'The most useful exercise of medical school': simulated death can be successfully incorporated into undergraduate simulation.

Abstract

Simulation is a crucial component of undergraduate education. The University of Oxford, in collaboration with Oxford Brookes University, is pioneering a simulation programme designed to reinforce the value of multidisciplinary team working using a series of maximally realistic scenarios. During these scenarios, students experience events that simulation has traditionally avoided, including patient death. Death is a somewhat controversial subject, particularly in undergraduate simulation. Despite studies suggesting students find it challenging to deal with death encountered in clinical practice,1 some recommend this should never be simulated in undergraduate education.2 We believe that simulation has a useful role to play in preparing students for these emotionally challenging events. Sessions comprise three 30-min scenarios over a half-day. A METI HPS manikin simulates the patient, an actor plays a family member, and an extended faculty of junior, middle-grade and senior doctors, and a nursing sister is provided. Each scenario is followed by a 45-min debrief. Scenarios are managed by teams of two second-year nursing students and three final-year medical students. After a brief handover, nursing students begin treating the patient, and bleep the medical team to attend at an appropriate point. Students are never asked to work outside the role of a newly qualified FY1/staff nurse and are free to call on senior support. Responses from seniors depend on the quality of student handover. Practical skills feature prominently. Scenarios are performed in real-time, and students are required to cannulate the manikin, prescribe all drugs and draw and label samples correctly. Students are provided with a simulated drug cupboard, including a lockable controlled-drugs box, and all necessary documentation. Scenarios …