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

Noah Havers, Alvaro Seebacher-Tomas and James Ashcroft
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DOI: https://doi.org/10.7861/fhj.2020-0183
Future Healthc J March 2021
Noah Havers
AAddenbrookes Hospital, Cambridge, UK
Roles: foundation year-2 doctor
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Alvaro Seebacher-Tomas
AAddenbrookes Hospital, Cambridge, UK
Roles: foundation year-2 doctor
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James Ashcroft
BUniversity of Cambridge, Cambridge, UK
Roles: academic clinical fellow
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  • For correspondence: jaa72@cam.ac.uk
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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

    IntroductionParticipants informed about the simulation and give informed consent to participate. Pre-simulation questionnaire undertaken and demographic data collected.
    Initial briefingCourse structure explained and participant trained to use pager and relevant contact details of specialist departments or senior clinicians.
    Major task structureStation 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 structureThroughout 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.
    DebriefParticipants undertook ‘diamond’ debrief conducted by three of the authors (all postgraduate doctors with 1–3 years’ postgraduate experience).
    Participant evaluationPost-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 measuresMedian (IQR)Significance vs pre-simulationSignificance vs post-simulation
    Giving treatmentPre-simulation3 (3–4)
    Post-simulation4 (4–4.75)0.04a
    Post-FiY14.5 (4–5)0.01a0.29
    Independent, responsible workingPre-simulation3 (2.25–4.5)
    Post-simulation4.5 (3.25–5)0.03a
    Post-FiY14.5 (4–5)0.02a0.54
    Dialoguing with patientsPre-simulation4 (4–5)
    Post-simulation5 (4–5)0.31
    Post-FiY15 (5–5)0.070.40
    History, examination, diagnosis and investigationPre-simulation4 (4–4.75)
    Post-simulation4 (4–5)0.54
    Post-FiY14 (4–5)1.001.00
    Communication and team workingPre-simulation4 (3.25–4.75)
    Post-simulation5 (4–5)0.07
    Post-FiY15 (5–5.75)0.01a0.06
    Procedural skillsPre-simulation4 (3–4.75)
    Post-simulation4 (4–4.75)0.95
    Post-FiY14 (5.575)0.791.00
    Patient safety, ethics and legal issuesPre-simulation4 (3–4.75)
    Post-simulation4 (3.25–5)0.77
    Post-FiY14 (3.25–5)0.621.00
    PaperworkPre-simulation2 (2–3.75)
    Post-simulation4 (3.25–4.75)0.03a
    Post-FiY15 (5–5)0.01a0.02a
    • ↵aConsidered statistically significant (p<0.05). FiY1 = foundation interim year-1 programme; IQR = interquartile range.

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A foundation interim year 1 sequential simulation experience and analysis of preparedness to practice early
Noah Havers, Alvaro Seebacher-Tomas, James Ashcroft
Future Healthc J Mar 2021, 8 (1) e137-e141; DOI: 10.7861/fhj.2020-0183

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A foundation interim year 1 sequential simulation experience and analysis of preparedness to practice early
Noah Havers, Alvaro Seebacher-Tomas, James Ashcroft
Future Healthc J Mar 2021, 8 (1) e137-e141; DOI: 10.7861/fhj.2020-0183
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