bluuebunny/crossref_metadata_2025 huggingface dataset:
53 Remote and Back Again: An Educator’s Tale of Simulation
Authors: Thorpe Amelia , Bailey Paul , Evans Laura , McDonald Christopher , Knight Paul , Howick Katie , Johnson Michael , Taylor Jennifer
Published: January 2022

Between November 2020 and May 2021, 61 simulation sessions were run either face-to-face or remotely for foundation-level doctors and pre-registration pharmacists. A total of 346 participants attended. Thirty-three sessions were face-to-face (185 participants) and 28 were remotely via Microsoft Teams (161 participants). The content was the same for both modalities.

The aim of the study was to discern whether there was a difference in learning points and confidence scores between face-to-face and remote participants.

Participants were asked to rate their confidence (see Table 1) before and after the course. They were asked to provide their main learning points and what they gained from the course. Confidence scores were compared and assessed for change. Responses were compared between face-to-face and remote.

Confidence score change on Likert scale 1–5.

All participants reported increased confidence. Table 1 shows that the changes were comparable, with the changes in the remote participants all being marginally higher than in face-to-face. The distribution of learning points for remote and face-to-face participants was identical. For both modalities, the top two points were communication and escalation. The dominant theme in remote was escalation and communication in face-to-face. Remote participants were positive about the course, in their free-text responses, ‘most innovative use of technology I have seen during COVID’ and ‘My hands are sweating, I can’t believe how real that felt’ a common theme in the comments was that they would rather do the course face-to-face.

While not preferred, remote simulation appears to deliver equivalent learning and is a suitable alternative when face-to-face is impossible. The main difference seen was in communication skills, which is concurrent with Cheng et al.
88 Streaming High-Fidelity ECMO Simulation from a Moving Ambulance
Authors: Hayes Thomas , Bernasol Aldwin , Pulford Lindsey , Bedingfield Rachael
Published: January 2022

The Trust needed to offer extra-corporeal membrane oxygenation (ECMO)

The aim of the study was to deliver high-fidelity ECMO simulation in a moving vehicle while simultaneously allowing candidates and faculty to watch the scenarios take place remotely.

A custom video-over-IP system was used to run three camera feeds and a patient monitor output. A laptop captured this in a quad-view format and streamed it to a dedicated video streamer. This was then networked locally via a router with a secondary laptop which displayed the stream. The router was connected to a mobile 4G modem, allowing the secondary laptop to share this video stream via Microsoft Teams (MS Teams). In addition, a USB audio interface and microphones ensured intelligibility while the vehicle was in motion.

Teaching groups were made up of 3–4 candidates from the ECMO team and 3–4 candidates from patient transport. Scenarios outlined a paediatric patient, currently on ECMO, being transferred to a specialist hospital in the region via ambulance. One or two candidates from each service would take part in the scenario and the remaining candidates would view the simulation in the centre debrief room. A technician in front of the ambulance controlled the simulator and monitored the streams. The lead ECMO specialist nurse spoke to the technician from the simulation centre via a mobile phone link. The role of a consultant was played by a member of the transport faculty on the ambulance. This allowed the faculty to oversee and prompt when necessary. Using MS Teams meant the stream could be shared with the debrief room at the centre, the control room, and with other interested parties outside of the centre. This created a unique learning experience where all candidates could see each scenario and play an active role in debrief when the ambulance returned to the centre. Successful delivery of this course will improve patient safety during potentially complex ECMO transfers. We hope to invite more remote participants via MS Teams to view the simulations and take part in the debrief, increasing learning opportunities for ECMO and transfer staff.
200 Paramedic Online Simulation: A Novel Approach
Authors: Watkins Charli , Hilliard Martin
Published: January 2022

In response to an initial lack of opportunity for frontline ambulance placements during the early stages of the COVID-19 pandemic, a university lecturing team developed a novel, interactive online simulation format for student paramedic education.

The technique aimed to provide the students with the opportunity to continue to practice and refine their questioning and clinical decision-making abilities, even without having a physical patient present.

The subsequently developed format was designed to help ensure continuing development of newly acquired clinical assessment principles. Case-based scenarios took the students through key stages of a pre-hospital patient encounter. These were carefully created to resemble the real-life setting as closely as possible.

The Blackboard Collaborate teaching platform was utilized in conjunction with pre-designed slides on Microsoft PowerPoint to facilitate the learning activity. Open access images of specific scenes, hazards, people and medication were selected to create visual cues and context for the initial stages of the call, with pre-recorded sounds enhancing this experience. Students were encouraged to use microphones and the chat functionality of Blackboard to interact with their simulated patient, who was played by a lecturer, and responded in real time. Simulated monitors and pre-recorded heart and lung sounds were utilized to provide students with clinical information in a similar timeframe and format to real-life clinical encounters. On the basis of the information gathered, students then devised clinical treatment plans and delivered virtual ‘handovers’ verbally. Debriefing immediately followed the scenario, with self-reflection from participating candidates actively encouraged and supported. Spectating students were then invited to provide their observations on the scenario itself, including facilitation of peer review. All scenario debriefs further contained specific learning points for discussion and exploration, helping to ensure learning was meaningful, with a strong relationship to contemporary issues in paramedic practice. Students reported a high level of satisfaction with this technique, repeatedly describing it anecdotally as both engaging and useful to their clinical development. Facilitator learning has included refinement of techniques and strategies, along with widening participation with other professions. Subsequently, the format has been employed in teaching a range of different healthcare professions, along with being used for online inter-professional learning events between student paramedics, nurses, and midwives, and registered pre-hospital clinicians alike.
136 Point-of-View Simulation of Illness Experiences for Health Professions: A Scoping Review of the Literature
Authors: Karvelyte Milda , Gormley Gerard J , Rogers Janet
Published: January 2022

Health professionals who have experienced ill-health appear to demonstrate greater empathy towards their patients. Simulation can afford learners opportunities to experience aspects of illness but to date there has been no overarching review of the extent of this practice or the impact on empathic skills. Our aim was to determine from the evidence – what is known about simulation-based learning methods of creating illness experiences for health professions and the impact on their empathic skills.

Arksey and O’Malley’s methodological framework informed our scoping review of articles relevant to our research question. Three databases (Medline, Embase and Web of Science) were searched in November 2020 and a sample of 516 citations were exported to Covidence Systematic Review Software© for screening. Following review and application of our exclusion criteria, 79 articles were selected in February 2021 to be included in this review.

Of the 79 articles, 52 [66%] originated from the USA, 37 (47%) were qualitative based and 17 (28%) used a mixed-methods model. 77 (97%) of the articles explored the impact on learners with the majority (85%) reporting positive impact and range of emotions evoked. For instance, loss of independence throughout paralysis or impairment simulations left the majority of participants feeling vulnerable – ‘somebody they did not want to be, something negative’. Often learners gained a greater sense of empathy towards their patients, generating a range of measures that they could translate into practice to demonstrate a more holistic approach (providing more time, conveying reduced amounts of information). However, some studies observed more negative effects and additional debriefing was required post-simulation. For example, auditory hallucination studies reported a decrease in intention to help or interact with individuals with a mental illness, they did not engender goodwill or a desire to have contact, but rather facilitated social distance and negative emotions, as well as an increased willingness to apply forced treatment. A sense of suspicion and less positive attitudes towards older adults was likewise observed in some simulations of old age. Learners were noted to internalize perceived experiences of illness and to critically reflect on their empathic role as healthcare providers.

A diverse range of simulation methods and techniques, evoking an emotional and embodied experience, appear to have a positive impact on empathy and could be argued as offering a complementary approach in healthcare education; however, the long-term impact remains largely unknown.
105 A Simulation-Based Departmental Induction Using Virtual Reality 360
Authors: Powell Sarah , Kasfiki Eirini , Blackmore Andrew , Wright David
Published: January 2022

One of the challenges faced during the COVID-19 pandemic was the need for quick departmental inductions to allow rotating and redeployed junior doctors to familiarize themselves with rapidly changing departmental environments. We were unable to continue traditional inductions due to various challenges including lack of senior staff to provide the induction due to increased workload; lack of administrative staff to support inductions due to sickness and self-isolation; and lack of physical space under the constraints of social distancing. Thus, an alternative was needed incorporating all aspects of a traditional induction. Video Reality 360 (VR360) technology and video simulation have been on the rise during the last few years in medicine

The aim of the study was to produce a simulation-based departmental induction programme that would be equally effective to the traditional model.

We started with identifying the components of a departmental induction and then held a multi-disciplinary team meeting to encourage the addition of topics felt to be important and often overlooked. Stakeholders were involved in a needs analysis on the induction material; previous and current departmental junior doctors, the lead pharmacist, medical registrars, emergency physicians, acute physicians, the clinical lead, the medical director and the director of medical education were all contacted with specific questions on content and junior doctors’ needs. Components of the recent General Medical Council surveys were taken into account to allow for a more junior doctor-centred induction. Subsequently, scenarios were designed with input from the directors of simulation and approved by the acute medical unit (AMU) lead. With the help of our colleagues at Hull Institute of Learning & Simulation (HILS) the scenarios were filmed, edited, and filed to produce an educational tool.

The end-product of our VR360 induction has been checked by the educational lead of AMU against specific variables and standards and was characterized as ‘much more flexible and a potentially more effective educational tool for junior doctors’ medical induction’. Initial feedback from junior doctors has been very positive; however, further feedback comparing traditional and VR360 induction is needed. Work is ongoing to produce an interactive VR360 induction video with the hope that this could replace face-to-face departmental induction within our hospital.
160 Applying Human Factors Practices and Simulation to Develop Systems and Processes for a Pandemic Vaccine Service
Authors: Gurnett Phil , Scott Julia
Published: January 2022

The COVID-19 vaccine hubs required rapid implantation. While organizations had plans as part of the emergency resilience response to the community, there were particular challenges for setting up and running vaccine hubs for COVID-19 that Human Factors and Ergonomic practices could help to identify and address prior to opening as a vaccine hub.

The aim of the study was to assist with understanding the abilities of vaccinators and design of processes for the vaccine service at Dartford and Gravesham NHS Trust.

Simulation, observation, semi-structured interviews and Hierarchical Task Analysis (HTA) were used to understand the complexity of the vaccinator role and potential challenges for the implementation of the vaccine service. This was then used in identifying an area that could meet the capacity requirements identified and to help design the process and flow through the vaccine hub.

The work undertaken was used to identify and design the processes required to deliver the vaccine service. This in turn helped to identify the space required and, due to changes in practice following potential reactions to the Pfizer BioNTech vaccine

Using simulation and HFE processes as part of a collaborative process with staff trained with these skills can help to design safer, more effective processes in healthcare.
154 An Observational Study: An Examination of Eye Movements When Assessing a Deteriorating High-Fidelity Patient Simulator
Authors: Harris Kirsty , Ryder Isobel , Dicks Matt
Published: January 2022

Simulation has been identified as one of the principles to improve patient safety

The aim of this study was to explore the gaze patterns of healthcare students when assessing an HPS.

A longitudinal study was conducted between 2014 and 2015 at three different time points (3, 6 and 12 months) with a final transfer study (with or without a patient monitor).

The study was conducted in a simulated environment with student paramedics and operating department practitioners (N = 6). Participant eye movements were measured whilst participants assessed a simulated patient with and without a monitor.

The images represent the gaze behaviour of 1 participant at testing phase 1 (Figure 1) and phase 3 (Figure 2). The gaze pattern changes and the participant demonstrates a more holistic approach when assessing a patient in phase 3 without monitor 3.

Phase 1.

Phase 3.

Encourage the use of an algorithm from the end of the bed to recognize a deteriorating patient and teach simulation with the HPS monitor switched into the off mode. Training through the observation of gaze patterns may help develop the design of simulation alongside augmented or mixed reality technology for the future.
205 Simulation as a form of Immersive Theatre
Authors: Esposito Maria
Published: January 2022

Immersive theatre is a style of theatre that removes the fourth wall of traditional theatre turning the audience into participants and engaging the five senses such as sight, sound, touch, taste and smell; a concept applied equally to multi-professional, human factor-based simulation. Peter Brook, one of our greatest theatre directors, says, ‘Drama is exposure; it is confrontation; it is a contradiction, and it leads to analysis, construction, recognition and eventually to an awakening of understanding’. This is without doubt what we do in simulation. We create scenarios, ‘the drama’, we create managing deteriorating patients, the ‘confrontation and contradiction’ and we enter debriefing, the ‘analysis, construction and eventual awakening of understanding’. Using the concepts of immersive theatre and drama, creating more realistic environments and authentic interactions, we can offer the participants a greater sense of reality in which to practice vital inter-professional medical care. High-fidelity simulation encompasses more than just a technological top of the range manikin which often comes at a premium cost. High-fidelity simulation is an attack on all of the senses, visually sick patients, noises and smells of the environment, even touch and taste. The soundscape of an emergency room, smells of humans, drugs, equipment, tastes of stewed tea and warm water, the touch of a sick patient or a disruptive relative in a visually authentic space creates the perfect setting for an immersive simulation experience.

By implementing psychological, sociological and physical fidelity, we offer a unique way of practicing essential skills of interprofessional working not only to enhance patient care and safety but also to allow a greater understanding of ourselves and others in stressful, urgent and critical situations. Applying ideas from the world of drama and theatre, creating authentic immersive environments can give participants the freedom to be in the simulation and steer them away from acting in the simulation.
17 Improving Resus Handover for Critically Unwell and Injured Patients
Authors: Mallon Bernadette , McKenzie Euan
Published: January 2022

During a single patient journey from admission to hospital discharge, multiple clinical handovers may occur between health professionals from different specialist inpatient teams and between staff at shift changes. Each handover carries a degree of risk for the patient. It is well recognized that poor communication during handovers has resulted in a significant proportion of preventable deaths

The aim of our quality improvement (QI) project was to improve the handover process between Scottish Ambulance Service (SAS) staff and Emergency Department (ED) staff for critically unwell and injured patients arriving into resus. In addition, we aimed to improve communication and staff satisfaction with the handover process.

By utilizing QI tools such as the model for improvement, process mapping and driver diagrams, change ideas were identified and trialled using inter-professional simulation as part of PDSA (Plan, Do, Study, Act) cycles. This project involved engagement with ED and SAS staff members via online surveys, simulation sessions and staff education.

We increased staff satisfaction with the handover process from 24% to 88% and no adverse events relating to our changes were reported.

From the information gathered during PDSA cycles, a new standard operating procedure (SOP) for handover in resus was created.
79 Importance of Delivering a Face-to-Face Course During a Pandemic
Authors: Mahalingam Jeevahan , Tinga Penelope , Lotlikar Amol
Published: January 2022

During the COVID-19 pandemic, most face-to-face courses were cancelled in line with government and trust guidelines reducing the risk of virus transmission and, if possible, delivered virtually. Given that this is not feasible for all courses, cancellation would have resulted in suspension of essential training for healthcare staff subsequently impacting on career progression.

We aimed to deliver Internal Medical training skills and simulations course, face-to-face with measures taken to minimize virus transmission as well as maintain good-quality teaching.

COVID-19 measures:

Fewer delegates per course to accommodate social distancing – infection control guided

Temperature check on registration

Wearing appropriate Personal Protective Equipment (PPE) whilst inside the teaching centre

Email instructing to notify if exhibiting symptoms of COVID-19, and advise not to attend

Maintain social distancing during course

Increase ventilation of rooms

Cleaning of equipment after each use and encouraged regular use of hand sanitizer

Use of register for track and trace purposes

Feedback forms of courses that were run pre-pandemic (2019/20) and during pandemic (2020/21) were collated and compared.

Four editions of the course were run over a period of 3 months and a total of 19 participants in 2019/2020. Four editions of the course were run over a period of 7 months with a total of 17 participants in 2020–2021. Feedback response was on a Likert scale ranging from ‘strongly agree’ to ‘strongly disagree’. For ease of comparison, Figure 1 shows ‘strongly agree’ and ‘agree’ responses only. The pre- and post-SARS-COVID-19 results from the feedback are similar across the board.

The results from the feedback forms are very similar for both courses run pre- and post-SARS-COVID-19. Free-text feedback and feedback on the day from the delegates were positive. The results suggest that the changes made to the course during the pandemic to allow for social distancing and to ensure that the courses were run COVID secure have not affected the quality of the teaching and the learning opportunities for delegates. Furthermore, written feedback showed that most candidates appreciated the opportunity to practice new skills and gain confidence and work fatigue did not dampen their motivation to learn. This highlights the importance of continuing to run face-to-face courses during the pandemic.
165 Medical Students’ Lived Experiences of Online Forum Theatre as a Form of Learning in Consulting with Victims of Domestic Abuse
Authors: McGrath Daire , Gormley Gerard , Reid Helen , Murphy Paul
Published: January 2022

Domestic abuse (DA) is a prevalent problem in today’s society; over 2.4 million adults in England and Wales experienced DA in 2019

A multi-disciplinary team developed an online FT exercise, which involved a simulated consultation between a GP and DA victim. Spectators are invited to take the place of an actor or guide the actor and decide what action to take, thus helping to change the outcome of the scene. A qualitative approach was conducted, involving hermeneutic phenomenology, to explore participants’ lived experience of the FT exercise. Following the online FT experience, medical students were interviewed, and interview transcripts were analysed using a template analysis approach.

Five themes were developed through our analytical process: (1) ‘Almost being there…but not quite’: the realistic experience of FT; (2) ‘Taken on an emotional journey’; (3) ‘Opening and controlling a privileged space’; (4) ‘Small things matter…’: cultivating and maintaining rapport and (5) critically reflecting on future professional self.

This study provides an in-depth view of a medical student’s experience of online FT. Online FT has the potential to provide a novel DA teaching method for medical students. By providing students with a unique opportunity to step into a GP’s shoes in a DA consultation, students can practice how they will handle a DA scenario, without any potential consequences, helping them to improve their consultation skills.
1 Prison Simulation: Creating Accessible Xr Content for Hybrid Tel Classrooms in He
Authors: Pywell Samantha
Published: January 2022

An Inter-professional Education (IPE) simulated learning prison was created in Microsoft Teams (MS Teams) for health and social care HE students using a #ReStartSim template

The aim was to deliver a simulated learning IPE event with additional features accessible across the XR spectrum (extended reality) for technology-enhanced learning (TEL) accessible to students and staff within and external to the university in preparation for the hybrid (and hyflex) HE classrooms of autumn 2021.

This simulation was co-created with colleagues across organizations thanks to the #DigiLearnSector, and based upon developments from a simulated learning event run in 2020

This simulation used both shared and profession-specific learning outcomes, and ran in September 2021 with second-year students who were used to navigating MS Teams resources. Digital skills were recorded in LinkedIn.
82 Surgeons Don’t Just Operate: Improving Junior Surgical Practitioners’ Non-Technical Skills Outside of the Operating Theatre Using High-Fidelity Simulation
Authors: Ellerton Laura , Kelly Ryan , Keshtkar Fatemeh , Mercer Simon , Parr Tim
Published: January 2022

The non-technical skills of surgeons play a significant role in patient confidence, experience and safety

The aim of the study was to improve non-technical skills and confidence of junior surgical practitioners regarding DNACPR conversations and obtaining operative consent.

We have developed a speciality-specific course to address the educational deficit surrounding non-technical skills outside of the operating theatre, focussing on DNACPR and consent, for junior surgical practitioners. It was piloted at Aintree University Hospital with their Orthopaedic Department. We combined lectures and workshops delivered by subject matter specialists with simulated scenarios. The simulated scenarios were debriefed by human factors specialists using the gold standard validated NOTSS tool

The pilot course in June was a resounding success; candidate confidence scores increased significantly across both skills and knowledge surrounding capacity, consent and DNACPR. All attending candidates have recommended the course to their peers and suggested integration into the Foundation training curriculum. However, identifying and implementing courses appropriate for all foundation doctors with such a specialized course would be challenging. Most foundation doctors have at least one placement in a surgical specialty. Therefore, it is more realistic to adjust the course to become less specialized, encompassing all the surgical specialities, to target all foundation doctors initially instead of juniors in each speciality. Following the capture of foundation doctors, the second phase of implementation will return to speciality-specific courses to address the learning needs of non-medical practitioners, such as Physician Associates and Advanced Nurse Practitioners, working in surgical departments.
96 A Virtual Mock Trial for Inter-Professional Learning
Authors: Dickinson Karen J. , Ward Wendy L. , Minarcin Robert , Trudeau Christopher , Neill Kathryn
Published: January 2022

As a healthcare professional, participating in a medical negligence trial is an intimidating and stressful prospect, exacerbated by the fact that many have never been in a courtroom. To meet this learning need, our institution runs a Mock Trial inter-professional learning event (IPE) designed to give law students and medical, nursing, pharmacy, public health and other healthcare professions students exposure to a medical negligence trial and the opportunity to learn about, from and with each other as they collaborate as a jury to reach a verdict. To continue to deliver high-quality inter-professional education during the COVID-19 pandemic, transition to the virtual platform was required. Important lessons learnt from this process can be applied to the effective planning of similar virtual events.

The aim of the study was to effectively transition a large-scale in-person inter-professional Mock Trial simulation to the virtual platform to increase the accessibility of simulation education during social distancing and beyond.

Subject matter experts from the local law school and a university-affiliated Office of Inter-Professional education (IPE) jointly developed content for the Mock Trial. Students enrolled in the virtual Mock Trial were given pre-course jury instructions, IPE objectives and technical connection information 2 weeks before the trial. Law students, the judge and simulated witnesses received script materials 1 month prior to preparing. Facilitators participated in a virtual ‘crash course’ training 1 week before and a 15-minute pre-huddle just prior. Jurors (the students) watched the trial via Zoom and then were put into inter-professional breakouts with a facilitator to deliberate. All returned to the main room and verdicts were delivered followed by a debriefing session. Facilitators also debriefed after the event conclusion. Pre- and post-assessments were completed by students.

The in-person Mock Trial event was conducted in 2018 and 2019, but was cancelled in 2020 due to the pandemic. In the 2021 learning event, 11 individuals were in person in the courtroom with the remaining students (143) participating via zoom. These 11 individuals comprised: one judge, four law students (two defense, two prosecution), five witnesses and one administrator. Social distancing/masking rules were obeyed. One witness participated via Zoom. Student and facilitator evaluation data, including assessment of IPEC competencies, were comparable to previous in-person events. This effective translation of a large-scale simulation event to the virtual platform demonstrates the utility and increased access to learners of this modality and will form a useful part of our simulation education toolkit post-pandemic.
182 Surgical Simulator Design, What are Educators and Trainees Requirements?
Authors: Heskin Leonie , Simms Ciaran , Traynor Oscar , Galvin Rose
Published: January 2022

Simulation is an important adjunct to aid in the acquisition of surgical skills of surgical trainees. The simulators used to enable trainees to learn technical skills, practice skills and to be assessed in competency exams, need to be of the highest standard and to be of consistent design. Input into the design and makeup of task trainers used to teach surgical skills come from a multitude of sources. Enquiry into the perspectives of simulation has been described in the past but there is little description, in the literature, of the expectations of the desired features of the simulator itself.

This study investigates the perceived requirements of simulation and simulators used to acquire skills in the surgical field, particularly in limb exploratory procedures in trauma.

This study concentrated on the implementation and desired features of simulators for the acquisition of surgical technical skills.

Semi-structured interviews were conducted until data saturation was achieved. An international group of 11 surgical educators and 11 surgical trainees, who had experience with surgical simulation, were interviewed via one-to-one video calls. The interviews focussed on the perceptions of simulation, the integration of simulators within a curriculum and the features of a simulator itself. This study concentrated on synthetic and virtual reality simulators for open surgical skills, as these types of simulators are open to design and redesign or adaptation. Interviews were recorded, transcribed and underwent thematic analysis. Ethical approval was obtained for this study.

Analysis of the perspectives of surgical educators and surgical trainees on simulated training in open surgery yielded three main themes: (1) attitudes to simulation, (2) implementing simulation, (3) features of an open skills simulator. The majority felt simulation was relevant, intuitive and a good way for procedure warmup and the supplementation of surgical logbooks. They felt that simulation could be improved with increased accessibility and a variety of simulator options tailored to the learner. Suggested simulator features included greater fidelity, haptic feedback and more complex inbuilt scenarios. On a practical level, there was a desire for cost-effectiveness, easy setup and storage. The responses of the educators and the trainees were similar and reflected similar concerns and suggestions for improvement.

There is a clear positive appetite for the incorporation of simulation into general surgical and limb trauma training. The findings of this will inform the optimal requirements for high-quality implementation of simulation into a surgical trauma curriculum. The findings will inform the optimal features desired in a simulator or task trainer design. The aim is to inspire a more considered design approach to optimize surgical skills training and ultimately lead to increased patient safety.
119 From Ad hoc Teaching Sessions to Full-Day Themed Teaching Days: An Undergraduate Education Team’s Response to the COVID-19 Pandemic
Authors: Boal Hayley , Murphy Kelly , Owen Eleanor , Jones Emma , Williamson Samantha , Utting Jennifer , Sutton Heather , Prew Jessica , Gleeson Joseph
Published: January 2022

The COVID-19 pandemic has had a significant impact on the education of medical students. Many final-year students felt overwhelmed by the pandemic and less confident in the clinical setting having missed a significant proportion of their fourth-year studies. In addition, with increased numbers of critically unwell patients, restructure of services and redeployment of staff, it was inevitable that teaching on clinical placement would be compromised.

The aim of the study was to develop an innovative near-peer educational programme with integrated simulation to support the learning needs of students and alleviate pressure from clinical specialities.

The team developed a programme whereby students attended a full day of protected small-group teaching each week, equating to a total of 72 taught hours per student over an 8-week placement. Each day centred around a common theme, for example, ‘the breathless patient’, working through patient-centred case discussion, diagnostic workshops and simulation (

Integrated design of the themed teaching days delivered to final-year students.

This innovative teaching programme was implemented over the 2020–2021 academic year and was well received by students as evidenced in the following feedback:

‘It was really helpful and interesting to have each teaching day themed on a presenting complaint’.

‘Protected time so (we) do not miss out if clinicians are busy’

‘The best teaching I have had during medical school (…) I loved how interactive, clinically focussed and relevant to F1/F2 each teaching day was’.

‘Consistently received feedback which I have been able to act upon to improve my clinical practice’

‘The improvement in my confidence, understanding & knowledge has been unbelievable’.

‘Simulation session was really useful and enjoyable (…) watching and feeding back is a really helpful way to recognize different clinical presentations and critically analyse ABCDE assessment & communication skills’

‘These teaching sessions are great and unlike anything normally provided on placement’.

The teaching programme has proved to be of such success that the team continue to develop them to integrate further aspects of clinical practice and inter-professional simulation. Furthermore, the team hope to develop themed teaching days for other student year groups to complement their clinical placements.
110 Using Simulation to Assess Systems and Processes in a New Paediatric Unit
Authors: Tilly Hanna , Bisheswar Rhea , Rubens Matthew , Sohi Dalbir
Published: January 2022

simulation is an emerging tool used to test systems, improve patient safety outcomes and prepare staff working in new clinical environments

The aim of the study was to use simulated learning events (SLEs) to assess the effect of a new environment on performance, interpersonal skills and system-based practice. As part of the wider paediatric improvement plan, the simulation programme has been used to enhance teamwork and implement a change to maximize patient safety.

Five multi-disciplinary SLEs based on paediatric and neonatal emergencies were held over a month following the opening of the new PAU. The simulations were low fidelity and

Ten latent errors were identified pertaining to the availability of equipment and medications; all were rectified within 2 weeks. Operational errors were also identified, including unfamiliarity with the new PAU location within the wider emergency team, leading to delayed attendance to the simulation. The time taken to attend the PAU by the anaesthetic team decreased by 69% once the emergency bleep message was amended with location instructions. We observed that, with each SLE, there were successive improvements in teamwork and operational behaviours. The teams were able to familiarize themselves with each other and the new working environment, consequently leading to reduced times on acquiring equipment for the emergency. There were a total of 20 participants from paediatric, anaesthetic and nursing backgrounds. Feedback was received from 55% of participants, of which all agreed or strongly agreed that the SLEs and debriefs contributed to their learning and helped develop their team-working and leadership skills.

SLE is an effective tool for systems testing in a new clinical environment and helps to identify potential critical and non-critical safety risks. We will continue to develop our simulation programme to assess a variety of clinical environments and share learning from the latent strengths and errors with the multi-disciplinary team, to improve clinical processes, team working and patient safety outcomes.
149 Updates to the Healthcare Simulation Design Standard of Best Practice
Authors: Alinier Guillaume , Watts Penni , Meakim Colleen , Nawathe Pooja , McDermott Donna , Charnetski Matthew , Ludlow Jocelyn , Horsley Elizabeth
Published: January 2022

Offering high-quality and purposeful simulation-based educational (SBE) activities to learners requires careful planning

The aim of this abstract was to present the changes made to the Simulation Design Standard in comparison to its previously published version

From 2019 to 2021, a group of simulation educators and researchers representing multiple specialities, simulation societies and geographic areas (the authors of this abstract) met regularly via a videoconferencing platform to review and revise the Simulation Design Standard based on their review of the latest literature and their individual experiences. The team identified several aspects that would benefit from being updated to make this key standard more explicit and applicable to all types of simulation modalities. Drafts of the standard were reviewed on multiple occasions by peer reviewers and the society’s leadership until the latest version was approved for publication.

An updated version of the Simulation Design HSSOBPTM will soon be published by INACSL in the journal

Criteria of the 2016 and 2021 HSSOBPTM for simulation design

It is expected that the revised Simulation Design Standard of Best Practice will be welcomed by healthcare educators and simulation technology developers. It has been designed as a guide to help educators in all the key aspects of designing SBE activities, irrespective of the modality employed. It should ultimately benefit all learners but also promote the continuing professional development of the healthcare educator with an interest in SBE. It includes an updated list of useful references readers can consult to find additional information.
155 Piloting a Tabletop Simulation to Prepare Nurses for Ward Coordination
Authors: Warren Rosie , Tysoe Finn , Lacey Kate , Owen-Smith Sophy
Published: January 2022

We know staff attrition is a core challenge for the NHS with many nurses leaving the profession in the first 2 years post-qualification

The aim of the study was to improve retention and resilience of the nursing workforce by increasing confidence in their ability at clinical coordination.

This table-top simulation pilot used a convenience sample of six staff nurses new to the role of clinical coordinator. We drew on clinical governance findings and input from experienced nurse-coordinators to simulate coordinating a shift on a surgical emergency unit. The shift was run in compressed time over 32 minutes followed by a 1.5 hour debrief. During the shift we used ‘injects’ intentionally designed to stimulate learning in:

Problem solving

Decision-making

Clinical processes

Supporting colleagues/workforce resilience

Situational awareness

The pilot was evaluated through peer observation and focus group. Peer observation provided an objective analysis of session content. A neutral party facilitated the focus group, which gathered data on how the training session had been received by participants and evaluated whether learning outcomes were met by content.

Participants were assigned to work in pairs. Briefing was provided for session content and timeline. We used a simulated handover of patients for verisimilitude. The 12-hour shift was compressed into 4-minute segments with a ‘countdown’ timer ticking off each segment as the simulated shift progressed. This added time pressure and demonstrated how decision-making skills can be influenced by external forces. The participants had access to the hospital intranet and documented their actions/decisions on a template. Facilitated discussion took place after the tabletop simulation followed by a lunch break and then the focus group.
50 Continuing Essential Education During the COVID-19 Pandemic: Virtual Neonatal Skills Training
Authors: Aguirre Diana , Brown Sebastian , Negrine Robert , Nash Matthew
Published: January 2022

Practical procedures are integral to neonatal care. All first-year paediatric specialist trainees (ST1s) are expected to develop essential skills from their first neonatal placement. However, many trainees join the speciality with minimal prior exposure. With recent changes in junior doctors’ contracts, reduced working hours and evolving clinical practices, trainees may not get enough clinical exposure to acquire required skills. Simulation is recognized as essential to bridge this training gap

The aim of the study was to adapt neonatal skills training to virtual delivery.

In September 2020, we trialled a half-day virtual training course for new trainees on core topics. The first part included ‘Human Factors’ followed by ‘Stabilization of the premature infant’ using a pre-recorded simulation followed by a live debrief. The second part covered ‘intubation and difficult airway’ followed by ‘vascular access’. We used interactive lectures and pre-recorded demonstrations. A full-day course was then organized for new trainees in March 2021. We included additional sessions on ‘Newborn Infant Physical Examination’ (NIPE), ‘chest drain insertion’ and ‘journal club’, including sign posting to the Critical Appraisal Skills Programme (CASP). Interaction was encouraged to facilitate peer bonding. A Paediatric Trainee Committee representative also joined to outline the support available for trainees. We followed a similar structure to the first course but added live simulation demonstrations of equipment and techniques.

Seventeen trainees attended the full-day course. A number of candidates rating the sessions as extremely useful were 16 for ‘Stabilization of the premature infant’ and ‘intubation and difficult airway’, 14 for ‘Human Factors’ and ‘NIPE’, 12 for ‘vascular access’ and ‘chest drain insertion’ and 11 for Journal club. Trainees commented positively on the videos, equipment demonstration, level of interactivity and overall usefulness of the course. Nine trainees commented on desire for additional face-to-face training.

After balancing the safety and learning needs of trainees, we adapted an established face-to-face skills day for virtual delivery during the COVID-19 pandemic. Whilst we recognize that virtual training is not a substitute for doing, we were able to maintain essential education during highly pressured times. Feedback demonstrates that our virtual teaching programme was well received and useful. It also emphasizes the value of actual practice and the urgency to restore hands-on training as soon as possible.
120 Cervical Spine Injury Immobilization and Management: Addressing the Gap in Knowledge and Improving Systems through Multi-Disciplinary in situ Simulation in a Busy Emergency Department
Authors: Pughe George , Smith Matthew , Atkinson Ben
Published: January 2022

Cervical spine (C-spine) injuries are a significant cause of morbidity and mortality, particularly in the elderly population

The aims of the study were to identify clinician knowledge gaps when starting EM, create a simulation-based teaching program to address these weaknesses and to improve multi-disciplinary systems relating to C-spine injury immobilization and management.

A sample of 20 clinicians finishing their EM rotation in April 2021 at Queen Alexandra Hospital, Portsmouth, completed a survey listing conditions/procedures they would have appreciated simulation scenarios on as part of induction. A 30-minute C-spine simulation station was designed focussing on knowledge gaps identified, incorporating Canadian C-spine rules, immobilization, radiological investigation and treatment. Sessions were delivered

About 70% of surveyed candidates included ‘C-spine’ within conditions/procedures they desired simulation teaching on. Candidate feedback suggested high levels of enjoyment with 100% of candidates scoring 7 or 8/8. The mean confidence of candidates before and after the session increased by 30.6% (52%–82.6%). 100% of candidates felt that the session was useful in improving day-to-day practice and 67.7% of candidates envisaged implementing teachings within the next week (96.8% within the next 3 months).

In a busy department, it is important to prioritize education and address workforce knowledge gaps. Trauma and C-spine injury appear to be an area of under-confidence in junior clinicians starting in EM. Short
3 The Implementation of Simulated Placements in Undergraduate Healthcare Courses During the Covid-19 Pandemic
Authors: Kirkham Lucy , Clark Debbie
Published: January 2022

In 2020 many healthcare students lost placement hours due to COVID-19. In response to this crisis, simulated placements were implemented to ensure students were able to achieve their practice hours. A pilot project was undertaken in November 2020. This was then developed at pace into a simulated placement module that could accommodate around 3,500 students by the start of January 2021. Nursing and Midwifery Council guidance was updated in February 2021

The study aimed to enable nursing students to maintain their hours as required by the NMC, and provide evidence to demonstrate achievement of their competencies. It also aimed to ensure patients and service users from all fields were represented within the activities.

A module blackboard site was developed online to house the materials. Each activity was mapped to the cohort-specific proficiencies which needed to be achieved for that particular level of study (BSc and MSc). A wide range of activities were included such as Oxford Medical Simulation, detailed case studies and scenarios including ‘talking head’ style videos and patient documentation, service user interviews, analysing Care Opinion patient feedback, and 360-degree tours of a patient’s home to undertake a risk assessment.

Students were able to access the simulated placements if waiting for a clinical placement due to lack of availability, if course completion was delayed due to ‘opting out’, or if the student was self-isolating or shielding. Students received comprehensive guidance as well as regular YouTube updates to walk them through the process. A mixture of live online sessions and self-directed activities were included and engagement was logged on a placement timesheet. There were also activities and live sessions focussing on student well-being and preparation for placements. It was also important to include activities focussing on other fields of nursing such as mother and baby or learning disabilities. A reflection was then uploaded to the digital placement assessment document so that it could be accessed virtually by the practice assessor and academic assessor. The simulated placements have since expanded into the Allied Health Professional courses within the university and it has been valuable to undertake interprofessional resource sharing to further enhance the simulated placements experience.