International Journal of Healthcare Simulation

Background and aim:

Simulated sessions are widely used within medical education. Despite the potential benefits of simulated learning, it suffers from a narrow scope of practice; acute, emergency presentations and procedural skills. There is less research for its utility in sub-acute and chronic disease management.

To develop expertise in medical practice, learners require sufficient foundational knowledge to facilitate more complex behaviours [1]. Within ward environments, lack of foundational knowledge in both ‘hard’ (knowledge) skills, and ‘soft’ (organizational) skills can limit learners’ potential for development. Considering legitimate peripheral participation theory, learners require ‘enculturing’ into an institution to develop ‘soft’ skills. Examples of ‘soft’ skills include understanding problem solving approaches, language, values and norms of the profession [2].

Aim:

To design and assess the educational impact of simulated ward round teaching sessions on medical students in semi-acute settings, focussing on ‘enculturing’ skills.

Methods:

This was a prospective study. We created a ward round-based simulation session, with six simulated patient scenarios, designed for clinical placement level medical students. Ten students were included in the study.

We utilized an induction exercise to familiarize students with medical documentation, a simulated ward round, and a consolidation exercise reviewing discharge paperwork and prescriptions. A simulated patient was present in each scenario, with a member of faculty facilitating. Simulated ward round entries, nursing handover queries and investigations were provided to students. Scenarios were 20 minutes; with objectives to produce ward round documentation and generate holistic clinical management decisions. Students participated in a ‘board round’, which served as a forum for station specific feedback.

Enculturing values were assessed via a 40-point, knowledge based formative assessment, covering the main themes of the session: appropriate documentation, medical abbreviations, and clinical decision-making. Assessment was administered both pre- and post-session. Qualitative feedback of the session was obtained from learners to identify themes for further development.

Results:

There was a significant improvement in knowledge following the session (see Table 1-A57). The results were analysed with a two tailed paired t test, with statistical significance reached (p = 0.0018). Positive qualitative feedback was given. The main themes of student feedback indicated improved confidence in the ward environment, with medical documentation and clinical decision-making.

Table 1-A57:

Results of pre- and post-intervention knowledge assessment

Student	Scores
	Pre test raw score (/40)	Pre test standardized score	Post test raw score (/40)	Post test standardized score	Absolute difference
1	16	0.40	36	0.90	+0.50
2	17	0.43	37	0.93	+0.50
3	28.5	0.71	37	0.93	+0.22
4	24.5	0.61	36	0.90	+0.29
5	16	0.40	29	0.73	+0.33
6	29	0.73	38	0.95	+0.22
7	30.5	0.76	36	0.90	+0.14
8	28	0.70	36	0.90	+0.20
9	33	0.83	36	0.90	+0.07
10	26	0.65	35	0.88	+0.23
			Mean Raw score Difference		10.75
			Mean Standardized Score change		+0.27
			p value (at 95% CI)		0.00018

Conclusion:

Our results demonstrate an increased sense of empowerment in the study population.

Simulated practice can be used effectively to enhance learning in sub-acute medical situations. Enculturing skills were particularly enhanced; promoting future learning through orientation within zones of legitimate peripheral participation.

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.