International Journal of Healthcare Simulation

Background:

Departmental induction is essential for trainee well-being and patient safety, particularly for doctors in the early stages of their careers. Studies have shown that junior doctors often feel underprepared and without sufficient knowledge for safe and efficient practice in surgical rotations ^[1]. Simulation has been suggested as a tool to improve preparedness. Simulation training in acute surgical presentations, surgical ward rounds, for theatre teams and for practical surgical skills is well established. However, much of junior doctors’ work involves assessing patients who have deteriorated following admission ^[2], including post-operatively. There is little in the literature exploring the use of simulation in preparing junior doctors to manage ward-based surgical emergencies.

Aim:

This pilot project aimed to create an immersive simulation-based course for junior doctors, focussing on the technical and non-technical skills required to deal with common post-operative and post-procedural emergencies, to improve the departmental induction process.

Methods:

Junior doctors completed a questionnaire to identify their learning needs. On the basis of this, six high-fidelity immersive simulation scenarios were designed: post-operative bleeding, post-ERCP pancreatitis, post-NG tube insertion aspiration pneumonia, anastomotic leak, post-operative wound dehiscence and post-operative cardiac arrest. The scenarios were constructively aligned to both technical and non-technical learning objectives. Scenario participation was followed by a facilitated debrief. Participants completed a pre- and post-course questionnaire exploring their experience on surgical wards, confidence managing surgical ward emergencies and evaluation of the course.

Results:

Two pilot sessions have been facilitated, involving seven junior doctors. Highlighted challenges of surgical ward work include the need for independent decision-making, obtaining senior support and ensuring review of post-operative patients. Pre-course, confidence was particularly low in identifying and managing post-operative emergencies, identifying patients who need to return to theatre and making escalation decisions for surgical patients. Confidence was higher in escalating to surgical seniors and recognizing own limitations. Post-course, confidence had improved in all technical and non-technical skill domains. Participants found the scenarios and subsequent debriefs relevant and educationally valuable. The main suggestion for improvement was to include the course earlier in the rotation. Data collection is ongoing.

Implications for practice:

Our results show that junior doctors find specific simulation-based training in surgical ward and post-operative emergencies extremely valuable, with improved confidence in technical and non-technical skills. We hope to embed this training as part of the departmental induction within our health board and suggest that simulation training for junior doctors on post-procedural emergencies would be of widespread benefit.