Simulation training day
Authors: Yasmeen Khan
Publication date: 29 Oct 2008
Newly qualified doctors entering the hospital environment are scared and underprepared when facing acutely ill patients. I am a foundation year 1 (F1) doctor currently based on a medical assessment unit in the United Kingdom, where some of the sickest patients arrive from the accident and emergency department. I have often had to deal with acutely ill patients, both medical and surgical. Initially, the thought of managing a sick patient evoked great stress for my colleagues and myself as we were thrown into the deep end with limited senior support. Bovier et al recognised that physicians in training were the most anxious group due to uncertainty in medical care. As medical students, we were more concerned about passing exams than recognising sick patients. When patients do present as acute emergencies, the urgency of the situation is such that there is often no time for teaching and training.
Educational tools that help build this skill are invaluable, particularly now that junior doctors gain less exposure to such patients as a result of the European Working Time Directive. Perkins recognised an improvement in patient outcomes following simulation training.
What did it involve?
The scenario based medical simulation training day consisted of a day out of the hospital environment into a simulated clinical setting. The course was held at the Hertfordshire Intensive Care and Emergency Simulation Centre, University of Hertfordshire. The trainers consisted of two consultant anaesthetists from our hospital trust who introduced simulator training and the SimMan. The Laerdal SimMan is a sophisticated interactive computer controlled simulator. The portable 1.65 metre mannequin has the ability to generate breath and heart sounds, with the sound coming from adjacent speakers. You can examine his pulse and blood pressure as well as insert intravenous lines and resuscitate him.
I was nervous when I walked into the seminar room, unsure of what to expect. A separate clinical room had a direct video link in real time to the seminar room, so the other members of the group could watch your performance. The group consisted of eight junior doctors—four F1s and four F2s. Eight simulated acute case scenarios were performed with pairs of F1 and F2 doctors. I was nominated with an F2. We were initially separated and briefed about a patient. A history was given of a 20 year old student who had been running on the treadmill at the gym when he collapsed. I was the medical F1 on call who had been asked to assess and manage him in the accident and emergency department. I adopted a systematic approach, assessing his airway, breathing, and circulation, and called for senior support appropriately.
The acute scenarios were based on real clinical situations such as a patient presenting with tension pneumothorax, supraventricular tachycardia, myocardial infarction, and postoperative complications. After each scenario we were critically appraised and had constructive feedback of our performance. We were asked what we did well and what we could improve, and listened to feedback from the audience. By watching each other we were able to refresh our knowledge and gain confidence. As juniors we are required to attend courses such as the acute life threatening events recognition and intermediate life support course, which also benefit our training but are unable to evoke the true sense of reality.
Evidence to support the use of simulation training
The range of training tools and teaching methods available to clinical skill centres has greatly improved since the use of oranges to teach cannulation. Simulation training is a positive teaching method in many aspects of medical education, from undergraduate to specialty training. Virtual reality simulation has been proved to shorten the learning curve on real surgical laparoscopic procedures when compared with traditional training methods. Simulation has many advantages as it allows for practice without risk in a controlled environment and unlimited repetition and immediate feedback.
Was the course worth attending?
The simulation day was invaluable and allowed us to refresh the knowledge we gained as undergraduates. SimMan provided realistic clinical situations, allowing us to manage acutely sick patients. We worked as a team supported by the trainers who played the role of nurses or specialists to recreate a real situation. The environment was stressful but it was controlled and we were supported. Being videotaped was unnerving, but it was beneficial as we were able to learn from each other’s shortcomings, which resulted in better management.
Where to find the course
The University of Hertfordshire has been running the SimMan training day courses for more than four years and information can be found on their website ( [Link] ). They require a group of eight students, with a fee of £75 a delegate. You receive a certificate of attendance to add to your portfolio. There are 10 simulation centres across the United Kingdom, and a comprehensive list is available from the National Association of Medical Simulators ( [Link] ).
Acknowledgments: Thanks to Indu Sockalingham, consultant anaesthetist, Lister Hospital, and trainer for the simulation training day; and Guillaume Alinier, university teaching fellow, University of Hertfordshire.
Competing interests: None declared.
- Bovier PA, Perneger TV. Stress from uncertainty from graduation to retirement—a population-based study of Swiss physicians. J Gen Intern Med 2007;22:632.
- Good ML. Patient simulation for training basic and advanced clinical skills. Med Educ 2003;37:14-21.
- Perkins GD. Simulation in resuscitation training. Resuscitation 2007;73:202-11.
- Bowyer MW, Pimentel EA, Fellows JB, Scofield RL, Ackerman VL, Horne PE, et al. Teaching intravenous cannulation to medical students: comparative analysis of two simulators and two traditional educational approaches. Stud Health Technol Inform 2005;111:57-63.
- Aggarwal R, Ward J, Balasundaram I, Sains P, Athanasiou T, Darzi A. Proving the effectiveness of virtual reality simulation for training in laparoscopic surgery. Ann Surg 2007;246:771-9.
Yasmeen Khan foundation year 1 doctor
Lister Hospital, East and North Hertfordshire NHS Trust