Using simulation to prepare for clinical practice

Abstract

Summary Background A significant proportion of medical students feel underprepared for clinical practice, especially in skills such as decision making, prioritisation and prescribing. Changes to medical curricula, including assistantships and shadowing, provide supervised practise, but students remain unable to fully take responsibility for patient care. Simulation may assist in addressing this deficit. A simulation course entitled ‘Simulated ward round and professional skills’ (SWAPS) was developed to improve student preparation for clinical practice. Methods Preliminary work surveyed 22 foundation doctors to identify perceived areas of weakness and to guide the learning outcomes of the course. Following the design and development of the course, 133 final‐year medical students were observed completing a 60‐minute simulation scenario aimed at providing experiential learning in a ward environment, reflecting professional practice. Students received structured feedback and completed pre‐ and post‐course questionnaires to evaluate changes in confidence over the learning domains. Qualitative feedback was also collected. Results The p values were significant in all assessed domains, indicating a perceived improvement in confidence following the SWAPS course. Qualitative feedback highlighted the perceived utility of the course in exposing students to clinical ward‐based scenarios infrequently encountered in their medical curriculum. Students praised the personal feedback received and realism of the simulation. Discussion This paper contributes to the growing body of literature supporting the use of simulation to replicate a ward round and the daily roles of a junior doctor. The SWAPS course seems to empower students to take responsibility for clinical decision making and experience some of the realities of foundation training in a simulated setting.

Workforce: Newly graduated doctors’ experiences of conducting medical ward rounds alone: A regional cross-sectional study

“…It also supports previous studies demonstrating low levels of confidence and self-reported preparedness for ward round conduct. [5][6][7] Less than half of those surveyed had received prior training in ward round conduct, which is in keeping with the previously described findings of Powell et al . 5 This study in YHFS is the largest of its kind, covers a wide geographical area and encompasses both DGHs and tertiary centres giving stronger external validity.…”

“…6 Furthermore, 89% (n=17) of respondents reported feeling unprepared for conducting ward rounds alone, 6 a finding supported by two other studies that demonstrated low levels of confidence for ward round conduct and related skills in medical students and foundation doctors. 5 , 7 The high frequency of FY1-led ward rounds 6 and lack of self-perceived preparedness [5][6][7] is concerning, especially given the lack of prior training 5 and skill deficit 2 identified in this area. The studies exploring this area to date are limited in number, and are predominantly small, local studies, but they clearly highlight the need for larger scale exploration into newly graduated doctors' experiences of conducting ward rounds alone.…”

Clinical Ability, Learning-Attitudes, and Self-Confidence among Nursing Students in Their First High-Fidelity Simulation Training

“…Also, basic items such as 'patient identification' seem to require a more thorough education. In a study of medical students from Moran, Green, and Blair (2017) [19]. where simulation was used to prepare them for clinical practice, and students highly evaluated the realism and the personalized feedback of the simulation.…”

Writing: be mindful of context

“…To reinforce the importance of professional writing, Morgan et al. include the documentation of clinical assessments as one of the requirements of a simulated intervention to prepare medical students for the transition to internship …”

“…6 To reinforce the importance of professional writing, Morgan et al include the documentation of clinical assessments as one of the requirements of a simulated intervention to prepare medical students for the transition to internship. 7 In his article on clinic letter writing , Seddon suggests that there is little formal teaching on this skill in the UK and that it is frequently poorly performed. 8 Communication at the point of transfer of care is extremely important for continuity, and should include the patient ' s current state of health, diagnosis, results of investigations, treatment, a management plan and follow-up.…”