Abstract
Introduction
In-situ simulation has been shown to improve professional skills, team working and clinical care via social learning theories, benefiting all of the wider multi-disciplinary team – including nursing, physician associate and administrative colleagues – in addition to medical staff, by building camaraderie and a sense of belonging. Thus, a novel in-situ simulation training programme was created within the Department of Medicine for the Elderly at Broomfield Hospital; additionally forming part of an ongoing quality improvement project in medical education.
Method
Cycle 1: 30-minutes long sessions held on frailty ward on ad-hoc basis.
Cycle 2: 30-minutes long sessions held on base ward of doctors on an ad-hoc basis, with select equipment provided.
Pre- and post-teaching questionnaires were circulated to participants, with data scored via Likert scales assessing pre- and post-teaching confidence in reviewing an acutely unwell patient, familiarity with ward staff and equipment, and confidence in escalating patients, and handover. Each cycle ran over 4 months, with new participants per cycle.
Results
Significant improvements in key metrics were noted following attendance at a simulation session. Following the first cycle (n=20), 75% of participants were confident above neutral midpoint in reviewing an acutely unwell patient post-attendance, compared to 20% pre-teaching. Confidence in escalation of unwell patients rose from 65% to 95%, and confidence in handovers increased from 45% to 85%. Following the second cycle (n=23), confidence above neutral midpoint in reviewing an acutely unwell patient rose from 13% to 69%. Confidence in escalation of unwell patients increased from 52% to 65%, and confidence in handover rose from 30% to 65%.
Conclusion
The implementation of in-situ simulation has been shown to improve confidence in reviewing an acutely unwell patient, along with other metrics related to patient care and communication, highlighting the need for high fidelity simulation in medical education within hospital settings.