International Journal of Healthcare Simulation

Background:

We introduced a pilot of medical emergency simulations using a high-fidelity manikin to fifth year medical students. These students were undertaking ‘Preparation for Practice’ two months before they started as junior doctors in the UK. The University specified a number of medical emergencies that students should experience during this time, but the timing of these can be sporadic leading to a lack of student exposure. High-fidelity simulation has been shown to lead to higher retention of knowledge and skill in the longer term within medical students compared to lecture alone [1], while increasing confidence and performance of learned skills when applied to real patients [2]. The aims of this project were to increase student exposure to medical emergencies, improve confidence, and ability to manage acute emergencies, and improve patient care and outcomes.

Methods:

Our cohort were 42 fifth year medical students who had passed final examinations and were undertaking ‘Preparation for Practice’ in a district general hospital. There were varying levels of previous simulation exposure within these students. There was no previous simulation incorporated into ‘Preparation for Practice’. The in-person scenarios included recreating life-threatening conditions on a high-fidelity manikin that can closely mimic a human presentation. The scenarios correlated with the core medical emergencies specified by the University for students to experience, discuss, and record in their logbooks. A session had four students, with four medical emergency scenarios per session. Each student was lead for one scenario, helper for another, and then observed two further scenarios. The lead student assessed the patient, initiated management, and prescribed in real time. There was discussion and feedback at the end of each scenario. Afterwards, students anonymously filled out an online feedback questionnaire.

Results:

We assessed confidence regarding management of medical emergencies pre- and post-simulation via a subjective rating scale. The data collected from students demonstrated an overall improvement in confidence by 25% after the high-fidelity simulation. 95% stated they felt confident in their ability to manage the case mix presented to them as a junior doctor after the session. 95% felt there was a role for simulation training within ‘Preparation for Practice’.

Conclusion:

We believe that simulation should be a core part of university curriculum, particularly in the transition period from medical student to junior doctor. We plan to incorporate this to future ‘Preparation for Practice’ programmes at our hospital, whilst bringing the idea to the University for consideration at other sites.

References

1. Waters PS, McVeigh T, Kelly BD, Flaherty GT, Devitt D, Barry K, Kerin MJ. The acquisition and retention of urinary catheterisation skills using surgical simulator devices: teaching method or student traits. BMC medical education. 2014;14(1):1–8.

2. Tuggy ML. Virtual reality flexible sigmoidoscopy simulator training: impact on resident performance. J Am Board Fam Pract. 1998;11(6):426–433.