International Journal of Healthcare Simulation

Background and aim:

Following the introduction of the ‘IMT3’ year as part of Internal Medicine Training in 2019, a ‘Step-Up’ simulation day was developed in 2021. Positive feedback from candidates reflected its usefulness in preparing to work as a medical registrar [1]. The scenarios were conducted with the subsequent cohort of IMT3 doctors and feedback assessed for sustained quality of training.

Simulation is recognized as an important tool in medical education [2]. It is now specified by the Royal College of Physicians that trainees participate in simulation inclusive of human factors and scenario training [3].

Activity:

The ‘Step-Up’ simulation day continues to consist of four progressive, high-fidelity scenarios that replicate a day in the life of a medical registrar. Each scenario occurs in the simulation lab for individual candidates, with peers observing via video-link in the debrief room.

Each scenario requires the candidate to perform a medical assessment of an acutely unwell patient, facilitated by use of the computerized manikin (SimMan Essential), whilst simultaneously tackling difficult conversations with a live actor and managing interruptions from a bleep. Participants also had the opportunity to lead simulated cardiac arrests with peers forming the cardiac arrest team.

Debrief and teaching continued to be provided by a qualified simulation facilitator alongside a specialist registrar or consultant. Feedback provision was moved to an online format and accessed via a QR code to be more environmentally conscious and to readily allow analysis and storage for future comparison. In order to assess sustained quality, the same five aspects of the day were assessed by participants on a ten-point Likert scale: relevance, pitch, clarity, usefulness and overall quality. Scores of 1 reflected strong disagreement and 10 of strong agreement. Free text feedback allowed candidates to suggest topics for future sessions or identify valuable learning points.

Findings:

Thirteen IMT3 or equivalent doctors participated in this round of ‘Step-Up’ simulation with 100% feedback rate. As in previous rounds median and modal scores were 10 in all 5 domains, ranging from 7 to 10. Free text feedback recorded multiple requests for further simulation sessions.

Conclusion:

‘Step-Up’ simulation was demonstrated previously to be a useful tool in progression to IMT3. Overall quality and usefulness were sustained year-on-year and simulated challenging discussions were highly valued by participants.

Therefore, this programme will continue for future cohorts, with ongoing monitoring of sustained quality and development of new scenarios to provide increased frequency of simulation training.

Ethics statement:

Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.