International Journal of Healthcare Simulation

Introduction:

On-call ward cover is one of the most daunting prospects for final year medical students approaching their first foundation year one (FY1) post. Final year students have spent years developing their knowledge, assessment, and clinical decision-making skills, but many feel unprepared for the on-call aspect [1]. 93% of the 46 students in this research felt “not so confident” or “not confident at all” for their first shift on-call. It is therefore essential to deliver specific teaching in order to prepare them [2]. As simulation provides a “risk-free” environment for learning critical aspects of medicine [3], it is an ideal technique for a task such as this.

Aim: The aim of this research was to design and deliver a teaching session to prepare final year medical students for their first FY1 medical on-call using simulation. The aim was to unmask the hidden curriculum of how to practise as an FY1 doctor on-call and build attitudes, skills, and behaviours beyond that of the classic curriculum.

Methods:

Forty-six final year medical students from Cardiff and Swansea University took part in an optional on-call ward cover simulation session. The simulation consisted of 10 – 12 scenarios carried out during a 90 – 105-minute session in a simulated ward environment. The scenarios included data interpretation, prescribing, escalation to a senior colleague, practical clinical skills and an ABCDE assessment of an acutely unwell patient. Throughout the simulation, the medical students were expected to answer bleeps, prioritise tasks and formulate a management plan for each case. At the end of the simulation, a group debrief was conducted discussing each case and common themes such as phone etiquette, prioritisation and senior escalation.

Results:

Results were collected in the form of an online feedback form assessing student opinions on how helpful the session was, confidence before and after the session, and general comments about the simulation. 100% of the students who attended the session reported that it was helpful and after the session, 72% felt “confident” for their first medical on-call. Comments regarding the simulation included positive thoughts about the session and specific mention to the fact that the “scenarios were interesting” and the “feedback was really useful at the end”.

Discussion:

On-call ward cover simulation can help final year medical students to feel more confident for their first shift out of hours and help to unlock the hidden curriculum of skills associated with an on-call.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

References

1. Cripps F, Roberts N, Lau D. P79 Preparing for life on-call: developing on-call simulation training for final year medical students. BMJ Simulation & Technology Enhanced Learning. 2019;5(suppl 2):A95.

2. Hawkins N, Younan H-C, Fyfe M, Parekh R, McKeown A. Exploring why medical students still feel underprepared for clinical practice: a qualitative analysis of an authentic on‐call simulation. BMC Medical Education. 2021;21:1–11.

3. Bradley P. The history of simulation in medical education and possible future directions. Medical Education. 2006;40(3):254–262.