International Journal of Healthcare Simulation

Background:

Core medical training was replaced by Internal Medicine Training (IMT) in August 2019. One of the more notable changes was the introduction of a 3^rd year, known as IM3, to IMT. This year is considered a step-up year or a junior registrar year, where advice from a supervising physician is readily available. To assist with this transition, we created step-up simulation-based scenarios. Previously, it has been demonstrated that simulation is an important tool in improving the confidence and knowledge of first year doctors. Simulation provides doctors an ethically and educationally safe setting to develop their practice [1]. The purpose of these scenarios is to replicate the complex patients and dynamic environments that on call general medical registrars need to manage.

Methods:

We created an in-person teaching day, entitled ‘Step up’, which consisted of four 20-minute, IM3 specific, high-fidelity scenario-based simulations. In each scenario, a computerised full-body manikin (SimMan Essential) was used. The manikin could be programmed to provide physiological response to scenario participants’ actions. The participants were each tasked to assess an acutely deteriorating patient (the manikin), whilst managing a demanding bleep to add realistic distractions and human factor issues to the scenario. Each participant completed one scenario and watched their peers complete the others from a separate room. Following this, participants were debriefed by qualified member of staff and then taught by a speciality registrar or consultant. Feedback forms were collected. The participants were tasked to rate the simulation day, using a nominal Likert scale from 1 to 10, for usefulness, relevance, clarity, and overall quality. 1 represented strong disagreement and 10 strong agreements with a particular domain.

Results:

Across 4 full days, we had 11 IM3 doctors take part in the ‘step up’ scenario-based simulations. 9 of the 11 participants completed feedback forms. Scores ranged from 8 to 10. Median scores for all domains were 10.

Conclusion:

We have demonstrated that ‘step up’ scenarios are a useful and relevant aid for those transitioning into IM3. Further research utilising comparative data will provide more meaningful conclusions. We will be repeating the simulation programme for the next cohort. We will have baseline, one and three-month follow up questionnaires to assess these scenarios further.

References

1. Buist N, Webster CS. Simulation training to improve the ability of first-year doctors to assess and manage deteriorating patients: a systematic review and meta-analysis. Medical Science Educator. 2019;29(3):749–761.