‘Step up’: utilising simulation to assist in the transition from medical senior house officer to registrar

Abstract

Core medical training was replaced by Internal Medicine Training (IMT) in August 2019. One of the more notable changes was the introduction of a 3 We created an in-person teaching day, entitled ‘Step up’, which consisted of four 20-minute, IM3 specific, high-fidelity scenario-based simulations. In each scenario, a computerised full-body manikin (SimMan Essential) was used. The manikin could be programmed to provide physiological response to scenario participants’ actions. The participants were each tasked to assess an acutely deteriorating patient (the manikin), whilst managing a demanding bleep to add realistic distractions and human factor issues to the scenario. Each participant completed one scenario and watched their peers complete the others from a separate room. Following this, participants were debriefed by qualified member of staff and then taught by a speciality registrar or consultant. Feedback forms were collected. The participants were tasked to rate the simulation day, using a nominal Likert scale from 1 to 10, for usefulness, relevance, clarity, and overall quality. 1 represented strong disagreement and 10 strong agreements with a particular domain. Across 4 full days, we had 11 IM3 doctors take part in the ‘step up’ scenario-based simulations. 9 of the 11 participants completed feedback forms. Scores ranged from 8 to 10. Median scores for all domains were 10. We have demonstrated that ‘step up’ scenarios are a useful and relevant aid for those transitioning into IM3. Further research utilising comparative data will provide more meaningful conclusions. We will be repeating the simulation programme for the next cohort. We will have baseline, one and three-month follow up questionnaires to assess these scenarios further. 1. Buist N, Webster CS. Simulation training to improve the ability of first-year doctors to assess and manage deteriorating patients: a systematic review and meta-analysis. Medical Science Educator. 2019;29(3):749–761.