International Journal of Healthcare Simulation

Background:

A common concern amongst final-year medical students is the on-call shifts as a Foundation Year 1 (FY1) doctor. With a large focus on knowledge, clinical and communication skills, and practical procedures, there is little in the medical curriculum to cover the non-technical skills required whilst on-call such as prioritization. A novel teaching programme was devised to help develop students’ confidence and preparedness for these shifts. This in situ simulation allowed the students to fully immerse into the role of an FY1 whilst experiencing the stressors of being on-call in a safe, risk-free environment.

Aims:

The aim of this course was to prepare final-year medical students for their on-call duties as FY1 doctors. This includes developing confidence with the technical aspects of on-calls such as managing the acutely unwell patient, as well as the non-technical skills expected from bleep-related tasks such as responding, prioritization and escalation.

Method/design:

A total of five sessions were delivered from September to December 2020 for final-year medical students. Twelve simulated on-call ‘activities’ were designed mirroring real tasks commonly encountered as an FY1 on-call. These activities were spread across the hospital involving the medical wards as part of the in situ training. The training utilized bleeps, simulated patient notes, simulated handover, mannikins for part-task procedures and actors. The students were briefed on how to respond to bleeps and the expectations of the training. Debriefs were carried out following the training facilitating reflections and relevant teaching on the various encountered activities. Students who took part in the training completed a pre- and post- course survey with a Likert-scale questionnaire to evaluate their confidence in the skills required of being on-call.

Implementation outline:

A total of 17 students completed the on-call bleep simulation. Only a third of the candidates had used a bleep prior to the session. Pre-course, 66.6% of candidates responded feeling not confident about being on-call as an FY1. Encouragingly, following the simulation, 100% felt more confident about being on-call. During the open feedback sessions, students valued the use of hospital wards, practicing procedures under time pressure, and performing handovers. This on-call bleep simulation was very well received and improved students’ confidence and preparedness for being on-call as an FY1 from August 2021. Students commented on how invaluable this training was. This on-call bleep simulation will continue to be implemented as part of the final-year teaching provided at the trust.