International Journal of Healthcare Simulation

Background and aim:

Surveying University of Nottingham (UoN) medical students in their final year with regards to applying an A-E approach in a medical emergency context, we found that they lacked confidence. In order to address this curriculum gap, we designed a low-fidelity simulation-based workshop which has been shown to improve confidence in developing key skills relating to medical emergencies [1].

This consists of a 2-hour session for groups of 6, for all students undertaking their medical placements at Nottingham University Hospitals (NUH).

After successfully implementing this workshop for students in their final year, we asked ourselves ‘when is it too early for medical students to cover A-E assessments in medical training?’

Considering this is an essential skill to develop and part of their intended learning outcomes (ILOs) that is also tested in their 3rd year examinations, we introduced an adapted version of this workshop for the more junior cohort.

Activity:

We constructed this workshop with alignment to both the final and third year UoN curriculum ILOs. Google forms were used to survey students’ confidence pre and post-session.

We used a low-fidelity simulation mannequin, focusing on an otherwise realistic clinical environment using medical notes, a portfolio of investigations and props. This included an observation monitor, a real-time display with altering vital parameters and a fully equipped emergency trolley.

Pre‐reading handouts on A-E assessment by the Resuscitation Council UK [2] were provided. We watched a pre‐recorded demonstration video of the management of hypoglycaemia prior to students working in pairs on three scenarios.

During the simulation scenarios, faculty members acted as either the patient or team members, including as a nurse and medical registrar.

Results:

We showed that participation in our workshop significantly improved student confidence in the specific domains (see Table 1-A82).

Table 1-A82:

Summary of the student questionnaire results

	Pre-session confidence	Post-session confidence	Improvement in confidence
FFP (3rd year medical students)
Recognizing when to perform an A-E assessment (n=31)	36.6%	100%	+63.3%
Confidence in applying an A-E assessment on an unwell medical patient (n = 31)	6.7%	90.3%	+83.6%
Confidence in managing chest sepsis (n = 31)	3.2%	70.9%	+67.7%
Confidence in managing a STEMI (n = 31)	9.5%	83.9%	+74.4%
Confidence in managing DKA (n = 31)	13%	70.9%	+57.9%
CP3 (5th year medical students)
Recognizing when to perform an A-E assessment (n=54)	87.3%	100%	+12.7%
Confidence in applying an A-E assessment on an unwell medical patient (n = 54)	29.1%	94.4%	+65.3%
Confidence in managing acute asthma exacerbation (n=36)	13.9%	97.2%	+83.3%
Confidence in managing hyperkalaemia with ECG changes (n=36)	11.1%	88.9%	+77.8%
Confidence in managing SVT (n = 36)	0.0%	83.4%	+83.4%

Written feedback from students suggested active participation in a simulated learning environment together with a detailed debrief and facilitated discussion was a powerful learning experience.

Conclusion:

This workshop has now been embedded into the teaching timetable at NUH. A-E assessment is a key template doctors of all grades use when facing the most critical situations.

Considering the feedback, introducing more junior students to the structure of an A-E assessment early is essential for creating a scaffold in their long-term memory, ingraining this into their professional practice. This will prepare them for their OSCEs and the new GMC mandated MLA examinations [3] and, more importantly, for when they start their roles as foundation doctors.

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.