Explore the vast range of titles available.

Impactful learning through simulation-based education involves effective planning and design. This can be a complex process requiring educators to master a varied toolkit of analysis tools, learning methodologies, and evaluative strategies; all to ensure engagement of learners in a meaningful and impactful way. Where there is a lack of thoughtful design, simulation-based education programmes may be inefficiently deployed at best, and completely ineffective or even harmful to learning and learners at worst. This paper presents a useful sense-making framework, designed to support simulation educators in designing their learning activities in a systematic, stepwise, and learner centred way.

Background Simulation-based mastery learning (SBML) is an effective, evidence-based methodology for procedural skill acquisition, but its application may be limited by its resource intensive nature. To address this issue, an enhanced SBML programme has been developed by the addition of both pre-learning and peer learning components. These components allowed the enhanced programme to be scaled up and delivered to 106 postgraduate doctors participating in a national educational teaching programme. Methods The pre-learning component consisted of an online reading pack and videos. The peer learning component consisted of peer-assisted deliberate practice and peer observation of assessment and feedback within the SBML session. Anonymised pre- and post-course questionnaires were completed by learners who participated in the enhanced programme. A mixture of quantitative and qualitative data was obtained. Results Questionnaires were distributed to and completed by 50 learners. Both sections of the pre-learning component were highly rated on the basis of a seven-point Likert scale. The peer learning component was also favourably received following a Likert scale rating. Peer observation of the performance and assessment process was rated similarly by first and second learners. The thematic analysis of the reasons for which peer-assisted deliberate practice was considered useful showed that familiarisation with equipment, the rehearsal of the procedure itself, the exchange of experiences and sharing of useful tips were important. The thematic analysis of the reasons why peer observation during ‘performance, assessment and feedback’ was useful highlighted that an ability to compare a peer’s performance to their own and learning from observing a peer’s mistakes were particularly helpful. Conclusion The SBML programme described has been enhanced by the addition of pre-learning and peer learning components which are educationally valued and allow its application on a national scale.

A new UK medical postgraduate curriculum prompted the creation of a novel national medical postgraduate ‘boot camp’. An enhanced simulation-based mastery learning (SBML) methodology was created to deliver procedural skills teaching within this national boot camp. This study aimed to explore the impact of SBML in a UK medical boot camp. One-hundred and two Scottish medical trainees attended a 3-day boot camp starting in August 2019. The novel enhanced SBML pathway entailed online pre-learning resources, deliberate practice, and simulation assessment and feedback. Data were gathered via pre- and post-boot camp questionnaires and assessment checklists. The vast majority of learners achieved the required standard of performance. Learners reported increased skill confidence levels, including skills not performed at the boot camp. An enhanced SBML methodology in a boot camp model enabled streamlined, standardised procedural skill teaching to a national cohort of junior doctors. Training curricular competencies were achieved alongside increased skill confidence.

This new addition to the popular Essentials series provides a broad, general introduction to the topic of simulation within clinical education. An ideal tool for both teaching and learning, Essential Simulation in Clinical Education provides a theoretical and practical introduction to the subject of simulation, whilst also offering strategies for successful use of simulators within general clinical education and demonstrating best practice throughout. This timely new title provides: The latest information on developments in the field, all supported by an evidence-base Content written by a global team of experts Discussion of policy and strategy initiatives to ground simulation within the healthcare context Practical examples of cases, including inter-professional learning. A superb companion for those involved in multi-disciplinary healthcare teaching, or interested in health care education practices, Essential Simulation in Clinical Education is the most comprehensive guide to the field currently available.

Background The use of video in healthcare is becoming more common, particularly in simulation and educational settings. However, video recording live episodes of clinical care is far less routine. Aim To provide a practical guide for clinical services to embed live video recording. Materials and Methods: Using Kotter's 8‐step process for leading change, we provide a ‘how to’ guide to navigate the challenges required to implement a continuous video‐audit system based on our experience of video recording in our emergency department resuscitation rooms. Results The most significant hurdles in installing continuous video audit in a busy clinical area involve change management rather than equipment. Clinicians are faced with considerable ethical, legal and data protection challenges which are the primary barriers for services that pursue video recording of patient care. Discussion Existing accounts of video use rarely acknowledge the organisational and cultural dimensions that are key to the success of establishing a video system. This article outlines core implementation issues that need to be addressed if video is to become part of routine care delivery. Conclusion By focussing on issues such as staff acceptability, departmental culture and organisational readiness, we provide a roadmap that can be pragmatically adapted by all clinical environments, locally and internationally, that seek to utilise video recording as an approach to improving clinical care.

Video evaluation of resuscitation is becoming increasingly integrated into practice in a number of clinical settings. The purpose of this review article is to examine how video may enhance clinical care during resuscitation. As healthcare and available therapeutic interventions evolve, re-evaluation of accepted paradigms requires data to describe current practice and support change. Analysis of video recordings affords creation of a framework to evaluate individual and team performance and develop unique and tailored strategies to optimise care delivery. While video has been used in a number of non-clinical settings, there has been a recent increase of video systems in the prehospital and other clinical areas. This paper reviews the key opportunities in the emergency department-based resuscitation setting to enhance ergonomics, technical and non-technical skills—at both team and individual level—through video-assisted care performance analysis and feedback.

At the Royal Infirmary of Edinburgh in Scotland, we video record all patients who are admitted into the ED resuscitation rooms as part of our continuous video audit system. Since installation in late 2015, numerous EDs from across the UK and abroad have repeatedly asked us the same questions: how did you do this; how did you 'get past ethics'; how do you get consent. The consistent problem for EDs wishing to integrate video is not the lack of supportive studies reporting video use; video-based studies have assessed the full spectrum of ED care, including communication during consultations, 1 family-staff interactions 2 and time-critical resuscitations. 3 The problem is that there is scarce guidance on how EDs can navigate the processes that will allow them to progress with their own programme of work. 4 Here, we report on our experience of the practical issues associated with video implementation, such as legality, ethics, data protection and staff acceptance, as these are the issues that are regularly cited as reasons why video is not used. 5 6 By focusing on these, we can start to answer the questions above that are pertinent to all EDs that pursue video audit and move towards video becoming an essential part of care delivery. [...]data should be processed for specific lawful purposes, it should not be kept for longer than necessary and appropriate technical and organisational measures should be taken to ensure it is secure. 16 17 This, however, should not be viewed as a permanent barrier to video; 98% of centres that reported video recording traumas in the USA obtained no form of patient or family consent, yet no site had any subsequent patient confidentiality, consent or medico-legal problems. 5 Similarly, in Australia, 96% of parents were satisfied with the provisions put in place to video record challenging neonatal resuscitation. 18 If a robust data system is put in place, approval committees, staff and patients are supportive.

IntroductionIn starting a new clinical placement, doctors in training must become aware of and apply standard operating procedures, as well as learn guidelines, simultaneously adjusting to new patient presentations, environments and personnel. This transition is thought to correlate with increased risk to patient safety, notably during the annual UK changeover. Mobile technologies are increasingly commonplace throughout the National Health Service. Clinicians at all levels are employing medical technology and applications (apps) with minimal local guidance. We set out to test the feasibility and utility of offering medical apps to out-of-hours (OOH) practitioners as an aid to clinical decision-making at point of patient contact. The theorised benefits were threefold: clinical education—real time support for clinical decision-making as one component of deliberate practice to build expert performance; decreased administrative burden–updating and accessing current guidelines; and service development—readily accessible feedback from users.MethodWe provided 32 devices in our emergency departments and OOH environments. The devices were preloaded with apps approved by our medical education department and clinical service leads to be used in support of care delivery.ResultsWe surveyed 123 clinical staff prior to the pilot discovering that 65% had used mobile apps to aid their decision-making. During our project, we saw the number of clinical users expand with our data series, suggesting the apps most useful to care delivery for this group of service providers.Future developmentsThere was huge enthusiasm for the project and we hope to maintain a clinician-led environment.

BackgroundWard rounds are a busy and complex environment. Aggressive patients can be either distracting to the participants, and often their behaviour can be attributed to personality traits. However, it is common knowledge amongst medical healthcare professionals that it is potentially a symptom of an organic cause. Therefore, is a complex and stressful environment, with multiple tasks to be performed, how likely is a medical student to identify the potential of a serious illness in an aggressive patient.MethodologyWe ran a simulated ward round at the university of Edinburgh involving final year medical students (n = 290). We used five patient scenarios with numerous distractors such as phone calls, being asked to perform other tasks, and requesting investigations, as well as being a part of the ward round. Two of the scenarios used were around one patient with acute pancreatitis and another with sepsis and airway compromise. Both these simulated patients were instructed to be aggressive. We measured the time between the patient expressing symptoms to the time of considering a possible cause of the patient’s symptoms, and also the number of prompts from faculty and the patients required to do so. The wards rounds included approximately 3 to 5 students, and each ward round was followed by a reflective debrief.ResultsThe busy environment in addition to the distractors played a major role in delaying the differential diagnosis, and also the required number of prompts. It was interesting that during the debrief sessions the students immediately suspected the issue if they were in a calm and distractor-free environment.Potential impactThe appropriate understanding and acquisition of non- technical skills are an important factor is diluting distractors and avoid potentially disastrous outcomes. Work around the subject should be continued in the future as part of the undergraduate curriculum.ReferencesFlin, R, O’Connor P, Crichton M. Safety at the Sharp End: A Guide to Non-Technical Skills. Surrey: Ashgate; 2008Fulde, G, 2011. Managing aggressive and violent patients. Australia Prescriber

BackgroundAs a newly qualified doctor, one of the daunting tasks to be learned and performed is the ability to certify death in a hospital setting. Junior doctors are frequently unsure about the steps of the examination required and apprehensive when asked to complete a death certificate.MethodologyThe University of Edinburgh currently offers a simulation exercise to all the final year medical students prior to graduation. An essential part of the exercise is to certify a death and complete a death certificate. The students are asked to watch a video explaining the process in detail prior to attending the course. We have included 290 students in this study divided in groups of ten. Our aim is to assess and analyse the appropriateness and the accuracy of the examination.ResultsMedical students have generally expressed feelings of uncertainty and anxiety around the subject of death certification. Data from the completed certificates will be collected and analysed. Each group is debriefed by tutors experienced in simulation-based training. The students will later be asked to report their experience in death certification once they start work as junior doctors, and also comment on benefits of the course with reference to specific aspects of simulation.Potential impactWe hope that by demonstrating the challenges facing the final year medical students when certifying a death in simulation, that the students would be engaged in taking part in a more interactive teaching style including a video of how to confirm and certify death appropriately. It has become clear to us how daunting and terrifying the first death confirmation is to the students even in a safe simulated environment.ConclusionsIssues surrounding death certification are a major concern to the newly qualified doctor, simulation offers a safe environment to identify and solve those issues.ReferenceCertification of Death (Scotland) Act 2011. www.scotland.gov.uk