Virtual safety: using online simulation to prepare trainees for their community safeguarding roles
Authors: Asiegbunam Nkiru , Laws-Chapman Colette , John-Legere Stacy 
Published: November 2022

Conducting child protection medical assessments (CPMA) where there are concerns of non-accidental injury (NAI) is a key clinical skill for paediatricians and part of the Royal College of Paediatrics and Child Health (RCPCH) curriculum [1]. Child Protection (CP) simulation training was commissioned following trainee feedback around unpreparedness when carrying out CPMA. The COVID-19 pandemic forced delivery of online CP simulation. Initial learners were paediatric trainees; with newly qualified school nursing and health visiting colleagues in subsequent delivery; allowing for multi-professional learning in the simulated environment. The session aims were to:

- increase familiarity with professional conversations in the CP context

- formulate an evidence-based opinion in cases of suspected NAI

- rehearse discussing outcomes of CPMA with parents/carers and social workers

We rehearsed, modified, and then, using Zoom as a synchronous platform, with a trained simulated patient (SP) and faculty as role players created three 10-minute community-based CP scenarios for a twice-yearly programme. Pre-course information and a pre-briefing explained the online limitations and opportunities, including how we co-create psychological safety, the option of a wellbeing ‘wobble’ room, also outlining the Diamond debriefing model [2]. Pre- and post-course surveys were sent to the 18 participants. Likert scale ratings on confidence and anxiety levels when approaching a CP medical; familiarity with and likelihood of using the HEADSSS tool [3] was analysed using paired T-test probability.

94% (17/18) had no previous CP simulation experience. Confidence in carrying out CPMA increased post-simulation (p= 0.00418) Anxiety going into the CPMA decreased post-simulation (p=0.00624). 44% were familiar with HEADSSS tool pre-course and 94% were more likely to use it post-course (Likert rating 4or5). Confidence in expressing concerns to parent/carer rose from 11% to 82.3% post-course (Likert rating 4or5). Free text learning points included ‘Use what you can agree on (parent and doctor) as a foundation for developing rapport.’ ‘… very useful in preparation for community.’ ‘… very helpful in giving me more confidence in carrying out medicals.’ ‘Never undertaken a simulation with an actor, it felt real (I was surprised)’, ‘interesting to share learning… as practitioners have different perspectives.’

Despite sensitivity of the subject and the emotive realism brought by the SP’s, psychological safety was achieved in this online interprofessional CP simulation training through detailed preparation in course design and faculty preparedness. The pilot was successful in preparing participants to fulfil their safeguarding role. Online training continues to be a synchronous induction for 2022.

1. RCPCH. Progress curriculum. Royal College of Paediatrics and Child Health 2018.

2. Jaye P, Thomas L, Reedy G. The Diamond: a structure for simulation debrief. The Clinical Teacher. 2015; 12(3):171–175.

3. Cohen E, Mackenzie RG, Yates GL. HEADSS, a psychosocial risk assessment instrument: implications for designing effective intervention programs for runaway youth. Journal of Adolescent Health. 1991;12(7):539–44.