International Journal of Healthcare Simulation

Background:

‘Human factors’ training is now explicitly referenced in the new Internal Medicine Trainee (IMT) curriculum ^[¹ ^]. The typical IMT scenario is based on deterioration of clinical conditions. The focus is usually the medical management of a certain condition with non-technical skills being discussed incidentally and sometimes superficially during the debriefing. The aim of this course was to see whether a course designed primarily to raise awareness of human factors and the non-technical skills that are part of the arsenal to reduce risk, would be well received by IMT trainees and whether we could truly deliver ‘human factors training’ [2] to this cohort.

Methods:

The course consists of seven scenarios each written with a human factors or non-technical skills focus. For example, the opening forum theatre has the aim of illustrating the effect of stress, emotion, and workload on clinical performance. The format allows different behaviours to be ‘tested’ in the same environment to see the effect choice of behaviour can have. Other non-technical skills explored include workload management, communication of adverse outcomes, and conveying uncertainty. All IMTs within Wessex were invited to attend one of 4 courses, with a maximum number of twelve participants. The scenarios are run in a ‘carousel’ format with a group debriefing after 3 scenarios. The course was delivered using actor role players who were invited to the debriefing allowing direct two-way feedback. Evaluation was completed using a questionnaire based on Kirkpatrick’s model.

Results:

There were 39 attendees across 4 courses. 100% of candidates enjoyed the course and would recommend it to colleagues. 85% said their opinion of SBE was improved by the course with none feeling worse about simulation afterwards. All felt that the course provided a good introduction to human factors.

Only one responder gave a technical skill as their most significant learning. The remainder all gave non-technical skills responses which are exemplified by this direct quote: ‘Really good course. I thought the use of ‘real’ patients made the experience so much more valuable. Was completely different to most other simulation I have done before which is invariably managing a deteriorating manikin patient which usually evolves into an arrest scenario. Found this actually useful for daily life on the job.’

Conclusion:

This course represents a new approach to IMT simulation. It has been well received and adaptations and extensions to the course are already being planned.

References

1. JRCPTB Curriculum for Internal Medicine. Royal College of Physician 2019

2. Jarvis S, Shaw P, Bagshaw M, Cantan C, Skelton S. CAP 737: Flight-crew Human Factors Handbook. 2014. Civil Aviation Authority.