P34 'sim is all well and good, but what is it really like?' Simulating the medical assessment unit for final year medical students. (November 2018)

• Record Type: Journal Article
• Authors: Hammond, Ben; Ritchie, Alyson; Hemmer, Laura; McNiven, Neil; Oliver, Rebecca; Smith, Tim
• Is Part Of: BMJ simulation & technology enhanced learning. Volume 4(2018)Supplement 2
• Page Start: A67
• Page End: A68
• Publication Date: 2018-11
• Subjects: Medicine -- Simulation methods -- Periodicals; Medical innovations -- Periodicals; 610.113
• DOI: 10.1136/bmjstel-2018-aspihconf.126
• Languages: English
• ISSNs: 2056-6697

Abstract

Abstract : Background: Medical graduates still feel unprepared for certain aspects of the Foundation Programme, particularly clinical reasoning and prescribing. 1 Several simulation initiatives have been reported mimicking FY1 ward life, 2 however tasks such as cannulation, prescribing and communicating with patients can become disconnected. Students also feel they lack experience in clinical decision making. Additionally, acute care simulations have been guilty of shrinking time where physiological changes happen faster than they would, results are available immediately along with a dedicated nurse for one patient. Students are aware that this is not true to 'real life' and have been left unsure how they will cope when part of the on-call medical team. We therefore developed a 'front-of-house' extended simulation using our 8 combined years of Foundation Programme experience to create the Simulated Medical Assessment Unit (SMAU). Summary of work: Over 3 days, pairs of students assumed the role of the on-call FY1 for an hour long simulation in our two-bedded SMAU bay (figure 1). Students 'clerked' a patient (played by a volunteer actor) referred by the GP or A and E, requiring them to initiate management of chest sepsis or acute pulmonary oedema. Faculty played the role of one ward nurse and a medical registrar who could be contacted via pager. After 1 hour, requested investigations were made available, giving 10 min preparation time before the post-take ward round commenced. Students were expected to present to a consultant who later debriefed them 'out-of-role'. Summary of results: 16/21 students responded to a survey and 100% found the simulation enjoyable and realistic. Free-text feedback was resoundingly positive, with students reporting increased confidence about becoming an FY1, feeling 'like [they were] actually part of a team' and enjoying the opportunity to 'work in real time and therefore think in real time.' Discussion and conclusions: As shorter simulations can often feel unrealistic, this simulation gave the students a unique insight into working on-call as an FY1 on the acute assessment unit. Proficient completion required integration of time-management, communication, data interpretation, practical, presentation, prescribing and documenting skills. This met students' wish for realism and preparation for on-call. Recommendations: Students suggested greater detail in actor briefing and application of makeup to ensure that the end-of-the-bed assessment mirrored how unwell the patient was on paper adding to the immersion. This should also increase reproducibility and consistency across student experiences. References: Monrouxe LV, Grundy L, Mann M, et al. How prepared are UK medical graduates for practice? A rapid review of the literature 2009–2014. BMJ Open2017;7:e013656. doi:10.1136/bmjopen-2016-013656 Yiangou A, Kamalanathan S, Altemimi B, et al . Piloting a fully immersive in-situ simulation teaching course for final year medical students: 'Carry the bleep'. BMJ Simulation and Technology Enhanced Learning 2016;2:A27.