International Journal of Healthcare Simulation

Introduction:

In 2022, the Joint Royal Colleges of Physicians Training Board introduced a new General Internal Medicine curriculum for medical registrars. This specified that “Simulation teaching involving human factors and scenarios training should be carried out in IM (Internal Medicine) Stage 2” (Joint Royal Colleges of Physicians Training Board) [1]. Despite this addition, no guidance was released regarding which scenarios to include or what “simulation teaching involving human factors” would specifically entail. With this background, the Postgraduate Medical Education Department at a large, tertiary hospital trust, designed and delivered a one-day course, aiming to meet the needs of medical registrars faced with this new curriculum requirement.

Methods:

Local stakeholders were consulted, in the form of the trust’s Chief Registrar and the Acute Medicine educational leads, to ensure scenarios and course structure were appropriate to senior medical registrar requirements. Entitled, “A series of unfortunate medical events”, the one-day course has been run twice to date and attended in each case by six learners. Each day incorporated a specific human factors session, before six simulations of a range of medical emergencies were carried out. Simulations incorporated managing disagreement with colleagues, working alongside a clinician in distress and communication failures, to promote discussion and consideration of the impact of human factors in medical emergencies. Faculty included an Acute Medicine consultant, two Medical Registrars, an Emergency Department registrar and Postgraduate Medical Education Fellows.

Results:

Quantitative feedback found learners strongly agreed the course was relevant to their level and needs, was of a high quality, given at the right pace, that their participation and interaction was encouraged and that the trainers appeared enthusiastic and well informed about the subject (Table 1-A96). Learners specifically enjoyed the “variety of clinical scenarios and combining SIM with human factors”, the use of “appropriate level simulation for senior trainees” and the “group exercise to think about human factors”. Constructive suggestions for improvements included, “involving trainees from other specialties (e.g., ICU)” and including a scenario where there is “conflict in treatment escalation decision making”.

Table 1-A96.

Learners asked to what extent they agreed with the following comments (1 = Strongly Disagree, 5 = Strongly Agree).

Comment	Average Rating (n=9)
Appropriate Content Level	4.8
Relevant Content to Need	4.9
Clear introduction	4.9
Course Aims Clearly Stated	4.9
Well Organized	4.9
Clear Summary of Learning Points	4.7
Well Informed Trainers	4.8
Enthusiastic Trainers	4.9
Candidate Participation Encouraged	4.9
Right Pace	4.9
Overall this course was of a high quality	5.0

Discussion:

A novel, tailored course, to meet the needs of senior medical registrars was designed and delivered with extremely positive subjective feedback from learners. The course design and content can be used as a template for other NHS trusts aiming to meet the needs of a nationally newly implemented curriculum.

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.

References

1. Joint Royal Colleges of Physicians Training Board, Curriculum for General Internal Medicine (Internal Medicine Stage 2) Training. 2022.