1HR ON-CALL — Using Simulated ON-CALL to Underpin Experiential Learning in Final Year Medical Students

Abstract

A survey of Blackpool Foundation Year One (FY1) doctors found limited training about being oncall. We could not find any direct mention in Tomorrow's Doctors for preparing undergraduates for this. 1 Working out of hours, on-call and with a reduced workforce is a known area of anxiety among junior doctors. With few examples in literature, 2,3 we developed a novel approach to aiding final-year medical students prepare for this. A simulated teaching programme allowed students to experience the pressures of working on-call. We hoped to imitate stressors within a safe environment. Students were each given a bleep for an hour. Supervisors role-playing a concerned nurse "bleeped" the students. Each task was held in a folder on different wards (no patient interaction or information was involved). They were relatively simple and designed to stimulate resourcefulness, communication and triage skills. Various resources were available including the number for the medical registrar, played by supervisors. The final station was always the unwell patient aimed at drawing the student immediately to this scenario. A facilitated feedback session explored students' positive and negative experiences, concerns and coping mechanisms. Over the three years of this running, results were resoundingly positive with students taking great confidence from the programme. During the open feedback session, students valued using open wards and having to navigate in an unfamiliar hospital as a realistic preparation for next year. Being on-call is an inevitable part of a junior doctor's work and we believe there is scope for better preparation within undergraduate training. We have developed an effective and sustainable simulation that has shown excellent results. Due to the positive reaction and low maintenance of the project, we aim to cement our teaching programme as a permanent feature for undergraduate students at Blackpool Victoria Hospital.

Student Perception of Skills and Simulation Delivery within an Undergraduate Nursing Curriculum.

“…Within other areas of healthcare, particularly medicine, simulation is an established part of the undergraduate curriculum, and has been positively evaluated (Pawlowicz et al, 2020;Riaz et al, 2020;Manalayil et al, 2020). Pre-registration nursing has remained task focused, possible due in some part to the standards set by the Nursing and Midwifery Council (NMC).…”

The Impact of Simulated Ward Rounds on the Clinical Education of Final-Year Medical Students: A Systematic Review

“…The key outcomes qualitatively evaluated by the papers are highlighted in Table 2, and where possible, were synthesised alongside quantitative data to provide a deeper understanding of the impact of simulated ward rounds on final-year medical students. In total, 10 studies reported on the negative emotions perceived by final-year medical students when performing simulated ward rounds [17][18][19][20][21][22][23][24][25][26]. Of these studies, eight provided qualitative data and two provided quantitative data, indicating that the students developed an array of negative emotions, with a temporal relationship to the act of performing simulated ward rounds.…”

“…In total, 10 studies reported on the negative emotions perceived by final-year medical students when performing simulated ward rounds [17][18][19][20][21][22][23][24][25][26]. Of these studies, eight provided qualitative data and two provided quantitative data, indicating that the students developed an array of negative emotions, with a temporal relationship to the act of performing simulated ward rounds.…”

“…This appeared to be felt to a high degree. MacDowall et al reported that, in their cohort, an average Likert score of 4.22 out of 5 (where 5 is strongly agree) applied to students being concerned regarding doing the right thing, and Manalayil et al similarly found Likert scores ranging from 4.0 to 4.4 out of 5 over 3 separate years when the students were asked if they were nervous prior to performing the simulation [25,26]. Negative emotions were found to be highly dependent on the simulated ward round scenario, as they were quick to dissipate following the completion of the simulated rounds.…”

“…A total of 11 studies reported on the realistic nature of simulated ward rounds [19][20][21][22][23][24][25][29][30][31]. Of these, 10 studies provided qualitative data and 1 provided quantitative data.…”