International Journal of Healthcare Simulation
Adi Health+Wellness
122 Adapting Foundation Programme Simulation in Response to a Pandemic: Has it Diminished Learning?
DOI 10.54531/SCFI7451, Volume: 1, Issue: Supplement 1, Pages: A26-A28
Article Type: In Practice, Article History

Table of Contents





A human factor-based simulation course is run for foundation doctors and nurses annually at a London teaching hospital. Simulation helps to improve technical and non-technical skills in a supportive environment [1]. The course was adapted in response to the COVID-19 pandemic. We analysed feedback from participants to understand whether the educational value of the course was maintained and to identify potential areas of improvement.


The aim of the study was to evaluate the impact of the course adaptations on the participants’ learning experience, delivery of learning objectives and quality of teaching.


The course comprises simulated scenarios with facilitated debrief sessions. Post-COVID-19 changes comprised: moving to a half-day format, reducing the number of scenarios from five to three, reducing the number of participants per session, running multiple courses on 1 day and reducing debriefing time. Feedback was gathered pre- and post-course using SurveyMonkey. The questionnaires utilized free-text answers and Likert scales based on the Human Factors Skills for Healthcare Instrument [2]. Two cohorts, before and after the changes were introduced, were analysed. There were 175 participants in cohort 1 (3 October 2019–11 March 2020) and 105 in cohort 2 (1 October 2020–12 April 2021).


Despite changes made, participants reported an improvement in clinical skills (Table 1) and human factors (Table 2). 67.6% of cohort 2 reported that personal protective equipment (PPE) had no impact on simulation; however, 7.6% felt masks hindered communication. Common themes reported in feedback are shown in Table 2. Both cohorts reported the course as useful (38% in cohort 1 and 36% in cohort 2). 7% of cohort 1 felt that the debrief needed shortening, compared with 4% in cohort 2 where shorter debrief models were used, conversely 6% of cohort 1 suggested more scenarios were needed compared with 8% in cohort 2 (Table 3).
Table 1:
Percentage of participants who reported feeling confident in clinical skills
% of participants who felt confident in the following scenarios
Pre-course 19–20Post-course 19–20DifferencePre-course 20–21Post-course 20–21Difference
Managing acutely deteriorating patients64.3294.129.7865.3992.9327.54
Assessing patients using ABCDE93.11006.992.3297.985.66
Escalating patient care93.0398.845.8192.2396.964.73
Using SBAR to handover information to colleagues79.8998.8418.9586.5497.9811.44
Accessing and using clinical guidance and policies80.4690.149.6885.5896.9711.39
Table 2:
Percentage of participants who reported that they could adequately do the following Human Factors Skills for Healthcare Instrument skills
% of participants who felt they could do the following
Pre-course 19–20Post-course 19–20DifferencePre-course 20–21Post-course 20–21Difference
Constructively managing others’ negative emotions at work50.6879.7829.153.483.8330.43
Requesting help from colleagues in other professions86.1397.1110.9880.5996.9616.37
Communicating effectively with a colleague with whom you disagree63.0185.5522.5453.3987.8734.48
Prioritizing when many things are happening at once69.3787.2817.9162.1485.8523.71
Speaking up as part of a team to convey what you think is going on69.3690.1720.816790.923.9
Involving colleagues in your decision-making process86.1394.798.6680.5898.9818.4
Dealing with uncertainty in your decision-making process65.3187.2821.9758.2588.8930.64
Asking other team members for the information I need during a busy ward environment80.9295.9515.0377.6796.9619.29
Recognizing when you should take on a leadership role67.0590.7623.7166.9888.8821.9
Monitoring the ‘big picture’ during a complex clinical situation56.6589.0232.3756.3185.8529.54
Anticipating what will happen next in clinical situations60.1189.0228.9151.4686.8735.41
Working effectively with a new team in clinical situations75.7392.4816.7567.9789.921.93
Table 3:
Common themes arising from participants’ feedback
% of participants% of participants
Good/useful course3836
Improved confidence/knowledge1116
Useful inclusion of human factors57
Good range of scenarios912
Useful debrief/reflection2144
Supportive/non-judgmental environment910.40
Supportive facilitators18.909.50
More focus needed on clinical skills54
Shorter debrief needed74
More scenarios needed68

Implications for practice:

This course demonstrates that simulation can be delivered safely throughout a pandemic while maintaining education value. Participants continued to find simulation useful; the use of PPE did not affect debriefing and learning processes. Changes did arise as a result of the changes: increased workload on staff (multiple sessions), timing issues, repetition in scenarios delivered and ward pressures on participants. Moving forwards, some adaptations such as the use of PPE will remain, but the course will return to a full day. To further evaluate the impact of the changes made. We are currently obtaining feedback from faculty.

Alam, O’Dowd, Dunnell, and Dev: 122 Adapting Foundation Programme Simulation in Response to a Pandemic: Has it Diminished Learning?



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Reedy G, Lavelle M, Simpson T, Anderson J. Development of the Human Factors Skills for Healthcare Instrument: a valid and reliable tool for assessing interprofessional learning across healthcare practice settings. BMJ Simul Technol Enhanc Learn 2017;3:135141. Adapting Foundation Programme Simulation in Response to a Pandemic: Has it Diminished Learning?&author=&keyword=&subject=In Practice,