International Journal of Healthcare Simulation

Introduction:

In the UK, where no established curriculum or specialized course is dedicated to emergency medicine (EM) referral skills, there is a pressing need for a comprehensive training program.

A 2022 survey of 148 EM doctors and 279 doctors from in-hospital specialities in Northern Ireland found that 73% of EM doctors struggled with referrals, while 79% of in-hospital doctors felt EM referrals were of low quality. A novel simulation-based referral skills pilot course was developed, offering education, practice opportunities, feedback, and assessment.

Methods:

A specifically designed simulation-based education (SBE) was delivered on the 8th of November, 2023, in Craigavon Area Hospital. The simulation was delivered by four faculty members and attended by fifteen EM ACCS trainees. The objectives were to teach the EM Drs to Stop, think, and prepare before referral, use the SBAR referral tool, show assertiveness, and stop deflection. Four challenging referral scenarios were delivered, mirroring a real-life situation that EM doctors often encounter (Argumentative, bossy, dismissive, and challenging clinical referrals). The Scottish Centre debriefing model was used, and the following microteaching topics were delivered (reactions to difficult situations, assertiveness, stopping deflection, redirecting behaviour, conflict management styles, and emotional intelligence).

Results:

The impact of the simulation program was significant. Of the 15 attendees, 60% had never received any training on referral skills. However, post-simulation, their confidence in making referrals improved from 13% to 80%. 87% rated the simulation high quality and 13% very high quality. 100% felt that the simulation would change their future practice and would recommend it to other EM Doctors. A follow-up questionnaire conducted five months post-simulation received ten responses, with 87% reporting a significant improvement in their referral skills.

Discussion:

While simulation programs in EM traditionally focus on resuscitation, trauma and procedural skills, there is a lack of emphasis on referral skills. Some EM specialists argue that referral skills are acquired through experience rather than formal training. Consequently, junior doctors rarely receive guidance on how to conduct referrals. Inadequate handovers have been associated with events and clinical errors in emergency medicine due to communication and missing information [1]. SBE expands medical education, recreating clinical settings for teaching, practising, and assessing. Trainees learn from mistakes and receive feedback. It is effective for teaching ED-specific skills [2]. The results of this pilot SBE on EM referral skills were promising and encouraging to expand its delivery at a broader scale.

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. Moslehi S, Masoumi G, Barghi-Shirazi F. Benefits of simulation-based education in hospital emergency departments: a systematic review. Journal of Education and Health Promotion. 2022;11(1):40.

2. Hock SM, Cassara M, Aghera A, Saloum D, Bentley SK. Attending physicians as simulation learners: summary of current practices and barriers in emergency medicine. Clinical and Experimental Emergency Medicine. 2024. ceemjournal.org

Acknowledgments:

The simulation program was funded by the Northern Ireland Medical Dental Training Agency.