International Journal of Healthcare Simulation

Background:

The transition to a foundation doctor is often a daunting process for medical students and, to prepare for this, students attend an assistantship placement in the final months of medical school. The transition to foundation year 1 (TTF1) programme is an 8-week placement where students shadow a junior doctor, taking on a vocational role, and attend various teaching activities including high-fidelity simulation. Evidence suggests that medical students transitioning to clinical practice feel unprepared for working on-call, managing acutely unwell patients and task prioritization, and are often unprepared for scenarios requiring expert communication techniques ^[1]. As such, we redesigned a simulation programme for TTF1 students using novel scenarios designed to focus on these key areas that students often struggle with.

Aim:

We aimed to evaluate the effectiveness of a redesigned simulation programme for TTF1 students, focussing on student satisfaction, confidence and attitudes across key domains.

Methods:

Fifty-three TTF1 students attended a 1-day high-fidelity simulation training day, separated into cohorts of 10 students. Students completed a pre-course (n = 53) and post-course online evaluation form (n = 49) using Likert scales (0–5) and qualitative data. Students participated in at least one clinical scenario, while observers viewed the scenarios in a separate room. Scenarios were created to reflect likely clinical on-call tasks such as falls assessment, recognizing and managing the acutely unwell patient, bleep prioritization, and de-escalation of an agitated patient-actor. Debrief was undertaken using the Diamond Debrief model.

Results:

In terms of confidence, there was an improvement across all core domains, namely diagnosing and managing acute medical emergencies (2.8 vs. 3.8), performing cardiopulmonary resuscitation (3.0 vs. 3.6) and working effectively with colleagues in the interests of the patient (3.3 vs. 4.2). 96% of students found that simulation was a valuable learning experience, allowing them to integrate theory with practice. 94% of students felt that the simulation allowed them to analyse their behaviours and actions and 88% found that scenarios resembled real-world situations. Attitudes towards simulation were positive, with 92% of students agreeing that simulation is a good way of learning technical and non-technical skills. Qualitative themes focussed on the real-world applicability of the scenarios, increased confidence in task prioritization, closed-loop communication and early escalation.

Implications for practice:

We have demonstrated the benefit of integrating simulation training within the assistantship period and the value of creating novel scenarios directly related to future practice as a junior doctor.