The use of multimodal educational tools for large scale simulated practice
Authors: Maguire Claire , Colton Scott , Wanless Stephen 
Published: November 2022

Due to the current placement capacity issues for nursing students [1] within the West Midlands and the continuation of the Nursing and Midwifery recovery standards [2], this enabled academic institutions to utilise up to 300hours of practice learning utilising a range of innovative practice-based simulations. At Birmingham City University (BCU) we were faced with providing simulation to large cohorts of students in excess of 500, reduced staffing and resources. The aim was to provide simulation based on the Nursing and Midwifery Council annexes A and B proficiencies [3] in large groups and still maintain an element of clinical realism and immersion.
The skills and simulation team developed several simulations which incorporated films, live actors, low-fidelity simulation, and problem-solving activities for students within the Future Nurse Course. Each simulation had pre- and post-work to be completed which was monitored and recorded via our online learning platform. The simulations developed and tested were:

Breaking bad news- A traumatic below knee amputation of a young farm worker which looks at issues with partner/autistic child/overprotective mother.
Hypoglycaemia- Adult hypoglycaemic patient within a General Practice setting with Paramedic input/Child hypoglycaemia/digital healthcare through use of Libre sensor.
Conflict Resolution- Case study around the care of a patient with dementia who keeps falling and a Matron who does not have time.
Pre-operative simulation- A 13-year-old high functioning Autistic child with torte teste requiring surgery and preoperative checking and Practice Assessor input.
Allergies and Sensitivities- Management of allergies and sensitivities, Use of EpiPen for anaphylaxis.
Hygiene- Shaving oral care/eyecare/female and male genitalia cleansing.
The deteriorating patient- A to E assessment.
Mobility and access- Use of equipment simulating frailty and disability.
Assistance dogs for medical and neurodevelopmental conditions.
Safeguarding- Looking at Trans/same sex couples/heterosexual domestic violence.
Female genital mutilation.
The simulations were evaluated by the students (N=550) and conclusions drawn from the feedback received. The large size of the groups being around 60 students is an issue both with staff and students, but it was recognised that this was beyond our control and that the large-scale sessions were ‘immersive in nature’ and reproduced substantial aspects of the real world interactively. Several students highlighted in their evaluation that they found the simulation content relevant to their clinical practice due to it demonstrating difficult situations that allowed them to practise their skills in a safe environment, promoting patient safety, and enhancing their situational awareness through guided experience.
Learners appreciate the relevance of the simulations to their developing clinical skills and recognised that the learning could be more targeted than within the practice setting although did not recognise it as clinical practice time.
1. Ford S. (2022) Placement delivery is vital for the future of nursing. Nursing Times.
2. Nursing and Midwifery Standards (2020 updated January 2022) Current Recovery programme Standards. NMC, London.
3. Nursing and Midwifery (2018) Future nurse: Standards of proficiency for registered nurses. NMC, London.