International Journal of Healthcare Simulation

Introduction:

Simulation has repeatedly been shown to be an effective method of teaching medical students [1, 2]. Most sessions are short and do not highlight the challenges of working 12-hour shifts, including prolonged stress and exhaustion.

Wilderness medicine is not often covered on UK medical school curricula, yet, is gaining popularity. The medical knowledge and human factors required for this speciality provide scope to develop skills for the UK Foundation Programme. Simulation facilitated experiential learning, exposes students to unique challenges requiring problem-solving and non-technical skills, reflecting those needed as a foundation doctor.

We developed a cost effective, high yield simulation exposing students to wilderness medicine, whilst challenging them to develop skills to aid them in the transition to the Foundation Programme.

Methods:

A Wilderness Medicine themed continuous simulation lasting 24 hours was presented to students. Challenging them to handle multiple scenarios after little rest. Designed and instructed by student doctors, it was reviewed and improved over four iterations. Each year the committee from the previous year met to reflect on their experiences and verbal feedback from participants to drive improvements in the next iteration.

Learning outcomes assessed continually were threefold, Human Factors, exposure to speciality and case specific learning outcomes. Outcomes were debriefed by the faculty the day after the simulation.

Results:

Four iterations ran between 2019-2024 (2020/2021 hiatus due to COVID19). Re-attendance of both candidates and faculty was high, demonstrating this unique opportunity to experience an intense 24-hour simulation outside that of regular teaching opportunities [3].

Qualitative, informal, verbal feedback from candidates highlighted common themes such as: “developing resilience to work in unfamiliar, stressful or unforeseen circumstances”, “working safely when tired” and “recognising stressors to managing personal wellbeing “. Developmental feedback focused the project to support the learning needs of students approaching Foundation training.

Discussion:

The project has improved over four years with high attendance, receiving hugely positive feedback from participants and faculty alike. With few resources it is possible to run a 24-hour continuous simulation, challenging students to manage stressful and unfamiliar situations.

This course facilitated self-development and reflection by students; with a focus on the human factors skills that will aid in their transition to the Foundation Programme, alongside developing experience in the subspeciality of wilderness medicine.

Continued improvement from junior doctors who attended the course demonstrates sustainable change; with a framework now in place so the program can be replicated with ease with further iterations and continuous improvement cycles.

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. Training and simulation for patient safety. Quality Safe Health Care. 2010;19(suppl 2):i34–i43.

2. Emily Appadurai Faris Hussain, Melanie Cotter KJ. A106‘FY1 for a day’ an immersive programme to prepare final year medical students for foundation training [Internet]. International Journal of Healthcare Simulation. 2023. Available from: https://www.ijohs.com/article/doi/10.54531/WXTU6327.

3. Kiknadze NC, Leary. Comfort zone orientation: Individual differences in the motivation to move beyond one’s comfort zone. Pers Individ Dif [Internet]. 2021;181:111024. Available from: https://www.sciencedirect.com/science/article/pii/S0191886921003998.