidence and perceptions around the multi-modal teaching style.

Results:

Responses were collected from sixteen Foundation Year 2 doctors who attended the two-hour training afternoon as part of their teaching programme. Data indicated an increase in numbers who agreed or strongly agreed that actively watching scenarios was as valuable as taking part themselves. Additionally, doctors were more confident prescribing treatments based on Trust protocols and were more comfortable using Trust guidelines to manage an unwell patient. Naturally, some challenges arose, with minor changes needed before we repeat this with Foundation Year 1 doctors.

Discussion:

There is huge scope for development of scenarios that integrate different teaching methodologies into simulation-based training. The success of this session has confirmed that, in addition to actively involving larger numbers of participants, a multi-modal teaching style can provide an enhanced opportunity for participants to follow the management of a patient over a longer period than is ordinarily afforded by established simulation formats. It also highlighted the value of this approach in provision of responsive teaching to address prescribing safety incidents. The potential for designing scenarios which allow incorporation of clinical skills using task-trainers is also an exciting possibility.

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.

References

1. Purva M, Fent G, Prakash A. Enhancing UK Core Medical Training through simulation-based education: an evidence-based approach A report from the joint JRCPTB/HEE Expert Group on Simulation in Core Medical Training [Internet]. 2016. Available from: https://www.jrcptb.org.uk/sites/default/files/HEE_Report_FINAL.pdf.

2. Au ML, Tong LK, Li YY, Ng WI, Wang SC. Impact of scenario validity and group size on learning outcomes in high-fidelity simulation: A systematics review and meta-analysis. Nurse Education Today. 2023;121:105705.

3. UK Foundation Programme. UK Foundation Programme Curriculum 2021 [Internet]. 2021. Available from: https://healtheducationengland.sharepoint.com/sites/UKFPOT/WebDocs/Forms/AllItems.aspx?id=%2Fsites%2FUKFPOT%2FWebDocs%2F4%2E%20Curriculum%2FUKFP%20Curriculum%202021%5FOct22%20update%2Epdf&parent=%2Fsites%2FUKFPOT%2FWebDocs%2F4%2E%20Curriculum&p=true&ga=1.

FY2 doctors in Greater Glasgow and Clyde (GGC) participate in Simulation-based learning to improve communication skills in difficult consultations. COVID-19 pandemic restrictions from 2020 – 2022, meant availability of in-person actors was limited. Two scenarios were therefore devised to run as ward-based manikin scenarios with faculty as actors, and two scenarios [1] run with professional actors. We aimed to assess the quality of each scenario to look for any differences between the manikin and actor based scenarios. The perceived importance of the debrief for learners in each scenario was also evaluated, as an effective debrief is considered necessary for successful simulation-based learning [2].

Methods:

Four scenarios were chosen with intended learning objectives (ILOs) concentrating on Assertiveness and End of Life Care (manikin) and Confrontation and Mental Health/Legal Frameworks (actors). Afterwards, participants were asked to score each scenario on a Likert Scale (1 – 5) for engagement, realism and relevance to practice and also which aspect of the scenario they felt was most useful for their learning – the content, presentation or debrief. Confidence levels in dealing with the associated communication skills were assessed before and after the session.

Results:

Questionnaires were completed by 110/146 participating FY2s. Overall scores for the session scenarios were good (score 4) to very good (score 5) for engagement (mean score 4.72/5, n = 4), realism (4.76/5) and relevance (4.82/5). The manikin-based scenarios were thought to be less engaging than those with actors (mean score 4.68 v 4.77, respectively) but there was no difference in scores for realism or relevance. For all scenarios, the debrief was thought to be the most relevant part of the learning experience (Figure 1-A66): 55 % overall, 53% for manikin, 60% actors. When ranking which scenario they found most useful, actor-based scenarios were chosen by 68% of learners. The ILOs rated best-achieved by the session were “Strategies to Discuss EOLC and DNACPR decisions” (81%) and “Managing Confrontation or Anger” (79%). Confidence levels improved after the session for all topics covered (data not shown).

Figure 1-A66.

Scenario component most relevant to learning

Discussion:

Manikin-based scenarios can be used to improve communication skills, with similar efficacy to scenarios using actors. However, participants in this simulation session found actor-based scenarios more useful. For all scenarios an effective debrief enhances learning. Some aspects of communication skills may be more suited for learning through manikin-based scenarios and this requires further assessment.

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.

References

1. Crichton L, Fisher L, Harrison N, Shippey B. Simulation Based Education Programme for Foundation Doctors. NHS Education for Scotland (NES); 2018.

2. Abuleba K, Auerbach M, Limaiem F. In: Debriefing Techniques Utilized in Medical Simulation. StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024.

We designed and delivered a course for physician associates (PAs) working in primary care [1]. The commissioner saw a learning need around young people’s mental health. Their own training analysis identified gaps in knowledge around: school refusal; effective engagement with adolescents; neurodivergence; de-escalation; and managing dynamics within appointments. The commissioner funded a one-day course and wanted simulation-based training for the 18 PAs.

Methods:

We agreed a one-day online simulation course would best suit the learners, using a modified Pendleton’s debrief model. The learning outcomes were: understanding common mental health presentations and associated risks; the role of family involvement in assessment and management; engaging teenagers and families effectively; de-escalation techniques; relevant legal frameworks; and when and how to escalate concerns.

We structured the day as follows: icebreakers for psychological safety [2], introduction to simulation and debrief, five clinical scenarios (simulated patients played by actors) covering a range of ages and mental health presentations, and structured debriefs led by faculty.

We wrote two completely new scenarios, drawing from clinical experience and following the identified learning needs. We adapted three scenarios from previous courses, ensuring they were relevant to the learners’ knowledge and skill levels as well as their clinical setting.

In pre- and post-course questionnaires, participants rated their knowledge and confidence levels, giving data on effectiveness. They also gave free text responses about satisfaction.

Results:

The participants rated their knowledge, skills, and confidence in relation to the learning outcomes. They also rated the course in terms of effectiveness, efficiency, and relevance to their job.

Post-course, participants rated their knowledge, skills, and confidence on the learning outcomes. 70-100% of participants felt they achieved the various learning outcomes. 90% felt the course met its stated aims and objectives, and 100% found it useful for their practice.

Participants suggested longer scenarios. One wanted more didactic input, noting that the group were slow to speak in the debriefs.

Faculty reflected that the participants were reluctant to volunteer for the scenarios, but felt that we established psychological safety.

Discussion:

The feedback was positive about content and delivery, with evidence of effectiveness. The commissioner joined as participant, which may have affected psychological safety. We wondered whether we could have more directly encouraged participants to volunteer, or called on individuals for comments in debriefs.

We will consider the merits and drawbacks of longer 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.

References

1. Health Education England. Physician Associates Working in Mental Health [Internet]. 2019. Available from: https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/physician-associates-working-in-mental-health.pdf.

2. Rudolph JW, Raemer DB, Simon R. Establishing a safe container for learning in simulation: the role of the presimulation briefing. Simulation in Healthcare 2014;9(6):339.

Caution is required when using animal/biological component (ABC) simulators. Their use can pose many challenges and risks for staff and learners. Sourcing the materials and safety when constructing, using, and disposing of ABC simulators are familiar challenges. However, using these materials can ensure more realistic and reliable models than their synthetic counterparts [1] which can create a more immersive experience with better learner feedback. Learners also have a chance to practice with the instruments and consumables required for a procedure in a safe manner where there is no risk to patient safety, but the procedure is not jeopardised [2]. We describe the development of a user guide with Standard Operating Procedures (SoPs) to mitigate risk and improve the performance of these simulators.

Methods:

Based on a literature search for health and safety guidelines, consultation with suppliers and simulation facilities and the ICAPSS experience in ABC simulation in procedures including bowel anastomosis, stoma formation and reversal, microvascular anastomosis, tendon repair, 3rd & 4th degree perineal repairs and endoscopic polypectomies, we developed a best practice guide, simulator SoPs and bespoke health and safety risk assessment templates.

Results:

The ABC best practice guide was developed and includes programme templates, recommendations for material ordering with images and descriptions of the animal material, dimensions and quantities. The SoPs for storage, preparation and modification, cleaning, handling, use and disposal of the ABC simulators were developed. SoPs also included bespoke health and safety risk assessment templates for biologic materials.

Discussion:

ABC simulation can be high risk and challenging but is an important aspect of simulation-based education. Mitigation of the risk and developing best practice SOPs and guides can ensure health and safety compliance and support facilities embarking on this type of simulation for the first time.

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.

References

1. Al-Sharshahi ZF, Hoz SS, Alrawi MA, Sabah MA, Albanaa SA, Moscote-Salazar LR. The use of non-living animals as simulation models for cranial neurosurgical procedures: a literature review. Chinese Neurosurgical Journal. 2020;6(1).

2. De Montbrun S, MacRae H. Simulation in surgical education. Clinics in Colon and Rectal Surgery [Internet]. 2012;25(03):156–165.

Regional anaesthesia plays an important role in modern practice, offering numerous advantages such as reduced opioid use and improved postoperative pain management [1]. However, ensuring a high level of competency amongst healthcare professionals in this field is essential to maximise its benefits and minimise risks. This abstract presents a regional block course for the Emergency Department (ED) that has been running successfully at Guy’s and St Thomas’ Hospital (GSTT).

Methods:

The regional blocks course at GSTT was designed to meet the growing demand for training in regional anaesthesia techniques in the Emergency Department to provide optimal pain management in acute fractures(2). The main target group were doctors above Foundation year 2, Physician Associates and Advanced Nurse Practitioners. The course offers comprehensive learning that tailors to all professional levels. It provides the knowledge base and expertise to be competent in the desired skills(2). The course includes both didactic sessions and hands-on training for a variety of healthcare professionals at different levels of training.

Key components of the course include:

● Didactic Sessions: The course begins with in-depth lectures covering anatomy, pharmacology, and the latest advances in regional anaesthesia. These sessions lay a strong theoretical foundation for participants, as well as allowing participants to engage in technical discussions with subject matter experts.

● Practical Workshops: A significant portion of the course is dedicated to practical workshops, where participants gain hands-on experience in ultrasound-guided regional anaesthesia techniques while being guided by experts in the field. This includes nerve identification (fascia iliaca, serratus anterior and nerves of the wrist/hand), needle placement, and patient positioning and assessment.

● Simulation Scenarios: To enhance skills and build confidence, the course integrates high-fidelity simulation scenarios. These simulations replicate real clinical situations, allowing participants to practice their skills in a safe and controlled environment.

Results:

The competence and confidence of participants completing the course are high in regional block techniques, as assessed through post-course evaluations (Figure 1-A62). In conclusion, the regional block course at GSTT has been popular among healthcare professionals, participants enjoy the course, make use of their learning and recommend it to others.

Figure 1-A62.

Discussion:

By combining didactic sessions, practical workshops and simulated scenarios, this program has had a positive impact on the clinician’s competency and confidence. This abstract highlights the importance of tailored simulated education in improving healthcare practices and patient care, especially in respect to acute pain management.

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.

References

1. Chitnis SS, Tang R, Mariano ER. The role of regional analgesia in personalized postoperative pain management. Korean Journal of Anesthesiology [Internet]. 2020 [cited 2023 Oct 19];73(5):363. Available from: /pmc/articles/PMC7533178/.

2. Pawa A, El-Boghdadly K. Regional anesthesia by nonanesthesiologists. Current Opinion in Anesthesiology [Internet]. 2018 [cited 2023 Oct 19];31(5):586–592. Available from: https://www.researchgate.net/publication/326384751_Regional_anesthesia_by_nonanesthesiologists.

Internal medicine trainees in Scotland attend national simulation training. Annual review days evaluate course content and it was highlighted at these that the mode of delivery of one of the sessions (Table 1-A60) was suboptimal: a 150-minute round table workshop discussing theoretical clinical decisions. Feedback requested more immersive simulation, presenting a dilemma as further immersive simulation in parallel with current sessions was not feasible due to availability of equipment and physical space. A modified shadowbox approach [1] was identified as a solution. Shadowbox simulation allows learners to view a scenario through the lens of an expert, using video with pauses for facilitated discussion to develop decision making skills [1].

Table 1-A60.

Learning objectives

Agitation and tracheostomy session	Shock and CVC session
Recognise subcategories of agitation and the use of such classification	Recognise and differentiate the cause of shock
Describe strategies for de-escalation and identify helpful and unhelpful practice points.	Describe the optimal approach to fluid resuscitation and how to assess fluid responsiveness
Explore different drug choices for specific circumstances.	Consider alternative management strategies when fluid responsiveness persists after large volume fluid resuscitation
Demonstrate understanding of legal frameworks in specific circumstances.	Demonstrate safe and effective placement and confirmation of CVC and describe how to deal with the important complications that rarely occur
Manage tracheostomy emergency.	Describe how to commence and titrate vasoactive drugs
Recognise specific features of patients, pathology and equipment which make risk of a tracheostomy issue higher or lower	Explore the optimal way to create and discuss treatment escalation plans

Methods:

Video footage of senior professionals working through clinical problems aligning to the curriculum was created. Each case was divided into short clips demonstrating optimal and, at times, additional contrasting suboptimal performance. During pauses between clips questions were posed to groups of six learners to encourage cognitive decision-making processes, facilitated in a similar way to a debrief of an immersive simulation scenario [2]. During each case a practical procedure was carried out by participants on a task trainer before returning to the debrief conversation. Pre and post questionnaires were completed by trainees as part of an iterative course evaluation.

Results:

Eighteen 120-minute sessions have been delivered to 40 trainees, with further sessions planned before June 2024. Qualitative feedback from trainee questionnaires described that the format was more suitable ‘to hold attention’. They described it as a ‘sim hybrid’. In contrast to prior expectations, this method was actually preferred to immersive simulation by some:

● ‘It made us draw from our own experiences and the topics we reflected on were less artificial than in sim. I liked the more informal set up in comparison to sim.’

● ‘Really good structure to break down complex issues and takes away pressure of sim.’

● ‘In some ways better than sim due to systematic nature.’

Discussion:

Trainee feedback demonstrate that this modified shadow boxing has been a successful modification to this training course. The sessions provided the benefits of a simulation debrief without the performance ‘hot seat’ pressure and performance anxiety Particularly when looking at non-technical skills it was powerful to contrast excellent vs suboptimal performance. This innovation should be of interest to a simulation audience as an example of delivery achieved with a more economic use of faculty, space and equipment.

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.

References

1. Mutch CP, Oliver N. Virtual simulation of communication skills challenges using a shadowbox technique. International Journal of Healthcare Simulation 2022;1:22–24.

2. Oliver N, Shippey B, Edgar S, Maran N, May A. The Scottish centre debrief model. International Journal of Healthcare Simulation 2023;(Xx):2023.

Simulation has been widely adopted in healthcare education. Traditionally, the design of simulations was through a hierarchical approach where experts contributed to the development of content and assessment processes. Whilst this has proved to be a reliable method, the effectiveness from the perspective of students has rarely been examined [1].

A growing body of literature highlights the benefits of co-creation in nurse education, which include improvements to learning, skills development, and patient centred practice through increasing students’ self-awareness and confidence [2]. This study reports the benefits of co-creation in enabling student nurses to address identified learning needs within a simulated environment.

Methods:

A survey, which utilised a four-point Likert scale, was circulated to all year two nursing students (n=452) to gauge their level of confidence in undertaking core skills which had been delivered in years 1 and 2 of the undergraduate programme. The data from this survey underpinned the development of two complex communication simulations. The questions from this survey were used to capture pre- and post-simulation data from student nurses who undertook these simulations. Following this simulation, students were sent an electronic survey to gauge the benefit of these simulation in supporting their ongoing professional development.

Results:

The initial survey was completed by 155 nursing students. Although 62% of students felt confident (58%) or very confident (15%) to systematically assess a patient and escalate their concerns to a colleague (53% confident; 24% very confident), students felt less confident to manage conflict (35% confident; 12% very confident), challenge poor practice (30% confident; very confident 11%), manage a critically unwell patient with sepsis (27% confident; very confident 7%) or to manage a patient post-overdose (27% confident; very confident 7%).

The results from this survey were used to co-create two complex communication simulations. Each simulation required students to work in small groups to either conduct a systematic assessment of a patient or to conduct a complex communication with a relative of the patient. The teams then met to decide what information would be shared with the relative which then formed the basis of a second simulation.

Discussion:

This is the first time that co-creation has been used to enhance programme development at undergraduate level. Feedback from the post-participation survey will reveal the extent to which these co-created simulations enhanced students’ knowledge, skills, and confidence. The results from this pilot study will inform future co-created content and curriculum development.

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.

References

1. O’Connor S, Zhang M, Trout KK, Snibsoer AK. Co-production in nursing and midwifery education: A systematic review of the literature. Nurse Education Today. 2021;102:104900.

2. Stirling K, Rogers A, Topping K. Does Simulation Enhance or Inhibit the development of Self-knowledge in Medical Education. Journal of Applied Learning and Teaching. 2024;6(1):85–100.

Simulation based medical education can be defined as any educational activity that utilises simulation aids to replicate clinical scenarios [1]. One currently burgeoning field of medical simulation is Tabletop Simulation (TTX). Contrary to other medical simulation methodologies, typically the TTX format has reduced emphasis on novel technologies alongside low clinical and environmental fidelity. To date, the majority of TTX has been implemented in disaster healthcare [2]. However, more recently there has been a surge in TTX which is likely due to accessibility and low development overheads. This mimics a ‘renaissance’ in leisure board industry, ‘Internet fatigue’ being a current dominant theory to explain this trend [3].

Anaesthetic specialty doctor training begins with a focus on clinical aspects of patient care. As time progresses individuals will eventually step up to becoming the most senior anaesthetist within a hospital overnight; running a small team, prioritising care and managing numerous other demands. The step up to the demands of this new role can be appreciable. I order to smooth this learning curve I developed an anaesthetic TTX entitled ‘The Bleep Test’ (Figure 1-A57) to model the pressure of a busy on-call night shift at a Major Trauma Centre.

Figure 1-A57.

Methods:

‘The Bleep Test’ is based within a fictional hospital which contains a finite amount of human and environmental resources. Each turn demands are placed on these resources in the form of tasks which come in the form of ‘bleep’ cards. The player(s) has to decide how to prioritise each of the tasks given the situational constraints and clinical need, as well as future potential anaesthetic tasks that may need an immediate response. Critically this game is designed as a ‘sandbox environment’ with focus on discussion and prioritisation, rather than winning. After playing the game anaesthetic trainees were asked to fill out a survey.

Results:

A-hundred percent of anaesthetic trainees gave the game ≥4 out of 5 for 1) how useful, and 2) how enjoyable the learning exercise was. 100% would play it again. Free-text comments included “Incredibly fun game and great way to tease out problem solving and non-clinical skills required on a typical “busy” night shift!” and “good springboard for discussions about the management of anaesthetic emergencies”.

Discussion:

The game was universally enjoyed and could even work as a one-player game. Further work needs to be done in order to quantify confidence improvement for new anaesthetic registrars. However, overall ‘The Bleep Test’ has been incredibly successful.

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.

References

1. Al-Elq AH. Simulation-based medical teaching and learning. Journal of Family Community Medicine 2010;17(1):35–40.

2. Ward RC, Muckle TJ, Kremer MJ, Krogh MA. Computer-based case simulations for assessment in health care: a literature review of validity evidence. Eval Health. 2019;42(1):82–102.

3. Donovan T. It’s all a game: The History of Board Games from Monopoly to Settlers of Catan. New York: St. Martin’s Publishing Group. 2017. p. 292.

Around 10% of 50,000 doctors in training in England take approved time out of training for various reasons such as parental leave, sick leave, career breaks and research. Returning to training can be challenging and is a major concern for trainees and trainers. During this period, trainees report lack of confidence in clinical knowledge and technical skills, lack of contact with supervisors, breakdown in pastoral relationships and support when actively sought out [1].

We recognised these challenges and piloted a virtual simulation course, UPDATES, supporting return to work for doctors in training within the general medical specialty.

Methods:

We identified trainees within the general medical specialty on approved time out of training, and circulated communication via emails and flyers regarding the UPDATES course to them as well as our trust’s medical resourcing department, postgraduate department, college tutors and clinical directors. Our sessions consisted of workshops including interesting cases, new guidelines, and simulated communication scenarios. The courses were delivered by simulation faculty and held virtually, with the morning to read course materials and the afternoon to work through cases. Participants were asked to complete pre- and post-course surveys to enable a full understanding of their experience during time out of training and its subjective impact on clinical and non-technical skills.

Results:

Pre-course survey showed participants had been out of training for at least 2 months due to maternity and sickness. At least 20% of participants felt their clinical and non-technical skills had changed since last working and only 40% felt connected to their trust and department. Candidates reported feeling “loss of confidence and lack of clinical knowledge”, “anxious”, “work related stress issues” and “lack of support”. Post-course survey revealed all candidates felt better connected to the trust and the course helped maintained their clinical and non-technical skills. Candidates reported “a great interactive session”, “every department should run a course like this to keep maximum people updated” and “enjoyed the format, very interactive and informative”.

Discussion:

Our findings are synonymous with that of Health Education England. Trainees report lack of confidence and pastoral support during time out of training. We have shown the delivery of virtual simulated courses addresses these issues and maintains clinical and non-technical skills to support return to 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.

References

1. SuppoRTT [Internet]. Health Education England. 2017; Cited 30/04/2024. Available from: https://www.hee.nhs.uk/our-work/supporting-doctors-returning-training-after-time-out.

Simulation has repeatedly been shown to be an effective method of teaching medical students [1, 2]. Most sessions are short and do not highlight the challenges of working 12-hour shifts, including prolonged stress and exhaustion.

Wilderness medicine is not often covered on UK medical school curricula, yet, is gaining popularity. The medical knowledge and human factors required for this speciality provide scope to develop skills for the UK Foundation Programme. Simulation facilitated experiential learning, exposes students to unique challenges requiring problem-solving and non-technical skills, reflecting those needed as a foundation doctor.

We developed a cost effective, high yield simulation exposing students to wilderness medicine, whilst challenging them to develop skills to aid them in the transition to the Foundation Programme.

Methods:

A Wilderness Medicine themed continuous simulation lasting 24 hours was presented to students. Challenging them to handle multiple scenarios after little rest. Designed and instructed by student doctors, it was reviewed and improved over four iterations. Each year the committee from the previous year met to reflect on their experiences and verbal feedback from participants to drive improvements in the next iteration.

Learning outcomes assessed continually were threefold, Human Factors, exposure to speciality and case specific learning outcomes. Outcomes were debriefed by the faculty the day after the simulation.

Results:

Four iterations ran between 2019-2024 (2020/2021 hiatus due to COVID19). Re-attendance of both candidates and faculty was high, demonstrating this unique opportunity to experience an intense 24-hour simulation outside that of regular teaching opportunities [3].

Qualitative, informal, verbal feedback from candidates highlighted common themes such as: “developing resilience to work in unfamiliar, stressful or unforeseen circumstances”, “working safely when tired” and “recognising stressors to managing personal wellbeing “. Developmental feedback focused the project to support the learning needs of students approaching Foundation training.

Discussion:

The project has improved over four years with high attendance, receiving hugely positive feedback from participants and faculty alike. With few resources it is possible to run a 24-hour continuous simulation, challenging students to manage stressful and unfamiliar situations.

This course facilitated self-development and reflection by students; with a focus on the human factors skills that will aid in their transition to the Foundation Programme, alongside developing experience in the subspeciality of wilderness medicine.

Continued improvement from junior doctors who attended the course demonstrates sustainable change; with a framework now in place so the program can be replicated with ease with further iterations and continuous improvement cycles.

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.

References

1. Training and simulation for patient safety. Quality Safe Health Care. 2010;19(suppl 2):i34–i43.

2. Emily Appadurai Faris Hussain, Melanie Cotter KJ. A106‘FY1 for a day’ an immersive programme to prepare final year medical students for foundation training [Internet]. International Journal of Healthcare Simulation. 2023. Available from: https://www.ijohs.com/article/doi/10.54531/WXTU6327.

3. Kiknadze NC, Leary. Comfort zone orientation: Individual differences in the motivation to move beyond one’s comfort zone. Pers Individ Dif [Internet]. 2021;181:111024. Available from: https://www.sciencedirect.com/science/article/pii/S0191886921003998.

The importance of non-technical skills for improving safety and efficiency in healthcare is well established, with a variety of behavioural marker systems (BMS) evolving to provide structure for the training and assessment of these behaviours [1].

Endoscopy Non-Technical Skills (ENTS) is a bespoke BMS initially developed to support trainee endoscopists in the UK. 14 years after first publication it is viewed as a valid, reliable, and effective tool for appraising individual and team non-technical skills with frequent application in research, education, training and practice [2].

The recent Joint Advisory Group ‘Improving safety and reducing error in endoscopy’ report identifies inconsistencies in the delivery of ENTS training, highlighting a need for a nationwide simulation-based approach [3]. We detail the method adopted by the Scottish National Endoscopy Training Programme (NETP) to address this need.

Methods:

Experts from clinical practice, education and simulation formed our faculty group, with aims to collaboratively develop an immersive simulation programme and oversee its delivery, and evaluation. Faculty development was achieved through completion of Clinical Skills Managed Education Network (CSMEN) faculty development e-learning resources and a 2-day introduction to simulation course.

Five scenarios were developed, based on breakdowns in non-technical skills commonly experienced in endoscopy. Intended learning outcomes and potential observable behaviours were mapped to ENTS to ensure each domain was represented and to provide cues for discussion during debrief. An ENTS handbook was provided as pre-reading and micro-teaching sessions were developed to introduce key concepts. The Scottish centre debrief model was used to structure the debriefing process.

Evaluation was achieved through post-course participant questionnaires. Faculty evaluation was delivered through self-reflection, iterative feedback, and meta-debriefing from simulation faculty.

Results:

The programme was successfully developed and delivered to 84 delegates, across 6 Sim centres. Participants reported positive experiences of simulation, improved knowledge of non-technical skills, and confidence in recognising areas for improvement in practice.

Emerging evidence from regions with prior attendance report improved safety briefing processes and increased utilisation of tools shared within the course. Wider impact evaluation is planned.

Discussion:

This method provides an effective way to onboard clinical faculty, facilitate mixed-discipline co-development and integrate an established BMS to scenario writing and debriefing processes with potential transferability to other fields. Key themes from delegate feedback suggest that engagement with the programme carries the potential to improve patient safety by emphasising the importance of civility, flattened hierarchies, strong team dynamics, shared decision making and improved communication.

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.

References

1. Prineas S, Mosier K, Mirko C, Guicciardi S. Non-technical skills in healthcare. Textbook of Patient Safety and Clinical Risk Management. 2021:413–434.

2. Ravindran S, Haycock A, Woolf K, Thomas-Gibson S. Development and impact of an endoscopic non-technical skills (ENTS) behavioural marker system. BMJ Simulation & Technology Enhanced Learning. 2021;7(1):17.

3. Joint Advisory Group on Gastrointestinal Endoscopy. Improving safety and reducing error in endoscopy (ISREE) implementation strategy.

The transition from higher specialist training to consultant is challenging. While trainees feel comfortable with the clinical management of patients, they feel unprepared for the consultant role [1]. SimWard Wolverhampton NHS Trust conducted a survey between 2023-24 which revealed that higher specialty trainees felt a lack in confidence, preparedness and understanding of a consultant’s role. They also reported a lack of exposure in managing complaints and a lack of awareness of support available to them as a new consultant.

These challenges were identified and a high-fidelity simulation-based education (SBE) course was piloted in 2023, preparing higher specialty medical trainees for a consultant role. Following its innovative success, this course has now been incorporated within internal medicine regional training programme. After a year of delivery, pre-and post- course feedback were reviewed to assess course impact on trainees’ perception of readiness.

Methods:

High-fidelity SBE was delivered between 2023-2024 to higher specialty trainees transitioning to consultant role within the next year. The course consisted of 4 workshops and 4 simulated scenarios addressing clinical metacognition, debriefing, post-take ward round, complaints management, conflict management and being a consultant. Pre- and post-course feedback were collected to assess perception of the course and areas of improvement.

Results:

Post-course feedback showed there were significant improvement in the number of candidates reporting an understanding of the roles and responsibilities of a consultant and an understanding of the support networks available to them as a new consultant. The candidates also reported an increase in confidence in the following: carrying out a post-take ward round, managing formal complaints, respectfully challenging colleagues, and escalating concerns about a colleague (Table 1-A53). Other relevant topics candidates suggested they would like to see in this course were job planning, preparation for coroner’s court, more conflict resolution, and more scenarios.

Discussion:

Results show that despite seven years of specialty training, higher specialty trainees still feel underprepared for their role as a new consultant. The overwhelming positive post-course feedback shows SBE addresses these concerns and gives higher specialty trainees the toolkit they to prepare them for consultant role. Therefore, a wider implementation of consultant preparation courses in the form of SBE is needed across specialties.

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.

References

1. Flavell S, Robinson A, Dacre J. The transition to consultant: Identifying gaps in higher specialist training. Clinical Medicine (London, England). 2020;20(4):406–411.

Table 1-A53.

Pre- and post-course feedback from higher specialty trainees following a high-fidelity SBE course to support transition from higher specialist training to consultant

	Pre-course feedback (%)	Post-course feedback (%)
I understand the roles and responsibilities of a consultant	80.0%	97.6%
I understand the support network available to me as a new consultant	34.3%	90.2%
I feel confident in carrying out a post-take ward round	77.1%	97.6%
I am confident in managing formal complaints	28.0%	90.0%
I feel confident to respectfully challenge colleagues	45.7%	92.7%
I feel confident to escalate concerns about a colleague	57.1%	90.2%

NHS England’s workforce plan details ambition to almost double the number of adult nurse training places by 2031. Universities across the UK are seeing record number of student admissions however, student nurse attrition remains a concern. An average attrition rate across all institutions in the UK is 24% [1]. Transitioning to university life requires students to adapt and integrate, formulating social connections that help foster a sense of belonging [2]. Nursing practice placement can cause feelings of nervousness and anxiety due to the anticipation of unfamiliar environments and responsibilities.

Research Question: “Can simulated practice within university curriculum effectively acclimate students to clinical environments, instilling requisite responsibilities whilst nurturing community building and safeguarding psychological well-being?”

Methods:

A collaborative approach was undertaken to develop the simulated practice. This involved students, academic leads and practice partners. Face-to-face meetings and on-line surveys captured indispensable elements of the curriculum. The timetable provided comprehensive and diverse opportunities for students to engage in a wide range of simulated clinical practices including: patient history taking, personal cares, A-E assessments, manual handling, patient assessments and emergency care. A scaffold approach was used giving students individual elements that would build momentum towards the grand finale ‘day in the life’ working as student nurses on a simulated ward.

A four-week programme was delivered between December and January 2023. The programme consisted of 196 students achieving 150 clinical placement hours. Students were allocated to community groups; each community were allocated a practice supervisor that was accessible throughout the placement.

Evaluation was carried out in stages and included a combination of quantitative and qualitative methods. Students carried out a formative mid-point assessment capturing their initial responses and an end-point self-assessment based around the learning outcomes.

Results:

Results highlighted various positive impacts that the programme had on students. Students consistently self-evaluated an improvement in knowledge, skills and behaviours alongside a significant increase in confidence, development of interpersonal connections and personal growth. Figure 1-A52 presents the students’ pre- and post-placement evaluation.

Figure 1-A52.

Discussion:

In summary, the simulated practice created an extremely positive experience that acclimates students to clinical practice and provides opportunity for developing community and safeguarding well-being. In line with the increasing student admission numbers, delivering transformative simulation to larger cohorts will be our future focus whilst ensuring authenticity and sustainability.

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.

References

1. Health Foundation. How many nursing students are leaving or suspending their degrees before graduation? [Internet]. 2024. Available from: How many nursing students are leaving or suspending their degrees before graduation? (health.org.uk).

2. Thompson M, Pawson C, Evans B. Navigating entry into higher education: the transition to independent learning and living. Journal of Further and Higher Education. 2021;45(10):1398–1410.

Junior doctors and undergraduate medical students often describe feeling unconfident describing skin lesions [1]. This is likely multifactorial, as a result of varying clinical exposure, tutor experience and length of clinical placement. Traditional learning formats such as lectures and tutorials are modalities that are commonly used in undergraduate dermatology teaching. Dermatology is heavily reliant on clinical examination findings; the question arises of whether this speciality can be taught via a lecture-based approach. Skin manifestations of pathologies are regularly encountered by physicians, with 25% of GP consultations assessing skin lesions [2]. Therefore, adequate dermatology training at an undergraduate level is paramount.

Methods:

We created a simulated dermatology clinic, with the help of third year students who volunteered as role-players. We created common dermatological lesions with the use of modern moulage on students of varying skin textures and colour. Third year students were briefed on the conditions. Fourth year students had the opportunity to take a focussed dermatology history, examine the lesion and formulate a management plan.

Results:

Before the session, we assessed the third- and fourth-year students’ exposure and confidence to dermatology, with 100% students rating as ‘minimal’. Pre- teaching 60% of fourth year students felt they would be able to identify common skin conditions ‘with assistance’. This improved to 70% of students feeling ‘very confident’ to identify common skin conditions post facilitated near-peer teaching. 100% third year students felt more confident in transitioning into fourth year, in which dermatology is part of their curricula.

Discussion:

The diverse simulated clinic format allows the students to clinically examine the lesions. The use of near-peer teaching with senior students imparting dermatological knowledge to junior students has been proposed3. However, to date and to our knowledge there has not been a study on proposing facilitated near-peer simulation with junior medical students in an upward mentoring approach. This teaching method enables third year medical students to gain an early exposure to dermatology, build confidence and reinforces continuous learning which is at the core of medicine. Above all, this format challenges the notion of hierarchical teaching. Use of facilitated upward mentoring benefits both junior and senior medical 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.

References

1. Chiang YZ, Tan KT, Chiang YN, Burge SM, Griffiths CE, Verbov JL. Evaluation of educational methods in dermatology and confidence levels: a national survey of UK medical students. International Journal of Dermatology. 2011;50(2):198–202.

2. Schofield JK, Fleming D, Grindlay D, Williams H. Skin conditions are the commonest new reason people present to general practitioners in England and Wales. British Journal of Dermatology. 2011;165(5):1044–1050.

3. Elamin S, Boohan M. Non-traditional teaching methods in undergraduate dermatology training: a scoping review. MedEdPublish. 2021;10:165.

The Organ Donation Taskforce recommend “staff involved in the treatment of potential organ donors should receive mandatory training in the principles of donation” [1]. Additionally, donation facilitation is within intensive care and anaesthetic curricula [2]. Clinical training in donation is challenging and opportunities are infrequent, making simulation training desirable. However, the National Deceased Organ Donation Course by NHS Blood and Transplantation (NHSBT) is reserved for senior intensivists and is consistently oversubscribed. We aimed to develop a programme to provide accessible simulation experience for all team members involved in donation and enable doctors to meet their training requirements.

Methods:

In collaboration with NHSBT we created three modules: Diagnosing Death using Neurological Criteria (DNC), Donor Management and Optimisation (DMO) and Donation after Circulatory Death (DCD). Pre-learning webinars provided information in advance, maximising time to explore human factors and psychological aspects during simulation training. We piloted in-situ modules at several London Intensive Care Units (ICUs) with support from Specialist Nurses in Organ Donation (SNODs). Delegates completed pre- and post-course surveys assessing technical knowledge and rating confidence levels using a Likert scale. Paired one-sided Wilcoxon signed-rank tests were used to test for significantly greater median post-course confidence scores, with p-value adjustment for multiple comparisons using the False Discovery Rate (FDR) method [3].

Results:

A total of 30 delegates attended 5 MEPOD modules across 3 London hospitals between November 2023-January 2024. 100% of delegates would recommend to their colleagues. Confidence working with a SNOD improved by 23% and confidence diagnosing and recording circulatory death improved by 38%. Table 1-A49 demonstrates higher median post-course confidence scores for every question for all courses. There were significantly greater post-course confidence scores (FDR-adjusted p < 0.05) for all questions except one.

Table 1-A49.

The 6 questions testing confidence levels in delegates for each module. Pre-course median and post-course medians were calculated. P-values were adjusted for multiple comparisons using the False Discovery Rate adjustment of Benjamini and Hochberg [3]. Green shows significant p-values (p<0.05). Red shows non-significant p-value.

Discussion:

We have demonstrated successful implementation of a modular educational simulation programme resulting in improved confidence managing organ donation across a range of delegates within London. It was challenging to condense a 2-day national course aimed at seniors into modular format aimed at the multidisciplinary team. Barriers to attendance were overcome by providing pre-learning and delivering short in-situ simulation modules. Due to small delegate numbers, we were unable to account for the effects of delegate seniority and course location on differences in pre- and post-course confidence. This novel project has increased accessibility to organ donation education across our region, which we aim to expand nationally with the support of NHSBT educational leads.

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.

References

1. Department of Health. Working Together to Save Lives. The Organ Donation Taskforce Report, 2011. Available from: https://bts.org.uk/wp-content/uploads/2016/09/The-Organ-Donation-Taskforce-Implementation-Programmes-Final-Report-2011.pdf.

2. The Faculty of Intensive Care Medicine. ICM curriculum: supporting excellence for a CCT in Intensive Care Medicine, 2021. Available from: https://www.ficm.ac.uk/sites/ficm/files/documents/2022-03/ICM%20Curriculum%202021%20v1.2.pdf.

3. Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. Journal of the Royal Statistical Society Series B (Methodological). 1995;57(1):289–300.

Simulation-based surgical training has revolutionised contemporary medical education by providing a controlled environment for learners to develop clinical skills and enhance patient safety [1]. Despite its widespread adoption, there remains a gap in understanding the perceptions and values that surgical consultants hold toward simulation-based methodologies [29. This study aims to explore instructors’ viewpoints comprehensively to improve the effectiveness of surgical training programs.

Methods:

Consultant surgeons teaching a course at a large London teaching hospital were invited to complete an 8-item survey exploring their enjoyment of teaching, enthusiasm for educational subjects, and perceptions of simulation’s significance, followed by a one-to-one in-depth interview. Thematic analysis was performed on the qualitative data.

Results:

Eleven surgeons specialising in General, Paediatric, Orthopaedic, and Ear, Nose, and Throat Surgery participated in the study. Enthusiasm for teaching was high (mean: 4.7/5) and simulation was viewed as valuable for effective learning and practice (mean: 4.8/5). Participants endorsed the role of simulation in translating theoretical knowledge into practical skills, enhancing patient safety, and fostering enjoyable learning experiences.

Qualitative analyses disclosed instructors’ perspectives on the ability of simulation to prepare novices for surgical procedures and enhance anatomical comprehension. A prevailing theme of scepticism among surgical educators towards simulation-based methodologies emerged, with references for traditional teaching methods such as real-life experiences and procedural demonstrations due to their perceived authenticity and effectiveness in providing realistic hands-on experiences for learners.

Discussion:

This study demonstrates that despite the recognised value of simulation, a significant proportion of consultant surgeon instructors still hold a preference for traditional teaching methods. These findings underscore the importance of addressing the prevailing scepticism among surgical instructors towards simulation-based methodologies, which may contribute to disengagement and suboptimal learning outcomes among students [3]. Encouraging enthusiasm among surgical simulation instructors is essential to optimising student learning experiences and overcoming scepticism towards innovative teaching approaches. Professional development initiatives focusing on motivation and instructional strategies can reignite enthusiasm and improve teaching effectiveness.

This study reveals a dichotomy in surgeons’ attitudes towards simulation-based training, with high enthusiasm for teaching and recognition of simulation’s value countered by persistent scepticism towards its effectiveness compared to traditional methods. Addressing this scepticism is crucial for optimising learning outcomes and improving surgical education. Encouraging instructor enthusiasm through targeted professional development can promote innovative teaching approaches. This research emphasises the importance of overcoming scepticism to enhance medical training programs, advancing simulation-based education, and fostering safer environments for future 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.

References

1. Evgeniou E, Loizou P. Simulation-based surgical education. ANZ Journal of Surgery. 2013;83(9):619–623.

2. Chernikova O, Heitzmann N, Stadler M, Holzberger D, Seidel T, Fischer F. Simulation-based learning in higher education: A meta-analysis. Review Educational Research. 2020;90(4):499–541.

3. Frenzel AC, Goetz T, Lüdtke O, Pekrun R, Sutton RE. Emotional transmission in the classroom: exploring the relationship between teacher and student enjoyment. Journal of Educational Psychology. 2009;101(3):705–116.

There is a growing demand for undergraduate student simulation nationally to improve preparedness for practice. Simulation can provide equitable access for students to different paediatric emergencies that can be missed during increasingly short placements and allow students to engage with scenarios in a more purposeful way than can be safely accessed on the ward. We aimed to introduce a simulation programme to improve medical student confidence in GMC focused outcomes for graduates [1] to better prepare these students for graduation.

Methods:

Students rotating through West Middlesex University Hospital for a paediatric rotation were timetabled one half-day simulation session in the penultimate week of a 6-week placement between November 2023 and March 2024. This session comprised of an introductory lecture into human factors and crisis resource management before completing three simulation scenarios including one communication skills focused station. Students were invited to complete a questionnaire at the start of the day and after the final simulation session to assess key learning outcomes outlined by the university curriculum, as well as exposure to eleven common paediatric emergencies. Debriefing was led by trained facilitators at varied stages of postgraduate training using the debrief diamond model [2]. Statistical significance was assessed using the student’s T-test.

Results:

Eighteen students took part in the simulation day, seventeen completed both pre- and post- session feedback. During their placement students only had been exposed to an average of 4 (range 3-6) of 11 common paediatric emergencies as identified by the Imperial medical curriculum. Students’ average confidence significantly improved in recognising a deteriorating child (p = 0.0013), taking a leadership role (p < 0.0001), initiating management for a deteriorating child (p = 0.0198), working together in a team in a clinical setting (p = 0.015) and completing an “iSBAR” handover (p < 0.0001). There was no significant improvement in students’ confidence escalating an unwell child to a senior (p = 0.1004) or requesting help from other colleagues (p = 0.0573). All seventeen students would recommend the session to a friend. Instructors felt the course benefited from the heterogeneity of experience amongst faculty.

Discussion:

Simulation was successful in improving student confidence in most major domains. In those domains that did not demonstrate a statistically significant improvement, this could perhaps be attributed to higher starting confidences. Through placement alone students do not garner sufficient exposure to a range of paediatric emergencies.

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.

References

1. General Medical Council. Outcomes for graduates 2018 [Internet]. United Kingdom: General Medical Council. 2018 [updated 2020; cited 2024 April 20]. Available from: https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/outcomes-for-graduates/outcomes-for-graduates.

2. Jaye P, Thomas L, Reedy G. ‘The Diamond’: A structure for simulation debrief. Clinical Teacher. [Online] 2015;12(3):171–175. Available from: doi:10.1111/tct.12300.

A level 5 (year 2) interprofessional falls simulation was developed for undergraduate healthcare students in Cardiff University to increase opportunities for interprofessional simulation across undergraduate, pre-registration healthcare programmes. Interprofessional simulation improves team performance and communication skills [1]. Falls are a major public health problem globally with older people at highest risk of serious injury or death and younger children being another high-risk group [2]. Falls was identified as a common curricular component for all healthcare professions. The aim is to present the evaluation findings from the launch of the interprofessional falls simulation.

Methods:

A one hour falls simulation scenario was designed which included a facilitator and student guide by an interprofessional working group consisting of champions from healthcare professions of the targeted learners. Staff training was delivered to support facilitation and debriefing skills. Sessions were co-facilitated and debriefed by two facilitators from different professions. An online JISC student evaluation survey was developed incorporating the SPICE-R tool [3] for IPE and to gain qualitative feedback. A separate online evaluation form was created and completed by facilitators post session.

Results:

The falls scenario was successfully implemented and evaluated across seven undergraduate programmes between September-November 2023. Of the 306 students that attended, n= 210 (69%) completed the evaluation survey. Ninety percent agreed/strongly agreed the session was relevant to their practice and enhanced their future ability to work on an interprofessional team and 86%-91% that it was useful, well facilitated, met the learning objectives and will influence their future practice (see Figure 1-A42). Student feedback regarding what was most useful included; ‘practicing a real-life scenario and getting feedback’ and understanding ‘how to work as a team with other health care professionals when fall occurs’ and ‘what each role does’. The least useful aspect was the duration; ‘having it only for 1 hour’. Facilitator feedback was also positive; ‘It was a good IPE for staff too!’ and ‘good to work with another member of staff from a different profession as we each had valuable insights we could add’.

Figure 1-A42.

Discussion:

Students benefitted from this experience and enjoyed working with other health professionals. Importantly, it introduced students to interprofessional team working in a simulated environment pre-registration. The session will be lengthened in response to the evaluation feedback. Facilitators felt the co-debrief was valuable in role modelling interprofessional working. In conclusion, it was a successful first run of this simulation for healthcare 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.

References

1. Blackmore A, Kasfiki EV, Purva M. Simulation-based education to improve communication skills: a systematic review of the past decade. Human Resource Health. 2020;18(1):2.

2. World Health Organisation (WHO). Falls, World Health Organisation, Falls (who.int). 2021. [Accessed 16 April 24].

3. Zorek JA, MacLaughlin EJ, Fike DS, MacLaughlin AA, Samiuddin M, Young RB. Measuring changes in perception using the student perceptions of physician-pharmacist interprofessional clinical education (SPICE) instrument, BMC Medical Education. 2014;14:101.

In the UK, only 1% of people die in a way that enables organ donation to be a possibility. This means that every opportunity for donation is extremely important to get right.

In 2021, three trainee leads for organ donation (TRODS) were appointed in Scotland. One of our aims was to identify gaps in teaching and training relating to organ donation. A national survey was distributed, and the findings demonstrated a clear lack of confidence in donation after cardiac death (DCD) and withdrawal of life sustaining treatment (WLST) for DCD. Respondents also felt that they had not received sufficient training in brain stem death testing. It was clear that further training and education was needed and in collaboration with NHS Blood and Transplant, the multidisciplinary Scottish Organ Donation Simulation Course (SODS) was established.

The aim of the course is to provide immersive clinical situations in which candidates can gain confidence in practical and communication skills and overall preparedness for dealing with these precious organ donation scenarios within the critical care environment.

Methods:

In November 2023, the first simulation session was delivered. A mix of simulated patients and high-fidelity manikins were used to create the learning experiences. The course focused on practical and communication skills in relation to BSD, DCD, WLST within a critical care environment. The specialist nurses for organ donation were fully integrated and immersed into the communication scenarios demonstrating their verbal and nonverbal skills with bereaved families [1]. Our use of simulated patients created an environment that reflected real life practice and allowed the candidates to feel both the emotion and challenges of these situations [2]. A multidisciplinary approach to the course created a more inclusive simulated learning environment where the clinical expertise and experience of each candidate were fostered by the mixed medical and nursing faculty.

Results:

Feedback was extremely positive and reflected the benefit of using simulation to facilitate learning. Comments such as “high fidelity” and “excellent facilitation for discussion and real time feedback” were included. Overall, this highlighted the benefit of establishing a Scottish simulation course.

Discussion:

With such positive feedback and a clear demonstration of an educational gap, NHS Education for Scotland with the support of NHSBT are now funding the SODS course. This will help to embed organ donation simulation into the national curriculum, enable greater access to education for the multidisciplinary team and promote clinical excellence within our Scottish critical care units.

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.

References

1. Morgan J, Hopkinson C, Hudson C, Murphy P, Gardiner D, McGowan O, Miller C. The Rule of Threes: three factors that triple the likelihood of families overriding first person consent for organ donation in the UK. Journal of the Intensive Care Society. 2018;19(2):101–106.

2. Potter JE, Elliott RM, Kelly MA, Perry L. Education and training methods for healthcare professionals to lead conversations concerning deceased organ donation: An integrative review. Patient Education and Counseling. 2021;104(11):2650–2660.

Quality Improvement Project: Assessing the Impact of an Ageing Experience Workshop on Undergraduate Medical Students’ Approaches to Elderly Care.

As part of the curriculum, third-year medical students are introduced to care of elderly patients and ageing related conditions. Current teaching methods and simulation experiences were reviewed, which revealed a potential area for improvement. Through the introduction of an “Ageing Experience Simulation Workshop”, this project aimed to improve students’ understanding of the ageing process, enhance empathy, and positively influence their attitudes towards older adults.

The workshop was well received by students and was able to positively impact their learning, across five domains. Thus, future work could focus on improving clinical practice.

Methods:

Cohorts of third year medical students (first clinical year) at a single site teaching academy used a 2.5-hour workshop that aimed to mimic different aspects of ageing. We simulated 5 domains: sarcopenia, peripheral neuropathy, visual impairment, hearing impairment and mobility disability [1]. A 5-point Likert scale was used with a pre- and post- workshop questionnaire with a total of 15 questions to evaluate the students’ feelings regarding elderly patients. Questions were framed in both positive and negative ways based on work by UCLA Geriatrics Attitudes (UCLA-GA) scale and Polizzi’s refined version of the ageing semantic differential [2, 3].

Results:

A total of forty-nine students were included. From comparison between pre-workshop and post-workshop questionnaire, 5 questions yield a significant shift (P<0.01) in response towards strongly agreeing. These included students reported confidence in understanding ageing, a feeling of empathy towards elderly patients, understanding sight issues, understanding communication difficulties, an understanding of mobility issues experienced in the elderly and felt the need for additional care in elderly patients. The remaining questions had no significant changes in response.

Discussion:

This project was designed for medical students to have an experience of ageing and reflect on their experiences. The workshops were facilitated by undergraduate faculty of medical educators familiar with the undergraduate curriculum and debriefing. The elderly can experience several age-related changes which can each affect their body. Results showed that the understanding of age-related conditions did improve which was an aim of the workshop. Separating individual effects of ageing allowed for focus on body systems and preventing overwhelming sensory and motor deprivation when mimicking the ageing process. The results show a clear positive improvement in confidence in the understanding of common age-related changes. The application to the wider curriculum and understanding for medical students cannot be understated.

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.

References

1. Bennett P, Moore M, Wenham J. The PAUL Suit©: an experience of ageing. The Clinical Teacher. 2016;13(2):107–111.

2. Polizzi KG. Assessing attitudes toward the elderly: Polizzi’s refined version of the aging semantic differential. Educational Gerontology. 2003;29(3):197–216.

3. Reuben DB, Lee M, Davis JW, Eslami, Osterweil DG, Melchiore S, et al. Development and validation of a geriatrics attitudes scale for primary care residents. Journal of the American Geriatrics Society. 1998;46(11):1425–1430.

Acknowledgments:

Special thanks to the Worcestershire Acute Hospitals NHS Trust Undergraduate Teaching Academy

Preparing for Consultant courses often focus on what trainees think the challenges of stepping up will be [1]. A Training-Needs Analysis (TNA) suggested West Midlands O&G trainees felt writing business cases, understanding NHS finance and job planning would be their biggest challenges as new consultants where conflictingly, a survey of local consultants felt the challenges were managing on calls, difficult clinical cases and colleagues, and also job planning.

Methods:

We devised a pilot course focusing on these latter elements, with a focus on really understanding the role of the consultant and the professional behaviours underpinning it, through a blend of faculty led workshops and simulated scenarios. The faculty leading the 9 candidates were well established consultants with a varied background of non-clinical interests, including research, QI and innovation, service development and postgraduate education. They were supported by SimWard faculty and an actor.

To support the aim of developing a deeper appreciation of the roles & responsibilities of a modern NHS consultant, we developed a novel session based on the idea of “speed dating”. This allowed the trainees to spend 10 minutes with each Consultant asking questions the candidates devised based on a short CV around their work life, areas of non-clinical interest and work-life balance.

Understanding job planning was brought to life through the Game of Job Planning, based on a board game with a set job plan, where the roll of a dice threw in work and life challenges to navigate.

The simulated sessions focused on managing challenging conversations with colleagues, handling complaints and managing logistical challenges of running on calls.

Results:

A post course survey revealed 80% of candidates strongly agreed they now felt more confident about being a consultant. All candidates agreed or strongly agreed they understood the roles and responsibilities of a Consultant compared with only 37% prior to the course. Comments included “Great, interactive course in a non-judgmental supportive learning environment.... made me feel better prepared for a Consultant role (and excited).”Fantastic job planning game...job planning never made sense until today”.

Discussion:

The candidates were unanimous that this course is essential for ST7, as we were able to teach things which aren’t covered in the standard curriculum. The job planning game was the highest rated session, demonstrating gamification of a typically dull topic can bring it to life whilst also promoting deep understanding. The course is rolling out to all O&G ST7 in the West Midlands.

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.

References

1. BMJ Careers. Five areas new consultants might want to consider beefing up their skills in. 4 Nov 2019.

The UK medical workforce has seen a significant increase in international medical graduates (IMGs) in recent years, with a surge of 121% between 2017 and 2021, making up 50% of the new starters in the workforce in 2021, with the majority (84%) originating from South Asia, the Middle East, and Africa [1]. Despite evidence of proficiency in English, IMGs face challenges in effective communication due to differences in culture, dialect and idioms [2]. This study aimed to assess whether simulations (SIMs) focused on difficult conversations could enhance IMGs’ confidence and ability to communicate professionally in English.

Methods:

Scenarios on safeguarding adults and vulnerable children, resuscitation status discussions, and duty of candour conversations were developed and delivered to IMGs who were new to the NHS during their Trust induction as a half-day course. Local faculty acted as patients with the aid of low fidelity manikins. One IMG led each SIM, while others observed aspects of the non-verbal and verbal communication, supported by set criteria [3]. References discussed in debriefing were sent to attendees by e-mail post course. Pre- and post-course surveys were employed via Microsoft Forms to measure changes in self-confidence and ability using 5-point Likert scales as open questions. Statistical significance was calculated using the paired samples t-test.

Results:

Majority of the IMGs (n=32) wanted to improve their communication skills (94%), management of difficult situations (88%) and understanding of the NHS (81%) prior to the course. Before the SIM, the mean confidence of the IMGs on their ability to practice was 3.87 out of 5. After the session, mean confidence rose to 4.39 out of 5 (increased by 0.52, p <.00001). In terms of strategies to raise concerns, mean confidence was 3.81 improving for 4.23 out of 5 after the session (increment of 0.43, p=0.00073). Receptiveness to feedback mean prior to the SIM was 4.13 increasing to 4.45 out of 5 after the session (gain of 0.32, p= 0.00543). IMGs reported improvement in communication skills (83%), namely in phrasing during difficult conversations (78%) as a significant learning point as better adherence to trust guidelines (62%), Figure 1-A37.

Figure 1-A37.

IMGs Simulations Feedback

Discussion:

SIMs focused on non-technical skills can enhance IMGs’ confidence and ability to communicate professionally in English. To further improve confidence and ability, follow-up sessions could be offered to smaller groups, with the use of microphones to facilitate listening during SIMs.

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.

References

1. General Medical Council. The State of Medical Education and Practice in the UK: Workforce Report 2022 - Full Report [Internet]. Available from: https://www.gmc-uk.org/-/media/documents/workforce-report-2022---full-report_pdf-94540077.pdf.

2. Health Education England. Welcoming and Valuing International Medical Graduates: A guide to induction for IMGs [Internet]. Available from: https://www.e-lfh.org.uk/wp-content/uploads/2022/06/Welcoming-and-Valuing-International-Medical-Graduates-A-guide-to-induction-for-IMGs-WEB.pdf.

3. Occupational English Test. Speaking Assessment Criteria - Updated 2018 [Internet]. Available from: https://prod-wp-content.occupationalenglishtest.org/resources/uploads/2018/08/22102547/speaking-assessment-criteria-updated-2018.pdf.

This abstract presents a comprehensive overview of our organisation’s journey towards re-accreditation with the Association for Simulated Practice in Healthcare (ASPiH), the UK’s national simulation accrediting body. Following initial accreditation in March 2021, several recommendations were made, necessitating a thorough evaluation of specific areas of our simulation education practices. The primary focus was on addressing identified needs, ensuring alignment with accreditation standards, and fostering continuous improvement in simulation-based education [1].

Methods:

Over the intervening three-year period, we reviewed the ASPiH recommendations and gradually revised our simulation education practice, encompassing updates to our programme evaluation, faculty training, and stakeholder engagement. Working with the original standards, in tandem with the updated standards, we wanted to work in a progressive way, matching to both the original and current 2023 standards [2]. Every staff member within the organisation was involved and led on a dedicated area of improvement, with regular standards update action planning sessions, consulting stakeholders, simulated patients and patient groups. We worked with a three-year Gantt chart, watching our progress in a visual manner.

Results:

Through diligent efforts, significant progress has been made in enhancing simulation education practices. A comprehensive summary can be found in table 1, but these are key take-aways: Peer reviews are undertaken at regular intervals ensuring educator competence in the debriefing process, addressing the recommendations of Standard 3. Regular programme and faculty evaluations are conducted to maintain content relevance, meeting the requirements of Standard 8. Formal policies have been established to address faculty responsibilities for patient safety and learner performance concerns, as per Standard 11, and robust documentation for quality assurance has been developed, aligning with Standard 21, Table 1-A36.

Table 1-A36.

Recommendation from 2021 accreditation and responses for 2024 re-accreditation

Discussion:

By addressing the recommendations outlined by ASPiH in 2021, we have strengthened our simulation education practices, ensuring alignment with accreditation standards and organisational goals. Accreditation and re-accreditation with ASPiH serve as a catalyst for organisational growth, fostering a culture of excellence and innovation in simulation education [3]. By embracing recommendations and driving continuous improvement initiatives, our organisation remains at the forefront of advancing simulation-based healthcare education, ultimately enhancing patient outcomes and healthcare delivery. From this position, we feel able to support other organisations as they work towards initial or re-accreditation, aligning with the new standards.

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.

References

1. Crawford SB. ASPiH standards for simulation-based education: process of consultation, design and implementation. BMJ Simulation and Technology Enhanced Learning. 2018;4(3):103–104.

2. Diaz-Navarro C, Laws-Chapman C, Moneypenny M, Purva M. The ASPiH Standards—2023: guiding simulation-based practice in health and care. Available from: https://aspih.org.uk.

3. Bohnert CA, Lewis KL. Certification, accreditation and professional standards: striving to define competency, a response to ASPiH Standards for Simulation-Based Education: Process of Consultation, Design and Implementation. BMJ Simulation and Technology Enhanced Learning. 2018;4(3):105–107.

In-situ simulation (ISS) is widely recognised to improve team working and to identify patient safety threats [1-2]. Anecdotally, the greatest barrier to overcome in delivery of ISS is workload and availability of facilitators. Our aim was to establish ISS within the everyday work environment as an opportunistic learning session.

Methods:

A group of 10 facilitators were recruited to the scheme. Each were given a briefing document and access to a bank of scenarios. 2 facilitators itemised equipment already available in the department. ISS sessions were opportunistically delivered when workload allowed by 2 or more facilitators, and roughly occurred on a fortnightly basis. Learning outcomes were disseminated to the department via email after the session and facilitators held responsibility to address safety threats.

Results:

Over a period of 6 months, we have successfully delivered 11 sessions with different clinical themes to 44 staff members (doctors, nurses, physician associates, nursing associates, trainee Nurse Practitioners). On average, the confidence in dealing with the clinical scenarios increased from 1.8 out of 5 (whereby 1 denotes not being confident at all and 5 represents being very confident) to 4.2. Learners can suggest further topics to cover and these are used to plan the next ISS sessions. Through these ISS sessions, we have distributed 5 learning bulletins, as well as exposed latent safety threats which have been raised and acted on within the department. Examples of these some of the threats identified include location of adult drug box, revision of whiteboards in resus and need for ligature cutters.

Discussion:

We have demonstrated that ISS can be embedded into the daily workplace of a busy paediatric emergency department. To successfully deliver ISS, a group of motivated and skilled facilitators can easily deliver frequent short sessions when the correct tools are easily available to them. Our ISS sessions demonstrate that, despite how stretched staff in emergency departments may be, they appreciate opportunities to learn and can help identify safety issues. This in turn will improve staff morale, quality of care and patient satisfaction.

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.

References

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

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

Microcephalic primordial dwarfism is the rarest and most severe form of dwarfism [1]. The associated craniofacial abnormality means patients are difficult to bag mask ventilate and intubate. A patient with primordial dwarfism is transitioning from Alder Hey paediatric hospital to our hospital. The patient requires frequent intubations which were achieved using an asleep, spontaneously breathing fibreoptic technique. This differs vastly from our usual practice in adults. We have developed a standard operating procedure (SOP) for anaesthetising and intubating this patient in our hospital. We are using in situ simulation to test our SOP and improve our system.

Methods:

We provided four x 1-hour high fidelity simulations in our emergency theatre for four different multidisciplinary teams, each comprising six members. We designed a scenario that mirrored the patient’s clinical presentation in an emergency, utilising an interactive paediatric mannequin and an actor as the parent. Each team was required to manage the patient and parent according to the SOP. We noted the behaviours of the teams and how they used the SOP. The simulation was followed by a debrief focusing on human factors.

Results:

Twenty-four candidates participated. Pre-simulation, only 1 candidate (4%) felt confident in using the techniques specified in the new SOP, increasing to 14 candidates (58%) post simulation. We identified the following areas for improvement and have revised the SOP accordingly:

● Make the SOP flowchart role based.

● Modify the SOP to include a “situation report” at 5-minute intervals.

● Make the anaesthetic plan clearer by using headings and coloured highlights.

Discussions in the debrief also identified latent factors in the wider hospital system which we are working to address. These included:

● Would staff on ward areas be skilled enough to recognise an early deterioration in the patient and refer to anaesthetics promptly?

● Would ward areas have adequate paediatric equipment?

● How would an intubation in a non-theatre environment be managed?

Discussion:

In situ simulation has been used to test and improve our SOP and enhance the confidence of our staff. We identified and have started to rectify latent factors within our hospital system. We now plan to:

● Use low-fidelity simulation with a 3D printout of the patient’s head to teach the SOP to the wider team.

● Repeat the high-fidelity simulation to ensure that our system is robust.

● Develop and test an SOP for a non-theatre intubation plan.

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.

References

1. Walking with Giants Foundation. About Microcephalic Primordial Dwarfism [Internet]. Liverpool (UK): Walking with Giants Foundation; 2008 [updated 2019, cited 2024 Apr 21]. Available from: https://www.walkingwithgiants.org/about-mpd/.

In the interprofessional healthcare setting, foundation doctors are expected to to meet mental health competencies outlined in the UK Foundation Training Curriculum 2021 [1]. However, a lack of formal mental health education can lead to diminished confidence and skills in managing patients with acute mental health and physical clinical needs across various clinical settings (e.g. Emergency Department/ED, medical and surgical wards) in doctors and allied healthcare professionals. Recognizing this gap, a simulation-based programme was designed and piloted by foundation doctors, overseen by simulation faculty, to address the needs identified through analysis of cross specialty surveys amongst trainers and learners.

Methods:

The aim of this study was to assess the effectiveness of a one-day learner-designed mental health simulation-based programme for interprofessionals in a tertiary London teaching hospital, featuring four common scenarios. The intended learning outcomes focused on management of acute mental health presentations, risk and safety assessment, application of relevant policies and legislation (e.g., CODE 10 policy, Mental Capacity Act/MCA, Mental Health Act/MHA), and de-escalation techniques. Simulated patient played by professional actors trained in mental health simulation were utilized in scenarios with support from facilitators and technicians, followed by debrief sessions after each scenario. Pre-course and post-course questionnaires, along with verbal feedback, were collected for evaluation.

Results:

Thirteen professionals, comprising 7 doctors and 6 nurses including site nurse practitioner, participated in the programme. Before the course, only 8% of participants had formal mental health training. Only 62% of participants were aware that MHA Section 5(2) cannot be applied in ED. Analysis of pre- and post-course questionnaires revealed a significant increase in confidence levels across various scenarios, such as managing active suicidal ideation (77% uncertain vs. 100% somewhat confident), acute psychosis (92% uncertain vs. 77% somewhat confident), delirium on background of schizophrenia, substance misuse (delirium tremens in acute alcohol withdrawal) and personality disorders (PD), such as borderline PD (BPD). Notably, there was enhanced understanding of CODE 10, de-escalation skills, and application of MHA legislation post-simulation (Figure 1-A33). Participants unanimously found the programme highly useful, citing that high fidelity level was maintained in scenarios with acquisition of soft skills including multi-disciplinary teamwork and prioritization of self-care, psychological and physical safety.

Figure 1-A33.

Discussion:

This study underscores the effectiveness of an interprofessional mental health simulation-based programme designed by learners in bridging the gap in formal mental health education and delivering compassionate, timely and safe mental health care to meet the emerging demand across the NHS.

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.

References

1. Health Education England. UK Foundation Programme Curriculum 2021 [Internet]. UK Foundation Programme NHS. 2021 [cited 2023 Oct 21]. Available from: http://foundationprogramme.nhs.uk/curriculum.

Acknowledgments:

Thank you to simulation faculty, development and technical team, staff from medical and surgical teams, nursing team, senior site nurse manager team, liaison psychiatry team and emergency medicine team who gave invaluable advice on all aspects of the pilot study including scenario design, teaching materials and with running of the pilot simulation programme.

MELISSA (Mobile Educational Learning, Improving Simulation and Safety Activities) is a double decker bus designed to deliver healthcare education and training across the Northeast and North Cumbria [1]. The North East of England is one of the largest geographical areas in terms of a NHS training region. The training region also includes North Cumbria, where NHS workers may face 80-mile (129km) trips to attend training at a main hospital site with clinical education and simulation facilities. The ambition of this innovative project is to deliver clinical training, service delivery or public information campaigns to remote and rural areas. The events supported involve the public, our patients and all members of the NHS workforce.

Methods:

The MELISSA team works in partnership with organisations to support work training and education across all aspects of healthcare. MELISSA can be booked by completion of an event form via the website. The team meet with each partner to discuss the proposed event and how this aligns to either Faculty of Patient Safety objectives, meets a training curriculum need or an NHS strategy [2]. A full-service evaluation is currently being undertaking with an academic partner utilising a ripple effects methodology.

Results:

Since 2020, MELISSA has facilitated 281 events with 23867 delegates on board, 23 clinical training events for example emergency medicine regional teaching and foundation doctors’ teaching/ wellbeing days, facilitated over 500 nursing & midwifery council competence signs offs in rural district hospitals and 41 healthcare careers sessions. MELISSA has worked with Middleborough United Football Club to deliver BLS and AED awareness sessions on match days to football fans and their families. MELISSA has also participated in 118 public awareness sessions and 111 clinical delivery sessions including educational student lead clinics. Recent feedback based on 54 responses from the facilitators who have used the service, utilising a Likert scale of 1-7 (1- very poor, 7 exceptional) showed very positive results with averages greater than 6 in most areas.

Discussion:

MELISSA is a popular resource in the North East and North Cumbria. The service has been used to support postgraduate training in the region for centres that are currently struggling with capacity challenges to accommodate their training demands. Due to increasing requests for the use of MELISSA, The Faculty of Patient Safety launched a second vehicle, MELISSA 2, in June 2023 which provides the fleet with greener credentials, more resilience and more sustainability to the service.

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.

References

1. MELISSA | The NHS Training and Simulation Bus [Internet]. NE Learning Trust. Available from: https://www.melissabus.co.uk/.

2. Faculty of Patient Safety | Home | North East Simulation Network [Internet]. North East Sim. [cited 2024 Apr 27]. Available from: https://www.northeastsimulation.co.uk/about/faculty-of-patient-safety.

The Association for Simulated Practice in Healthcare has identified the importance of resource management in team training to improve clinical performance, to develop culture, and educational governance within a safe and supportive learning environment [1]. Simulation has been successfully used as a quality and risk management resource to test new medical facilities for safer patient care.

Methods:

The scenarios were designed to last for approximately thirty minutes. The debrief was approximately one hour. The in-situ simulations were designed to consider:

● Emergency management within specialities

● Design of the new clinical environment

● Equipment and ergonomics

● Environmental and Human Factors such as transfers, portering, communication, manual handling

The clinical simulations were run over multiple days, these included Major Trauma, Obstetrics and Neonatal, Critically Unwell Adult and Child, Primary Percutaneous Coronary Intervention and a Major Incident scenario. Clinicians and nurses from the Emergency Department (ED), as well as stakeholders attended from Medical specialties, Porters, Chaplaincy, Blood Bank (Biochemist and Nurse), Manual handling, Consultants in Anaesthesia and Intensive Care, Critical Care Lead for Trauma, Neonatal and Obstetrics Doctors, Paediatric speciality Doctors, Lead Resuscitation Officer, Patient Safety Officers, Theatres, Clinical Governance, and Critical Care Lead for Paediatric Critical Care.

Simulations enabled the department to highlight areas where the environment required additional/specialist equipment. After each scenario, a debrief was performed, specifically looking at the non-technical/human factors/equipment issues that arose. Issues were identified with door access, lift usage, signage, transfers and manual handling. The Emergency Department (ED) was not fully operational and therefore not everything could be tested.

Results:

From the simulations key recommendations were made for equipment to be purchased and they highlighted the environmental factors that could impact the day-to-day running of the ED. Pharmacy raised concerns regarding medication availability in the new location and its distance from the main hospital site. The risk associated with the extended transfer routes to the main hospital with the crossing of a link bridge, the lack of lifts with no override key, and lack of signage were highlighted. New standard operation procedures were also recommended. The simulation report was presented to the ED operational team for consideration.

Discussion:

Overall, the simulations provided a safe environment in order to expose potential problems to the ED team prior to opening, this enabled mitigations to be actioned. The simulations also allowed for all staff to immerse themselves within the new environment to allow for familiarisation of the department prior to opening.

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.

References

1. The ASPiH Standards - 2023: guiding simulation-based practice in health and care. ASPIH. 2023. Available from: https://aspih.org.uk.

Anaesthetic emergencies, though infrequent, pose a significant threat to patient safety. Simulation-based training offers participants the opportunity to immerse themselves in safe, realistic clinical scenarios, allowing them to hone their skills without risking patient harm. For the educator, the challenge lies in balancing the vast array of emergencies to be taught with limited resources available. We explored whether focusing on transferable skills, specifically human factors, can improve confidence in managing these emergencies.

Methods:

The East and North Hertfordshire Anaesthetic Novice Simulation (ENHANS) course, a one-day program designed for novice anaesthetists, ran five times between April 2023 and March 2024. It covered a range of common and complex anaesthetic emergencies with a focus on human factors. It combined pre-course material with debriefing sessions following each simulated scenario. These debriefings, led by trained facilitators, followed the ‘description, analysis, application’ technique, focusing on understanding what, why, and how actions evolved during the scenario and allowing participants to learn through reflection [1]. We also explored how human factors affected the progress of the scenario.

To assess effectiveness, participants completed pre- and post-course questionnaires using a five-point Likert scale. These questionnaires evaluated confidence in managing various anaesthetic emergencies, including both those directly practiced and those not explicitly covered.

Results:

Forty participants attended the simulation across five sessions. We observed a statistically significant improvement (Wilcoxon Signed-Rank test) in self-reported confidence in managing anaesthetic emergencies (mean pre-course score: 1.9, post-course: 3.9, p <.05). Confidence also improved for practiced scenarios (mean pre-course score 2.1, post-course 4.0, p <.05) and for unpractised scenarios (mean pre-course 2.3, post-course 3.3, p <.05).

Discussion:

Our findings demonstrate a statistically significant improvement in self-reported confidence across all emergency scenarios, including those not directly practiced. This suggests a key strength of the course: its focus on transferable skills. By emphasising human factors, like communication, teamwork, and situational awareness, ENHANS equips participants with a broader framework applicable to diverse emergencies. This aligns with the concept of ‘deliberate practice’, where core skills development fosters greater adaptability in novel situations [2].

The positive outcomes of this study support integrating human factors training into simulation-based education for anaesthetists. This approach offers several advantages. Firstly, it allows for efficient use of limited resources by focusing on transferable skills. Secondly, it equips participants with a broader toolbox applicable to diverse emergencies, potentially enhancing 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.

References

1. Eppich W, Cheng A. Promoting excellence and reflective learning in simulation (pearls). Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare. 2015;10(2):106–115.

2. Briese P, Evanson T, Hanson D. Application of Mezirow’s transformative learning theory to simulation in Healthcare Education. Clinical Simulation in Nursing. 2020;48:64–67.

A child becomes the subject of a child protection plan if they are judged to be at continuing risk of harm at an initial child protection conference (ICPC) [1]. During 2023 over 74,000 ICPCs took place, with 50,780 children placed on protection plans [2]. The main aim of this project was to create a realistic simulated ICPC, to enable students to experience what it is like to attend a ICPC as they rarely get to do this in real life due to confidentiality and the sensitivity of the information shared. The project promoted collaboration with multiple different professionals from programmes across the University, including the School of Arts, Media and Creative Technologies, Police, Social Work, Nursing and Allied Health Professions. It has enabled a richer learning experience for all students in the School of Health and Society.

Methods:

The design was developed from an existing case study of a simulated family embedded for teaching and learning in the Social Work degree programme. This case study was adapted to fit into a safeguarding case. Repurposing resources already created for a different programme saved time and reduced duplication of effort. Professionals were invited to participate to take on roles based on the requirements of the scenario. Professionals required prior experience of attending ICPCs. as they were not given a script and acted in role in response to the scenario content and information presented as they would in real-life practice.

Media students were hired from the University consisting of 2 film crew, a director, an editor, and a sound technician.

Results:

The immersive digital content has had a positive impact on the development and promotion of collaborative and interprofessional working. A short trailer of the immersive digital content will be showcased. The simulated ICPC is scheduled to be used for teaching and learning imminently and feedback will be sought from student learners and facilitators.

Discussion:

The benefits of this project have exceeded expectations. Professionals involved in the simulated ICPC were onboard from the start and enthusiastic about the creation of a shared resource, which will be beneficial to all. Having the same goal helped to progress the project. Everyone took their roles seriously and commented on how, during the simulation, they forgot it wasn’t a real case. A positive outcome from this project was the development of future projects and an opportunity to create working partnerships with other programmes that will continue 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.

References

1. Gov.uk. Children in need [Online]. 2023. Available from: https://explore-education-statistics.service.gov.uk/find-statistics/characteristics-of-children-in-need#content.

2. Department for Education. Children in need census [Online]. 2023. [Available from: https://www.gov.uk/guidance/children-in-need-census.

This quality improvement initiative focuses on utilising in-situ simulation techniques to promote active participation from the multidisciplinary healthcare team to improve in-patient falls management. The project focused on a simulated patient that had sustained a fractured neck of Femur after experiencing a fall on the ward. Safe transfer of the fallen patient and identification of equipment needed was central to the project’s objectives. In doing so, learner centred engagement assisted in the identification of organisational and systematic barriers that impinge on best practice.

As in-situ simulation can proactively identify latent system issues that may be acting as barriers in achieving best practice [1], how effective can it be in improving staff management, in response to a fallen in-patient that has sustained a Fractured neck of Femur?

Methods:

A collaborative approach was initiated and fostered to allow key stakeholders to identify fall-related issues and areas most in need of improvement within the Trust relating to falls. Using in-situ simulation, a standardised patient was utilised to recreate a realistic scenario, where a patient falls on the way to the toilet. The standardised patient ‘role plays’ that they have sustained a hip injury which presents as a fractured neck of femur, hence unable to get up from the floor. The multidisciplinary ward team were then observed to see how they collectively managed the fallen patient and how they safely transfer the patient from the floor. A protected, inclusive debrief was then carried out to enhance understanding of the scenario undertaken and to highlight barriers encountered.

Results:

Although the multidisciplinary team appeared to have a good awareness of Trust policy and procedure pertaining to post-fall care, accessibility to essential equipment needed was lacking. A need for staff training in the safe use of this essential equipment was apparent.

Discussion:

By carrying out this immersive in-situ simulation, specific ward issues that required attention were identified, problems that may have gone unnoticed if not presented in a realistic scenario, recreating real-time patient care needs. Therefore, in-situ simulation is an ideal and effective modality in capturing authentic latent issues that may occur during the management of a fallen patient that has sustained a fractured neck of femur. The need for improvements were identified and cascaded to the relevant teams to remove barriers for best 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.

References

1. National Health Service (NHS) Nottingham University Hospitals. In-situ Simulation [Internet]. 2024 [cited 23/02/24]. Available from: https://www.nuh.nhs.uk/insitu-simulation/

The Mental Health First Aid (MHFA) awareness course typically involves PowerPoint presentations with limited practical skills practice, leaving attendees with insufficient hands-on experience. This gap was identified by recipients of MHFA training, who were lay individuals. Working in collaboration, we aimed to transform the traditional MHFA training by incorporating simulation-based learning, providing attendees with immersive experiences and practical skill development. Considering the simulation-based ‘I’ taxonomy [1], this initiative falls into improvement, (making something that already exists better), involvement (inviting excluded groups to generate new perspectives), and influence (potential to encourage attendees to actualise their skills).

Methods:

We designed a supplementary half-day workshop as a continuation to the half day MHFA awareness course. Simulation-based activities focused on communication frameworks such as MHFA’s ALGEE (Assess, Listen, Give support, Encourage professional support, Encourage other support) [2] and STEPS (Start, Time, Empathy, Provision of support, Sense check) [3]. The development group concluded that focussing on the most common presentations first aiders might encounter, would have optimal benefit to society. Scenarios covered situations within the community when first aiders might be faced with: people with depression, acute anxiety, and post-traumatic stress disorder.

Results:

The incorporation of simulations after MHFA awareness training significantly enhanced participant engagement and skill acquisition. Data from groups before the simulation addition and from groups after the simulation addition, revealed a marked difference in self-assessed levels of confidence in applying ALGEE and STEPS frameworks. Post-workshop evaluations indicated increased understanding of mental health issues and improved readiness to provide support in real-life scenarios. Furthermore, participants expressed appreciation for the immersive learning experience and its applicability to diverse settings.

Discussion:

Our findings underscore the effectiveness of simulation-based learning in augmenting MHFA training outcomes. By providing opportunities for practical application of communication frameworks and exposure to real-world scenarios, simulations facilitated deeper learning and skills practice among attendees. This transformative approach not only enhances the quality of MHFA training but also promotes safety, and has the potential to improve mental health outcomes. Our simulation-based approach to MHFA training offers a replicable and pertinent strategy for organisations seeking to promote mental health literacy. Co-designed with lay attendees, this innovative training methodology ensures that MHFA training remains dynamic, engaging, and impactful in addressing the evolving needs of communities.

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.

References

1. Sharon MW, Buttery A, Spearpoint K, Kneebone R. Transformative forms of simulation in health care – the seven simulation-based ‘I’s: a concept taxonomy review of the literature. International Journal of Healthcare Simulation. 2023.

2. Mental Health First Aid. ALGEE: How MHFA helps you respond in crisis and non-crisis situations[Internet]. Mental Health First Aid. 2021. Available from: https://www.mentalhealthfirstaid.org/2021/04/algee-how-mhfa-helps-you-respond-in-crisis-and-non-crisis-situations/.

3. STEPS Curriculum [Internet]. SimComm Academy. [cited 2024 Apr 28]. Available from: https://simcommacademy.com/services/steps-curriculum/.

We run a busy simulation centre in South London, with increasing demand for courses. We have become proficient at delivering several online courses on the same day, but for in-person courses we are limited by only having one simulation suite. We work with actors as simulated patients to cover mental health topics.

Other centres have tried novel methods to increase participant numbers [1]. We build on our existing practice to do similar.

Methods:

We have iteratively developed the capacity and skills to deliver two courses simultaneously from one sim suite.

By converting office space into a second debrief room, we have duplicated space for participants. This involved adding new connectivity to allow a SMOTS display, as well as creating a suitable learning space.

We have added the same functionality to a third room in our building, so we have the option to run three in-person courses at the same time.

It is important to consider double delivery of the same course separately from parallel delivery of different courses. To deliver the same course to two groups, one simulation technician can easily control the space, and the same actors can portray their characters twice. Parallel deliveries require more planning, so that the scenarios do not clash, and the simulation space displays the correct setting.

Results:

We will use the evaluation data to compare courses run traditionally against those run as double. We have gathered routine data on participant satisfaction. We will be able to compare numerical and free-text responses across the two categories. Anecdotally the participants have had an equally positive experience, and have not noticed the added cognitive load.

The costs have been negligible, by using old but functional equipment and spaces which we already have access to. There is no increase in actor costs.

We encountered logistical challenges in using what was previously only an office as a debrief room. The technician has been controlling the proceedings of the day across both groups, which is a new skillset to develop.

Faculty and technical teams feel a great deal of satisfaction at the end of these days, which bolsters team morale.

Discussion:

Double delivery has been a successful development, provisionally with no evidence of impaired quality. Actor costs will be the same or less, and there is better utilisation of available space. Parallel deliveries allow greater fidelity via a wider variety of actors.

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.

References

1. Lewandowski J, Haynes J, Dores C, Randles D. The double debriefing room: a pilot to challenge the issue of capacity whilst enhancing efficiency. 00:00:00.0 [cited 2024 Apr 30]. Available from: https://www.ijohs.com/article/doi/10.54531/JNNN8327.

Simulation based education (SBE) within undergraduate health care professional courses and secondary care is acknowledged to be an essential component to train individuals and teams to deliver safe and effective patient care [1]. Acceptance of SBE’s role and value within primary care (PC) settings is evolving, but widespread endorsement and recognition of its transformative potential for education and training is lacking [2]. This is despite the long tradition for General Practitioner (GP) training to include working with simulated patients (SPs) to develop consultation skills as a fundamental concept, and the adoption by the Royal College of GPs of the Simulated Consultation Assessment as part of membership examination [3]. Simulation around emergencies which can occur in PC is an area where traction to expand is being observed.

Methods:

Emergencies in PC simulation training sessions were offered to practices across the region over the last 12 months. The sessions were facilitated by members of the regional PC simulation faculty, who all hold clinical roles within PC, and are trained in simulation methodology. Broad learning objectives were set, and educators were enabled to feel these were fluid to allow for participant’s own experiences and views to be heard as the experts in their own practice environment, team, and culture.

All staff were invited to attend, including administration staff. SPs portrayed either the relative or patient and were integral to the debrief. Production of outcomes and changes identified to be made was owned by the practice team with support from the faculty. An end of course questionnaire was given to all participants.

Results:

Over the 12-month period 58 sessions were delivered and responses received from 630 learners in 55 different PC roles.

98% agreed or strongly agreed that it was relevant to their development needs. Emergent themes from qualitative feedback concerned increased awareness of exemplary communication as a team, with the patient and relative and other organisations. That the simulation illuminated the value of all staffs’ roles and improved the sense of team and working on a shared goal was a strong theme, with evidence this was due to the programme being designed, led and delivered for PC-by-PC. A final theme around leadership and followship was also identified.

Discussion:

Simulation on emergencies which can occur in PC is valued by staff and has potential to enable SBE to be adopted within PC to the benefit of patients and practices.

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.

References

1. Barry IS, Scalese RJ. Best evidence on high-fidelity simulation: what clinical teachers need to know. Clinical Teacher 2007;4(2):73–77.

2. Bray L, Krogh TB, Østergaard D. Simulation-based training for continuing professional development within a primary care context: a systematic review. Educ Prim Care Off Publ Assoc Course Organ Natl Assoc GP Tutors World Organ Fam. 2023;34(2):64–73.

3. Simulated Consultation Assessment (SCA) [Internet]. [cited 2024 Apr 30]. Available from: https://www.rcgp.org.uk/mrcgp-exams/simulated-consultation-assessment.

In 2023, in response to the 2022 Ockenden report, a national labour ward co-ordinator (LWC) framework was developed by NHS England [1]. This framework acknowledges the unique role of a labour ward/delivery suite co-ordinator.

Multi-professional PROMPT training currently takes place locally, but there has never been a course specifically designed to reflect the unique non-technical challenges of the co-ordinator’s role.

Methods:

A full-day simulation course (called D.i.S.C.O) was designed in collaboration with senior midwifery team members focusing on leadership, operational management, and communication. This course included three immersive simulation scenarios, and two forum theatres – all of which had debrief points mapped to the trust’s local leadership framework, and the national labour ward co-ordinator framework.

A feedback survey was used to evaluate the course on the day, and then followed up a month later to review the lasting impact (ongoing). Within the survey, co-ordinators were asked to score relevance and difficulty of scenarios, as well as give qualitative feedback on what they found helpful or what they would change. Specifically, they were asked to comment on reflections about their own leadership style during the day, linking in with the LWC framework, and what they would take back to their practice going forwards.

Results:

Over 90% of attendees agreed/strongly agreed that scenarios were appropriately pitched, relevant and allowed them to reflect on their own practice.

Specific comments in the feedback included the benefit of seeing different leadership styles as well as reflections on the benefit of being able to adapt approaches to different situations. Conflict resolution, and supporting junior colleagues were common themes that candidates found helpful with a suggestion to have more resources for conflict resolution which we were able to act upon for the second group.

Discussion:

Having external faculty, actors and using forum theatre helped to enable constructive debrief for this senior group, as evidenced by attendees’ feedback comments. From the discussions, not only were staff able to reflect on their own practice, but also able to brainstorm what changes to the system would help them in this role. Data on how these ideas have been implemented, as well as the longer-term impact on individuals will be collected within the follow-up feedback.

Going forwards, we hope to use these themes to support other senior healthcare teams.

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.

References

1. NHS England. Labour ward co-ordinator education and development framework. NHS England » Labour ward co-ordinator education and development framework. [Accessed 8 April 2024].

Recent data from the General Medical Council (GMC) highlight the significant presence of International Medical Graduates (IMGs) in the NHS, comprising 52% of new entrants in 2022 [1]. Despite their robust clinical knowledge, IMGs face higher referral rates to the GMC, possibly due to their unfamiliarity with the NHS [2]. It is therefore vital to improve on the integration and retention of IMGs who have a key role in alleviating the high pressure on the workforce within the NHS.

Methods:

A survey was conducted among IMGs to identify their learning needs and exposure to simulation training. Five scenarios utilising high-fidelity manikin and simulated actors were developed, including mental capacity assessment, end-of-life escalation, cardiac arrest event, anaphylaxis management and sepsis recognition whilst working with a challenging colleague.

Pilot sessions, each involving six IMG participants, were conducted. Post-scenario debriefings targeted key curriculum themes, ranging from A to E assessment to escalation of care. Feedback was collated using a questionnaire featuring a mix of open and closed questions graded on a 5-point Likert scale.

Results:

Survey findings reported that 45% of respondents had no prior exposure to simulation training, while 7% were uncertain about its concept. 96% expressed keen willingness to attend simulation sessions if provided the opportunity.

Participant feedback indicated high satisfaction with content and delivery, with increased confidence in managing acutely unwell patients and navigating challenging situations related to human factors. Many found the debriefing sessions particularly helpful in addressing areas of improvement. Suggestions for program improvement included pre-session information, run-through of an A to E assessment and a mix of live and manikin simulated patients for enhanced realism.

Discussion:

The transition of IMGs to a new country, lacking an established support system, presents an undeniably daunting challenge. Beyond disparities in healthcare systems, language and cultural differences further compound the integration process. To address this, we prioritised tailored training to meet the unique needs of IMGs.

Simulation training has emerged as a transformative tool, offering a safe environment to develop technical and non-technical skills while mitigating risk to patient safety. Moreover, the program aims to instill concepts of human factors, equipping IMGs to navigate common medical, ethical, and legal challenges within the NHS.

Feedback collected represents a limited sample size. A collaborative effort with stakeholders to secure support and resources will ensure the effectiveness and sustainability of future simulation sessions for IMGs.

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.

References

1. The General Medical Council. The state of medical education and practice in the UK: workplace experiences 2023. [Internet]. 2023. Available from: https://www.gmc-uk.org/about/what-we-do-and-why/data-and-research/the-state-of-medical-education-and-practice-in-the-uk. [Accessed 29 April 2024].

2. Lane J, Shrotri N, Somani BK. Challenges and expectations of international medical graduates moving to the UK: An online survey. Scottish Medical Journal. 2024;00369330241229922.

Acknowledgments:

We express our sincere appreciation to the members of the Simulation Faculty at University Hospital Coventry and Warwickshire for their invaluable contributions to this project. Their dedication made this project possible and provided support to international medical graduates throughout their journeys.

The Centre for Snakebite Research & Interventions at the Liverpool School of Tropical Medicine (LSTM) houses >150 venomous snakes. This includes the black mamba (Dendroaspis polylepis) which can cause life-threatening features within 30-minutes of envenomation [1,2]. Early care is essential to prevent death and disability, with the Royal Liverpool University Hospital (RLUH) being the closest point of care.

Clinicians, snakebite experts and herpetologists updated an existing standard operating procedure (SOP) for the safe transfer and acute management of occupational snakebite envenoming between LSTM and RLUH. In-situ simulation was used to test the SOP, as well as the ability of RLUH to receive such a patient.

Methods:

We conducted an in-situ simulation of a black mamba envenoming at the LSTM herpetarium, utilising a simulated patient. The scenario continued in real time to arrival and management in the emergency department (ED).

Implementation of the SOP was evaluated by senior clinicians and snakebite experts with further feedback obtained during a human-factors focused debrief.

Results:

Several processes that required review were identified. These included:

Key roles and responsibilities for the LSTM staff needed further clarification particularly in regard to the responsibility of communicating information to RLUH clinical teams:

● Handover between teams as information was not fully cascaded to all the relevant clinical teams

● There was limited knowledge and experience within the ED in managing snakebite envenoming

● Lack of clarity with regards to how to seek expert assistance and escalation from the assessing clinician

● Lack of familiarity of anti-venom risking inappropriate administration.

Discussion:

As a result of the in-situ event several improvements to the SOP have been implemented. These include:

● The development of first and second responder roles at the LTSM

● Clearly defined communication responsibilities

● Specific pre-alert routes between the LTSM and RLUH

● Refinement of a quick reference guide for ED doctors and decision to transfer this with the patient to aid in a timely and informed assessment

● Expired anti-venom will no longer be transferred with the patient, but is available at LSTM if guided by expert advice.

It is expected these changes will result in improved management of occupational snakebite envenoming however, this is an iterative process. Existent SOPs require further review, and a simulation scenario is being developed to improve familiarity amongst the ED clinicians. We plan to repeat the in-situ simulation and include other clinical teams to identify any additional latent 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.

References

1. Aalten M, Carsten B et al. The Clinical Course and Treatment of Black Mamba (Dendroaspis Polylepis) Envenomations: A narrative review. Clinical Toxicology. 2021;59(10):860–868.

2. Závada J, Valenta J et al. Black mamba dendroaspis polylepis bite: a case report. Prague Medical Report. 2011;112(4):298–304.

Acknowledgments:

Thanks to all the staff at the Liverpool School of Tropical Medicine and Royal University Hospital Liverpool who took the time to participate in the simulation.

Multi-casualty major incidents require effective coordination of many agencies, including prehospital and hospital teams. Simulation as a tool for interprofessional learning is well-established within healthcare [1]. However, it is unusual for healthcare and emergency services to collaborate within multi-agency simulation. Given the resources and planning required to deliver this [2], there are logistical challenges to deliver a joint, immersive simulation experience for healthcare and non-healthcare professionals in a major incident context [3]. Furthermore, there are challenges inherent to involving different professional groups, each with their own educational backgrounds and cultures.

The authors explore:

● How can varying simulation approaches be aligned for a common purpose in the context of multi-agency major incidents?

● How best can a variety of participants be engaged in simulation when each have their own learning needs?

Methods:

A major incident simulation occurred in an urban city centre re-creating a road traffic collision and concurrent river-based rescue. This was facilitated by fire and health services, however involved a larger multi-agency response, with more than 100 participants, including individuals from the police and coastguard. Undergraduate nursing, paramedic, medical and journalism students were involved with support from embedded faculty. Registered nurses and emergency medicine trainees also attended.

Healthcare professionals adopted the role of casualties, triaged and transported rescues, observed multi-agency communication strategies, and undertook initial patient assessments within a simulated emergency department. Various simulation approaches were implemented throughout the exercise including fully immersive components, ‘pause and play’ effects, and real time observational discussion. Faculty reflections were collated from hot and cold team debriefs to evaluate the impact on learning and the challenges of facilitating an immersive multi-agency simulation.

Results:

Based on these reflections, we analysed the challenges and conflicts involved with running a multi-agency simulation. A key theme from this was the use of simulation across, and through, several boundaries. This included the challenges of balancing postgraduate and undergraduate learning needs within the same educational environment; utilising multidisciplinary teams to enhance interprofessional learning; awareness of the different approaches to systems hierarchy; simulation strategies within different agencies; coordinating facilitation between agencies; and the impact of hospital-based healthcare professionals working in an unfamiliar pre-hospital setting.

Discussion:

This work can inform future multi-agency simulations and prompt consideration of new approaches to interdisciplinary and interprofessional learning. This experience challenged the usual norms of simulation by traversing several boundaries including across agencies, professions, simulation approaches and techniques, hierarchical structures, and undergraduate and postgraduate learning spaces.

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.

References

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

2. Saiboon IM, Jaafar MJ, Harunarashid H, Jamal SM. The effectiveness of simulation based medical education in teaching concepts of major incident response. Procedia - Social and Behavioral Sciences 2011;18:372–378.

3. Simpson E, Sharp K, Paterson S, King C, Stark C, McGowan N. Planning an immersive multi-agency major incident simulation. International Journal of Healthcare Simulation. 2(Suppl 1).

Acknowledgments:

Acknowledgement to the Scottish Fire and Rescue Service for their collaboration in this learning event.

The inherent challenge in learning radiography lies in the inability to confirm the correct positioning of a person until the resultant x-ray is examined. Spurious use of ionising radiation is unlawful and unethical, so radiography education has been limited to the teaching of theoretical concepts reinforced by practical placement learning. Latterly, the profession has introduced procedural simulation using radiographic phantoms or interactive electronic media [1], but immersive simulation involving patient journeys and procedures is uncommon due to the need to expose the subject to ionising radiation.

Simulation in mammography education is further limited by the intimate nature of the procedures and the radiosensitivity of the breast. Immersive simulation, providing technical and non-technical learning has not been described in the literature, but we posited that it would be highly beneficial to learners, as breast imaging and interventional procedures require excellent communication and technical proficiency.

We describe a pilot study undertaken to transform mammography education; whereby immersive simulation was used to follow a patient journey in a high-risk situation in breast imaging and advanced practice.

Methods:

The study involved 37 learners and a blended immersive simulation, whereby learners interacted with a human simulated person (SP) and a voiced manikin, when necessary, to remove risk of harm to the human SP. The manikin underwent an assessment of a breast mass involving different imaging modalities (Figure 1-A18) and communication challenges over 5 hours. Industry partners facilitated the simulation and academics facilitated learner debrief.

Figure 1-A18.

Results:

Anecdotal evidence was collected from all attendees. Learners suggested that the communication issues and techniques discussed during the event would be used in their future practice. Industry partners were enthusiastic about their inclusion and were keen to participate again.

Discussion:

Literature suggests the quality of the individual’s experience during breast imaging is crucially dependent on the radiographer’s interpersonal skills [2]. Performing radiological interventional procedures requires high haptic sensitivity and fine motor skills [3]. The pilot study garnered anecdotal feedback from learners suggesting that this method of teaching and learning satisfied both needs.

Industry partners have since repeated the exercise for their application specialist trainees, suggesting that this also holds value for ‘training the trainers’ who teach those who use the equipment.

In conclusion, it is possible to transform radiography education and include industry partners by using immersive simulation. The study continues to gather evidence to support the use of immersive simulation of this type for radiography education and for future research.

Ethics statement:

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

References

1. Sujar A, Kelly G, García M, Vidal FP. Interactive teaching environment for diagnostic radiography with real-time X-ray simulation and patient positioning. International Journal of Computer Assisted Radiology and Surgery. 2021;17(1):85–95.

2. Clark S, Reeves PJ. Women’s experiences of mammography: A thematic evaluation of the literature. Radiography. 2015;21(1):84–88.

3. Chellali A, Dumas C, Milleville-Pennel I. Haptic communication to support biopsy procedures learning in virtual environments. Presence: Teleoperators and Virtual Environments. 2012;21(4):470–489.

E-Delphi is a popular online health and educational research technique to improve decision-making processes and obtain agreement on formulating healthcare standards [1]. This is a cost-effective and efficient technique that offers participants flexibility in contributing from anywhere, anytime, compared to traditional Delphi [2].

Simulation-based Education (SBE) deliver a realistic teaching approach and standardised experience within a harmless learning environment [3]. Formulating SBE strategies in academic settings is needed to enhance the learning experience and promote equal educational exposure. This study aims to develop novel SBE Strategies at the University of Manchester (UoM).

Methods:

Different quality standards were reviewed based on selective strategies from various associations, including the International Nursing Association for Clinical Simulation and Learning (INACSL) standards, the Society for Simulation in Healthcare (SSH) Accreditation Standards, the Association for Simulated Practice in Healthcare (ASPiH) SBE in Healthcare Standards Framework and Guidance, and the National Framework for SBE.

A panel (n=43) was established using purposive sampling according to their credentials in the SBE field during the first round and then increased to (n=45) in second and third rounds, including UoM faculty, global experts, postgraduates or early career, and UoM undergraduates.

The Delphi process consisted of three rounds/ surveys; each survey encompassed three areas: Connectivity, Collaboration, and Partnerships; Promoting Quality; and Stability, Sustainability, and Growth of SBE. The study acceptance consensus rate was 80%. Data were collected between September and December 2023.

Results:

By the end of three Delphi rounds, there was an overall 90% agreement, and many were accepted at 100% consensus. The Delphi surveys started with 29 SBE strategies in the first survey, then increased to 35 SBE strategies in the second survey, and finalised with 39 SBE strategies in the third survey. The study response rate was 35, 29, and 27, respectively. Final SBE strategies are illustrated in Table 1-A17.

Discussion:

Employing these SBE strategies within faculty is essential as it is considered an innovative teaching modality in healthcare. However, logistics could be a challenge associated with implementation, and resources required for this investment need to be identified. In this study, there was a great number of participants engaged in the Delphi rounds with a good response rate. In addition, the variability of panel role, profession, and level indicated a variety of opinions, which is the core of Delphi study. Also, it strengthened study findings by identifying the different expectations of the SBE strategies acquisition at UoM.

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.

References

1. Green RA. The Delphi Technique in educational research. SAGE Open. 2014;4(2):2158244014529773.

2. Donohoe H, Stellefson M, Tennant B. Advantages and limitations of the e-Delphi technique. American Journal of Health Education. 2012;43(1):38–46.

3. Alfes CM, Rutherford-Hemming T, Schroeder-Jenkinson CM, Lord CB, Zimmermann E. Promoting interprofessional collaborative practice through simulation. Nursing Education Perspectives 2018;39(5):322–3.

Acknowledgments:

Funding: King Saud bin Abdulaziz University for Health Sciences.

Table 1-A17.

Simulation-based Education Strategies

1. Connectivity, Collaboration, and Partnerships
1.1 Leadership and Governance
1.1.1 Appoint a lead/s for Simulation to lead the development and implementation of the Simulation Strategy and report progress to the Faculty Leadership Team. Leadership will be clearly defined, and appropriate governance models and processes will be explicitly described.
1.1.2 Review and clarify academic programme and technical support structures and leadership roles in relation to simulation, and articulate roles and responsibilities to ensure parity across faculty (including workload tariff) and goals of simulation regularly (e.g., every two years).
1.1.3 Develop and facilitate collaborative working relationships with Technical Services Operational Managers to better understand the roles and responsibilities of simulation technicians/technologists and ensure colleagues have clear career pathways with access to ongoing training and development.
1.1.4 Develop and facilitate collaborative working relationships with Information technology (IT) Services and E-Learning Support Teams to promote the sharing of ideas, taking responsibility for innovation and best practices in using simulation and immersive technologies to enhance the learning experience.
1.1.5 Develop and facilitate ongoing relationships with executive stakeholders, faculty/organisational development teams, quality improvement and assurance, teaching and learning teams.
1.1.6 Appoint student representatives with clearly defined roles and responsibilities to inform the development of simulation.
1.1.7 Work with the Social Responsibility and Public Engagement Team to ensure strategies, plans, and goals align with Patient and Public Involvement and Engagement (PPIE) principles, e.g., PPIE representation in steering groups.
1.2 Communications and Networking
1.2.1 Establish a Community of Practice and/or Steering Committee with clear mechanisms to share best practices, learning, and expertise across all university healthcare programmes, including cooperation with, for example, but not limited to, the Association for Simulated Practice in Healthcare (ASPiH), International Nursing Association for Clinical Simulation and Simulation Learning (INACSL), Society for Simulation in Europe (SESAM), and Association of Standardized Patient Educators (ASPE).
1.2.2 Develop a digital platform/virtual learning environment to promote effective communication pathways, share resources (e.g. iRIS and e-learning for health) and expertise, showcase best practices, and facilitate collaborations across simulation within the university.
1.2.3 Continue to develop and establish liaisons with external stakeholders relevant to individual healthcare simulation training requirements, including professional regulatory and statutory bodies, Royal Colleges, and NHS (National Health Service) Trusts, ensuring protected time for Discussion via regular meetings.
2. Promoting Quality
2.1 Training and Development
2.1.1 Provide new and existing academic staff/faculty member, delivering simulation, with flexible and accessible training opportunities in simulation pedagogy as part of continuing professional development by completion of simulation development programmes such as, but not limited to, the Certified Healthcare Simulation Educator (CHSE), and Simulation Faculty Development Programme (e.g., e-lfh.org.uk).
2.1.2 Provide new and existing academic staff/faculty member delivering simulation with flexible and accessible training opportunities in immersive technology, e.g., Virtual Reality, Artificial Intelligence, and Serious Gaming based on the curriculum and intended learning outcomes for programmes.
2.1.3 Support new and existing academic staff/faculty member delivering simulation to continue developing knowledge and skills in the debriefing process, including meta-debriefing as appropriate.
2.1.4 Support academic staff/faculty member delivering simulation to participate in advisory committees, professional or practice-based simulation forums, or networks as part of continuing professional development.
2.1.5 Develop and implement a roadmap for professional development designed specifically for academic staff/faculty member delivering simulation. The professional development plan and/or pathway should include, but not be limited to, membership and engagement with professional Simulation Networks, attendance at local/regional/national/international conferences, completion of Simulated-Based Education study days/courses, and achievement of individual accreditation with a relevant simulation association.
2.1.6 Support simulation technicians/technologists in the development of knowledge, skills, and behaviours that will enable them to continue to provide consistent, high-quality simulation in safe learning environments by completion of professional registration with the Science Council, e.g., Simulation Technician Level 3, and Certified Healthcare Simulation Operations Specialist certification (CHSOS) scope.
2.1.7 Develop and implement an internal mentorship programme and/or peer-shadowing opportunities to provide continuous support and professional development of academic staff/faculty member/simulation technicians, delivering simulation.
2.2 Standards and Quality Assurance
2.2.1 Raise awareness and promote the application of Healthcare Simulation Standards of Best Practice, including, but not limited to: Association for Simulated Practice in Healthcare (ASPiH), International Nursing Association for Clinical Simulation and Learning (INACSL), Society for Simulation in Europe (SESAM), Association of Standardized Patient Educators (ASPE) and Simulated Patient Common Framework Checklist (Health Education Northwest).
2.2.2 Embed Healthcare Simulation Standards of Best Practice into the design and development of all simulation activities, and consider programme/organisational accreditation, as appropriate, with a relevant simulation association.
2.2.3 Ensure that staff designing and delivering simulation are knowledgeable of the ethical standards of simulation-based experiences and adhere to the Healthcare Simulationist Code of Ethics.
2.2.4 Use a periodic review and feedback process to ensure all simulation activities delivered across faculty, are feasible, appropriately designed based on programmatic resources, and in alignment with the simulation strategy. This will be measured by quality assurance processes, e.g., annual evaluation of programme simulation activities, incorporating outcomes data, learner, academic staff/faculty member, and external stakeholders’ feedback.
2.2.5 Undertake a training needs analysis to identify training and development needs for academic staff/faculty member delivering simulation and simulation technologists/technicians, using, for example, the Simulation Educational Needs Assessment (SENAT) tool.
2.2.6 Engage in annual peer-review processes to ensure ongoing development of academic staff/faculty member delivering simulation.
2.2.7 Establish a clear process and/or system of reviewing simulation resources, e.g., standards of best practice, e-learning materials, evidence-based practice, and training and development courses, to ensure academic staff/faculty member/ simulation technologist/technicians remain up to date.
2.3 Research and Evaluation
2.3.1 Commit to undertaking evaluations of all aspects of simulation activity (i.e., briefing or pre-brief, simulation activity, debriefing, simulated patient’s skills in portraying their role) to determine the quality and/or effectiveness of the simulation-based experience on an individual, divisional, school or faculty level. Evaluation should map to learning evaluation models, e.g., Kirkpatrick, and include feedback from learners, academic staff/faculty member, simulated/standardised patients, Equality, Diversity and Inclusion (EDI) leads, and external stakeholders.
2.3.2 Facilitate appropriate training and supervision for academic staff/faculty member designing and delivering simulation to develop research projects and evaluation processes that consider educational effectiveness and efficiency, patient safety, quality of care, and the preparedness of learners for the workforce.
2.3.3 Establish systems to actively support and promote the dissemination of outcomes/findings from research and/or evaluation processes in professional/scientific journals, and internal and external conferences.
2.3.4 Disseminate evaluation data internally (with proper anonymisation), promoting recognition and improvement at an individual, division, school, and faculty level.
3. Stability, Sustainability, and Growth of SIM
3.1 Accessibility
3.1.1 Review current specialist teaching spaces with a view to developing a system/process for sharing spaces, e.g., Aseptic Suite, to increase capacity for simulation delivery and enhance learner’s experience of simulation.
3.1.2 Map existing simulation equipment and auditing processes, e.g., part-task trainers, full-body manikins, advanced procedural trainers, and VR (Virtual Reality) headsets, with a view to developing a system/process for sharing equipment to increase capacity for simulation delivery.
3.1.3 Ensure full-body manikins, part-task trainers, and avatar-based simulation, represent all patient populations, e.g., race, ethnicity, age, various body sizes, and disability, to promote equity, diversity, and inclusion.
3.1.4 Review the use and training of simulated patients across the faculty, with a view to establishing a pool of simulated patients, ensuring that they are trained for the roles that they are required to undertake, including providing feedback and debriefing in line with evidence-based practice, and reflect all patient populations to promote equity, diversity, and inclusion.
3.1.5 Identify a learning space to build and develop an innovative simulation centre/hub to increase capacity for simulation delivery, including Interprofessional-Enhanced Simulation.
3.1.6 Ensure digital innovations are accessible for all learners, ensuring an inclusive approach to teaching and learning.
3.2 Preparation and planning
3.2.1 Assess academic staff/faculty member readiness for simulation growth, e.g., workload, role and responsibility, training, and development needs.
3.2.2 Forecast programme/faculty growth for simulation, including personnel (academic staff/faculty member, simulation technicians/technologists), Information technology (IT), E-learning, and Librarian support, workload, roles and responsibilities, training and development needs, simulation equipment and facilitates, ensuring equity of access for learners across all healthcare programmes.
3.2.3 Explore and identify priorities, benefits, challenges, and solutions for incorporating simulation and immersive technologies into all healthcare programmes within the faculty, using, for example, the Simulation Culture Organizational Readiness Survey (SCORS).
3.2.4 Develop and implement a quality assurance framework to enable continuous progress in simulation preparation, planning, delivery, and integration into new healthcare programmes.
3.3 Finance
3.3.1 Prepare an operational budget considering current and future goals and priorities, including identifying fixed (e.g., maintenance and service contracts), variable (e.g., personnel, reimbursements for simulated patients, consumable items, training and development for staff and simulated patients, peer review, audit, dissemination of research and scholarly activity) costs, future capital expenditure, and human resources.

In the UK, where no established curriculum or specialized course is dedicated to emergency medicine (EM) referral skills, there is a pressing need for a comprehensive training program.

A 2022 survey of 148 EM doctors and 279 doctors from in-hospital specialities in Northern Ireland found that 73% of EM doctors struggled with referrals, while 79% of in-hospital doctors felt EM referrals were of low quality. A novel simulation-based referral skills pilot course was developed, offering education, practice opportunities, feedback, and assessment.

Methods:

A specifically designed simulation-based education (SBE) was delivered on the 8th of November, 2023, in Craigavon Area Hospital. The simulation was delivered by four faculty members and attended by fifteen EM ACCS trainees. The objectives were to teach the EM Drs to Stop, think, and prepare before referral, use the SBAR referral tool, show assertiveness, and stop deflection. Four challenging referral scenarios were delivered, mirroring a real-life situation that EM doctors often encounter (Argumentative, bossy, dismissive, and challenging clinical referrals). The Scottish Centre debriefing model was used, and the following microteaching topics were delivered (reactions to difficult situations, assertiveness, stopping deflection, redirecting behaviour, conflict management styles, and emotional intelligence).

Results:

The impact of the simulation program was significant. Of the 15 attendees, 60% had never received any training on referral skills. However, post-simulation, their confidence in making referrals improved from 13% to 80%. 87% rated the simulation high quality and 13% very high quality. 100% felt that the simulation would change their future practice and would recommend it to other EM Doctors. A follow-up questionnaire conducted five months post-simulation received ten responses, with 87% reporting a significant improvement in their referral skills.

Discussion:

While simulation programs in EM traditionally focus on resuscitation, trauma and procedural skills, there is a lack of emphasis on referral skills. Some EM specialists argue that referral skills are acquired through experience rather than formal training. Consequently, junior doctors rarely receive guidance on how to conduct referrals. Inadequate handovers have been associated with events and clinical errors in emergency medicine due to communication and missing information [1]. SBE expands medical education, recreating clinical settings for teaching, practising, and assessing. Trainees learn from mistakes and receive feedback. It is effective for teaching ED-specific skills [2]. The results of this pilot SBE on EM referral skills were promising and encouraging to expand its delivery at a broader scale.

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.

References

1. Moslehi S, Masoumi G, Barghi-Shirazi F. Benefits of simulation-based education in hospital emergency departments: a systematic review. Journal of Education and Health Promotion. 2022;11(1):40.

2. Hock SM, Cassara M, Aghera A, Saloum D, Bentley SK. Attending physicians as simulation learners: summary of current practices and barriers in emergency medicine. Clinical and Experimental Emergency Medicine. 2024. ceemjournal.org

Acknowledgments:

The simulation program was funded by the Northern Ireland Medical Dental Training Agency.

Simulation Based Learning (SBL) is a relatively new concept in the Pharmacy profession [1]. In 2024, NHS Education for Scotland (NES) has made participation in SBL mandatory for Foundation Training Year Pharmacists and those completing the NES General Practice Clinical Pharmacist (GPCP) framework. The aim of this project was threefold: to determine if this type of education could be offered to all Pharmacists working in Primary Care, to evaluate the benefits to Pharmacists’ development and to determine if it could be delivered out with a dedicated simulation suite.

Methods:

The first step was to describe the concept of SBL to the Pharmacy team and explore how it may be beneficial in the development of Pharmacists. The next step was to determine whether there was a suitable location locally to deliver SBL within a Primary Care setting. In keeping with the NES initiative to enhance pharmacy education using SBL, we conducted a pilot study. We initially carried out one session with 4 participants, each doing one scenario focussing on non-technical skills. The plus/delta model was used to de-brief the scenario. Participants were given a pre and post evaluation survey, seeking their views on how they felt before and after participating in SBL, with questions focussing on their confidence in certain areas.

Results:

The session ran smoothly, showing that the logistics of delivering SBL within a Primary Care setting, and out with a dedicated simulation suite was possible. The pre and post evaluation surveys showed that Pharmacist confidence grew in terms of general review of patients, clinical decision making, managing complex patients and giving/receiving feedback from colleagues. This SBL has now been extended out to several other Primary Care Pharmacy teams within the health board, showing similar increased levels of Pharmacist confidence in the above areas.

Discussion:

SBL is a valuable tool to support the development of Pharmacists within Primary Care. We recommend the use of SBL across the Pharmacy profession, including those working in different sectors, and at different grades e.g. pharmacy technicians.

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.

References

1. Lloyd M, Watmough S, Bennett N. Simulation-based training: applications in clinical pharmacy. The Pharmaceutical Journal. 2018.

Acknowledgments:

Acknowledgements to Andrew Christopherson and Neil McGowan from NHS GG&C, and also the NES simulation team for their support.

Fires within operating theatres are rare but can have grave consequences for patients and staff. Transferring an anaesthetised patient in an emergency carries significant risk. The recent ‘Fire safety and evacuation guidelines’ published by the Association of Anaesthetists, recommends multidisciplinary fire evacuation training be incorporated into annual mandatory training [1]. A purpose-built four table ‘Barn operating theatre’ opened in 2023 as part of transformation works at University Hospitals Dorset. Barn theatres are large open-plan surgical spaces. Each patient is operated on in a dedicated operating area, separated by mobile screens. Barn theatres are unique environments, with very few in the United Kingdom. Large-scale multi-casualty fire evacuation simulations of a barn theatres have not been conducted previously in the UK. The primary aim of this exercise was system testing and to identify any unknown latent safety risks.

This collaborative project was conducted with: the Fire Safety team, the Quality & Risk team, the Head of Emergency Planning, Resilience and Response, the Theatre Management team, the Theatre Educators, and the Simulation Team.

Methods:

Fire simulations were conducted with three multidisciplinary theatre teams who each, simultaneously, had a patient who was at a different peri-operative phase. Two simulations were run with the “fire” occurring at different locations within theatre. Scenarios were designed to increase the risk of a failure occurring by increasing cognitive load on the staff involved. The end point was safe evacuation of patients. Each operating team had a debrief and then shared key points with the larger group. Switchboard was also engaged in this event.

Results:

Teams completed timely evacuations without major challenges, but there were a number of near-misses. Findings highlighted:

● The importance of communication and co-ordination between neighbouring teams within the barn theatre.

● The need for vertical evacuation devices closer to theatre.

● The benefits of pre-packed transfer bags.

● The importance of making the 2222 fire call.

● An obstructed evacuation route.

Discussion:

It would not be feasible to run practical sessions for all staff members, so the focus was on testing the new systems and processes. Each team brought a different perspective with slightly differing agendas, such as, are we testing individual’s knowledge, use of front-loaded education, and managing the interaction of simulation as an education tool versus enhancing fidelity for systems testing. This project generated several safety recommendations and provided evidence for additional funding and changes to procedure and infrastructure.

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.

References

1. Association of Anaesthetists. Fire safety and emergency evacuation guidelines for intensive care units and operating theatres: for use in the event of fire, flood, power cut, oxygen supply failure, noxious gas, structural collapse. 2021. Available from: Fire safety and emergency evacuation guidelines for intensive care units and operating theatres | Association of Anaesthetists.

Sudden Unexpected Death in Infancy (SUDI) is a traumatic scenario for the professionals involved. A unique set of skills are required to manage this effectively and due to its uncommon nature, professionals may be dealing with this tragedy for the first time. The first NI Multi-Agency SUDI Protocol outlining expectations of staff is being developed on following recommendations in the Kennedy Report [1]. Despite all this, comprehensive training does not currently exist in Northern Ireland. An innovative simulation-based course with multi-agency involvement and parental involvement was designed to address this gap in training with specific focus on delivering family-centred care and conducive multi-professional working.

Methods:

An immersive simulation-based course was designed to align with the goals of both the 2023 Interim Protocol and the draft Multi-Agency Protocol. It was piloted on 25th April 2024 in Craigavon Area Hospital Simulation Suite and delivered to 8 senior doctors/higher-specialty trainees within Paediatrics and Emergency Medicine. A robust faculty made up of consultants with SUDI expertise, paramedics, senior police, a Coroner, clinical psychology, actors - as well as the voice of a parent’s experience via a surrogate - allowed for invaluable insight. Directors of the Public Health Agency (PHA) Child Death Programme observed with interest for Protocol influence. High-fidelity simulations focused on futile resuscitation and delivering compassionate family care. The unique role of the police and Coroner as well as clinical psychology to promote staff wellbeing was delivered via interactive sessions. Pre- and post-questionnaires were completed.

Results:

The course had significant impact on participants, faculty and members of PHA. Of the 8 participants, 62% had never dealt with a SUDI scenario, 78% lacked confidence in management and 100% lacked a good understanding of the role of the medical team and other agencies in the investigation of these deaths. 100% of participants reported improved confidence and understanding across all domains. Awareness of where to seek personal mental health support also improved from 0% to 100%. The effect of actors was described as ‘invaluable’ and ‘hauntingly accurate’. Faculty feedback was overwhelmingly positive.

Discussion:

Simulation-based training for SUDI is emotionally charged and can be difficult but there is a desire for such training and the benefits are enormous as evident in the feedback. There is significant interest from PHA and other stakeholders to roll this out as a regional initiative and redesign to target police participants in a multi-professional approach similar to other parts of the UK.

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.

References

1. Sudden unexpected death in infancy and childhood Multi-agency guidelines for care and investigation The Royal College of Pathologists Pathology: the science behind the cure [Internet]. 2016. Available from: https://www.rcpath.org/static/874ae50e-c754-4933-995a804e0ef728a4/Sudden-unexpected-death-in-infancy-and-childhood-2e.pdf.

The UK government has mandated 50% foundation doctors complete a 4-month placement in General Practice (GP) [1]. This means that GP trainees have completed most of their previous training in a hospital environment. As a result they have less exposure to primary care systems and ideas for quality improvement projects (QIP) which may be completed by other members of the health care team within the hospital setting.

During the coronavirus pandemic a GP emergency simulation course was developed to support trainee wellbeing and enhance induction. We have continued this course as part of our ST1 induction and over time we have adapted our debriefs to help trainees identify some quality improvement projects they could complete as part of their mandatory training [2].

Methods:

We use 5 scenarios and use reflective questions to suggest potential QIP ideas.

● Scenario 1 – Hypoglycaemia in a diabetic patient during Ramadan

Does your practice have a policy for diabetic patients during Ramadan?

● Scenario 2 – Anaphylaxis

Do you know where your emergency drugs are located and are these monitored?

● Scenario 3 - Baby with meningitis

Does your practice have a protocol for managing unwell children and summoning colleagues for help?

● Scenario 4 - Acute psychosis

Does your practice have a protocol for managing patients who are agitated/ potentially aggressive and may require detention?

● Scenario 5 - Palliative care home visit

Does your practice update key information for palliative patients including their wishes for final place of care.

Results:

Many trainees have subsequently introduced quality improvement ideas which will improve patient safety and communication within their practice, and are evidence of transformative simulation [3].

Examples include:

● Introducing anaphylaxis bag – protocol/ drug doses and medication all stored within one area and checked on a regular basis.

● Introducing meningitis bag – as above.

● Developing leaflet for patients with diabetes practising Ramadan

● Protocol within practice highlighting Ramadan and potential changes to diabetic medications for all clinical staff.

Discussion:

Whilst quality improvement is not the primary objective of this course it appears to be a positive outcome. Prior to this many trainees commented that they thought quality improvement projects were “completing an audit.” Following this course, they felt positive about practical ways to improve patient safety and systems within the practice, and actually make a difference. We will continue to encourage trainees to participate in quality improvement and aid patient and practice safety and trainee development.

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.

References

1. Department of Health. Delivering high quality, effective, compassionate care: developing the right people with the right skills and the right values: A Mandate from the Government to Health Education England. 2013.

2. Royal College of General Practitioners. WPBA: Quality Improvement Project (QIP). 2024. Available from: https://www.rcgp.org.uk/mrcgp-exams/wpba/qip. [Accessed 30 April 2024].

3. Weldon SM, Buttery AG, Spearpoint K, Kneebone R. Transformative forms of simulation in health care – the seven simulation-based ‘I’s: a concept taxonomy review of the literature. 2023.

The Integrated Care Programme for Older Persons in Ireland (ICPOP) aims to change the way health and social care for older persons is planned and delivered, with the goal of improving patient experience, quality and outcomes.

Implementing integrated care for older adults is a complex task requiring a collaborative approach among several healthcare disciplines and working environments. Interprofessional simulation-based education (SBE) provides an ideal learning environment for probing the current system of care, providing opportunity to identify key issues that are compromising the patient journey so they can be actioned in a meaningful way. Here we outline our experience of using simulation to enhance the care journey for the older adult.

Methods:

Two interprofessional simulation scenarios were designed and facilitated by an expert panel in the simulation laboratory. Multi-disciplinary team members from the Frailty at the Front Door (FFD), specialist geriatric ward (SGW) and Integrated Care Programme for Older Persons (ICPOP) participated. The scenarios worked through the health care journey of patients within the ED and acute hospital setting, incorporating multidisciplinary discussions, onward referrals and communication processes between the different teams. There was a facilitated debriefing session afterwards among participants, stakeholders from hospital, community and national programmes. Feedback was obtained following both scenarios in an anonymous online questionnaire.

Results:

Twenty-three participants provided feedback following both scenarios. Overall, participants enjoyed participating in the simulation and reported that they would be eager to engage in future SBE. The simulation highlighted areas for quality improvement pertaining to existing communication structures. All participants stated they found the simulation relevant to their area of practice and expressed that their practice would change as a result of the simulation, with improved communication noted as a key learning outcome by many. Participants noted that relationships developed through SBE could lead to the delivery of more efficient patient care and better patient outcomes.

Discussion:

Through SBE we identified key areas for quality improvement for older adults moving between multidisciplinary services. Future SBE sessions are planned to explore the continuum of older adult care bringing together teams from primary care, rehabilitation and specialist inpatients services.

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 demand for emergency care escalates, Emergency Departments (EDs) seek to create capacity by commissioning temporary clinical spaces, such as mobile units attached to infrastructure, or via entire new-build departments. Expanding and modernising the areas in which treatment is delivered aims to improve the quality of care by increasing capacity within the system; however, moving to new spaces presents challenges and opportunities [1]. In-situ simulation (ISS) has been used in the literature to test new builds [2], but often with a theoretical basis that safety threats can be found and fixed without a full exploration of everyday clinical work, and often lacking a longitudinal view of risks or opportunities that emerge after moving into the new environment. Modern EDs are appreciated as socio-technical systems, where work is completed by teams using specialised tools and equipment, and staff constantly adapt how they work to meet inherently variable demands. Safety II (SFII) is an approach to understanding complexity in healthcare systems that has developed into a coherent set of guiding principles, but it requires further application in emergency care [3].

Methods:

Ethical approval was not required for this work as it was a service evaluation. A multidisciplinary team developed a mix of clinical and non-clinical multimodal simulations (n=30) delivered in the newly built ED two weeks before move-in. Seventy-seven staff members from multiple cross-boundary professional groups participated in the project. ISS were designed to identify latent safety threats (LSTs), illuminate practice variability in Everyday Clinical Work (ECW), and understand how staff adapt to manage demands, informing better system learning. After move-in, the team facilitated longitudinal feedback by organising focus groups to understand how staff had adapted to the new environment.

Results:

Forty-four LSTs were identified for action or mitigation, Table 1-A8. The Simulation Coordination Team (SCT) also redesigned several patient pathways by learning from descriptions of everyday clinical work and then streamlining processes. After moving into the new build, the 4-hour Emergency Access Standard improved by 4.41%, the average time a patient was seen within 60 minutes by a senior decision maker improved by 2.67%, and the average ambulance handover achieved within 30 minutes improved by 6.33%.

Discussion:

The SCT found that combining ISS with SFII theory promoted a better understanding of ECW, adaptations, and threats to the system before moving to the new build. Engaging multiple stakeholders, from executives to external teams, created learning opportunities and shaped better responses to demands.

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.

References

1. Patterson MG. In situ simulation: detection of safety threats and teamwork training in a high-risk emergency department. BMJ Qual Safety. 2013;125–133.

2. Francouer CS. It takes a villages to move hospital: simulation improves intensive care preparedness for a move to a new site. Hosp Paediatrics. 2018.

3. Anderson JR. Beyond ‘find and fix’: improving quality and safety through resilient healthcare systems. International Journal of Quality in Health Care. 2020;204-211.

Table 1-A8.

Description of simulation, Testing, LST(s), and Mitigation/Action

Sim Ref	Simulation	Testing(Process/ Pathway)	LST(s) Identified/ Categories	Mitigation/ Action
1	Patient Journey:Chest Pain	• Logical flow through ED to:○ Assessment area○ Ward○ Discharge• Streaming routes• Pre-assessment cubicle suitability	1.  The reclining chairs in the pre-assessment/ECG rooms are not fit-for-purpose so can these be static examination couches? Can we consider the same for Triage? (En)	1.  Appropriate examples sent to project management - purchased and in situ before new build move
2	Collapse at triage:Cardiac Arrest	• To assess in triage room and move to resus/cubicle• Space and availability of equipment	2.  Why are there two emergency buzzers? (En/T)3.  Will Vocera work throughout the build? (En)4.  Where are the emergency buzzer panels? (En/T)5.  Where are the otoscopes/ ophthalmoscopes going? (En)	2.  Build/project team state it is new regulations3.  Additional access points for WIFI are now installed and all “black spots” identified and resolved before move4.  Shown to sim team, panels still required programming – completed before move5.  Discussed with clinical team. Fitted in every cubicle on a side wall at the head-end of the wall
3	Transfer to CT of critically unwell patient:Elderly Abdo Pain	• Logistics of space• Availability of equipment and routes.	6.  Do we get priority for the pod system if others are queued? (En)7.  Where is the alert phone going? Will there be a ringer in resus? (En)	6.  Pod system has not changed. Project team advised no impact on ED.7.  Will be positioned at the Nurse in Charge (NIC)/ Emergency Physician In Charge/ Progress Chaser Desk. No ringer in resus.
4	Transfer to theatre of trauma patient.	• Communication with theatres• Distance from New ED	8.  Pathway development conversation (T/P)9.  Do we have any new syringe drivers? (Eq)10. Is there telemetry in resus (as you cannot see the patient in Bay 1 from sat at the nurses desk for example)? If so, does it alarm at the desk or just in the bay? (Eq)	8.  Direct to theatre pathway.9.  Medical library to implement a process for medical devices ED have a total of 24 pumps. ED now have syringe driver and infusion pump charging stacks in ED for majors and resus.10. Yes, central monitoring in resus and at NIC staff base and alarms at all telemetry stations.
5	Collapse on way to Ambulatory Care	• Time for response to emergency buzzer from different areas• Space and logistics	11. Are we finalised on labelling above doors of areas? (See and Treat for example is not labelled from the Major’s side which has caused confusion when moving patients during a number of sims) (En)	11. Signage is yet to be complete - once installation has been finished we can complete a walk through - FBC installed - further additions now on order - awaiting install date from TDC
6	Prepare for transfer to a different hospital	• Admin logistics (printing/ photocopying)• Logistics of ambulance attendance	12. The doors are very heavy - assuming this is just because they will be automatic? (En)	12. They are automatic – not turned on for a number of sims as work still ongoing.
7	Major Haemorrhage:Trauma	• Maj Haemorrhage protocol• Distance from blood bank• Time for blood to get to New ED	13. Can we have clocks and whiteboards in every resus bay? (En/Eq/P)	13. Clocks and whiteboards ordered and fitted before move.
8	Major Trauma:Adult	• Ambulance pt to resus from ambulance bay• Familiarisation of trauma team with New ED• Trauma network awareness• Location of equipment in New ED	14. Screens needed for resus (in case we need to split cubicles for major incidents etc.) (En/Eq)	14. Additional screens made available to ED before move.
9	Major Trauma:Paediatric	• Ambulance patient via ambulance door to resus compared to moving them to Paeds ED• Availability of equipment (major trauma kit)• Introducing trauma team to new resus.• Knowledge of how to manage paeds trauma patient and trauma network• Step-up vs. step-down Paeds ED and Resus	15. Can we have a joint adult and paediatric airway trolley in all resus bays? (Eq)	15. They are not big enough for both sets of equipment, so will remain separate.
10	Cardiology:ST Elevation Myocardial Infarction	• Walk in process of how chest pain managed via triage• Assessment of pt in space available• Availability of equipment (ECG machines etc.)• Bring through for ECG in pre-assessment rooms behind triage• Transfer to majors vs. resus.• Where to get drugs from in majors and resus	16. Are there drugs in triage? (Eq)17. Is there canulation kit in triage, or just in the post-triage intervention/ECG rooms? (Eq)	16. Paediatric triage has drug cupboards, we can move the current drug cupboard from triage in the retained estate into one of the triage rooms. New cabinets now ordered - awaiting install date17. Stock was to be defined by clinical teams. There is cannulation equipment in triage.
11	Aortic Dissection	• Moving from corridor to resus• Arterial line equipment• New monitor set-up• Use of syringe drivers in new space• Transfer bag suitability	18. Can we have emergency buzzers in the long corridor? (En/P)	18. Yes - awaiting install date.
12	Cardiology:Bradycardia	• Level 2/3 care in the space we have• Medical management of bradycardia including pacing and drugs	19. New telemetry monitors will need testing (Eq/En)	19. Tested and functional
13	ED Operations and Escalation:Trust-wide Tabletop	• Triage Delay• Bed Wait• Staffing Crisis (Nursing and Medical)• Ambulance Offload Delay• Internal Critical vs. Major Incident• Full Resus• Multiple Cardiac Arrests• IT Service Failure• Phone/ Bleep Failure• POD Failure• Mass Strike Action (e.g. 72-hour walk-out)• Delays with non-admitted patients/ peaks in activity	20. ED Operations and Escalation Plan update needed (P)	20. Update dynamic and being reviewed
14	COPD:Type 2 Respiratory Failure	• Access to equipment in resus• Level 2/3 care• Use of NIV in new resus• IT and communication infrastructure	21. Why is there medical air ports in Resus - previous incident meant they were capped-off in old ED. (Eq/En/T)	21. Health and Safety team aware, medical air requested at design stage and restricted. Approved by medical advisor committee, they all have different outlets to Oxygen - removable caps attached before move which is aligned to the Risk Assessment.
15	Overdose:Calcium Channel Blocker	• Use of high dose glucagon/ insulin• Do we need “poisons box” in Pharmacy• IT and communication infrastructure	22. Discuss with Pharmacy regarding a box of 30 Glucagon and rotation into live-stock when dates get close (Eq/P)	22. Implemented in resus drugs room.
16	Infection Risk:Negative Pressure Room	• Test negative-pressure room• Access from outside by ambulance	23. The negative pressure room needs to be resus specification. (En/Eq)	23. Negative pressure room will have full resus specification before handover.
17	Minor Injury:Woundcare Simulation	• Access to minors cubicles• Storage of woundcare equipment• Process of senior advice from minors for complex wound	24. Why is there no main desk for notes in See and Treat? (En)25. Are there x-ray screens in S&T? (En/Eq)26. Is there equipment in S&T for Oxygen etc? If not, why are there ports?27. Door codes need to be more intuitive, or the codes will no doubt be written on the door frames. (En/T)28. S&T cubicles need to have basic analgesia including local anaesthetic and equipment. (Eq/En/T/P)	24. There are desktop computers in every cubicle in See and Treat (S&T)25. Yes, Picture Archiving and Communication System (PACS) screen installed before move.26. Yes, all cubicles are configured the same.27. Door codes have been changed to be more intuitive28. The aim is to have a drugs cupboard in S&T. Equipment trollies in situ before move.
18	Pregnant:Resuscitative Hysterotomy	• Access to equipment in resus• Use of multiple teams in new space	29. Further discussions as per point 8	29. Further discussions as per point 8
19	Cardiac Arrest:Adult	• Familiarisation with new environment• Familiarisation with equipment	30. We need level 3 care trollies in the main department (Eq)31. Do the big glass doors in the main department have any way of becoming opaque (En)	30. Additional trollies purchased and stocked.31. Yes - there are curtain rails on the inside. Curtains fitted before move.
20	Cardiac Arrest:Paediatric	• Familiarisation with new environment• Familiarisation with equipment	32. New buzzer system has two separated colours (blue and red) need to twist lenses so blue is outermost and more visible for higher-priority emergencies (En/T)	32. Split removed from every lens – now entire fitting flashes the colour
21	Rapid Tranquilisation:Adult	• Availability of drugs• Availability of expert help• Emergency buzzers and Vocera badges• Ease of access to guidelines• Difficult airway drills and support	33. The ventilators in resus need to be in an intuitive/ergonomic position as ITU would struggle to set it when ventilating due to size of bay (En/Eq)	33. When bays set up, trolley moved closer to head of cubicle than centre as bars are fixed to wall.
22	Rapid Tranquilisation:Older Adult	• Availability of drugs• Availability of expert help• Emergency buzzers and Vocera badges• Ease of access to guidelines• Post-procedural logistics	34. X-ray waiting area is a potential risk for patients if we are unable to guarantee escorts due to buzzer system in retained estate not linking to new build (P/En)	34. Current buzzer systems ring in retained estate - x-ray will need to call 2222 when ED move. Email sent to radiology and resus team to ensure new process
23	Overdose:Rapid Sequence Induction	• Availability of kit• Speciality ease of access• Speed of medication collection	35. RSI drugs box would be useful (Eq/T)	35. Box agreed by Pharmacy and contents decided by ED and ITU teams
24	Hypothermia	• Rewarming therapies and availability• Distance for supporting equipment	36. New warmer required (Eq)	36. Funding identified and ordered
25	Sedation:Complicated fracture reduction	• Availability of drugs• Availability of expert help• Emergency buzzers and Vocera badges• Ease of access to guidelines• Post-procedural logistics	37. More computers are required for note taking (Eq/P)	37. 6 computers installed in cubicles and 8 new computers-on-wheels ordered - feedback from clinicians during workshops that laptop-safe is being used more often
26	Major Haemorrhage:Medical (Gastrointestinal Haemorrhage)	• Re-test process after changes made• Speed of blood product availability in new space	38. Ascites pathway discussed - work towards looking for Same Day Emergency Care space or input (P)	38. Care Group are discussing – will depend on priorities of the division of Medicine and Long Term Condition
27	Paediatric:Peri-arrest	• Timely response of teams• Access to equipment	39. Moving paediatric patients to resus will split paediatric nurses and takes longer the old build (En/T/P)	39. Resus bay identified in paediatric emergency department and stocked as resus. Paediatrics will be treated in paeds rather than resus when condition and staffing would deem this safer for patients
28	Neonatal:Resuscitation	• Existing equipment suitability	40. Need a new resuscitaire - current one is outdated, not fit-for-purpose or robust (Eq)	40. Uniformity with new purchases within maternity/neonatal areas – same model of resuscitaire procured.
29	Mental Health:High Risk/Absconding	• Buzzer configuration	41. New buzzer system - needs labelling correctly (En)42. New buzzer system - needs every emergency pull (red and blue) to ring in all areas (En/P)	41. Programming signed off and tested42. Programming signed off and tested
30	Major Incident:Multi-Agency Simulation	• Test the new build is fit for purpose to manage a mass casualty incident• Test layout and newly formulated major incident plans are fit for purpose• To test flow throughout the new build in a major incident	43. Major Incident Plan and training need amending in line with feedback (Eq/P)44. Uniformity of triage systems with statutory ambulance service would be useful (P)	43. Amended and new training rolled out as mandatory for ED staff44. Procured and will be used when delivered

Key: Equipment (E^q); Environment (Eⁿ); Teams (T); Process (P)

In response to concerns highlighted by the Ockenden Report [1] and East Kent Maternity Services Report [2] healthcare organisations are seeking innovative strategies to address deficiencies in service delivery. This, coupled with a Care Quality Commission (CQC) report of a large Trust’s maternity services, revealed several significant shortcomings in maternity care, including failures in teamwork, professionalism, and communication.

Methods:

A workshop-based approach utilising simulation was informed by an extensive fact-finding process, involving one-to-one and group interviews with consultants, midwives and managers. This ensured a comprehensive understanding of the issues raised in the national and local reports and facilitated the customisation of scenario-based simulations to address specific areas of concern. Two separate site three-day workshops consisted of scenario-based simulations with actor role players using adapted forum theatre techniques with debriefing, reflection and action planning. Demonstrating support for the principles and values agreed by the extended team was essential; this included appreciating shared values and common goals, being open, honest, showing mutual respect, trust, kindness and feeling comfortable to be heard but also listen, and challenge.

Results:

Feedback from participants and data collected during the simulations indicated a positive impact on participant understanding, confidence, and skills. Participants reported improved awareness of the issues highlighted in the reports and expressed increased confidence in their ability to address them. Subjective outcomes were:

● 58% increase in feeling comfortable to initiate a challenging conversation with a more senior colleague.

● 83% increase in the perception that by not starting a challenging conversation with a colleague the individual takes no responsibility to improve the culture

● 60% increase in the ability to listen actively to others when an issue affects them directly and their viewpoint is different.

Discussion:

Utilising simulation in the development of a local response to the Ockenden and East Kent maternity services reports proved to be an effective strategy. Two simulation-based ‘I’ categories were identified: inclusion and identification [3]. This was a valuable opportunity for participants, as key stakeholders, to practice and refine their skills in a safe environment, and, through simulation, to identify, discover and recognise what was happening for them in their unit. Discussion was rich, honest, challenging and illuminating. This approach holds promise for replication in other healthcare settings seeking to address similar challenges in service delivery and quality improvement.

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.

References

1. Ockenden D. Ockenden report - final [Internet]. GOV.UK. Crown; 2022. Available from: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1064302/Final-Ockenden-Report-web-accessible.pdf.

2. Kirkup B. Maternity and neonatal services in East Kent: “Reading the signals” report [Internet]. GOV.UK. 2022. Available from: https://www.gov.uk/government/publications/maternity-and-neonatal-services-in-east-kent-reading-the-signals-report.

3. Sharon MW, Buttery A, Spearpoint K, Kneebone R. Transformative forms of simulation in health care – the seven simulation-based ‘I’s: a concept taxonomy review of the literature. International Journal of Healthcare Simulation. 2023.

In-situ simulation (ISS) is a form of simulation-based learning that takes place in real clinical settings, with benefits including the identification of system vulnerabilities, refinement of protocols and improvement of inter-professional dynamics, all without endangering patients [1]. This theoretical basis for learning is underpinned by situativity theory and principles such as the systems engineering initiative for patient safety (SIEPS) [2]. We report on the use of ISS prior to the relocation and expansion of two existing ICUs totalling 31 beds into one new purpose-built 55-bed facility, as part of a redevelopment of the Royal Sussex County Hospital in Brighton.

Methods:

A number of high-fidelity multidisciplinary simulations were held in the new facility prior to relocation, followed by detailed documented team debriefs to identify safety themes. Simulations included unanticipated cardiac arrest and difficult intubation. Scenarios were conducted in a variety of open bays and negative pressure side rooms to maximise learning. Additional timed simulations were conducted for time-critical ITU transfers such as the computed-tomography (CT) scanner, theatre complexes and interventional radiology suites.

Results:

Key themes were the accessibility of emergency equipment as well as challenges in the ergonomics and layout of the new unit. Barriers to emergency medication access and the need for improvements to the bedspace nomenclature were also raised. Feedback from staff was universally positive with common themes being a greater level of preparedness and familiarity with the new environment. The simulations also identified potential challenges with staffing templates on the new unit. As illustrated in Figure 1-A6, safety issues were fed back to their relevant medical and nursing leads to develop strategies to improve safety.

Discussion:

We highlight the successful implementation of ISS within a QI framework to aid the safe relocation and expansion of a large critical care facility. We are now exploring the ongoing use of multidisciplinary ISS on the new critical care unit, with other scenarios such as raised intracranial pressure under development. Critical aspects of this model are the need for key stakeholder buy-in and staff engagement at all levels, with appropriate senior oversight throughout.

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.

References

1. Calhoun AW, Cook DA, Genova G, Motamedi SM, Waseem M, Carey R, et al. Educational and patient care impacts of in situ simulation in healthcare. Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare. 2024;19(1S).

2. Carayon P, Schoofs Hundt A, Karsh B-T, Gurses AP, Alvarado CJ, Smith M, et al. Work system design for patient safety: The SEIPS model. Quality in Health Care. 2006;15(suppl 1):i50–8.

Figure 1-A6.

A six-stage quality improvement methodology for service development and evolution utilising in-situ simulation

Good clinical documentation provides evidence for safe, high-quality, continuous patient care. Nevertheless, fostering effective nursing documentation practices in this digital age remains a significant challenge. Time-consuming and burdensome perceptions towards documentation, negatively impacts maintenance of accuracy and legal prudence [1]. Following organisation-wide implementation of digitised health records, an internal review highlighted significant variation in nursing documentation practices. The limited extent traditional pedagogical approaches can meaningfully improve documentation [2] prompted exploration of alternative strategies to identify and address perceived contextual barriers to effective digital documentation. Drawing on improvement methodology, this educational initiative aimed to transform electronic nursing documentation by encouraging critical thinking, evidencing of rationale behind contributions to nursing care and realigning to the nursing process.

Methods:

A simulation-based workshop was developed with stakeholders and delivered to 75 nurses and healthcare assistants in one UK acute hospital. Pedagogically informed by the process of double loop reflection [3], the workshop consisted of three simulated exercises centred around a single-patient, pre-recorded scenario; 1) electronic documentation of a care episode, 2) writing a witness statement for the coroner, and 3) presenting at a mock coroner’s court inquest. Each activity was followed by a facilitated debrief. The aim was to encourage participants’ to critically evaluate their underlying perspectives and documentation practices to transform habitual thinking and actions beyond standardised electronic templates. Participants completed a pre and post-course surveys to evaluate the learning intervention.

Results:

There was an overall increase in self-reported confidence in documenting challenging clinical situations, with the proportion of those ‘completely’ confident increasing by over threefold from 9.4% to 32.4%. Several themes emerged during qualitative analysis. This included changes in perspective towards nursing documentation with a particular emphasis on importance, thoroughness, and efficiency alongside an intention to change documentation practice. Systemic and cultural factors were also identified as potential inhibitors to changes in behaviour.

Discussion:

Simulated experiences that actively engage participants in critical reflection and discourse can provide transformative learning experiences in nursing. Immediate self-reported changes in participants’ perceptions of the evidential quality of digital documentation suggests promise that may support future changes in practice. However, the process also surfaced barriers to action and change, including systemic and cultural factors. This will inform ongoing organisational learning regarding enhancing documentation effectiveness. Future work will focus on expanding and evaluating the longitudinal impact of this educational intervention and supporting wider improvement efforts to address the identified contextual barriers.

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.

References

1. De Groot K, Triemstra M, Paans W, Francke AL. Quality criteria, instruments, and requirements for nursing documentation: A systematic review of systematic reviews. Journal of Advanced Nursing 2019. 2019;75:1379–13931.

2. Bunting J, de Klerk M. Strategies to improve compliance with clinical nursing documentation guidelines in the acute hospital setting: a systematic review and analysis. SAGE Open Nursing. 2022;8.

3. Argyris C, Schon D. Organizational learning: A theory of action perspective. Reading, Massachusetts: Addison-Wesley Publishing Co; 1978.

Within NHS organisations, administrative staff play a crucial yet often overlooked role in communication and upholding organisational values. Over 500,000 of 1.2 million NHS staff, work in the vital range of fields that support clinical care [1]. These staff receive 0.01% of the NHS training budget, yet they have a significant interface with patients, the public and colleagues [1]. Building upon previous success, this study aims to expand the rollout of simulation-based training to include administrative staff in both inpatient and outpatient settings.

Methods:

The expanded rollout utilised a hybrid approach, offering face-to-face workshops and live online sessions to reach administrative staff across inpatient and outpatient settings, over a large geographical spread. Fully briefed actors enhanced the simulation scenarios, which focused on communication domains crucial for administrative tasks. Building on previous experience of participant reluctance, an emphasis was placed on collaborative co-design with the participant groups. Demonstration, immersion, and feedback through 3.5hours of simulation involved simulated patients/relatives/colleagues (actors). The scenarios focused on four domains of telephone, email, letter and face-to-face communication. Emphasis on giving (and receiving) positive feedback was a vital thread.

Results:

A ‘pre and post’ evaluation method is used to assess increase in knowledge and confidence.

Before the workshop 42% of respondents expressed no, limited, or neutral knowledge about the importance of being able to change their communication style to suit the situation. After the workshop, 100% of respondents expressed good or excellent knowledge.

Before the workshop 61% of respondents expressed no, limited, or neutral knowledge about how to use de-escalation techniques with patients and relatives. After the workshop, 97% of respondents expressed good or excellent knowledge of this area.

A total of 340 administrators have attended the 14 development workshops, with one facilitator and four actors per workshop.

Discussion:

The expanded rollout of this simulation-based improvement initiative represents a transformative approach to addressing the training needs of administrative staff across inpatient and outpatient settings. By incorporating crucial elements such as co-design, simulation-based learning, and alignment with organisational values, the initiative enhances administrative performance [2,3]. The utilisation of actors and a hybrid delivery model ensures scalability and effectiveness in reaching a wider cohort of administrative staff. This scalable and replicable approach has the potential to benefit a wide range of NHS organisations, ensuring continuous improvement and alignment with organisational goals.

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.

References

1. Cowper A. Mobilising the NHS’s hidden army [Internet]. Health Service Journal. [cited 2024 Apr 28]. Available from: https://www.hsj.co.uk/interactive/mobilising-the-nhss-hidden-army/7004957.article.

2. Feder V, Fibiger K, Knaak S. On the very, very frontlines of mental health care. Psychiatric Services. 2019;70(2):148–50.

3. Paper Works: the critical role of administration in quality care [Internet]. National Voices. 2021 [cited 2024 Apr 28]. Available from: https://www.nationalvoices.org.uk/publication/paper-works-critical-role-administration-quality-care/.

The total number of all reported written complaints, in England, to hospitals, community health services and primary care in 2022-23 was 229,458 [1]. Common themes across these complaints are communication issues, patient care issues and a lack of adherence to the organisation’s values and behaviours. Simulation-based ‘I’s (SBIs) are a useful taxonomy for categorisation, with simulation-based ‘influence’ reported to have the potential to profoundly influence both the relational aspects of care, and the development of a collaborative culture [2]. In response to communication challenges, this SBI presents a transformative approach through co-designed simulation workshops.

Methods:

Information was collected from healthcare trusts, education providers, and directly from patients and carers, with the aim of addressing systemic issues, while fostering a culture of patient-centred care. This co-designed framework, ensured that the content of the workshops was based on real patient complaints, with the developed simulations verified by specialist departments for authenticity. The collaborative effort ensured relevance and applicability across diverse NHS settings. Expert facilitators, supported by trained actors, delivered eight sessions to multidisciplinary audiences. Both live online and face-to-face sessions, ensured accessibility across a large geographical area.

Results:

Evaluation feedback revealed the transformative impact of these workshops on participants’ communication skills and awareness of patient safety issues. Disjointed care and its consequences were a key takeaway, including the impact of how one single encounter can influence the care pathway. The co-designed approach facilitated meaningful engagement and resonated with attendees, regardless of organisational context, and stimulated empathy, deepening participants understanding of the patient or complainants’ perspective [3]. Pledges were made by all participants, ranging in breadth, from an individual change to changes within the healthcare environment.

Discussion:

The development and delivery of these workshops highlight the potential of co-designed simulation workshops as a replicable solution for enhancing communication and patient safety across NHS organisations [4]. By integrating real patient experiences with expert facilitation and actors, the workshops offer a transformative SBI learning experience that is influential across organisations. The nature of these workshops not only ensures relevance but also fosters a sense of ownership and accountability among participants. By actively involving healthcare professionals and patient’s experiences, in the design process, staff are empowered to address communication challenges proactively, ultimately improving patient outcomes and organisational culture. The widespread adoption of this approach has the potential to influence and drive systemic change within the NHS, promoting a culture of continuous improvement and patient-centred 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.

References

1. NHS England. Data on written complaints in the NHS, 2022-23 [Internet]. NHS Digital. 2023. Available from: https://digital.nhs.uk/data-and-information/publications/statistical/data-on-written-complaints-in-the-nhs/2022-23.

2. Sharon MW, Buttery A, Spearpoint K, Kneebone R. Transformative forms of simulation in health care – the seven simulation-based ‘I’s: a concept taxonomy review of the literature. International Journal of Healthcare Simulation. 2023.

3. Visscher K. Experiencing complex stakeholder dynamics around emerging technologies: a role-play simulation. European Journal of Engineering Education. 2023;1–19.

4. Brazil VA, Purdy E, Bajaj K. Simulation as an improvement technique. In: Dixon-Woods M, Brown K, Marjanovic S, Ling T, Perry E, Martin G, editors. Elements of Improving Quality and Safety in Healthcare. Cambridge University Press. 2023.