foundation doctors’ simulation at chft

Foundation Doctors’ Simulation at CHFT

Dr Sarah Hoye

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

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

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

Training Day Incorporates…..

1. DVD, role play and script2. Handover simulation3. Medical crisis simulation (based on sepsis)

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 script2. Handover simulation3. Medical crisis simulation (based on sepsis)

– As day progresses, sim work gets harder but their confidence is built up and repetition used.

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

Handover Simulation

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

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)

ASK THE AUDIENCE

PHONE A FRIEND

50:50

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

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

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