Simulation to develop tomorrow’s medical registrar

Abstract

Critical incident analysis reveals that poor performance in 'human-factor' or non-technical skills, such as decision making, leadership, teamwork and situational awareness, are frequently identified as key underlying features leading to adverse events. Simulation technology is a rapidly emerging modality used to develop technical and non-technical skills within specialist training as increasing shift-pattern work reduces work-based exposure and learning opportunities. To date, however, there is little literature regarding its use within core medical training to develop crisis resource management skills and medical registrar competency. We present results from a pilot in situ high-fidelity, multidisciplinary, simulation training course in which core medical trainees practised the role of a medical registrar within challenging crisis scenarios. Twenty-one trainees completed the simulation course. All trainees agreed that the course improved their clinical skills and knowledge, concentrated on key non-technical skills that are important in crisis management and, importantly, would change their clinical practice and improve patient safety. Trainee overall performance strongly correlated with assessment of non-technical skills during the simulation scenario. Trainees invited to return for a repeat session after previous concerns and specific feedback showed a visible improvement in performance, with an objective improvement in self-assessed performance. This pilot programme shows the benefits of a high-fidelity, in situ, multidisciplinary simulation training course for core medical trainees in developing the key crisis resource management skills necessary at medical registrar level. As a historical apprenticeship model of training becomes increasingly variable and absent, we present a novel complimentary training strategy for tomorrow's medical registrars.