P68 A pilot programme to facilitate the induction of foundation year one surgical doctors. (31st December 2017)

• Record Type: Journal Article
• Authors: Ravindran, D; Karapinar, Y; Elloy, M; Davies, RSM
• Is Part Of: BMJ simulation & technology enhanced learning. Volume 3(2017)Supplement 2
• Page Start: A72
• Page End: A72
• Publication Date: 2017-12-31
• Subjects: Medicine -- Simulation methods -- Periodicals; Medical innovations -- Periodicals; 610.113
• DOI: 10.1136/bmjstel-2017-aspihconf.148
• Languages: English
• ISSNs: 2056-6697

Abstract

Abstract : Background: Leicester Royal Infirmary (LRI) has the busiest general surgical on-call in England. Despite a comprehensive lecture based induction programme Foundation year 1 (FY1) doctors consistently report feeling under prepared and lacking in the necessary skillset to provide high quality patient care in a stressful on-call working environment. To address these challenges a simulation based training (SBT) workshop was introduced to complement the FY1 surgical induction. Studies evaluating SBT have demonstrated their usefulness in assessing doctors 1 and improving skillset in final year medical students. 2 Aim: To improve confidence and skill-set of new FY1 doctors in managing common clinical challenges encountered whilst on-call in general surgery at the LRI. Methodology: All new FY1 doctors to the general surgical department were offered a place on a half-day SBT workshop to be delivered on the first day of their surgical rotation. Four immersive scenario simulations were designed focusing on aspects of clinical care that are often reported as being challenging for the on-call FY1; peri-operative haemorrhage, cardiorespiratory compromise, sepsis and low urinary output. Surgical registrars trained in debriefing acted as faculty with each attending FY1 assessed against hospital protocols and guidelines by the same surgical registrar for all four scenarios; clear instructions were provided for faculty and 'in-scenario personnel' to follow. A comprehensive individualised debriefing was performed following completion of the four scenarios by each FY1. Pre- and post-SBT workshop questionnaires were completed by the FY1's assessing the impact of the pilot SBT on their confidence levels. Results: Pre-SBT only 42% of FY1s felt prepared for their first day as a surgical FY1 on-call. Following attendance on the SBT workshop there was a significant increase in the FY1s confidence in a) assessing and initiating management based on high EWS (pre-SBT vs post-SBT: 40% vs. 86%), b) recognising and managing surgical emergencies (pre-SBT vs post-SBT: 42% vs. 80%) and c) escalating unwell patients to seniors (pre-SBT vs post-SBT: 58% vs. 92%). 89% of attending FY1s reported SBT boosted their overall confidence in being suitably prepared for their first day as surgical FY1. Conclusion: This study highlights: a) the benefit of incorporating SBT into a general surgical induction programme, and b) such a SBT workshop can be successfully run by middle grade doctors with experience in SBT. Future recommendations include a) mandating SBT as part of speciality induction and b) structured assessment of performance. References: . Hall AK, Pickett W, Dagnone JD. Development and evaluation of a simulation-based resuscitation scenario assessment tool for emergency medicine residents. CJEM May 2012;14(3):139–46. . Sinha SN, Page W. Interns' day in surgery: Improving intern performance through a simulation-based course for final year medical students. ANZ J Surg 2015Jan;85(1–2):27–32.