bluuebunny/crossref_metadata_2025_split huggingface dataset:
999 ‘emergency’ – the immersion of student health care professionals within the The SIMEX series disaster and emergency response exercise (2022)
Authors: Tanner Melanie , Knight Laura , Dobson Lucy , Herbert Sarah 
Published: November 2022

As part of the SIMEX Series exercise [1] the University hosted a simulated mass casualty incident where Nursing/Allied Health students were joined by colleagues from the local Hospital Trust to treat simulated patients with a variety of presentations. The exercise was an educational activity and at key points in the simulation, action was paused to enable everyone to learn from significant injuries. The students involved were able to assist the emergency team to test disaster event response and build vital skills including interpersonal communication, supporting distressed patients, de-escalation techniques, and recognition of deteriorating patients.
Nursing students assumed the roles of Band 5 Nurses and were allocated a shift. Also participating were Radiographer and Operating Department Practitioners students. Each student was designated an area (e.g. minors, majors) and was linked with a Nurse from the Acute Trust who coordinated care. The exercise used 43 simulated casualties, consisting of drama and healthcare students. Professional actors helped to support the authenticity of the event, especially around some of the more complex injuries such as a lady who required a Perimortem C Section and a patient presenting with schizophrenia. An amputee actor played the role of a person who required an amputation as a result of the simulated emergency. He was able to draw upon his own experience adding depth to the role. Simulations were designed in coordination with the hospital team to rehearse treatment of uncommon presentations. Further scenarios were developed to enable the students to achieve their proficiencies and to display the professional values required to support patients in challenging situations.
Initial feedback has been very positive, highlighting how the event has helped the students build upon and consolidate the fundamental skills required to be confident and competent in their future roles [2].
We are currently awaiting formalised evaluation from a partnering university who undertook pre- and post-evaluation from all ‘players’. Immediate feedback included the students using language such as ‘empowered’, ‘empathy’, ‘unity’, and ‘team spirit’ to describe their experiences. Furthermore, the students identified that the exercise had high-fidelity and enabled them to embark on interprofessional learning to test not only their physical skills but also their emotional intelligence.
Following the success of SIMEX 2022, discussions surrounding SIMEX 2023 have commenced and it is hoped the event will expand to a larger number of students across the Faculty, in line with Nursing and Midwifery Council Standards [3].
1. The Simex Series Disaster & Emergency Response Exercise.
2. Nursing and Midwifery Council (2018) Standards of proficiency for registered nurses.
3. Nursing and Midwifery.(2018) The Code: Professional standards of practice and behaviour for nurses, midwives and nursing. associates
Visualisation of the transmission of microbial particles in the neonatal intensive care unit
Authors: Groucutt Jessica , Nash Matthew 
Published: November 2022

Neonates in intensive care are vulnerable to colonisation and invasive infections from multi-resistant gram-negative bacteria [1]. In 2021 our neonatal unit (NNU) fell victim to an ESBL-Klebsiella outbreak. An outbreak control plan was formulated that included education; hand-hygiene and cleaning auditing; cohorting infants; mass screening infants and environment; and reduction of equipment in clinical areas. Our NNU has an active multidisciplinary simulation programme. Simulation is an effective educational tool to increase competence of healthcare providers [2]. We wanted to use simulation to highlight the ease of transmission of particles from a colonised infant.
The simulation involved a preterm 28-week infant corrected to 35-week gestation with numerous desaturation episodes. The baby was known to be colonised with pseudomonas. A ‘monitored’ low-fidelity manikin was placed in a cot in an isolation room. Candidates were unaware that the manikin was covered with ultraviolet powder. The manikin had numerous desaturation and bradycardic episodes necessitating airway and breathing support, clinical assessment, and septic screen. The spread of powder was assessed afterwards with a black-light.
The simulation lasted just 8 minutes. There were exemplary unprompted infection-prevention measures with appropriate handwashing and personal protective equipment. Despite this the powder spread to staff facemasks, stethoscope, resuscitation equipment, patient trolley, and monitor.
This demonstrated the ease of transmission of particles to other surfaces despite adherence to infection prevention policies. Most striking was the transmission to candidates’ facemasks which are not routinely changed, and could be a potential risk of carriage of microbes to other infants.
1. Patel SJ, Green N, Clock SA, Paul DA, Perlman JM, Zaoutis T, Ferng YH, Alba L, Jia H, Larson EL, Saiman L. Gram-Negative Bacilli in Infants Hospitalized in The Neonatal Intensive Care Unit. J Pediatric Infect Dis Soc. 2017;6(3):227–230.
2. Aggarwal R, Mytton OT, Derbrew M, Hananel D, Heydenburg M, Issenberg B, MacAulay C, Mancini ME, Morimoto T, Soper N, Ziv A. Training and simulation for patient safety. BMJ Quality & Safety. 2010;19(Suppl 2):i34–43.
Step up to ST3 emergency medicine simulation course
Authors: Keitley James , Rajan Dan , Walthall Kirsten , Brown Annemarie 
Published: November 2022

The UK Emergency Medicine training pathway has three phases; Core (CT1-2), Intermediate (ST3), and Higher (ST4-6) [1]. The transition from Core to ST3 can be daunting – whilst not ‘registrars’, ST3s are often on ‘middle grade’ rotas. Trainees are expected to manage complex adult and paediatric cases with new portfolio requirements to demonstrate these competencies. They further develop leadership skills when supporting junior doctors and managing the department [2]. An ‘Introduction to ST3’ course was developed initially in the North West Deanery to address this transition. Using the original concepts, course content and format were adjusted for a Merseyside step up course.
The redesigned three-day course contained workshops including ST3 challenges, paediatrics, night shifts, and wellbeing. 12 scenarios were organised into ‘leadership’ (sick medical and trauma patients), paediatrics (including major trauma and safeguarding), and ‘challenges’ (e.g. behavioural disturbance, burns, managing conflict with colleagues and supporting juniors). They took place in a simulation suite with either manikins or simulated patients. Data were analysed pre-course, post-course, and at one to two years post-course with thematic analysis used for free-text responses.
47 candidates took part in 2019–2021. Pre-course questionnaires showed a key concern was caring for paediatric patients. Other themes were supporting juniors, management skills, being an isolated leader, and confidence. Contemporaneous feedback showed the simulations and talks were rated positively throughout. Simulations were challenging and rated as a useful aspect. The highest rated talks have been night shift work (9.78/10, n=18), supervising others (9.67/10, n=12), and paediatrics (9.67/10, n=12). Improved confidence particularly in challenging situations has been a common theme. Lower rated talks from 2019 were replaced subsequently, and the course remains receptive to feedback. In 2021, ‘The Floor’ game [3] was incorporated for departmental management skills and participants found this particularly useful. One to two years later, candidates reiterated the importance of the course in their transition, particularly regarding paediatric cases. They highlighted the benefit of discussing portfolio requirements and the value of networking with peers.
The step up course has been an important aid when transitioning to ST3 with feedback consistently positive at the time of the course and subsequently. Analysis of this feedback has informed improvements for the 2022 iteration happening shortly, and reinforced aspects including ‘The Floor’, to provide a supportive transition for trainees. As one trainee reported, the course ‘made me excited for ST3, [a] reminder why I’m an ED trainee’.
1. The Royal College of Emergency Medicine, 2021. Curriculum 2021.
2. Walthall K, editor. Introduction to ST3; Course Guide. 2019.
3. Focus Games, 2022. The Floor Game.
Utilisation of digital authoring platform to enhance simulation delivery
Authors: Muir Cheryl 
Published: November 2022

The development and ongoing critique of simulation-based scenarios is critical to ensure a researched and standardised approach to learning [1]. This is achieved by creating scenarios that have set learning objectives to improve clinical practice within multidisciplinary teams and patient safety. Additionally, a robust scenario leads to stimulating and open debriefings [2]. Whilst a paper-based scenario will do this, the aim is to highlight the benefits of using a digital platform for both creating and updating scenarios.
Paper scenarios have been used for many years to achieve the goals highlighted above but it became increasingly obvious that the resources needed to review, critique, and update those scenarios were no longer effective. This situation was emphasised due to the need to have multiple copies of scenarios across many sites. In order to maintain a quality service, whilst still being able to maintain resources to redevelop and enhance existing scenarios, we implemented a digital authoring platform called IRIS.
Scenarios were transferred and created allowing a centrally controlled catalogue that could be audited and version controlled. Any changes made would automatically update the scenario on all the users’ tablets thus ensuring the same version of the scenario was used across all sites. An immediate benefit was the reduction in time spent redeveloping scenarios. This allowed for added details to be entered dependent on if it was a standardised patient or manikin driven scenario. Another benefit was the ability to rapidly collaborate and co-author with peers and subject matter experts. IRIS interfaces with manikins from leading vendors, sending patient data states directly to the manikins reducing setup time. We noticed an increase in simulation engagement as authors were able to log on remotely to update work.
IRIS allows easy design and supports the development of high-quality scenarios. Its implementation saved resources in terms of time, staffing and environmental footprint. It enabled us to have a central hub of scenarios that dismissed the need to do multiple updates in multiple places and enabled us to have an audit trail of changes, by date time and user. Moving to a digital platform enhanced the experience of our users giving them a better learning experience leading to improved patient care.
1. Alinier G. Developing high-fidelity health care simulation scenarios: A guide for educators and professionals. Simulation & Gaming. 2011;42(1):9–26.
2. Dieckmann G, Gaba D, Rall M. Deepening the theoretical foundations of patient simulation as social practice. Simulation in Healthcare Journal. 2007;2(3):183–193.
Using virtual reality to educate healthcare professionals on patients’ experience of delirium
Authors: Cyrus Angelus , Chubb Rebecca 
Published: November 2022

Delirium is an acute onset confusion that has fluctuating consciousness symptoms such as hallucinations, mood changes and distractibility. It is experienced by around 2 in 10 patients within the hospital [1]. Amongst these patients, 96% are older adults and their outcomes are consistently worse due to the delirium alone, including increased mortality rates [2]. It can also be extremely frightening and distressing. Hence, the attitudes and knowledge of healthcare professionals surrounding delirium is an important topic to address in order to aid prevention as well as manage delirium. Despite training, delirium is under reported and generally poorly managed. Studies have found that the use of virtual reality in medical education has improved empathy, depth of knowledge, and self-awareness [3]. Using a 360° camera and virtual reality headsets, an in-patient scenario was created whereby the effects of delirium such as hallucinations and disorientation were depicted. The aim of the project was to establish whether virtual reality can be used to improve healthcare professionals understanding and awareness of patients’ experience of delirium. The virtual reality video and the interviews can be found on YouTube.
Eight people were recorded using the VR and five of them were interviewed afterwards. The interviews were conducted using an unstructured approach in which the topics of how the virtual reality tool changed their perception of dementia, what they learnt from the tool, and whether they thought the tool was useful, were discussed. Thematic analysis was carried out retrospectively.
The thematic analysis of the qualitative data highlighted four key themes amongst the healthcare professionals’ responses. These themes were education, insight, empathy, and future practice. The most common theme was insight, with comments such as ‘having the virtual reality, it breaks that barrier between you and them,’ ‘you realise how just isolated that person is,’ and how the virtual reality made them feel like they are ‘in the room,’ emphasising this theme.
The outcome has been to prove concept and highlight the usefulness of virtual reality as a method of educating healthcare professionals. We have been emboldened by the feedback received. We are looking to incorporate the VR film as part of a broader simulation-based training. The training is already being adopted by local clinical teams and our local university partners.
1. Combined NHS (National Health Service). Delirium Training Video (Virtual Reality). 2022.
2. Royal College of Nursing. Delirium | Older people | Royal College of Nursing. The Royal College of Nursing. 2013.
3. Dyer E, Swartzlander BJ, Gugliucci MR. Using virtual reality in medical education to teach empathy. Journal of the Medical Library Association. 2018;106(4):498–500.
Creating a sustainable weekly interprofessional simulation for the emergency department (ED) clinicians
Authors: Diaz Celia , Shah Rupali , Dawson Neil , Ray James 
Published: November 2022

Simulation-based education has been shown to improve clinical practice [1]. It offers an environment whereby complex real world situations can safely be practised facilitating learning through immersion, reflection, and feedback [2].There has been an increasing awareness amongst the medical profession as to the importance of simulation, we therefore created a sustainable simulation programme for the multidisciplinary team (MDT) at the Horton General Hospital (HGH) Emergency Department (ED) – Oxford University Hospitals NHS Foundation Trust.
Several simulations were designed involving trauma, airway management, and acute adult and acute paediatric presentations. The focus of the simulations was based on identifying errors due to human factors. The simulations were designed utilising feedback forms as well as analysing information from clinical incident forms. These provided a platform to understand areas of improvement and targeted scenarios were created. A weekly simulation programme was then created involving the ED MDT (doctors, nurses, allied healthcare professionals) as well as other specialities (Paediatrics, Trauma and Orthopaedics, Anaesthetics and Acute General Medicine). The session was run every week for 2 hours in the ED as an ‘in-situ’ educational activity to provide a higher level of fidelity and provide an immersive environment for the participants. These scenarios were then debriefed by senior members of the team including speciality registrars and consultants trained on debriefing and human factors.
The debriefings involved the discussion of human factors pertaining to the simulations and were learner-led. The feedback from the MDT was grossly positive; nursing staff and healthcare professionals in particular felt more empowered after the sessions to raise concern. Feedback was collected using an online survey which was sent to the participants following the session. Feedback obtained from participants aided improvement of targeted learning points and therefore aided debriefing.
Our simulation programme has been run over 18 months and has had excellent feedback. We continue to improve our simulations and increase the participant numbers through the use of video links for the sessions; thereby engaging a wider audience. This has been crucial throughout the pandemic due to various reasons (room constraints, staff isolation).
1. Al-Elq AH. Simulation-based medical teaching and learning. Journal of Family & Community Medicine. 2010;17(1):35–40.
2. Datta R, Upadhyay KK, Jaideep CN. Simulation and its role in medical education. Medical Journal of the Armed forces India. 2012;68(2):167–72
Breaking bad news: a multiple cohort student paramedic simulation event with integrated service users
Authors: Geis Emma 
Published: November 2022

This simulation aimed to meet the indicative content of a communication module, which focused on breaking bad news. The aim of this session was for first year paramedic students to observe bad news being given in a simulated environment. The objectives were for students to understand the emotive realism [1] behind breaking bad news, highlight the importance of integrating service users into simulated healthcare education, and to recognise the impact of observation and feedback.
The first-year paramedic students were introduced to the SPIKES [2] model prior to the event being commended due to its ability to allow patients and relatives to have their own reaction to bad news. The first year students then observed the second and third year students undertake two simulations and used the SPIKES tool to structure feedback on how they broke the bad news. One of the simulations was a cardiac arrest case in which the patient was pronounced deceased by the paramedics, and the second was the treatment of a patient that was suffering from a myocardial infarction. Within both simulations the students were expected to treat the patient utilising best practice and then break the bad news. The final element to this simulation was the inclusion of service users who acted as patients and relatives, and were given the opportunity to feedback as to how they felt during the communication [3].
We gathered feedback via a Microsoft form from all parties with a total of 23 responses: 11 first year students, five 2
Overall, this simulation-based activity brought together the theoretical subject matter of communication and created an inclusive learning space for a variety of people to learn.
1. Buckman R. How to break bad news: a guide for health care professionals. University of Toronto Press; 1992 Aug 8
2. Baile WF, Buckman R, Lenzi R, Glober G, Beale EA, Kudelka AP. SPIKES – a six-step protocol for delivering bad news: application to the patient with cancer. The oncologist. 2000;5(4):302–11.
3. Orr F, Kellehear K, Armari E, Pearson A, Holmes D. The distress of voice-hearing: The use of simulation for awareness, understanding and communication skill development in undergraduate nursing education. Nurse Education in Practice. 2013;13(6):529–35.
Boot camps and academia: odd bedfellows for a national collaborative approach to training non-medical cystoscopists
Authors: Rafferty Brian , Fraser Fiona , Ker Jean , Robertson Allison , Brown Mary , Cooper Mark 
Published: November 2022

Scottish cystoscopy service provision faces significant challenges in the years ahead driven by COVID-19’s impact on diagnostic waiting times, the development of national treatment centres to expand infrastructure/service delivery, and limited short-term medical capacity to support recovery. These factors have greatly increased demand for the rapid development of a supportive non-medical cystoscopist workforce [1]. There is currently no agreed national approach to non-medical cystoscopy training in Scotland despite clear guidance on competencies from the British Association of Urology Nurses (BAUN). Our proposed solution has been to collaboratively develop and pilot an accelerated learning programme, including a simulation ‘bootcamp’, that pump primes adaptation to the role and clinical training requirements through technical and non-technical skill rehearsal.
We invited experts from clinical practice, education, and simulation to form a national short life working group (
Diagram of the national short life working group
A unified model for pilot was developed, integrating clinical simulation, theory, and work-based learning (WBL). It focuses on core cystoscopy skills initially, providing the necessary knowledge and ‘hands on’ ability required for independent practice. The process is primed by a two-day ‘cystoscopy bootcamp’ using simulation-based education (SBE). This comprises of a variety of methods including high volume cystoscopy skill rehearsal of increasing realism, progressing to cadaver. Non-technical skills are simulated through bespoke scenarios relevant to the role including obtaining informed consent, team communication, and delivering bad news. Expert discussion and debriefing is interwoven throughout. Formal evaluation is ongoing with early reports of increased preparedness and quicker adaptation to the clinical environment. In addition to the anticipated benefits, bootcamp also established early peer support mechanisms and, through the engagement and networking of diverse faculty, fostered integration with the wider community of practice, and a commitment to building a continually improving, user-informed simulation programme.
The method provides a cost-effective collaborative way to explore research, educational models, and the challenges of implementation in real time, through a multi-professional lens. The approach has been crucial to ownership, commitment and acceptance of the programme while fostering integrated cross discipline delivery.
1. Scottish Government Endoscopy and urology diagnostic recovery and renewal plan. 30 Nov 2021 Endoscopy and urology diagnostic: recovery and renewal plan – gov.scot (