Though they are knowledgeable, foundation year one (FY1) doctors can lack skills and confidence in acute situations due to inexperience. This was witnessed when a new FY1 on call attended an acute upper gastrointestinal bleed (UGIB), a common emergency with a 10% in hospital mortality rate. We aimed to improve FY1s’ ability to manage these critical patients through simulation based teaching, before and after the introduction of an algorithm summarising current guidelines.After assessing the FY1s’ perceived level of confidence in managing UGIBs, they individually attended a simulation session which evaluated specific aspects of their assessment and management plans. Immediate debriefing and subsequent teaching sessions reinforced learning points, with an algorithm instituted as an aide mémoire to improve efficiency. A repeat simulation session assessed improvements in both subjective confidence and objective management targets. All FY1s expressed improved confidence in managing patients with UGIBs. There were improvements across the board in their assessment and management, notably: verbalisation of concern for hypotension increased to 100% (from 60%), two points of intravenous access requested in 100% of cases (from 53%), and a 76 second reduction in time to call for senior support. Collectively, these individual aspects led to improved patient care.Effective management of acute patients is best learnt through exposure, and simulation based teaching provides a safe but powerful modality to aid transition from textbook theory to ward situations. Algorithms can streamline care and hasten the stabilisation of patients. This project reinforces generic competencies that FY1s can translate to their management of not only UGIBs, but many acute presentations, providing a convincing argument for broader simulation use in FY1 teaching.
Background/contextFoundation Year 1 (FY1) doctors, though knowledgeable, can lack skills and confidence in acute situations due to inexperience. This was witnessed when a new on-call FY1 attended an acute upper gastrointestinal bleed (UGIB); a common emergency with a 10% in-hospital mortality. We aimed to improve FY1s’ ability to manage these critically unwell patients through simulation-based teaching, before and after the introduction of an algorithm summarising current guidelines.MethodologyAfter assessing the FY1s’ self-perceived confidence in UGIB management, they individually attended simulation sessions. We evaluated and timed multiple aspects of their assessment and management plans, identifying pitfalls and areas where guidelines were not adhered to. Individualised, immediate debriefing and subsequent teaching sessions re-enforced learning points, with a streamlined algorithm designed as an aide memoir to improve efficiency. A repeat simulation session was arranged to assess improvements in subjective confidence and objective management targets in these patients.Results/outcomesThe FY1s reported finding the algorithm and education programme helpful, expressing improved confidence in UGIB management. There were improvements across the board in various aspects of assessment and management, such as verbalisation of concern for hypotension increased from 60% to 100%; two points of access gained in 100% (from 53%); 76 s reduction in time to call senior. Collectively, the individual aspects all lead to improved patient management.Conclusions/recommendationsEffective management of acutely unwell patients is best learnt through exposure, with inexperience the likely source of FY1s’ self-reported under confidence. Simulation-based teaching provides a safe but powerful modality to aide transition from textbook theory to ward situations. Algorithms can streamline care, reducing time to stabilise patient, potentially improving morbidity and mortality. This project reinforces generic competencies that FY1s can translate to their management of not only UGIBs but many acute presentations, providing a convincing argument for broader simulation use in future FY1 teaching.ReferencesPatterson M, Blike G, Nadkarni V. In situ simulation: challenges and results. Adv Patient Saf. 2008;2(3):1–18Gee V, Morrisser N, Hooks S. Departmental induction and the simulated surgical ward round. Clin Teach. 2015;12(1):22–6Bewley WL, O’Neil HF. Evaluation of medical simulations. Mil Med. 2013;178(10 Suppl):64–75Sen B, Wollard M, Desira N. Does the Introduction of a COPD pro-forma improve the standard of care delivered by junior doctors in the emergency department. COPD. 2010;7(3):199–203
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