Using high-fidelity simulation to design a course for overseas doctors in managing common medical, ethical and legal challenges within the NHS

Methods

We surveyed doctors who were new to the NHS to identify challenging workplace situations that are often not covered in trust induction or undergraduate training. Overseas doctors at various grades may not always have senior supervision on these initial encounters, putting patient safety and ultimately fitness to practice at risk. Based on these discussions, we identified four major themes: protecting patient safety within the pressures of bed shortages; decision on escalation care plans in a critically unwell patient without mental capacity; management of needlestick injury and patient confidentiality in high-risk patients; and acting on a serious patient incident and communicating it to relatives as a duty of candour.

These concepts were then incorporated into four medical scenarios, which involved a high-fidelity manikin and simulated actors. The scenarios were initially evaluated by the simulation faculty to ensure they met intended objectives and were practical to run. Once the scenarios were finalised, we piloted a 1-day course to six international candidates with additional workshops and lectures to address key common issues highlighted by the simulation debriefs. Evaluation was collated using a questionnaire with a mixture of open and closed questions graded on a 6-point Likert scale.