International Journal of Healthcare Simulation

Background:

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.

Aim:

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.

Method:

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).

Results:

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 19–20	Post-course 19–20	Difference	Pre-course 20–21	Post-course 20–21	Difference
Managing acutely deteriorating patients	64.32	94.1	29.78	65.39	92.93	27.54
Assessing patients using ABCDE	93.1	100	6.9	92.32	97.98	5.66
Escalating patient care	93.03	98.84	5.81	92.23	96.96	4.73
Using SBAR to handover information to colleagues	79.89	98.84	18.95	86.54	97.98	11.44
Accessing and using clinical guidance and policies	80.46	90.14	9.68	85.58	96.97	11.39

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 19–20	Post-course 19–20	Difference	Pre-course 20–21	Post-course 20–21	Difference
Constructively managing others’ negative emotions at work	50.68	79.78	29.1	53.4	83.83	30.43
Requesting help from colleagues in other professions	86.13	97.11	10.98	80.59	96.96	16.37
Communicating effectively with a colleague with whom you disagree	63.01	85.55	22.54	53.39	87.87	34.48
Prioritizing when many things are happening at once	69.37	87.28	17.91	62.14	85.85	23.71
Speaking up as part of a team to convey what you think is going on	69.36	90.17	20.81	67	90.9	23.9
Involving colleagues in your decision-making process	86.13	94.79	8.66	80.58	98.98	18.4
Dealing with uncertainty in your decision-making process	65.31	87.28	21.97	58.25	88.89	30.64
Asking other team members for the information I need during a busy ward environment	80.92	95.95	15.03	77.67	96.96	19.29
Recognizing when you should take on a leadership role	67.05	90.76	23.71	66.98	88.88	21.9
Monitoring the ‘big picture’ during a complex clinical situation	56.65	89.02	32.37	56.31	85.85	29.54
Anticipating what will happen next in clinical situations	60.11	89.02	28.91	51.46	86.87	35.41
Working effectively with a new team in clinical situations	75.73	92.48	16.75	67.97	89.9	21.93

Table 3:

Common themes arising from participants’ feedback

	19–20	20–21
	% of participants	% of participants
Good/useful course	38	36
Improved confidence/knowledge	11	16
Useful inclusion of human factors	5	7
Good range of scenarios	9	12
Useful debrief/reflection	21	44
Supportive/non-judgmental environment	9	10.40
Supportive facilitators	18.90	9.50
More focus needed on clinical skills	5	4
Shorter debrief needed	7	4
More scenarios needed	6	8

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.