International Journal of Healthcare Simulation

Background:

The transition from medical student to Foundation Year 1 (FY1) doctor represents a vital stage in the development of a newly qualified doctor. It is well established that medical students struggle with this transition [1]. There is evidence that simulation-based education (SBE) improves competence and confidence [2]. At our Trust, medical students undergo a Transition to Foundation Year 1 (TTF1) placement to prepare them for their upcoming roles. This study’s aim was to improve the confidence of final year medical students beginning their FY1 jobs in August 2022 by introducing them to common FY1 situations like prioritising tasks, handing over, being part of the on-call team, and practising clinical skills to improve patient safety as per the General Medical Council (GMC) outcomes for graduates [3]. We designed and implemented a simulation-based training day during their TTF1 placement.

Methods:

We collected feedback from a focus group of nine final year medical students regarding what would help best prepare them. We mapped these against their medical school’s curriculum and the GMC’s framework [3]. They reported they were inadequately prepared for FY1 and all agreed to have a training day covering different domains to increase their confidence. We designed a TTF1 training day that included lecture-based teaching on how to survive FY1, three scenarios based on common FY1 situations and a teaching session on ultrasound guided cannulation. The training day was delivered to five cohorts (29 medical students) during their TTF1 placements in 2022. During this training day, medical students completed a pre- and post-programme questionnaire which measured self-reported changes in confidence levels via a 5-point Likert scale across domains: verifying deaths, prioritising tasks, cannulation, handing over, and being part of the on-call team. The questionnaire also explored their expectations of the day and what they had learnt from the day. This was analysed using the framework analysis.

Results:

Quantitative results revealed: increased preparedness for their FY1 role (+24%; <0.001) and being part of the on-call team (+58.7%; p<0.001), increased confidence in prioritising tasks (+28.6%; <0.001), verifying deaths (+131.5%: <0.001), and cannulation (+50%; <0.001). Analysis of qualitative results revealed common themes of improved confidence in ultrasound guided cannulation, increased knowledge-base, clearer understanding of handling common FY1 situations, and 100% of participants agreed that this training day was useful.

Conclusion:

The implementation of a TTF1 training day proved to increase the students’ confidence and levels of preparedness for their upcoming jobs.

References

1. Cameron A, Millar J, Szmidt N, Hanlon K, Cleland J. Can new doctors be prepared for practice? A review. Clin Teach. 2014;11:188–192.

2. Lateef F. Simulation-based learning: Just like the real thing. Journal of Emergencies, Trauma and Shock. 2010;3(4):348.

3. General Medical Council. Outcomes for Graduates 2018. 2018. https://www.gmc-uk.org/-/media/documents/dc11326-outcomes-for-graduates-2018_pdf-75040796.pdf [Accessed on 1/06/2022]