A foundation interim year 1 sequential simulation experience and analysis of preparedness to practice early

Noah Havers; Alvaro Seebacher-Tomas; James Ashcroft

doi:10.7861/fhj.2020-0183

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Fig 1.
Foundation interim year-1 preparedness improvement. a = p<0.05 vs pre-simulation; b = p<0.05 vs post-simulation; FiY1 = foundation interim year-1 programme.

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Table 1.

Sequential simulation model

Introduction	Participants informed about the simulation and give informed consent to participate. Pre-simulation questionnaire undertaken and demographic data collected.
Initial briefing	Course structure explained and participant trained to use pager and relevant contact details of specialist departments or senior clinicians.
Major task structure	Station 1 New admission with pneumonia and pre-existing COPD, low suspicion of COVID-19. Key investigations available for review include ABG (type 1 respiratory failure), CXR (pneumonia and COPD) and ECG (normal). Escalation plan: bleep and discuss with the medical registrar for an urgent review.
	Station 2 Ward-based deterioration with urinary infection causing agitation and confusion. Key investigations available for review include blood test results (infection), CXR (normal) and urine dip (infection). Escalation plan: bleep and discuss with the medical and microbiology specialist registrars for advice.
	Station 3 Acute deterioration with suspected perforated abdominal viscera. Patient played by actor requiring history taking and examination. Key investigations available for review include VBG (metabolic acidosis), CXR (pneumoperitoneum) and ECG (normal). Escalation plan: bleep and escalate to the surgical registrar.
Minor task structure	Throughout major tasks, participants are were given several (one to five) minor non-urgent tasks through the bleep system. These tasks were designed to take less than 5 minutes and should be completable over the phone.
Debrief	Participants undertook ‘diamond’ debrief conducted by three of the authors (all postgraduate doctors with 1–3 years’ postgraduate experience).
Participant evaluation	Post-simulation questionnaire and semi-structured interview to explore the participants’ experiences.

ABG = arterial blood gas; COPD = chronic obstructive pulmonary disease; CXR = chest X-ray; ECG = electrocardiography; VBG = venous blood gases.

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Table 2.

Participant preparedness measures pre-simulation session, post-simulation session and after the 4-week foundation interim year-1 programme

Preparedness outcome measures		Median (IQR)	Significance vs pre-simulation	Significance vs post-simulation
Giving treatment	Pre-simulation	3 (3–4)
	Post-simulation	4 (4–4.75)	0.04^a
	Post-FiY1	4.5 (4–5)	0.01^a	0.29
Independent, responsible working	Pre-simulation	3 (2.25–4.5)
	Post-simulation	4.5 (3.25–5)	0.03^a
	Post-FiY1	4.5 (4–5)	0.02^a	0.54
Dialoguing with patients	Pre-simulation	4 (4–5)
	Post-simulation	5 (4–5)	0.31
	Post-FiY1	5 (5–5)	0.07	0.40
History, examination, diagnosis and investigation	Pre-simulation	4 (4–4.75)
	Post-simulation	4 (4–5)	0.54
	Post-FiY1	4 (4–5)	1.00	1.00
Communication and team working	Pre-simulation	4 (3.25–4.75)
	Post-simulation	5 (4–5)	0.07
	Post-FiY1	5 (5–5.75)	0.01^a	0.06
Procedural skills	Pre-simulation	4 (3–4.75)
	Post-simulation	4 (4–4.75)	0.95
	Post-FiY1	4 (5.575)	0.79	1.00
Patient safety, ethics and legal issues	Pre-simulation	4 (3–4.75)
	Post-simulation	4 (3.25–5)	0.77
	Post-FiY1	4 (3.25–5)	0.62	1.00
Paperwork	Pre-simulation	2 (2–3.75)
	Post-simulation	4 (3.25–4.75)	0.03^a
	Post-FiY1	5 (5–5)	0.01^a	0.02^a