George Hogg

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.

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).

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.

Innovative teaching in situational awareness

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.

O18 Introducing a teaching ward round for medical students in the transition from theory to practice using simulation

Background/Context A joint publication by the Royal College of Physicians (UK) and the Royal College of Nursing (UK) in 2012 identified that ‘Despite being a key component of daily hospital activity, ward rounds remain a much neglected part of the planning and organisation of inpatient care’. The document further identified that opportunities to improve patient care and safety through communication, information sharing and joint learning were being lost due to a lack of structured ward rounds. As part of the Transition between the first three years of theory and two years of practice a Ward Simulation Exercise (WSE) was introduced to give students the opportunity to revise and consolidate their technical and non-technical skills in a safe and realistic clinical environment. Education Programme During the AMUWSE the consultant lead the ward round as in reality. The patients were a mix of real patients, simulating an acute illness in keeping with their underlying condition, and simulated patients playing the role of an acutely unwell patient. After the ward round there was a huddle where ward round tasks and the new admission clerk-ins were prioritised and allocated. The aim of the study was to identify from students the impact of a consultant-led ward round using real and simulated patients within a simulated acute medical ward setting. Questionnaires were administered to 179 medical students following attendance at the simulated ward round and a subsequent ward simulation exercise. Results The results showed that students found the ward round an excellent opportunity for the consultant and other qualified staff to convey medical knowledge and increase communication about patient care. Free text responses included reference to understanding the functions of the ward round in relation to patient centred care and the functions of the multi-professional team. Through simulation students were exposed to clinical learning opportunities common to an acute medical unit. The value of simulation is that these opportunities can be highlighted, supported and then consolidated through debriefing. Conclusions and Recommendations This study contributes valuable evidence on the opportunities provided by enhanced simulation in terms of communication, orientation to acute medicine, the realism of using simulated patients and those with real clinical conditions. It also gives other teachers and course designers a cost-effective way of introducing students to the medical ward round and its valuable contribution to student learning.

P41 Exploring the impact of moulage on assessment of patient deterioration

Background At the point of graduation from medical school, students are expected to demonstrate competence making a range of decisions in the clinical context (General Medical Council, 2015). However, research continues to highlight that both students and newly graduated junior doctors lack effective methods for dealing with complex decisions, with students emphasising having little, if any, experience of making numerous clinical decisions during their undergraduate training (McGregor et al., 2012). To combat this, an Acute Medical Unit ward simulation exercise (AMUWSE) has recently been implemented into the 4th year curriculum at Dundee Medical School, to offer students the opportunity to develop this aspect of clinical practice. Aims This study aims to explore how students perceive their clinical decision-making ability is influenced through participation in an AMUWSE, and how it can be improved to make it an effective means of developing these skills. Methodology An action research approach was adopted to investigate Dundee 4th year medical students’ perceptions of how completion of an AMUWSE influences clinical decision-making skills. An initial anonymous online questionnaire was circulated to ascertain the views of students, before four focus group interviews were conducted to provide a deeper exploration. These interviews were recorded and subsequently transcribed, before undergoing thematic analysis to generate key themes. Results Completed questionnaires demonstrated that the majority of students perceived the AMUWSE to have been of significant benefit in improving a range of clinical decision-making elements. 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. Conclusions This research study has emphasised the effectiveness of an AMUWSE to improve the clinical decision-making ability of medical students. Introduction of such a teaching intervention also offers invaluable insights for undergraduates into the nature of clinical practice, allowing participants the opportunity to gain awareness of, and preparedness for, the responsibilities of a junior doctor. Despite these findings, areas for improvement have been identified to make this ward simulation exercise a more effective means of improving clinical decision-making. Furthermore, there remains a need for further consideration of how these skills can be developed during the ”basic science” years of medical education. References . General Medical Council (GMC). Outcomes for graduates [Online] 2015. Available at: http://www.gmc-uk.org/education/undergraduate/undergrad_outcomes.asp. [Accessed 10th May 2017]. . McGregor CA, et al. Preparing medical students for clinical decision making: A pilot study exploring how students make decisions and the perceived impact of a clinical decision making teaching intervention. Medical Teacher2012;34(10):508–517.

P59 Exploring student perceptions of ward simulation as an exercise to improve decision-making skills in the clinical context

Background At the point of graduation from medical school, students are expected to demonstrate competence making a range of decisions in the clinical context (General Medical Council, 2015). However, research continues to highlight that both students and newly graduated junior doctors lack effective methods for dealing with complex decisions, with students emphasising having little, if any, experience of making numerous clinical decisions during their undergraduate training (McGregor et al., 2012). To combat this, an Acute Medical Unit ward simulation exercise (AMUWSE) has recently been implemented into the 4th year curriculum at Dundee Medical School, to offer students the opportunity to develop this aspect of clinical practice. Aims This study aims to explore how students perceive their clinical decision-making ability is influenced through participation in an AMUWSE, and how it can be improved to make it an effective means of developing these skills. Methodology An action research approach was adopted to investigate Dundee 4th year medical students’ perceptions of how completion of an AMUWSE influences clinical decision-making skills. An initial anonymous online questionnaire was circulated to ascertain the views of students, before four focus group interviews were conducted to provide a deeper exploration. These interviews were recorded and subsequently transcribed, before undergoing thematic analysis to generate key themes. Results Completed questionnaires demonstrated that the majority of students perceived the AMUWSE to have been of significant benefit in improving a range of clinical decision-making elements. 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. Conclusions This research study has emphasised the effectiveness of an AMUWSE to improve the clinical decision-making ability of medical students. Introduction of such a teaching intervention also offers invaluable insights for undergraduates into the nature of clinical practice, allowing participants the opportunity to gain awareness of, and preparedness for, the responsibilities of a junior doctor. Despite these findings, areas for improvement have been identified to make this ward simulation exercise a more effective means of improving clinical decision-making. Furthermore, there remains a need for further consideration of how these skills can be developed during the ”basic science” years of medical education. References . General Medical Council (GMC). Outcomes for graduates [Online] 2015. Available at: http://www.gmc-uk.org/education/undergraduate/undergrad_outcomes.asp. [Accessed 10th May 2017]. . McGregor CA, et al. Preparing medical students for clinical decision making: A pilot study exploring how students make decisions and the perceived impact of a clinical decision making teaching intervention. Medical Teacher 2012;34(10):508–517.