Foundation Doctors’ Simulation at CHFT

1. Foundation Doctors’ Simulation at CHFT Dr Sarah Hoye

2. Simulation Opportunities • Training days • Combined: • FY1 Day 4 (Human Factors & simulation) • Fy2 Day 3 (Leadership & simulation) • Simulation Spring • Run during mandatory weekly teaching 1-2pm

3. Training Day • The practicalities • Theory of Human Factors • (Have you ever…., Swiss cheese, buckets – self, context, task) • “Distracters and errors” video & role play (scripted) • SUI’s & RCA’s & Incident reporting & Dennis’ Story • Handover – theory, simulation & discussion • Theory of effective leadership • Bromiley Video • Medical crises simulation – authoritarian approach • Reflections, conclusions, learning outcomes review

4. Combined Training Days • 9 sessions from January – March 2014 • 5 FY1s & 4 FY2s per day • Combined as 1 years experience supports others’ learn, encourages discussion (not all new) & eases burden on CHFT time-wise. • How we prepared? • Venkat & I wrote PowerPoint after brainstorming around the Aims & Objectives distributed by the Foundation School • Many SPA & OOH work

5. Training Day Incorporates….. 1. DVD, role play and script 2. Handover simulation 3. Medical crisis simulation (based on sepsis)

6. What we developed • An 82 page PowerPoint that has instructions as to how to explain content or proceed with interactive material • Focussing on the sim components……. • Sim in my eyes is not just mannikin use • But should be flexible in definition, as long as interactive learning. Therefore: 1. DVD, role play and script 2. Handover simulation 3. Medical crisis simulation (based on sepsis) • As day progresses, sim work gets harder but their confidence is built up and repetition used.

7. DVD, Role Play and Script • DVD extract “Distractors and Errors” • Highlights 3 buckets: self, context, task • They then do 4th run-through – the perfect management of how to deal with distractions & Human Factors when reviewing a septic patient

8. Handover Simulation • SBAR & components of a good handover • Focus areas – leading simulated handover • Presentation skills • Situational judgement • Risk assessment • Prioritisation

11. Leadership Simulation • Theory – how hard it is to be authoritarian etc. • Elaine Bromiley video • Then practical – they get to lead the team • all 9 people involved: patient is an FY • FY stands back and instructs them in sepsis scenario • repeat+++ • LIFELINES! – show cards • REFLECTION really important to support learning (example – not prescribing antibiotics but talking about it)

14. Challenges • Faculty recruitment • Faculty training • Faculty quality control! • FTPD time to support session delivery • Enthusiastic groups better for interactive approach • Sim is ‘scary’ as on the spot reaction needed, immediate feedback and variety of skills levels

15. Plan for the future • Spread days more evenly round the year • 1 per month avoiding winter • Reduce number of days from 9 to 6 • Less pressure on faculty • Try to ensure FTPDs are on ‘lighter’ clinical days in case of ‘emergency’ • Means more trainees (14 per day) • Split afternoon: 1 group does handover / 1 sim than swap? • Suggestion: trainees to make handover with info given • more challenging & last longer • Develop 2nd simulation scenario for afternoon? • Split larger group functions into 2 for sepsis sim, but keep together • half to observe and reflect on HF issues & half to sim • Use new simulation suite +/- sim man

16. Simulation Spring • Run during weekly teaching 1-2pm • 4 sessions over 8 week period • Alternate sites – Calderdale / Huddersfield • Learning outcomes based around • Prioritisation • Communication with MDT • Task delegation • Patient review & management planning • Knowing when to seek support • Acutely ill patient common scenarios