Exploring student perceptions of ward simulation as an exercise to improve decision-making skills in the clinical context.

This article was migrated. The article was marked as recommended. Introduction: At the point of graduation, medical students are expected to demonstrate competence making a range of decisions in the clinical environment. However, research continues to highlight that both students and graduates lack effective methods for dealing with complex decisions, with students emphasising having little, if any, experience of making many clinical decisions during their undergraduate training. To combat this, an Acute Medical Unit ward simulation exercise (AMUWSE) has been recently incorporated into the 4 th year curriculum at Dundee Medical School to aid the development of these skills. Methodology: This study aimed to explore how students perceive their decision-making ability is influenced by an AMUWSE and how this teaching exercise could be improved. An action research approach was adopted to investigate medical students' perceptions of how participation in this exercise influences clinical decision-making skills. An initial online questionnaire was circulated before four group interviews were conducted. Results: It was found that the majority of students perceived the AMUWSE to have been of significant benefit in developing clinical decision-making. A number of learning points from the exercise were identified, incorporated into six overarching themes: making clinical decisions, prioritising, handing over information, asking for help, dealing with time constraints and preparation for clinical practice. Within many of these themes, students expressed deficiencies in teaching during the "basic science" years of medical school. Conclusions: This study highlighted the effectiveness of an AMUWSE to improve the clinical decision-making ability of medical students, while offering invaluable insights into the nature of clinical practice. Despite this, areas for improvement have been identified to make this simulation exercise a more effective means of improving clinical decision-making. Furthermore, there remains a need for consideration of how these skills can be developed during the early years of medical school. While a complex process, certain teaching interventions, such as an AMUWSE, have shown potential in aiding this development; helping to create more competent, well-equipped junior doctors.

The effects of an enhanced simulation programme on medical students' confidence responding to clinical deterioration.

BACKGROUND: Clinical deterioration in adult hospital patients is an identified issue in healthcare practice globally. Teaching medical students to recognise and respond to the deteriorating patient is crucial if we are to address the issue in an effective way. The aim of this study was to evaluate the effects of an enhanced simulation exercise known as RADAR (Recognising Acute Deterioration: Active Response), on medical students' confidence. METHODS: A questionnaire survey was conducted; the instrument contained three sections. Section 1 focused on students' perceptions of the learning experience; section 2 investigated confidence. Both sections employed Likert-type scales. A third section invited open responses. Questionnaires were distributed to a cohort of third-year medical students (n = 158) in the North East of Scotland 130 (82 %) were returned for analysis, employing IBM SPSS v18 and ANOVA techniques. RESULTS: Students' responses pointed to many benefits of the sessions. In the first section, students responded positively to the educational underpinning of the sessions, with all scores above 4.00 on a 5-point scale. There were clear learning outcomes; the sessions were active and engaging for students with an appropriate level of challenge and stress; they helped to integrate theory and practice; and effective feedback on their performance allowed students to reflect and learn from the experience. In section 2, the key finding was that scores for students' confidence to recognise deterioration increased significantly (p. < .001) as a result of the sessions. Effect sizes (Eta(2)) were high, (0.68-0.75). In the open-ended questions, students pointed to many benefits of the RADAR course, including the opportunity to employ learned procedures in realistic scenarios. CONCLUSIONS: The use of this enhanced form of simulation with simulated patients and the judicious use of moulage is an effective method of increasing realism for medical students. Importantly, it gives them greater confidence in recognising and responding to clinical deterioration in adult patients. We recommend the use of RADAR as a safe and cost-effective approach in the area of clinical deterioration and suggest that there is a need to investigate its use with different patient groups.

Innovative teaching in situational awareness.

BACKGROUND: In the UK the publication of the Health Select Committee Report highlighted the need to incorporate human factors training in health care education. In response there has been a rise in health care professional training in human factors, focusing on non-technical skills, such as teamwork, leadership and situational awareness. CONTEXT: Using simulation and contextualised learning, we have developed a non-technical skills programme for undergraduate medical students that introduces situational awareness training in the first year. Early integration of human factors into the undergraduate programme can be built upon in a constructivist approach throughout the undergraduate curriculum. Initially no formal ethical approval was required as this was an integral part of the undergraduate teaching programme and did not involve patients; however, ethical approval was gained for the analyses of this session from the local University Research Ethics Committee. Approval included the information sheets and consent forms provided to students, which permitted use of data 'in future posters/publications/presentations'. INNOVATION: Students were introduced to hazards and cues that they may find in clinical areas, encouraged to explore the simulated clinical areas gathering information, interpret their findings and then consider future states. There has been a rise in health care professional training in human factors, focusing on non-technical skills IMPLICATIONS: Initial feedback from both the students and the tutors involved has been positive. In addition, the opportunity for linking this to other non-technical skills developments in different clinical settings and in interprofessional settings is being considered. The next stage is to explore students' perceptions of this session and their learning through questionnaires and focus-group interviews before developing further.

Using simulation to support doctors in difficulty.

BACKGROUND: A small percentage of medical trainees will have performance concerns identified within their clinical practice. These trainees require specific interventions to address these concerns. The Postgraduate Ward Simulation Exercise (PgWSE) was developed as a joint collaboration between the University of Dundee and NHS Education for Scotland (NES). CONTEXT: The PgWSE takes around 90 minutes to complete. It allows assessors to directly observe the performance of trainees within a simulated ward environment. Trainees are assessed individually on their ability to prioritise competing demands, work as part of a team and make safe informed clinical decisions. INNOVATION: The PgWSE is the first specific national intervention to support the assessment and remediation of trainee doctors in difficulty. Nine PgWSE scenarios have been developed to reflect clinical practice: three in general surgery, four in general medicine and two in medicine for the elderly. To enhance realism, simulated patients (SPs) are recruited and trained for each exercise. Standardised assessment tools were developed and validated for assessors to make individual and consensus judgements regarding a trainee's performance. Self-assessment of performance is used to disengage trainees from the simulated activity and to prepare them for constructive feedback. IMPLICATIONS: The PgWSE has been shown to be a valuable tool for the management of trainee doctors in difficulty in Scotland. Although the PgWSE is time and resource intensive, it has been shown to have a positive impact on the remediation of trainees and in the provision of objective, detailed and comprehensive feedback to the referring deanery. Within NES there are four geographical centres led by a postgraduate dean with responsibility for supervision of postgraduate medical education.

The benefits of a ward simulation exercise as a learning experience.

This article describes the findings from a pilot study undertaken to identify the potential benefits of a ward simulation exercise in developing the capabilities of newly qualified nurses. Eight newly qualified nurses were recruited to participate in this pilot study which was based in the Clinical Skills Centre, Ninewells Hospital, Dundee. This pilot study was performed in conjunction with NHS Tayside Practice Education Facilitators and the University of Dundee. Data collection methods involved reflective learning logs which were reviewed independently by an expert group of teachers and practitioners. A focus group session was also undertaken to understand the lived experience of the newly qualified nurse during the ward simulation exercise. Core themes (listed in order of importance) related to the professional development of newly qualified nurses that were identified through this pilot study were: an increase in confidence, development of stress management skills, improved management of the acutely unwell patient, the transfer of skills learnt in simulation to the clinical setting, development of communication skills and reflection skills. Participants in this pilot study demonstrated increased levels of confidence in their communication skills, their ability to prioritize care and to engage in collaborative teamworking.

Over the counter clinical skills for pharmacists.

BACKGROUND: This paper describes the development, implementation and evaluation of a clinical skills course for pharmacist independent and supplementary prescribers. The aim of the course was to develop the clinical and procedural skills of pharmacists to enable safe practice at an advanced level, in conjunction with their prescribing role. METHODS: The development of the programme used qualitative data from interviews with practising pharmacists, senior pharmacists and clinical skills teachers to identify the list of procedural skills to be learned and practised. On completion of the programme participants were asked to provide written feedback on the content, learning and reaction in practice. RESULTS: Feedback from the participants was positive, with high satisfaction reported in terms of workshop organisation, content, teaching and skills practice. Participants completed an objective structured clinical examination (OSCE) at the end of the workshop, and the results for each of the five skill stations tested were good. Participants also kept a reflective logbook in practice, detailing when and how they used the skills learned during the workshop. INNOVATION: This is the first national clinical skills assessment course of its kind to be undertaken in support of the development of a standardised approach to clinical and procedural skills. The use of structured learning with simulation, simulated and real patients, standardised procedural checklists, and peer learning and support has led to a very successful course for participants across Scotland. IMPLICATIONS: The clinical skills assessment course is easily transferable across professions, and could be used to develop safe and effective clinical skills practice in a wide range of settings.

Evaluation of a teaching pack designed for nursing students to acquire the essential knowledge for competent practice in blood transfusion administration.

This article describes the evaluation of a teaching pack designed for nursing students to acquire the knowledge required for safe administration of blood transfusions. The Serious Hazards of Transfusion (SHOT) Committee is a confidential reporting body, which gathers data from the United Kingdom and reports the serious sequelae of blood transfusion. The SHOT reports have repeatedly identified that errors in blood transfusions are wholly avoidable. Nurses, as the health care professionals ultimately responsible for the bedside check, have the final opportunity to prevent a mis-transfusion [Nursing and Midwifery Council, 2004a. The NMC code of professional conduct: standards for conduct, performance and ethics. NMC, London; Serious Hazards of Transfusion, 2002. SHOT Annual Report 2001-2002. SHOT Scheme, Manchester]. The educational strategies implemented will be explained and evidence that applying structured learning programmes in the undergraduate nursing curriculum can improve students' knowledge presented. A structured questionnaire was employed to assess students' knowledge of the process for transfusing blood components pre- and post-teaching and evaluate the effectiveness of the teaching pack. The results will be presented and discussed.

The use of simulated learning to promote safe blood transfusion practice.

The transfusion of blood and blood products is a complex, multi-professional task which is liable to errors at any point in the journey from donor to recipient. The serious hazards of transfusion (SHOT) scheme has documented reports which consistently demonstrate that the administration of the incorrect blood component is a major cause of morbidity and mortality in the United Kingdom. Training programmes which focus on different stages of safe effective blood transfusion are currently available but none involve practice in the workplace setting. This paper shares the design, implementation and subsequent evaluation of a simulated ward exercise, which was developed in partnership with the Scottish National Blood Transfusion Service (SNBTS), NHS Tayside and the University of Dundee Medical School to reinforce learning in a workplace context. The exercise was evaluated from a number of different perspectives. The exercise demonstrated that it is an effective method of reinforcing safe transfusion practice in a non-threatening realistic workplace environment. Costs in terms of time, finance and staff numbers may however preclude large scale implementation in practice.