Developing a junior-led near-peer simulated patient teaching programme in a minimal resource environment
Authors: Speed James , Jackson Peter , Muller Stephen 
Published: November 2022

High-fidelity simulation-based scenarios develop the knowledge and practical skills of medical students by recreating a more accurate reflection of managing difficult cases in high pressure environments. In circumstances with limited resources, ingenuity must be employed to recreate immersive environments. One creative method of achieving this is utilising ‘near peer tutors’ (NPTs), defined as ‘a trainee one or more years senior to another trainee’ [1]. NPTs can be employed as facilitators and simulated patients [2]. We aimed to design, implement and qualitatively evaluate a minimal resource simulation teaching programme for medical students that utilises NPTs, at a rural District General Hospital.

A lesson plan was designed for the teaching sessions. This included a pre-session examination; a pre-session presentation; simulation cases followed by a ‘STOP5 Hot’ debriefing [3]; a post-session examination and participant feedback collection. 17 NPTs were recruited from Foundation Year (FY) 1 and 2 Doctors, with two or more allocated to facilitate each session. Roles divided amongst the NPTs included acting as a patient, acting as a nurse, leading the scenario. The ‘STOP5 Hot’ debrief was then facilitated by the lead NPT. Three lead clinicians were responsible for administration: a FY2 Doctor provided session resources; an Internal Medicine Trainee supervised each session; a FY1 Doctor communicated with NPTs and students. Qualitative feedback was collected from students at the end of each session in the form of a questionnaire.

A total of 9 sessions were run from 7/1/22 – 31/3/22 attended by 22 medical students. The sessions were positively received by both students and teachers who described the sessions as ‘well organised’; an ‘open/accessible/safe learning environment’ and included ‘realistic scenarios’. Students described benefiting from ‘clear, useful feedback’; ‘observing the life-cycle of management within a scenario’ and the use of NPTs memory aids (including mnemonic devices). NPTs reported that the teaching ‘reinforced their skills in emergency assessments’, ‘time management of sessions was efficient’, and that the scenarios provided had ‘appropriate level of background information’. Suggested improvements included ‘greater variety/complexity of cases’, ‘scenario specific tick-lists to review management steps’, and ‘expanding the use of technology’.

A junior-led near-peer simulated patient teaching programme was well received by both students and near-peer tutors. Further research could evaluate the improvement in knowledge of students following the sessions and the effectiveness of providing teaching opportunities to junior doctors. Future aspirations include expanding the portfolio of scenarios by collecting cases from junior doctors’ reflections.

1. Aba Alkhail B. Near-peer-assisted learning (NPAL) in undergraduate medical students and their perception of having medical interns as their near peer teacher. Medical Teacher. 2015;37(sup1):S33-S39.

2. Williams B, Song J. Are simulated patients effective in facilitating development of clinical competence for healthcare students? A scoping review. Advances in Simulation. 2016;1(1).

3. Walker C, McGregor L, Taylor C, Robinson S. STOP5: a hot debriefing model for resuscitation cases in the emergency department. Clinical and Experimental Emergency Medicine. 2020;7(4):259–266.