‘Visiting uncertainty’: an immersive primary care simulation to explore decision-making when there is clinical uncertainty

Abstract

ABSTRACT Doctors are required to be able to care for patients in a variety of settings, including the patient’s home. Patients requiring urgent care in their own homes are at risk of acute deterioration. However, differentiating acute deterioration from self-limiting conditions in the primary care environment can be challenging, even for GPs who are experienced in managing clinical uncertainty and ambiguity. Preparedness for practice of foundation doctors is directly related to opportunities for experiential learning and medical students face many barriers to obtaining experience of acute care in clinical environments. Simulation has been used in healthcare education as an adjunct to experiential learning in clinical environments since the 1950s. At present, the utilisation of immersive simulation in primary care environments for medical students is uncommon even though many foundation doctors will work in primary care. This article describes how faculty at a UK medical school developed an immersive simulated home visit scenario on an ‘Acute Care Course’ for medical students during their Assistantship. Debriefing discussions between students, faculty, and simulated participants focused on the cognitive, emotional, and ethical impacts of uncertainty and how this influenced clinical decision-making for medical students. Having an authentic simulated scenario in the primary care environment, where clinical uncertainty and ambiguity are ubiquitous, offered students opportunities in experiential learning in how to make clinical decisions, despite clinical uncertainty and ambiguity, when assessing and caring for acutely unwell patients.