International Journal of Healthcare Simulation

Background:

The COVID-19 pandemic resulted in limited opportunities for medical students to assess patients in the Surgical Assessment Unit (SAU) at an acute teaching hospital. Inadequate exposure to acute surgical conditions affected student-reported confidence and preparedness for Objective Structured Clinical Examination (OSCE). We hypothesized that simulation-based teaching during the pandemic could supplement disrupted learning ^[1] and improve patient safety ^[2].

Aim:

The aim of the study was to address the quality dimension of patient safety. This Quality Improvement Project (QIP) was designed to increase student confidence by 50% in the assessment and management of acute surgical conditions, and preparedness for OSCE.

Method:

The educational intervention ‘Simulated SAU’, consisting of scenarios based on common acute surgical presentations, was co-designed with project champion, placement lead, teaching fellows and medical education department, utilizing transformational leadership. Model for improvement approach was utilized with Plan-Do-Study-Act (PDSA) cycles. During the first PDSA cycle, intervention was delivered over 3-hour sessions in March 2021 to 12 third-year medical students, through the use of simulated patients. The second cycle encompassed integration of learning points including amended scenario and debrief timings, and improved questionnaires, delivered in April 2021 to a further 11 third-year medical students. Students completed paired 14-item pre- and post-intervention paper questionnaires consisting of 5-point Likert scale questions on confidence and preparedness. The Wilcoxon signed-rank test was used for statistical analysis, with a p-value of <0.05 considered statistically significant.

Results:

During the first cycle, student-reported median confidence in assessment increased by 50% (p = 0.01), and in management by 66.7% (p = 0.02). Students felt 50% more prepared for OSCE assessment (p = 0.02). During second cycle, median confidence in assessment increased by 100% (p = 0.003), in management by 100% (p = 0.004), and students felt 50% more prepared for OSCE assessment (p = 0.015). 100% of students felt simulated SAU is useful and future sessions would further enhance surgical learning.

Implications for practice:

The QIP achieved its aim to increase student confidence with statistically significant differences, through a high-fidelity simulation intervention. Through QI methodology and leadership for improvement, this QIP has successfully bridged the educational gap resulting from the pandemic, with emphasis on delivering safe patient care. Next steps encompass integration of learning points over the following PDSA cycle, engagement of new staff and resource sharing for future implementation and sustainability. Simulated SAU intervention is low-cost, requires minimal staff and is simple to deliver, hence has the potential to become integrated within medical education across numerous educational settings and enhance patient safety.