Simulation Placement in the Foundation Programme
Matthew Everson and Matthew Cheaveau
matthew.everson@doctors.org.uk
Bristol Medical Simulation Centre
University Hospitals Bristol NHS Foundation Trust
Introduction
A limited number of doctors can undertake clinical education jobs during their Foundation Programme in the United Kingdom. We describe our experience of a unique Foundation Year Two (F2) simulation placement and describe our experiences, the opportunities it offered, the skills we developed and the challenges we encountered.
How the post was developed
Last minute changes to our Foundation Programme rotations resulted in a simulation placement being introduced. As this was a new rotation, we had a great opportunity to design and mould the job as we desired. We were based in a simulation centre that provided undergraduate and postgraduate training for a range of healthcare professionals using a variety of manikins from simple part-task trainers to full immersion high-fidelity simulators.
Our Aim and Objectives
By the end of our four-month rotation, we were expected to be able to plan and deliver teaching sessions using simulation. We were expected to achieve the following learning points during the job:
- Understand the principles of designing and developing education interventions
- Demonstrate planning and facilitate simulation education both within the simulation centre and at the point-of-care
- Effectively use moulage and props to create realistic simulated environments and scenarios
- To develop technical debriefing skills and human factors and team training scenarios
- Describe the educational theory and research behind the different teaching strategies and techniques
Tailored induction
Although it is daunting arriving in a new clinical environment for the first day, we found it more unnerving starting in the simulation environment. We had so many questions. What was our role? What was expected of us? Did we have anything to contribute? What would we fill our time with? We quickly realised there were countless opportunities available.
During the first weeks we had a personalised induction programme. We were trained how to use the simulation manikins and we attended a simulation course as a ‘consumer’ to gain an overview of how a typical course operates. We also attended the ‘Train the Trainers’ course where we received further training in the theory and techniques of constructing sessions and debriefing in simulation.
What the post entailed
During the four-month job we assisted with numerous undergraduate and postgraduate courses, such as Acute Medical Emergencies for medical trainees and Medical Emergencies for undergraduate dentists. We operated the manikins, participated within scenarios, taught delegates and assisted with debriefing.
We were heavily involved in point-of-care simulation in the clinical environment. This involves undertaking simulation in the ward setting to train healthcare professionals within their normal working environment. It aims to enhance education, improve patient safety and reach out to professionals that would not formally have these opportunities otherwise, such as healthcare assistants. Again, our role ranged from facilitating and debriefing scenarios, in addition to technical support.
We have plenty of opportunities to undertake non-simulation teaching as well. We delivered lectures, classroom and bedside teaching on a variety of topics to medical undergraduates. Given our flexible timetable we had autonomy to complete other additional work such as audits and quality improvement projects, as well as attend teaching days, taster sessions and conferences.
What we achieved
In addition to these commitments, we designed, developed and implemented a number of projects during the rotation. Our main project involved teaching third year medical students how to manage the critically unwell patients using a number of simulated scenarios. We contrasted high-fidelity simulation (realistic environments with sophisticated manikins) to low-fidelity manikins (simple environments with basic resus manikins) and compared outcomes in knowledge and confidence before and after the sessions. We discovered fidelity made no difference to knowledge or confidence in these novice learners.
We were both keen to complete a postgraduate certificate in medical education at the university. Unfortunately, this was self-funded, but we felt it complemented the job well. The qualification offered a flexible modular course, which covered the knowledge and skills needed to teach more effectively, as well as improving skills in educational design and management. The certificate has certainly challenged our educational practices, particularly in delivering lectures and in accommodating different learning styles.
Skills Developed
Excluding the obvious, the simulation placement has enabled us develop a number of additional transferable skills including time-management, prioritisation and organisational skills. We contributed to the appraisal and assessment of undergraduates and developed effective feedback techniques which are very useful in clinical medicine.
The Challenges
We were apprehensive spending a sixth of our Foundation Programme out of clinical practice. In order to maintain our clinical skills and knowledge we undertook one day a week doing the acute medical take. This provided an excellent opportunity to complete the Foundation Programme clinical competencies and prevent deskilling. It was however, at times, difficult to balance these clinical commitments and simulation work.
One of the greatest challenges we found was facilitating more senior clinicians who had much greater experience and knowledge than ourselves, or to obstinate medical students who were disengaged. In the former case, we were able to contribute more on issues regarding human factors and patient safety, and we are still working on the latter!
The Future
We have both found it exciting pioneering this simulation placement. We have developed numerous additional skills in both simulation and more broadly in medical education, which will no doubt benefit us in our future careers. We have refined our teaching skills and we have a greater appreciation of the merits of medical education. We have no doubt rotations in clinical education during the Foundation Programme offer countless valuable skills which can be transferred into any medical speciality.
Acknowledgements
We would like to thank Sarah Sibley, Andrew McIndoe and David Grant who supervised us during this unique opportunity.