Immersive Simulation in the Foundation Programme Dr Ben Shippey Dr Neil Harrison Dr Lesley Creighton Dr Lana Fischer

Introduction Background to the project What we did Key messages

‘Competent in 370 competencies!’ Foundation clinical placements Clinical placements great for CVS exam etc but for some more specific and rare competencies this is a challenge

‘The Foundation Programme is a two-year generic training programme which forms the bridge between medical school and specialist/general practice training.’

Simulation Based Education

‘Competent in 370 competencies!’ Foundation clinical placements Immersive SBE A constructively aligned intervention allows a programme directors to know that more specific outcomes are being met as well as the essential skills

Research Questions Plan Reflect Cycle Which of the Foundation curriculum competencies do Foundation doctors feel they require more training in to support their learning during clinical experience? Would a simulation based educational intervention be appropriate to address these needs? Does the proposed intervention meet the identified training needs? Act Observe NEEDS

Plan Reflect Re-Plan Reflect Re-Plan Reflect Cycle 1 Cycle 2 Cycle 3 Identify possible foundation competencies for programme Reflect Establish competencies to be addressed by intervention Re-Plan Conduct a literature review in light of cycle 1 Reflect Consideration of suggestions Re-Plan Re-development of intervention Reflect Thematic analysis of data and re-develop intervention Cycle 1 Cycle 2 Cycle 3 Act Construct and deliver a questionnaire Observe Analyse data from questionnaire responses Act Develop an intervention Observe Study of the intervention by experts Act Deliver intervention and issue questionnaire Observe Run focus groups, tutor field notes

Analytic Hierarchy Process Establish competencies for intervention Goal Trainee perceived usefulness 0.5 Clinical significance 0.5 Criteria Alternatives

Cycle 1 Results CURRICULUM COMPETENCY TOTAL TRAINEE USEFULNESS SCORE Emergency detention Indicators for ICU Assessment of capacity Unsuccessful treatment End of life care Learning/communication difficulties Angry patents Safeguarding patients Unconscious patient Advanced care planning Consult via interpreter Palliative care Medical Evidence Physiological change Monitoring therapeutics Adverse drug events Three way consultation Challenging others infection control TOTAL TRAINEE USEFULNESS SCORE 0.082 0.074 0.073 0.071 0.064 0.063 0.061 0.057 0.056 0.055 0.054 0.048 0.043 0.042 0.041 0.019 1 CLINICAL SIGNIFICANCE SCORE 0.035 0.017667 0.07 0.051333 0.061333 0.074333 0.079 0.076 0.052333 0.051 0.056667 0.018 0.072667 0.049 0.053333 0.069668 1 COMBINED RANKING SCORE 0.0585 0.0458335 0.0715 0.0611665 0.0626665 0.0686665 0.07 0.0665 0.0541665 0.0531665 0.0525 0.0553335 0.033 0.0578335 0.046 0.0476665 0.0511665 0.044334 1 ACTION ward round clinic impractical sim not needed already covered in ALS too low

The interventions FY Sim Ward Round FY Sim Clinic PACE

PACE and feedback/debriefing

Cycle 3 Results - Clinic

Cycle 3 Results – Ward Round

‘Its been very good. Congratulations!’ Quotes ‘Very good session. Excellent feedback.’ ‘Discussions with tutors were very useful, gained tips about communication skills in each specific scenario.’ ‘Good range of topics covered.’ ‘Very useful real life advice on how to practice.’ ‘Patients all very realistic – didn’t feel too much like simulation.’ ‘It was excellent.’ ‘Good opportunity to cover things not covered in other teaching’ ‘Simulated scenarios of rarer clinical events’ ‘Its been very good. Congratulations!’

Conclusions Important FY doctor training needs were established. A constructively aligned pilot SBE programme was designed and delivered to all FYs in Tayside. The programme met FY expectations and training needs. Next steps… Follow them into practice National integrated programme of SBE to support FY clinical placements

Pilot programme of targeted SBE Foundation clinical placements NHS Tayside FY1 and FY2 Pilot programme of Immersive SBE

Foundation clinical placements FY1 and FY2 Programme of Immersive SBE Allows programmes directors to delivery a quality programme of training to an entire cohort of FYs

Thank you – questions?