International Journal of Healthcare Simulation

Background:

Transition from medical student to foundation doctor can be a daunting process. There is growing interest for research into ‘how prepared medical graduates are for practice’, with a systematic review showing graduates feel unprepared for prescribing, clinical reasoning/diagnosis, and emergency management [1]. Following reports by medical students describing the benefits from simulation programmes for preparation to practice [2], a group of doctors established a junior-led near-peer simulated patient teaching programme at a district general teaching hospital to supplement the medical education programme. With qualitative evaluation demonstrating positive reception from teachers and students, this study aimed to quantitatively evaluate the effectiveness of the programme on improving the knowledge of medical students/junior doctors and providing junior doctors with opportunities to gain teaching experience.

Methods:

Nine simulation teaching sessions were run between 7/1/22 – 31/3/22, with a total of 22 medical students and 17 Near-Peer Teachers (NPTs) [3] involved. Knowledge tests were completed by medical students and NPTs before and after each simulation session, as well as feedback forms enquiring about confidence in managing different cases (choosing from the options of: very confident; confident; mildly anxious; anxious). NPTs were also asked to report on their confidence in teaching cases and whether they wanted feedback by a supervising clinician in the form of ‘Developing the Clinical Teacher’ assessment; a mandatory task for foundation year trainees. The difference in examination scores and confidence rankings before and after the sessions were calculated for students and teachers, allowing for quantification of improvement following simulation sessions.

Results:

Medical students demonstrated an average improvement in test score of 13% from a simulation teaching session, whilst NPTs had an average test score increase of 5%. 86% of students reported an improvement in confidence of managing cases related to their scenarios after the teaching session. 75% of NPTs reported an improvement in confidence of both managing and teaching scenarios. Almost half (46%) of foundation year doctors completed mandatory ‘Developing the Clinical Teacher’ assessment through this initiative.

Conclusion:

A junior-led simulated patient teaching programme improves both medical student and NPT knowledge of managing clinical on-call scenarios. This programme also contributed to foundation year trainees achieving the mandatory teaching assessments. Such programmes benefit both students and teachers demonstrating the potential for junior-led programmes to supplement student teaching and doctor training programmes.

References

1. Monrouxe L, Grundy L, Mann M, John Z, Panagoulas E, Bullock A, Mattick K. How prepared are UK medical graduates for practice? A rapid review of the literature 2009–2014. BMJ Open. 2017;7(1):e013656.

2. Manalayil J, Muston A, Ball A, Chevalier D. 1HR ON-CALL – Using Simulated ON-CALL to Underpin Experiential Learning in Final Year Medical Students. Journal of European CME. 2020;9(1):1832749.

3. Aba Alkhail B. Near-peer-assisted learning (NPAL) in undergraduate medical students and their perception of having medical interns as their near peer teacher. Medical Teacher. 2015;37(sup1):S33-S39.