International Journal of Healthcare Simulation

Background:

The transition from medical school to foundation practice can be anxiety provoking as the pressure to balance medical and surgical quandaries with the human factors of handovers, task management, and team working can be complex [1]. Often it is the latter human factors that are hard to teach that can make shifts challenging. Students rarely practise skills of prioritisation, handover, and utilisation of team members before starting work. This leads to unsatisfactory practice and increased stress levels among the workforce with a compromise to patient safety [2]. The aims of the Foundation Undergraduate On-Call Simulation (FOCUS) was to increase the students’ confidence and understanding of these tasks which form the basis on an On-Call shift for a foundation doctor.

Methods:

We designed and delivered a one hour simulated on-call shift for 42 medical students during their post-finals assistantship at the Mid Yorkshire NHS Trust. The simulation was modelled on a shift covering medical wards out of hours at Foundation Year 1 level and included the use of a high-fidelity manikin with a review an acutely unwell patient. The sessions ran throughout the day and evening facilitated by three clinical fellows in medical education. We were able to run the session with two students partaking simultaneously on parallel wards which allowed for a joint debriefing.

Results:

We saw an increase in confidence across all areas including handover, task management, and working within a Multidisciplinary Team (MDT). Before FOCUS, only 13 students felt somewhat confident compared to 27 after. Ten students felt no confidence in escalating to seniors before FOCUS. Nine out of these ten students felt somewhat confidence afterwards. We received very positive qualitative data with one student stating FOCUS was the ‘best prep I’ve had for FY1’.

Conclusion:

FOCUS is a new programme created for post-finals medical students that was designed and introduced in 2022. Having received excellent feedback, we have plans to expand the course to more students in the coming year. We also wish to offer adaptations of this course to students in earlier years to promote improvement of the skills required to practise a safe and efficient on-call shift. We would also encourage other Trusts to adopt this programme where possible as the impact on confidence of post-finals students is significant and will lead to reduced stress and anxiety levels in newly qualified junior doctors.

References

1. Bywaters E, Calvert S, Eccles S, Eunson G, Macklin D, McCullough C, Rowland A, Thomson A, Miller P, Hayden J, Leinster S, Rubin P, Simpson J, Lilleyman J, Russell J, Stevenson E. Safe handover: safe patients. 1st ed. London: British Medical Association. 2004.

2. McCullough J H, van Hamel C. Anxiety Among Newly-Qualified Doctors: An Eight-Year Analysis. Medical teacher. 2020;42(1):52–57.