Simulation Based Learning for Final Year Medical Students at Cardiff University

Clare Cann, Owen Deery, Katja Empson, Kirk Freeman, Sarka Furmanova, Ben Griffiths, Chris Hingston, Paul Kinnersley, Ben Magabe, Matt Morgan, Joseph Riddell, Nick Smith, Paul Frost

School of Medicine, Cardiff University

Introduction
Tomorrows Doctors states, That graduates must be able to diagnose and manage acute medical emergencies1. A report from the National Confidential Enquiry into Patient Outcomes and Death (NCEPOD) has recommended that junior doctors develop a systematic approach to acute illness and seek senior advice more readily2. However factors such as the European Working Time Directives and the creation of nurse specialist posts may limit opportunities for foundation trainees to develop these skills3,4. To address this, final year medical students receive a structured acute care teaching programme during their Junior Student Assistantship (JSA) placement. Cardiff JSA students were provided with a simulation based learning programme.

Results
Overall student scores for session 1-4 evaluation for both Block 1 (n=8) and Block 2 (n=9) indicated an overwhelmingly well received teaching programme. Graph: Overall student scores for session 1-4 evaluation for both Block 1 (n=8) and Block 2 (n=9).
100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Enjoyed Useful Relevant Objectives met Improved Knowledge Improved Skills Increased confidence Increased competence 5. Very Much Indeed 4 3 2 1 0. Not at all

Method
Four simulation sessions (three scenarios per session) using SimMan were delivered to two student groups; Block 1 (n=9) and Block 2 (n=8). Scenarios were constructed around three learning objectives; develop competency in the use of National Early Warning Scores (NEWS), the Airway, Breathing, Circulation, Disability and Exposure (ABCDE) approach to acute illness and the use of the Situation, Background, Assessment, Recommendation (SBAR) communication tool. Faculty included clinicians, a simulation tutor and technician. Students role played as a Foundation doctor with an acting nurse embedded in the scenario. Roles as relatives were also offered. Following each scenario a clinician facilitated a debrief which enabled reflection of performance. Students were formatively assessed. At the end of each session students completed an eight question session evaluation form. Answers were scored using a six point Likert scale, (0: not at all - 5: very much indeed). Ethical consent was not required.

SBAR communication Debrief circle

Discussion
A systematic approach to acute illness can be taught using simulation integrated into clinical placements during the final year. Further evaluation is required to examine whether this teaching is associated with improved patient outcomes.

A,B,C,D,E approach

References
1. 2. 3. 4. Tomorrow's Doctors GMC 2009; London: 4. Cullinane M, Findlay G, Hargraves C et al. NCEPOD 2005; London. Council Directive 93/104/EC OJEC 1993; 307: 18-24. Leary A et al. Nurs Stand 2009; 23: 40-4.

Students observing