International Journal of Healthcare Simulation

Background:

The UK Emergency Medicine training pathway has three phases; Core (CT1-2), Intermediate (ST3), and Higher (ST4-6) [1]. The transition from Core to ST3 can be daunting – whilst not ‘registrars’, ST3s are often on ‘middle grade’ rotas. Trainees are expected to manage complex adult and paediatric cases with new portfolio requirements to demonstrate these competencies. They further develop leadership skills when supporting junior doctors and managing the department [2]. An ‘Introduction to ST3’ course was developed initially in the North West Deanery to address this transition. Using the original concepts, course content and format were adjusted for a Merseyside step up course.

Activity:

The redesigned three-day course contained workshops including ST3 challenges, paediatrics, night shifts, and wellbeing. 12 scenarios were organised into ‘leadership’ (sick medical and trauma patients), paediatrics (including major trauma and safeguarding), and ‘challenges’ (e.g. behavioural disturbance, burns, managing conflict with colleagues and supporting juniors). They took place in a simulation suite with either manikins or simulated patients. Data were analysed pre-course, post-course, and at one to two years post-course with thematic analysis used for free-text responses.

Results:

47 candidates took part in 2019–2021. Pre-course questionnaires showed a key concern was caring for paediatric patients. Other themes were supporting juniors, management skills, being an isolated leader, and confidence. Contemporaneous feedback showed the simulations and talks were rated positively throughout. Simulations were challenging and rated as a useful aspect. The highest rated talks have been night shift work (9.78/10, n=18), supervising others (9.67/10, n=12), and paediatrics (9.67/10, n=12). Improved confidence particularly in challenging situations has been a common theme. Lower rated talks from 2019 were replaced subsequently, and the course remains receptive to feedback. In 2021, ‘The Floor’ game [3] was incorporated for departmental management skills and participants found this particularly useful. One to two years later, candidates reiterated the importance of the course in their transition, particularly regarding paediatric cases. They highlighted the benefit of discussing portfolio requirements and the value of networking with peers.

Conclusion:

The step up course has been an important aid when transitioning to ST3 with feedback consistently positive at the time of the course and subsequently. Analysis of this feedback has informed improvements for the 2022 iteration happening shortly, and reinforced aspects including ‘The Floor’, to provide a supportive transition for trainees. As one trainee reported, the course ‘made me excited for ST3, [a] reminder why I’m an ED trainee’.

References

1. The Royal College of Emergency Medicine, 2021. Curriculum 2021. https://res.cloudinary.com/studio-republic/images/v1633447432/RCEM_Curriculum_2021_Master/RCEM_Curriculum_2021_Master.pdf?_i=AA [Accessed on 14/06/2022].

2. Walthall K, editor. Introduction to ST3; Course Guide. 2019. https://www.researchgate.net/publication/334250058_Introduction_to_ST3_Chapter_1. [Accessed on 14/06/2022].

3. Focus Games, 2022. The Floor Game. https://thefloorgame.com/ [Accessed on 14/06/2022].