Immersive Simulation in the Foundation
Programme
Dr Ben Shippey Dr Neil Harrison Dr Lesley Creighton Dr Lana Fischer
Introduction
– Background to the project
– What we did
– Key messages
‘Competent in 370 competencies!’
Foundation
clinical
placements
‘The Foundation Programme is a twoyear generic training programme which
forms the bridge between medical school
and specialist/general practice training.’
Simulation Based Education
‘Competent in 370 competencies!’
Foundation
clinical
placements
Immersive
SBE
Plan
Research Questions
Cycle
Act
1. Which of the Foundation curriculum competencies do
Foundation doctors feel they require more training in to
support their learning during clinical experience?
2. Would a simulation based educational intervention be
appropriate to address these needs?
3. Does the proposed intervention meet the identified
training needs?
Reflect
Observe
Plan
Identify possible
foundation
competencies for
programme
Reflect
Re-Plan
Establish
competencies
to be
addressed by
intervention
Conduct a
literature
review in light
of cycle 1
Cycle 1
Reflect
Re-Plan
Reflect
Consideration
of suggestions
Redevelopment
of intervention
Thematic
analysis of
data and redevelop
intervention
Cycle 2
Cycle 3
Act
Observe
Act
Observe
Act
Observe
Construct and
deliver a
questionnaire
Analyse data
from
questionnaire
responses
Develop an
intervention
Study of the
intervention
by experts
Deliver
intervention
and issue
questionnaire
Run focus
groups, tutor
field notes
Alternatives
Challenging others infection control
Three way consultation
Adverse drug events
Monitoring therapeutics
Physiological change
Medical Evidence
Trainee perceived
usefulness 0.5
Palliative care
Consult via interpreter
Advanced care planning
Unconscious patient
Safeguarding patients
Angry patents
Goal
Learning/communication difficulties
End of life care
Unsuccessful treatment
Criteria
Assessment of capacity
Indicators for ICU
Emergency detention
Analytic Hierarchy Process
Establish competencies for
intervention
Clinical significance 0.5
Cycle 1 Results
CURRICULUM COMPETENCY
TRAINEE USEFULNESS SCORE
CLINICAL SIGNIFICANCE SCORE
COMBINED RANKING SCORE
ACTION
Emergency detention
0.082
0.035
0.0585
ward round
Indicators for ICU
0.074
0.017667
0.0458335
clinic
Assessment of capacity
0.073
0.07
0.0715
impractical
Unsuccessful treatment
0.071
0.051333
0.0611665
ward round
End of life care
0.064
0.061333
0.0626665
ward round
Learning/communication difficulties
0.063
0.074333
0.0686665
clinic
Angry patents
0.061
0.079
0.07
clinic
Safeguarding patients
0.057
0.076
0.0665
sim not needed
Unconscious patient
0.056
0.052333
0.0541665
ward round
Advanced care planning
0.055
0.051333
0.0531665
already covered in ALS
Consult via interpreter
0.054
0.051
0.0525
ward round
Palliative care
0.054
0.056667
0.0553335
clinic
Medical Evidence
0.048
0.018
0.033
clinic
Physiological change
0.043
0.072667
0.0578335
too low
Monitoring therapeutics
0.043
0.049
0.046
too low
Adverse drug events
0.042
0.053333
0.0476665
too low
Three way consultation
0.041
0.061333
0.0511665
ward round
Challenging others infection control
0.019
0.069668
0.044334
clinic
1
1
1
TOTAL
Score Comparison
0.09
0.08
0.07
0.06
0.05
0.04
0.03
0.02
0.01
0
Curriculum Competency
The interventions
FY Sim Ward Round
FY Sim Clinic
Cycle 3 Results - Clinic
Percieved confidence pre and post exercise
5
4.5
4
3.5
3
2.5
2
Percieved effectiveness of exercise
1.5
1
0.5
0
Consulting using a translator
Dealing with complaints and
angry patients
Average pre exercise
Assessing a patient for an
emergency detention order
Average post exercise
Discussing evidence nd risk with
patients
5
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
Consulting using a
Dealing with
Assessing a patient Discussing evidence
translator
complaints and angry for an emergency nd risk with patients
patients
detention order
Cycle 3 Results – Ward Round
Perceicved Confidence pre and post exercise
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
Perceicved effectiveness of exercise
Speaking up when
colleagues are behaving
in an unsafe way
Managing toxic drug
levels
Safeguarding vulnerable Discussing end of life Discussing common drug
adults
care
side-effects with
patients
Average pre exercise
Average post exercise
5
4.5
4
3.5
3
2.5
2
1.5
1
0.5
0
Speaking up
Managing toxic Safeguarding Discussing end of
Discussing
when colleagues
drug levels vulnerable adults
life care
common drug
are behaving in
side-effects with
an unsafe way
patients
Quotes
‘Very good session. Excellent feedback.’
‘Discussions with tutors were very useful, gained tips about communication skills in
each specific scenario.’
‘Good range of topics covered.’
‘Very useful real life advice on how to practice.’
‘Patients all very realistic – didn’t feel too much like simulation.’
‘It was excellent.’
‘Good opportunity to cover things not covered in other teaching’
‘Simulated scenarios of rarer clinical events’
‘Its been very good. Congratulations!’
Conclusions
1.
Important FY doctor training needs were established.
2.
A constructively aligned pilot SBE programme was designed and delivered to all FYs in
Tayside.
3.
The programme met FY expectations and training needs.
Next steps…
• Follow them into practice
• National integrated programme of SBE to support FY clinical placements
Pilot programme of targeted SBE
Foundation clinical
placements NHS Tayside
FY1 and FY2
Pilot programme of
Immersive SBE
Foundation clinical
placements
FY1 and FY2
Programme of Immersive
SBE
Thank you – questions?