Ethical Standards In Research Research Articles

A20Does the use of simulation enhance the development of registered physiotherapist’s respiratory ‘on-call’ skills – a literature review

On-call respiratory physiotherapy is utilized when an acutely unwell patient could deteriorate without immediate assessment and treatment overnight. Education related to this topic varies greatly and is often of poor quality. Simulation-based education (SBE) has been increasingly used within other areas of healthcare yet, Gough et al. [1] completed a study in 2013, which found only 39% of acute trusts used simulation for respiratory on-call training. To determine from existing research, whether SBE can enhance the development of registered physiotherapists respiratory ‘on-call’ skills in order to impact future practice. A qualitative literature review was completed as part of a PgCert in Health Simulation at Coventry University, in March 2023. Ethical approval was gained from Coventry University (P149952). Studies included were found by searching AMED, CINAHL Embase and Medline databases. PRISMA flow diagram Eleven papers were selected to be reviewed after the removal of duplicates, screening and the exclusion criteria were applied. The main themes identified were the use of high-fidelity simulation, the measure of confidence and/or competence, and findings of positive implications for practice. SBE is widely used for other healthcare professions with positive outcomes; however, its use within respiratory physiotherapy is limited. Most studies chose to measure self-reported levels of competence and confidence, which is an example of Kirkpatrick level-one evaluation. These measures have only casual links to transfer of knowledge and behaviour change, which are key requirements when applying training to clinical settings. Interestingly, the review also demonstrates favourable use of high-fidelity manikins within this population. Although this was not discussed by the researchers, this may be a barrier for further implementation due to cost and technical knowledge required to use the equipment. The use of SBE has been beneficial in other healthcare professions and similar positives were found for its use with respiratory physiotherapists. However, much of the research is of low quality, and further research is required to review other confounding factors that may influence the outcomes and longitudinal staff behaviour. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A51Educational effectiveness of a high-consequence infectious disease training course using ultraviolet simulation

High-consequence infectious diseases (HCID) are pathogens which spread easily between people, have high mortality rates, and lack effective treatment [1]. Examples include Ebola and Lassa fever. Most emerging pandemics, including COVID-19, are initially classified as HCID. Assessment of patients with suspected HCID infection is an advanced procedural skill requiring application of enhanced infection control measures including patient isolation, personal protective equipment, and decontamination. There is a risk of healthcare worker infection if procedures are not followed [2]. HCID often present in non-specialist centres; there is a need for an accessible, educationally effective HCID course for NHS staff. We developed a course for clinicians in infectious disease and emergency medicine, in collaboration with the Health & Safety Executive and clinicians in the UK-HCID network. The course uses a blended approach; theoretical components are taught with online learning. Practical components are taught with high-fidelity, multidisciplinary simulation using VIOLET, a mannequin which coughs, vomits and sweats ultraviolet markers ( Ultraviolet tracers are used to replicate contact and airborne transmission of infectious pathogens in simulation scenarios Between 01/12/22 and 01/04/23, 57 specialized clinicians participated. All participants passed post-course competency-based practical assessments. Participants demonstrated significant gains in knowledge between pre- and post-course tests (mean score 61% vs. 83%, This is the first HCID simulation course internationally using ultraviolet markers to allow visualization of contamination. The course appears to be an effective educational intervention and improves learner confidence in PPE use. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A1Interactive simulation training course for professionals working with children and adolescents with eating disorders

Background and aim: Research suggests that eating disorders (ED) in children and adolescents are on the rise [1]. One study found that the incidence of anorexia nervosa in young girls aged 10–14 years increased by 50% between 1980 and 2000 [2]. Another study reported a 119% increase in the number of hospitalizations for eating disorders in children aged 12 and under between 1999 and 2006 [3]. These statistics highlight the urgent need for improved prevention, early intervention and treatment of eating disorders in young people. This 1-day interactive simulation training course is designed to enhance the knowledge, confidence and skills of medical doctors, psychiatrists, RMNs, physical health nurses, dieticians, general practitioners and family therapists who are working with children and young people (CYP) with eating disorders. Methods: This 1-day simulation course was delivered online. The course focuses on the assessment and management of CYP with ED, understanding the challenges faced by professionals in engaging CYP with ED in different settings, thinking about dynamics within family systems and in wider systems, and gaining a better understanding of capacity, consent and other conundrums. The course includes simulated scenarios played by trained actors to support the development of effective communication skills and Maudsley debrief model is employed to give participants feedback on their contributions and assist them in learning positively and constructively from their experience. Participants completed a pre- and post-course questionnaire measuring their confidence in course-specific skills and human factors skills, as well as collecting qualitative feedback on their experience of the course and intention to apply the learning. Results: Participants were asked to complete a pre-course and post-course questionnaire rating their knowledge, confidence and skills related to working with patients with eating disorders. Paired samples t-tests were conducted to analyse the difference in ratings between the pre- and post-course questionnaires. Results demonstrated a significant difference in the scores for course-specific questions between the pre-course (M =25.48, SD = 4.50) and post-course (M = 32.44, SD = 3.53), t(12) = 46 p < .001, 95% CI [−8.11, −5.80]. 100% of the participants reported that they would recommend the course. Conclusion: The course was effective at improving participants’ knowledge, confidence and skills in working with CYP with ED. The participants found the course useful for their clinical practice. Ethics statement: Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A109A simulation escape room: Does gameful training promote active learning and student engagement

Gamification of learning is becoming increasingly popular within higher education [1]. Student activities described as ‘gameful training’, including Escape Rooms, have reported additional learner benefits including improved teamwork, creative thinking and communication skills compared to traditional session designs [2]. There is a small number of existing case studies demonstrating their utilization within healthcare professional education and the reported additional benefits included pertinent skills such as task delegation and leadership, as well as being an engaging teaching strategy that promotes active learning [3]. A trial simulation escape room was created and implemented for level 5 adult and mental health branch nursing students within a Higher Education Institution. 12 different teams of students entered the escape room and worked together to ‘treat Arthur’, a patient presenting with acute anxiety and chest pain. Students were required to assess, escalate and manage Arthur effectively and would ‘escape the ward’, once he had received all of the required treatment. The learning outcomes for the scenario and subsequent puzzles and tasks were created based on recent curriculum teaching allowing students to apply prior learning within the escape room environment. Puzzles included coded locked boxes and students were required to apply relevant knowledge, such as answering pharmacology questions, to generate codes and progress throughout the scenario. Simulation equipment was utilized and students unlocked clinical treatments and medical devices which in turn had to be delivered to Arthur. The facilitator maintained an active role within the scenario and allowed students to practise communication skills such as escalating their concerns about Arthur via the telephone. It must be noted that the design time was significant for one scenario and required several pilots to ensure that all components were cohesive. Full support and creative input was required from the simulation technicians to ensure the activity’s success. Students fed back that they enjoyed the activity and were observed to work effectively together and prioritize and delegate throughout the task with minimal supervision. Students also stated the scenario context was helpful to apply their prior learning and were pleased that they had been able to manage this patient presentation together. Feedback from facilitators was also positive and both staff and students found it to be an engaging experience. Simulation escape rooms offer an innovative and engaging way for students to apply learning and vital practice technical and non-technical skills. For educators, clear learning outcomes and allowing sufficient design time is a necessity. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A61A comprehensive training programme for Medical Support Workers at a large teaching hospital

The Medical Support Worker (MSW) programme enables International Medical Graduates (IMG) and refugee doctors to support clinical teams, whilst General Medical Council registration is gained [1]. North Bristol NHS Trust, a large teaching hospital in South-West England, has designed and implemented a novel training programme for a second cohort of 30 MSWs. A comprehensive learning needs assessment informed the content of the programme. Learning needs were identified from two probing questionnaires and reflective pieces, completed by 22, 27 and 29 MSWs respectively; alongside Health Education England and General Medical Council guidance [2, 3]. Four principal areas were identified- (1) Communication, (2) Portfolio Development, (3) Career Development, (4) Preparation for work in the NHS. A subsequent teaching programme consisted of simulation, human factors, communication and ethics training, alongside community theatre delivered communication skills, interview preparation practice, portfolio training sessions and a specifically tailored lecture series. The programme was evaluated using two delayed surveys, formed largely of Likert scale questions, completed by 25 and 17 MSWs. Communication, social skills or cultural change were highlighted as the biggest challenges by 64% MSWs. Only 48% of MSWs felt confident working in the NHS. Confidence in managing emergencies, sensitive discussions, presenting cases, and updating relatives was low (0-35%). 75% requested teaching in assessing acutely unwell patients and decision-making. 60% wanted to improve teamworking skills. : Confidence working within the NHS rose from 48% to 92%. 100% of MSWs reported that the teaching programme helped them prepare for work as doctors in the NHS. There was a greater understanding of the structure and function of the NHS, the role of allied healthcare professionals, plus the portfolio and professional development requirements of doctors (92%). 100% of MSWs felt their communication skills had improved. 87.5% reported increased confidence with informal conversation and 100% reported increased confidence in voicing opinions and raising concerns. Additionally, 100% of MSWs reported increased confidence recognizing and assessing acutely unwell patients. Confidence in managing emergencies, sensitive discussions, presenting cases, and updating relatives improved (60-88%). This well-received, novel programme addresses some of the unique learning needs of MSWs and helps them prepare for work as doctors in the NHS. Collaborations with other trusts are taking place to establish whether the programme could be adapted for IMGs more broadly. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A81Advance Choice Documents: a Simulation for Service Users, Carers and Clinicians

Advance Choice Documents (ACDs) are one of the important upcoming reforms to the Mental Health Act in the UK [1]. The aim of the document is to allow service users greater autonomy when they are well, to make decisions and guide what happens if they become unwell in the future. It is created by a service user and clinician in a shared decision-making process. Maudsley Learning (ML) collaborated with an Institute of Psychiatry, Psychology and Neuroscience research team to provide a co-produced simulation day for service users, carers and clinicians. The aim was for participants to be able to gain a greater understanding of how to co-produce and implement ACDs. ML ran two separate simulation days, alongside, members of the research team including a lawyer and facilitator with lived experience. The initial part of the day included didactic teaching; allowing participants to learn more about ACDs and have a space to ask questions from those with lived experience, clinicians and lawyers. This ensured participants gained a baseline level of knowledge to undertake the scenarios. There were four simulation scenarios written, but only three took place on both days because of limited time. These revolved around one patient; the participants followed the patient through their ACD journey. The patient was played by an actor. All scenarios were designed to involve a clinician, often with the presence of a carer and service user as well. The debrief consisted of a modified Pendleton model with feedback from service user, carers and clinicians to allow feedback and learning from all involved. Participants were asked to complete a pre-course and post-course questionnaire. Paired samples t-tests were conducted to analyse the difference between pre- and post-course questionnaires. Results demonstrated a significant difference in scores for course-specific questions between the pre (M = 3.17, SD = 0.81) and post (M = 4.21, SD = 0.20), t(5) = -5.26, p <.05, 95% CI [-1.55, -0.53], with a large effect size of d = -2.15. 100% of participants would recommend this course. This was the first simulation that ML has run with a mixed group of learners that included not only clinicians, but also service users and carers taking part in the simulation and debrief. The feedback was positive and helped to improve the knowledge around ACD’s. It was also noticeable the positive difference it made having clinicians, service users and carers learning from one another. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A39Managing transitions from CAMHS for people with autism spectrum disorder (ASD) – interactive simulation training course

Transitions from CAMHS services to adult mental health care present a challenge to patients, carers, and professionals alike and are often managed poorly by services, leading to avoidable anxiety and adverse experiences for service users [1]. For patients with autism, transitions can be extremely distressing and require careful consideration and planning to ensure continuity of care. There is a lack of clarity for professionals and services users about what resources are available and appropriate for people with autism. This course is designed to provide professionals working in both CAMHS and adult mental health with a better understanding of autism and introduce strategies to improve the management of transitions and care of individuals with autism. Maudsley Learning, in collaboration with the ESTIA Centre, offered an online simulation training program on two occasions. The course aimed to provide participants with a clinical understanding of autism and autistic persons’ lived experiences, to equip participants with person-centred strategies to support individuals with autism, address the challenges faced by autistic individuals during child-to-adult transitions, and implement strategies to improve the care of individuals with autism who have co-morbid mental and physical illnesses. The training began with group icebreakers and a didactic introduction to simulation training to establish psychological safety followed by five scenarios covering different aspects of ASD and the challenges faced by individuals with ASD during transition. To add higher fidelity and better learning experience, we involved actors with autism and intellectual disability. The Maudsley debrief model was used to provide constructive feedback to participants on their contributions and facilitate positive learning experiences. Participants completed a questionnaire before and after the course assessing their confidence in skills related to the course. They also provided qualitative feedback on their experience and their willingness to apply their learning. Paired samples t-tests did not find a significant difference in scores for course-specific questions between pre-course (M =16.75 SD = 2.50) and post-course (M = 20.25, SD =.50), t(2.64)=3 p >.0.05, 95% CI [-7.70,.70]. 100% of the participants reported that they would recommend the course. This course was co-produced and involved actors with autism and intellectual disability for better learning. The score improved slightly, but not significantly due to a small number of participants. All participants found the course helpful for their clinical practice and would recommend it. The course is best conducted in-person for optimal learning experiences. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A38Bridging the gap to FY1 – A high fidelity, regional programme with real life actor-based simulation of the acutely unwell patient

Simulation based learning is becoming an increasingly important focus across medical curricula internationally [1]. The need for medical students to be both theoretically and practically competent is essential in the transition to becoming a successful junior doctor. High technology driven manikin simulations are useful, however access is limited by lack of equipment, finance, and training. In district general hospitals this restricts junior doctors’ exposure to teaching and students’ access to a diversity of cases. Utilizing junior doctors as Near Peer Tutors (NPTs) provides a real life equivalent to the simulation experience that comes closer to exposing trainees to the realities of hospital life as an on-call doctor [2]. A 6-week programme originally designed in a separate NHS Trust was adapted and streamlined with improvements made to data collection, labour division and content delivery. Ten simulation sessions across two district general hospitals ran from 18/10/22 to 21/04/23 with 37 medical students and 8 NPTs. Each week focused on typical, in-hospital scenarios commonly faced by junior doctors. A self-assessment confidence survey and digital knowledge quiz was undertaken on the weekly topic followed by a 10-minute, high yield, interactive lecture delivered by a NPT. Students were split into groups of two and each group assessed the ‘acutely unwell patient’ with an ‘ABCDE’ styled approach to diagnosis and management. The NPT actor simulated improvement or decline based on the management decisions of the students. A STOP5 hot debrief ran at the end to give constructive feedback and promote discussion [3]. Self-assessment confidence scores by medical students were quantified against a 4-point Likert confidence scale. The students’ confidence rating improved by an average of 0.65 units (average pre-teaching = 2.40, average post-teaching = 3.05) (p<0.00001). Following the session, 35/37 students described themselves as ‘quite confident’ managing an emergency scenario compared with 13/37 prior to the session. Thematic analysis of the perceived benefit by students highlighted 3 main areas; an opportunity to engage in practical scenarios, utilization of A-E assessments, and the benefits of real-life actors. Students enjoyed the ‘informal setting’, ‘life like’ encounters, and expressed they would like to attend additional specialty specific sessions. NPT centred medical simulation in a low-cost environment is a compelling method of engaging junior doctors as teachers and equipping medical students with the skills to become future on-call doctors. We encourage the implementation of similar programmes alongside medical school curricula to supplement preparation for practice. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A111Undergraduate nursing programme entry: Encouraging offer holders to select their university offer, based on an informed overview of programme content

Choosing the right university and programme is crucial for aspiring nursing students and their families. With so many options available, it can be challenging to make an informed decision [1-3]. The aim of this initiative was to provide student nurse offer-holders and their parents/partners with an overview of the undergraduate nursing programme’s content, in an effort to encourage them to select the right university. The initiative was developed and conducted over six months (Dec 2022 - May 2023). It consisted of five Saturday morning sessions, each included taster lectures, clinical skills sessions, and simulations with actor role players. Offer-holders attended one rotation, while the parents/partners of offer-holders attended another rotation. The facilitated simulations were collaboratively designed by the University branch specialists and the education provider, and involved actor role players. In order to cover child, adult and mental health branches, for aspiring students, the scenario content was broad based and applicable to all. Scenario 1: Communication with relatives of a baby failing to thrive Scenario 2: Communication with an adult patient and her husband Both simulations were conducted as forum theatre and aligned with NHS values. Evaluation forms completed by potential nursing students and their parents/partners were overwhelmingly positive. Attendees reported that the sessions were informative and enjoyable, with the simulations being a particular highlight. The use of actor role players helped to make the simulations more realistic and engaging. Attendees felt that the sessions assisted them to better understand what to expect from the nursing programme, which would aid them in making a more informed decision about which university to choose. Offer holders and their families need to make an informed decision when choosing a nursing programme. The study showed that providing a comprehensive overview of the programme’s content through taster lectures, clinical skills sessions, and simulations can be an effective way to encourage students to select the right university. The use of actor role players in the simulations helped to create a realistic and engaging learning experience for attendees. Overall, this initiative highlights the importance of providing potential nursing students with the necessary information to make a decision about their education. By making an informed decision, the fit is likely to be right and the chances of attrition reduced. Further studies will be conducted by the university admissions teams to establish if these tasters assist with retention. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A110Simulated Physiotherapy Placement: An alternative to clinical placement for first year undergraduate Physiotherapy students

To address the existing workforce deficit within Physiotherapy an extra 500 Physiotherapists need to be trained every year - an additional 15% of current student numbers. The biggest barrier to expansion of student numbers is placement capacity. Novel and innovative models of placement are being trialled, with a strong emphasis on the four pillars of clinical practice. Simulation, and virtual based placements offer alternative models of placement provision [1]. Current literature has detailed successful simulated clinical placement within Physiotherapy using full or partial substitution of clinical placement. It has been shown that switching up to 25% of practice learning to a simulated model does not compromise student attainment or competency [2]. However, these studies tend to involve small student numbers. For simulated placements to be a practical alternative they need to be delivered at scale. The aim of this pilot project was to develop, deliver and evaluate an on campus simulated placement experience for 140 first year Physiotherapy students at a large UK university. A four-week program of activities was designed to simulate the core learning that occurs on a typical physiotherapy clinical placement. Including case scenarios with standardized patients, virtual case discussions with clinicians, expert patient panel, day in the life of videos, note writing workshops and live streaming of patient sessions. Students attended two observational days in practice with structured debriefing on campus. Themes for the placement included communication, risk assessment, patient journeys, wellness and effective learning on placement. The development of the learning activities was research and stakeholder informed. Clinical scenarios were co-designed with level 5 Physiotherapy students. Placement evaluation was collected via a questionnaire including open ended questions and Likert scales (0-5). Students agreed that that placement was engaging and interesting (mean score of 3.45), with the greatest agreement that the placement had improved note writing, communication and understanding of professionalism. Students ranked simulated clinical scenarios and observation as their preference for activity, with peer learning to support these activities to be ranked the lowest. A review of placement attainment data noted a correlation with previous clinical placement data. There was an increase in a student’s perception of their preparedness to go on a clinical placement pre and post simulated placement. Large scale, simulated on campus placements are workable and a useful learning experience for first year Physiotherapy students. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A55‘Who’s in charge? Me!’ Using simulation for band 5 nurses who are learning to lead

The ‘Standards Framework for Nursing and Midwifery Education’ set out by the Nursing and Midwifery Council states that nurses are expected to develop ‘supervision and leadership skills’ [1]. However, band 5 nurses at a NHS Trust indicated their reticence about taking on ‘nurse in charge’ roles and wanted to build their confidence in engaging in challenging conversations with an assertive approach. As an education provider, we worked alongside the Trust nursing practice development team to develop and deliver a simulation-based workshop to help improve band 5 nurses leadership skills through simulated scenarios. The workshop was integrated into a leadership development day. To encourage all nursing staff to ‘embrace their inner leader’, The Royal College of Nursing described five ways to do so – be a role model, show emotional intelligence, motivate others, create shared goals and display courage [2]. Scenarios, with actors, were developed to allow practice of these strategies whilst having difficult conversations from within a leadership role and included: listening to a colleague with personal difficulties, dealing with angry relatives, supporting a patient after unwelcome news and discussing with a clinician concerns about professionalism and kindness. Participants were provided a communication framework (STEPS: start, time, empathy, provision of support, sense check)) to assist their preparation, pacing, framing and summarizing. Of the 12 sessions completed ( Everyone was so brilliant! I was so nervous about the simulation but (the facilitator) has been wonderful. Actors were amazing. Facilitators have been so kind and knowledgeable. Attending this study day has given me better confidence in my own ability to be in charge and deal with challenging situations. STEPS has given me a very good guide in dealing with professional communication as a nurse in charge. Live actors are very beneficial for us as it gives us real life actions to follow and deal with daily situations in the ward. Immersive and interactive. This simulation-based workshop developed with RCN leadership values in mind, has supported 180 band 5 nurses with their leadership roles. It has been immensely well received and has assisted these nurses in their workplaces. Based on the success of the first 12 sessions, 12 additional sessions are planned with pre and post feedback data from attendees being collated for analysis. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A18Barriers and facilitators to the use of healthcare simulation to support the professional development of healthcare professionals: a systematic review of qualitative research.

The effectiveness of simulation-based education (SBE) in improving healthcare education among practising healthcare professionals (HCPs) is well recognized [1–3]. However, there is limited research available that explores the facilitators and barriers to the use of these activities amongst this population. The aim of this study was to determine those barriers and facilitators that exist to the use of healthcare simulation amongst practising HCPs through the systematic review of existing qualitative literature. Searches were performed using Medline and CINAHL from February to May 2022 with an updated search performed in June 2022. Reference list searches of included studies were also conducted. English-language, peer-reviewed studies that used qualitative methodology to examine barriers and/or facilitators to the use of SBE activities amongst HCPs practising in a hospital setting were included. Data were extracted and a quality appraisal tool was applied by the primary author, with 30% of included studies independently extracted and appraised by a second author to examine the agreement. Barriers and facilitators were coded inductively using thematic analysis. Thirteen studies were included out of a total of 2109 screened. Four main themes related to facilitators and barriers were identified: (1) management and leadership; (2) resources; (3) perceived impact and (4) learning experience (see Thematic analysis of facilitators and barriers to the use and uptake of SBE activities This study identified common barriers and facilitators to the use of SBE activities. By anticipating and addressing these adequately, the use and uptake of SBE activities amongst practising HCPs can be further enhanced. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A103The Future of Aiding Student Placement Expansion: is it simulation, is it sustainable?

In recent years many Higher Education Institutions (HEIs) have recognized the benefits of Simulation Based Education (SBE) and incorporated it into their teaching programs, in some cases utilizing it to replace traditional ‘clinical placement’ hours [1]. This has been catalysed by the COVID-19 pandemic whereby there has been unprecedented demands on NHS services, forcing the industry to offer alternative placement models [2]. To contribute to placement expansion by offering a simulation-based student placement. We created a six week non-clinical, simulation placement designed to host two Physiotherapy students. The overarching objective of this placement was to enable students to create and run their own simulation training session by their final week. They were based in the simulation team and networked with other students and clinicians to guide their research and planning. We collated feedback from the students at the end of their six-week placement via anonymous, online Microsoft feedback forms. Throughout 2022 we ran this placement twice and collated data from the 4 Physiotherapy students, all who were in their second year of study. Thematic analysis suggested the most common skills students felt they gained were soft skills (i.e. organization and prioritization) and development of varied communication styles. Additional themes that were mentioned included simulation specific skills. There were two areas where students felt they were unable to develop due to the placement communicating with ‘real’ patients and clinical note writing. Students were asked to score their clinical knowledge relating to their chosen simulation topic area at the beginning and end of the placement. Scores increased from ‘Good’ (2 students) and ‘Average’ (2 students) at the beginning of the placement to ‘Good’ (1 student) and ‘Very Good’ (3 Students) at the end of the placement. Qualitative themes suggested the students felt the overall variety of activities and exposure to clinical scenarios/teams they may not have seen before was unique to this placement and both enjoyable and valuable. Previous studies have identified misconceptions relating to the purpose of simulation and its aims [1]. Our data reflected this concept as students rated their knowledge of simulation at the beginning of the placement as ‘Very Minimal’. However, our placement offering has proven to successfully increase this awareness and offer the opportunity to develop transferable skills and clinical knowledge in a way that is both exciting and aids placement expansion whilst incurring minimal cost. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A66Standardizing debriefing in Wales: the Triangular Approach

Debriefing after simulation practice offers a crucial opportunity for guided reflection and learning. However, there are many structures and models available [1]. Health Education and Improvement Wales (HEIW) holds regular simulation webinars, workshops and conferences. During these events, the simulation community in Wales expressed their willingness to standardize debriefing in order to facilitate faculty sharing and to support interprofessional simulation. National debriefing experts carried out a review of the relevant literature and devised the Triangular Approach to Debriefing, incorporating agreed debriefing principles, a simple structure and recommended strategies with links to relevant key articles. This approach was shared and piloted by simulation faculty at a national workshop in September 2022. The feedback received was excellent. Comments received guided a document review. The final version was incorporated in the Essential Faculty Development Course and is currently in available in Welsh and English. The triangular approach embraces a set of collaboratively identified principles, an easy to use structure and a summary of well referenced strategies: Principles adopted include facilitating safe and constructive discussions, with Inclusion of all participants and respect for different learner needs, aiming to guide reflective practice and sharing of mental models with the highest level of facilitation possible. A four-step structure (see Recommended strategies cover psychological safety (such as ground rules, time management, authenticity and validation of contributions), how to focus the discussion, facilitation techniques, closing and meta-debriefing. Debriefing structure in the Triangular Approach to debriefing The Triangular Approach to debriefing has been welcomed by the simulation community in Wales. It is not expected to be the only way that facilitators debrief, but a gateway into good quality debriefing for new faculty, supporting the development of national expertise and encouraging to explore other available models as well as key debriefing literature. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A96Whole System Transformed: Making Discharge Everyone’s Business

Delayed discharges are a challenge in every hospital. The Scottish Government are ‘committed to significantly reducing the number of people who are waiting to move from hospital wards to more appropriate settings [1]. This transformative simulation has been designed for all multidisciplinary team members involved in a patient’s care to engage in discharge planning; and to ‘respond to health service needs [2]. This simulation was created to break down barriers between acute and community care, reduce silo mentality and share the decision-making and risk around discharge. Empower any member of staff to have discharge conversations. Emphasis on early discharge conversations. Join up acute and community staff involved in the discharge process. The simulation involves a three-hour session with three scenarios. The session has run in both acute and community hospitals. Participants are multidisciplinary, and have included doctors, nurses, allied-health professionals (AHP), flow team, carers representatives, social workers, social care staff, home care staff and NHS Education for Scotland (NES) staff. The participants, in pairs, have a simulated conversation with a patient’s relative about discharge. The learning objectives from the scenarios are around realistic medicine, managing risk and dealing with anxious families. To assess the immediate impact of the simulation, participants complete a pre-simulation questionnaire on arrival and a post-simulation questionnaire at the end of the session. The results were from the pilot session pre and post simulation questionnaires in March 2023. Participants ( Prior to the simulation participants were asked ‘What makes it difficult to have these conversations?’ Themes from the qualitative answers were family expectations and managing uncertainty, both of which were learning objectives in the scenarios. Our participant feedback has shown that this Discharge without Delay Simulation has ‘made discharge everyone’s business.’ This simulation can provide transformative change to help healthcare professionals have early discharge conversations. This provides better patient-centred care by returning the patient to a homely environment, to reduce delayed discharges and increase patient safety. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A40The importance of human factors and the implementation of the ‘Social GRACES’ in simulation training: a 6-month review of foundation simulation training at Guys and St Thomas’ (GSTT) NHS Foundation Trust

Traditionally the focus of simulation has been centred on clinical management. More recently there has been a drive to enhance training on ‘human factors’ [1]. In simulation, human factors can be challenging to replicate, particularly with regards to how individuals interact within a system. At GSTT we introduced a concept known as ‘social GRACES’ into simulation training. Social GRACES, first described by John Burnham in 1992 [2], outline a framework to understand an individual’s personal and social identity. An abundance of research into the development of human factors skills exists in the literature. Our aim was to integrate social GRACES into our simulation programme as a novel approach to engage trainees with human factors. Between October 2022- April 2023, there were 23 full-day simulation training days. The course started with an introduction on human factors and the social GRACES. This was followed by a ‘lost at sea’ activity where trainees worked individually and in teams to prioritize the items they would take if lost at sea. This was followed by 4 clinical scenarios with debriefs related to clinical management, human factors and social GRACES. Pre and post course questionnaires were disseminated, and delegates were consented for data being used for quality improvement. Unique identifiers allowed for paired data analysis. 101 pre-course and 138 post-course feedback forms were received. To allow for paired analysis, only completion of both questionnaires was included, leaving 83 responses. There was a statistically significant increase in the percentage of responders who strongly agreed they felt confident in recognizing (7.2%-35.2%), assessing (15.7%-43.4%), managing (3.6%-20.5%) and escalating care (15.7%-35%), in acutely unwell patients. Additionally, confidence improved in understanding the impact of human factors in delivering care (9.6%-35%) and the performance of healthcare professionals (9.6%-39.8%). We explored confidence with regards to the practical implementation of human factors in healthcare ( 10 questions were devised to assess confidence relating to practical aspects of human factors in healthcare with regards to teamwork, communication, and leadership. Following paired data analysis, we found a statistically significant improvement in confidence in all areas investigated. The results demonstrate that the interplay between managing acute clinical scenarios & human factors can effectively be taught through simulation and enhanced with an understanding of social GRACES. An increased understanding of human factors and simulation training was useful in improving 3 crucial skills; teamwork, communication and leadership, which are instrumental in improving clinician confidence and patient outcomes. Future direction should look to include awareness and implementation of human factors within mainstream simulation to effectively replicate real time clinical scenarios & pressures. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A99Designing and implementing e-noting for use in simulation scenarios for sustainability and realism

Due to the nature of simulation-based education, large amounts of blank paperwork are used and disposed of in any given scenario. As many trusts are now moving towards e-noting, including e-obs and e-prescribing, the use of these in simulation can be extremely beneficial for the learners. These were highlighted by the author as areas for sustainability and increased realism throughout the simulation sessions run by the team at Dartford and Gravesham NHS Trust [1]. This initiative was developed to cut down on the amount of paper waste used during scenarios and increase the realism for the learners taking part. E-obs, e-prescribing and e-noting templates were created using Microsoft Excel and Microsoft Word that mirrored the programmes used throughout the trust, and were made readily available for the learners taking part in the simulation scenarios. These were then saved as templates, and a new version created for each existing patient throughout the scenarios. On top of this, each new scenario created also required a new set of e-noting, including a NEWS, prescription and the relevant paperwork. ‘Patients’ who had progressed through ED, for example, had a completed CAS card, and their NEWS chart reflected the several sets of observations already taken. The NEWS chart template was also adapted for patients with COPD, and PEWS charts for each paediatric age group were also created, alongside separate e-prescribing to mirror the paediatric version of the drug charts throughout the trust. Learners who participated in the scenarios using e-noting provided positive feedback, highlighting the realism and relevance to practice. 43 learners were asked to complete a short survey after taking part in 1 or more scenarios using the new e-noting system. 79% of learners reported that they found the system easy to use, 90% reported the relevance to clinical practice, 81% reported that it was realistic and 95% were happy that this is a feasible and sustainable way to utilize prescribing, observations measurement and note writing/history taking throughout the simulation sessions. 4% reported not using the e-noting system during their scenario. Although the creation of the e-noting system required additional time and resources at the start, they quickly became easy to implement and adapt to each new patient or scenario. The use of this system leads to much less paperwork being destroyed and increased the realism for the participants who use e-noting throughout the trust. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A42A palliative care skills study day is an effective way of meeting palliative care registrar curriculum Direct Observation of Procedural Skills (DOPs) requirements

The new Speciality Training curriculum for Palliative Medicine from August 2022 identifies key procedural skills that, for the first time, can be performed in a simulation (SIM) skills lab to demonstrate proficiency [1]. These include tracheostomy care, managing non-invasive ventilation (NIV) and the management of indwelling ascitic drains. These skills can be difficult to acquire in non-hospital settings like hospices and in the community. A bespoke, pilot palliative care skills day was organized to assess the suitability for theory, skills training and subsequent opportunity to demonstrate proficiency by sign off against curriculum competencies. A total of 11 palliative care trainees from the Northern Deanery attended a pilot SIM study day in March 2023. Three parallel workshops were planned – tracheostomy care, the insertion and management of ascitic drains and managing NIV. Each workshop was delivered by local experts in the area (non- palliative care professionals) with experience of teaching and training other professionals. assessing internal medicine trainees. Trainers were briefed on learning outcomes prior to the session by two palliative care consultants, and the clinical context of each session was set within relevant palliative care environments for e.g. the care of a patient in a hospice, in the community or in a hospital. Trainee confidence was assessed before and after SIM training with the use of 10-point Likert scales and free text comments. Overall self-reported trainee confidence and competence scores increased for all three workshops (Paracentesis 7 to 8.8 out of 10, NIV 4.5 to 8.6, tracheostomy care 3.8 to 8.9). All trainees agreed it was an effective and educational way of addressing curriculum objectives; and agreed it should be a rolling programme offered regionally. Trainees commented on the positive learning environment, the small group sizes, the benefit of being taught by experts and having the opportunity to be assessed for curriculum requirements. Trainees who had previously achieved competencies commented on the benefit of refreshing skills. One area for development identified was the lack of standardization on DOPs forms about the level of proficiency required. This will be fed back to the regional training committee for the future. Trainees identified further clinical skills that could be addressed in a skills lab and hence, a second skills day will be organized. SIM training is an effective tool for delivering training around procedural skills for palliative care registrars. It also brings opportunity to demonstrate proficiency in specific practical skills. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A60A Simulation Based Quality Improvement Project to improve patient care in the Urgent Care Environment

In the two years prior to commencement of the project, data suggested that incidents related to patient safety were high on one Urgent Care Ward. Evidence also suggested that staff turnover and the number of junior staff in post were also higher than usual with little support available. A series of monthly, clinical Simulation Based Education, (SBE) Sessions were held over eight months with the aim of allowing staff to practice, in a safe space, the specific clinical skills required to work in that environment ultimately resulting in safer patient care by increasing knowledge, skills and confidence, [1]. Training consisted of monthly 3-hour sessions, 3 scenarios per session, each followed by a structured debriefing cementing understanding and learning. Scenarios were relevant to Urgent Care and as realistic as possible using High Fidelity Simulators. A mixed methodology was used to collect qualitive and quantitative data over 11 months allowing for robust analysis, [2]. Pre and Post session Confidence Scales were completed by candidates as well as a feedback form to identify key learning points and to advise on the suitability. A comparison study was made, collecting patient safety data at the beginning and end of the project. 26 candidates attended. 3 attended twice. Candidates were qualified and student Nurses and Health Care Assistants with varying levels of Urgent Care experience. Following sessions all candidates reported that they felt more confident managing deteriorating patients and that they felt more confident to summon assistance. They all reported that scenarios were relevant to practice. 65 learning points were identified with 7 common themes. The most useful part of sessions was realism and relevance. Patient Safety Data indicates some improvement in the number of reported incidents. Some variables could have influenced data and further study is required. Results were positive and the project has been adopted throughout Urgent Care across the Trust to improve patient safety and retain staff The project aimed to improve patient safety by providing SBE to staff on one Urgent Care Ward. Analysis of data suggests there was some benefit to patient care and demonstrated a positive impact on staff confidence. It also identified key learning themes. The educational program will be offered across the Trust and further study will enable more persuasive data. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

A77Translational simulation in practice: an enhanced orthopaedic induction for new trainees

The gap between imagined and realized healthcare practice is indisputable. For trainees who rotate between departments, the challenges of navigating complex healthcare systems are unmet by standard induction programmes [1,2]. Our simulation centre and orthopaedic department collaborated to create an enhanced departmental induction using immersive simulation. Following a thorough needs assessment for new trainees rotating to trauma and orthopaedics. We looked at previous trainee feedback, adverse event data from our safeguarding reporting system, and expert opinion from orthopaedic staff. It became clear that at times of transition, the process of accessing timely and appropriate support was challenging. Furthermore, there were a myriad of clinical duties and patient cohorts covered by the trauma team. Working within this dynamic and complex structure was difficult for new trainees. We used team-informed process mapping to define the escalation systems in place, and the distinct roles within the team. We identified key learning objectives for a simulation induction session. We used a case vignette of an unwell trauma patient and aligned the scenario design to the required learning objectives on clear escalation pathways and whole team working within a complex environment. Following a successful pilot run, this enhanced induction is routinely delivered four monthly for junior doctors rotating to the orthopaedic department. Current trainees, orthopaedic consultants, and senior managers also attend this trainee induction as an open forum for dialogue on service improvements. All participants have rated these sessions as good or excellent; they value the whole team approach and repeatedly ask for further simulation sessions. Feedback from other members of the trauma team following these sessions commented on increased connection within the team, which included junior trainees attending departmental meetings. The orthopaedic team also felt that, following the induction programme, new trainees had demonstrated improved handover skills when escalating unwell patients. This whole team simulation-enhanced approach to orthopaedic induction is novel, and in contrast to the majority of standardized induction programmes [3]. This work provides a template that can be applied to different healthcare systems. By delivering constructively aligned simulation sessions, we can improve team training and enable new trainees to flourish during periods of transition. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.