O18 Follow the file: using a major incident simulation to train undergraduates in complex trauma management

Abstract

Introduction Recent terrorist attacks in the United Kingdom have heightened the need to prepare for potential major incidents.1 Previously, macrosimulation exercises have been used to prepare for military deployments to conflict zones2 and to test for latent errors in new facilities.3 This paper evaluates how we incorporated a simulated major incident exercise into the undergraduate teaching program at our institution. We hoped that by using experiential learning4 that the medical students would have the opportunity to be exposed to many complex trauma topics and trauma experts in a short period of time. Methods Twenty-seven medical students (4th and 5th year) participated in the exercise, which centred around a bomb blast in the centre of Liverpool. They were all comprehensively briefed and each allocated a file containing their patient clinical details. The students then presented to the Emergency Department at an allocated time to coincide with the script of the major incident and followed the clinical journey that their hypothetical patient would take through the trauma system. Senior clinicians and participating multidisciplinary team members delivered multiple short sub-speciality teaching sessions individually or in small groups during the exercise as the students moved around the facility. Students were asked to record their topics of learning in the case file and this was analysed at a later date. Results Learning topics were recorded by 24 of the 27 students (89%). There were 27 separate topics noted. All topics taught were relevant to major trauma and those most commonly documented included damage control resuscitation, burns, pneumothorax and the management of blast injuries. Figure 1 demonstrates the frequency with which topics were covered, with bold emphasis on the most popular. The highest number of separate topics logged by one individual was 12. Discussion and Conclusion We have shown that a major incident macrosimulation2 in a mature trauma system provides the opportunity to educate undergraduates in complex trauma. This exercise was successful in exposing students to a large range of complex trauma scenarios over a short space of time, enabling experiential learning.4 Although a broad base of topics was covered, no one individual received teaching on all topics, nor did all students document receiving teaching. A few students did not engage fully with the exercise, perhaps not appreciating the potential benefits. Overall, the exercise received positive feedback and proved popular. References Aylwin CJ, Konig TC, Brennan NW, et al.Reduction in critical mortality in urban mass casualty incidents: Analysis of triage, surge, and resource use after the London bombings on July 7, 2005. Lancet 2006;368:2219–2225. Arora S, Sevdalis N. HOSPEX and concepts of simulation. Journal of the Royal Army Medical Corps2008;154:202–205. Jones C, Murphy M, Rimmer R, et al.Using fully immersive simulation to identify latent errors in a new major trauma unit centre. BMJ Simulation Technology and Enhanced Learning 2015;1(S2):A21. Felicia P. Handbook of research on improving learning and motivation through educational games: Multidisciplinary approaches2011. Hershey, PA: Information Science Reference: 1003.