Establishing an acute illness management simulation programme for general medical registrars in a tertiary UK hospital

Abstract

Introduction: Simulation based medical education (SBME) enables professionals to train and develop in a safe environment remote from patients.1 Although the benefits of SBME programmes are far reaching, simulation based medical education of human factors has only recently been incorporated into the internal medicine stage 2 curriculum.2 The simulation team at University Hospitals Plymouth NHS Trust sought to establish registrars' experience and perception of simulation. Subsequently a training programme was designed around registrar orientated intended learning outcomes and human factors were incorporated. The training programme was tested and feedback was gathered from participants. Material and methods: A survey of medical registrars' experience and perception of SBME was initially conducted. General medical registrar orientated intended learning outcomes were generated from the survey. A simulation programme was designed and delivered around these outcomes. Participant feedback has enabled the effectiveness of the programme to be assessed. Results and discussion: 11 of 38 medical registrars completed an initial survey. The majority of trainees (9/11) received 1–4 hours of simulation training in the preceding 12 months, 2/11 received no simulation training and 1/11 received 4–8 hours. 9/11 wanted a simulation based procedural programme. 5/11 wanted to focus on clinical management and 3/11 wanted to focus on professional skills. Two simulation based procedural programmes were initiated. A dedicated pleural procedural training programme with regular sessions run throughout the year and an annually held comprehensive procedural training day to meet the general medicine curriculum requirements.In addition, between June 2023- February 2024, eight dedicated simulation sessions on acute illness management/human factors have been conducted for general medical registrars. Feedback was returned by 86% (30/35) participants. 100% (30/30) of respondents felt the simulations met the intended learning outcomes and met their training requirements. The average relevance of the cases was highly rated [Median 9.0/10.0, IQR 9.0–10.0]. Facilitator performance was highly rated [Median 9.0/10.0, IQR 8.5–10.0]. Free text responses were overwhelmingly positive with comments that the programme was ‘engaging’, ‘well informed’ performed in ‘non-judgemental environment’ and sessions were ‘fun, educational and interactive’. Areas of Improvements included incorporating other MDT members, having more cases and ensuring a small participant to facilitator ratio. Going forward 71.4% of registrars wanted simulation on a frequency of less than 3 monthly, 9.5% wanted biannual simulation and 14.3% were content with annual simulation. Conclusion: Early data of a means tested simulation-based programme on acute illness management/ human factors for registrars based on registrar orientated intended learning outcomes is highly rated by participants. This data would suggest registrars highly value the addition of simulation-based programme incorporating human factors to the internal medicine curriculum. Further data collection of the confidence and performance of participants having undergone the simulation programme could support an expansion of the simulation-based programme.