International Journal of Healthcare Simulation

Background and aim:

Increased pressures within the NHS, shortened learning hours and disruptions caused by the COVID-19 pandemic has significantly impacted surgical training. Current courses focus on single training levels, but errors occur through systemwide failures [1]. We developed a SSEP targeting cross specialty and team-based patient management, focused on clinical knowledge and skills, cognitive simulation, leadership and human factors based upon real life events to optimize training in a system that lacks time and exposure.

Methods:

A six-month pilot program was designed with monthly sessions, attended by surgical nurses, junior doctors and consultants, covering common surgical scenarios mapped to the ISCP curriculum [2], and topics highlighted through local clinical governance. Immersive interactive sessions were delivered by a dedicated consultant led education team to provide a mixed reality environment for each simulated scenario. Faculty encompassed emergency, anaesthetic and surgical consultants to facilitate realistic multidisciplinary team working. The professional identity and grade of participants were maintained during each simulation to ensure sessions were representative of real-life events with a clear mutual goal to improve knowledge and skills to transpose into safer patient care at all levels of seniority. Sessions combined simulated scenarios with structured teaching, clear learning objectives, detailed peer feedback and opportunity for juniors to complete work-based assessments with consultants. Senior trainees benefited from participation in the design and delivery of sessions providing opportunities to strengthen their leadership skills. We recorded participants pre- and post-simulation confidence, and knowledge, were measured using 5-point Likert scale feedback forms, and multiple-choice questionnaire (MCQ) paper respectively.

Results:

Two-paired T analysis showed statistically significant improvements in participant confidence across all 4 simulations (Table 1-70). Participants also received statistically significant higher scores in the post-simulation MCQ test compared with their pre-simulation scores (4.07 ±0.53, 4.43 ±0.26, p = 0.02, n = 14) at the 95% confidence interval. Limitations included variable attendance due to service needs and strikes.

Table 1-A70:

Pooled two-paired T-Test analysis of participant self-rated confidence, in managing clinical scenarios and core topics, before and after participation in 4 high-fidelity simulated scenarios, at the 95% confidence interval (*Significance α = ≤0.05). df = difference

		N = No of participants	Mean	Variance	df	t Stat	T critical two-paired	Significance P (T<=t) two-tail
Simulation 1: Sepsis and Anaphylaxis	Pre-simulation	14	8.29	2.219	13	-2.687	2.160	0.002
	Post-simulation	14	9.00	1.538
Simulation 2: Post-operative anastomotic leak	Pre-simulation	8	8.25	1.642	7	-2.376	2.365	0.024
	Post-simulation	8	8.88	1.267
Simulation 3: Acute Abdomen	Pre-simulation	19	16.84	2.760	18	-3.693	1.734	0.002
	Post-simulation	19	18.26	2.760
Simulation 4: Post-operative PE and Cardiac arrest	Pre-simulation	14	15.79	5.566	13	-4.387	2.160	0.000*
	Post-simulation	14	18.00	1.231

Conclusion:

Our SSEP is an effective strategy for the improvement of trainees’ confidence and knowledge in managing challenging surgical scenarios, which actively contributes to the development of skills for clinical practice. Evaluation of long-term knowledge retention is necessary. Our ambition is to develop the program as a quality improvement project (QIP) that implements learning from significant events and demonstrate improved outcomes in these domains. We endeavour to embed this simulation training across the region.

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.