Ethical Standards In Research Research Articles

A54Co-produced scenario-based simulations: Respect for, and understanding of, those from transgender and gender diverse communities

In July 2018 the government launched the national LGBT action plan to advance the rights of LGBT people to improve the way that public services work for them, regardless of their sexual orientation, gender identity or sex characteristics [1]. Transgender and gender diverse (TGD) [2], individuals continue to experience discrimination and disadvantages in accessing healthcare whilst often having complex health needs, furthermore, there is a gap in undergraduate curriculums on TGD patient care [3]. A workshop was co-produced with members of the TGD community; scenario content was translated from their own experiences of prejudice and disrespect. In order to maximize participation, the scenario is delivered through forum theatre. It centres on an individual from the TGD community (played by a trans-actor) and the assumptions of a health professional (played by an actor). Audience members watch the scenario unfold; at closure of the first run through, the audience have a facilitated discussion. During the second run through, audiences are invited to change the behaviour of the health professional, leading to preferable, respectful and safe care. The actors have been trained to amend their actions as instructed by the audience members via the facilitator. After the simulation, the trans-actor de-roles and then describes the journey of transitioning their gender identity and presentation. The simulation and the lived experience are separated and treated as two separate elements of the training. The co-produced scenario-based simulation has been successful in promoting respect and understanding of those from the TGD community. Audiences have been a broad range of professional groups: vocational, undergraduate and registrants. This session has been repeated over fifty times, with changes made to suit the audience background. Health professionals have had the opportunity to learn and practice appropriate communication skills. The lived experience component post-simulation was impactful in providing a personal insight into the challenges faced by TGD individuals. Participants reported an increase in knowledge of the needs of, and confidence in communicating with, members of the TGD community. The co-produced, replicable, scenario-based simulation, featuring forum theatre and lived experience, is an effective method of promoting respect and understanding of those from the TGD community. The simulation provides healthcare professionals with the opportunity to learn and practice appropriate communication skills. Separating the simulation with lived experience is an essential component, due to ethical and safety issues, although linking the two, strengthens the authenticity of the session. 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.

A17Digital patient simulation versus patient actors – what do participants prefer?

Nottinghamshire Healthcare Medical Education delivers simulation-based learning to over 500 medical students and junior doctors each year. The scenarios for these sessions are co-produced and delivered with a simulated patient actor. In January 2023, we introduced a new type of simulation allowing participants to interact with a digital patient. The AVATr digital patient received good feedback delivered remotely [1], but we intended to use it face to face. Our aim was to find out whether participants found the digital patient more or less useful than the patient actor. A secondary aim was to explore if the digital patient was helpful in preparing for simulation with a patient actor. The digital patient simulation was delivered in the morning of a full-day session to a cohort of F2 doctors. Participants sat on a chair in front of a green screen with a go-pro filming them. Participants were able to see themselves in a third-person perspective on a TV screen and interact with a digital patient. The digital patient was controlled by a facilitator who chose responses from a grid depending on what had been asked and how it had been asked. The participants experienced two scenarios – one around assessing psychosis and one on adult self-harm. The participants also had a simulation later that day with a patient actor. We collected qualitative and quantitative feedback via digital forms and analysed the results. Ninety-two participants attended the sessions between January 2023 and March 2023. 70% of participants Agreed or Strongly agreed that the virtual patient was useful, compared to 100% for the patient actor. If facilitator familiarity with technology was adjusted for 68% of participants, Agreed or Strongly agreed the digital patient was useful. Eighty-six per cent of participants believed that digital patient simulation helped them prepare for the patient actor simulation. Total numbers in Clustered bar graph comparing Likert-scale responses to the statements The Virtual Patient was useful and The Patient Actor was useful We found that whilst participants overwhelming preferred simulation with a patient actor to simulation with a digital patient, the digital patient played a role in helping prepare participants for simulation with a patient actor. 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.

A69Sustain and Spread: A Standardized Solution for High Quality Simulation

The past three years during Covid19 have brought significant changes to our simulation service, including a change of specialist extended faculty. As we began to resume our standard service, and new faculty members joined the team, it became apparent that we had been heavily reliant on individual faculty memory and had lost some organizational memory. This impacted the efficiency and quality of the service, as well as the experience for the new staff members. Therefore, we decided to evaluate all our courses to identify opportunities that would improve the overall service and help integrate new faculty. We initially used a scoping exercise based on the System Engineering Initiative in Patient Safety (SEIPS) framework [1] to evaluate all our courses looking at course design, scenario design, evaluation tools and course delivery to highlight themes for service improvement. Potential service improvement ideas were prioritized taking into consideration the Hierarchy of Intervention Effectiveness to ensure improvements were mixed across the person and system-focused levels [2]. The SEIPS scoping exercise highlighted inconsistency in course design, delivery and evaluation. As a team we set about designing a standardized approach that could be applied to both established and new courses, aiming to enable course resilience and retain valuable knowledge and documentation. We have designed and embedded standardization in all aspects of course design, delivery and evaluation: SEIPS based scenario design proforma Course introduction with a human factors workshop Incivility workshop Technical teaching aid for debriefing Human factors teaching tools Pre- and post-course evaluation Anonymized feedback from faculty was used to assess the impact of the standardized course design. This standardized approach has supported existing and new faculty to develop and run high quality courses; created a shared understanding of teaching content and delivery, and has had a positive impact on the consistency of course quality. By scoping and exploring our service we illuminated gaps within our organizational memory and were able to strengthen these by designing a series of innovative documents, proformas, teaching aides and evaluation. This standardized approach helps to enable consistent high quality, support new faculty, whilst still allowing for flexibility and adaptations when delivering courses. 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.

A94Starting from scratch, creating a sustainable multi-professional student simulation programme

Simulation Based Education (SBE) is well established across healthcare disciplines. However, the benefits can only be obtained in their entirety if simulation is embedded routinely in the healthcare system [1]. Aim: To create and embed SBE sessions targeted at Nursing and Allied Health Profession students within their placement learning. We collaborated with clinicians to create training sessions covering clinical and transferable skills alongside scenarios that are not covered in university teaching. Attendance of the sessions was voluntary, allocating places on a first come, first served basis. The session format consisted of an initial teaching presentation followed by a simulated scenario, debrief, topic specific activities and a final group discussion. We collated data from students immediately after the session via anonymous, online feedback forms. We have since sent follow up questionnaires to all students we had contact details for who attended a session in 2022. We created and delivered 18 simulation training sessions covering 13 topics, totalling 70 hours of training delivery. A total of 103 students from 6 professional groups participated. The students were in varying stages of their education, belonging to 8 HEIs. We received 74 responses out of the 103 students. Our results showed 99% of students felt the training session met their learning needs and 62.7% found the simulation and debrief the most beneficial part. Additionally, 87.5% found it beneficial working alongside other students and 81.3% reported the session allowed them to gain better understanding of differing professional roles. Students’ confidence levels relating to their ability to manage the clinical scenario significantly increased post simulation with 64.7% rating ‘Somewhat Confident’ and 27.5% rating ‘Extremely Confident’. We received 26 responses to the follow up questionnaire. In total 94% reported they have since applied the skills they learnt in practice. Furthermore, 42.9% stated their experience in our sessions had been influential in considering applying for posts in Trust. Simulation allows NHS students to learn essential clinical skills and collaborative working [2]. Our data proves our sessions are successful in increasing confidence scores, insight into other roles and provided invaluable networking time and peer support. We have created a catalogue of simulations that are sustainable and can be utilized in future student placements. We can also conclude we are not only developing our student NHS population but directly influencing our future workforce in Somerset. 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.

A19Identification of clinical reasoning models commonly used in simulation-based education

Simulation can immerse learners in scenarios that mimic clinical situations, simultaneously mitigating safety risks and increasing standardization in healthcare education [1]. Through simulation, learners can get the chance to develop clinical reasoning with focused learning opportunities [2]. Clinical reasoning is multidimensional in nature, and underdeveloped clinical reasoning skills and the risk of cognitive overload can potentially threaten patient safety and delay care, so it is important to systematize, optimize and structure clinical reasoning for simulation-based education [3]. That can be achieved through using valid clinical reasoning models but with careful consideration to the contributing and influencing factors of case complexity, staff seniority, competence, scope of practice, specialty and subspecialty. A scoping review was undertaken to answer the questions: what are the best available valid and reliable clinical reasoning models for simulation-based education? We searched Medline, Scopus, Education Research Complete and Google Scholar to identify relevant recent primary research conducted on this topic from 2000 onwards. The search included MeSH topics of ‘Clinical reasoning’, ‘Simulation-based education’ and ‘Clinical Reasoning models’. The inclusion criteria were primary studies describing the clinical reasoning models developed for simulation-based courses. Two independent researchers agreed on the inclusion of the identified articles for full-text review. This review followed the review guidelines of Joanne Briggs Institute. Five valid and reliable models to structure the clinical reasoning process while attending simulation-based training were identified and are reported in Identified clinical reasoning models based on the scoping review There is an adequate number of clinical reasoning models to be used while taking part in simulation-based training; however, there is a significant basis to test the reliability and validity of these models against different competence and seniority levels, and applicability to other healthcare professions. The authors are presently working on the development of a new model using an innovative and rigorous approach. 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.

A12Development of a summative assessment method for interprofessional simulation and other interprofessional education (IPE) activities

Collaborative learning is recognized as essential in ensuring the delivery of safe and effective healthcare. It is fundamental to creating the healthcare teams of the future [1,3]. Central to this, is the early exposure of healthcare students to multiple, healthcare professions to begin the process of thinking and practising in a more interprofessional way. Importantly, how the interprofessional experience is assessed is crucial to the success of collaborative learning. This was the background to the development of an interprofessional module within the School of Nursing & Midwifery at Queens’ University Belfast. (1) To collaborate on the development of additional IPE workshops to supplement an established interprofessional simulation model. (2) To develop an assessment component for the interprofessional activities, including interprofessional simulation. (3) To evaluate the process. Drawing upon the expertise associated with the implementation of a highly successful interprofessional simulation programme, an interprofessional education (IPE) group was established with representation across the Faculty. From the outset, there was a need to have a shared understanding of the module and its complexities, and to work together to collectively support the pedagogy, shaping student learning and assessment, and providing the best educational experience [2]. The team collaborated on sourcing and establishing IPE workshops, developing reflective questions, as well as working on designing and integrating an online video within a digital platform, and streaming all students to one interprofessional workshop. An evaluation questionnaire was created using Microsoft Forms. The 17-item questionnaire incorporated three Likert scales, plus two either/or answers and two questions on digital device/browser. The questionnaire had 10 qualitative ‘free response’ questions to allow candidates to elaborate, expand, clarify or illustrate their answers. The collaboration with staff across the Faculty of Medicine Health & Life Sciences resulted in the establishment of four additional IPE workshops to complement an established six. Total number of IPE workshops, Interprofessional opportunities that utilize a reflective video-based assessment contribute positively to the student experience and are a welcome addition to the undergraduate nursing curriculum. 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.

A43MAGIC – the management of acute emergencies in GP surgeries using <i>in situ</i> simulation and checklists, project final phase: completed quick reference handbook and plans for sustainability

GP teams manage a wide spectrum of acutely unwell and deteriorating patients, these are unexpected, high risk, low frequency events. Ambulance delays mean patients may need prolonged input prior to transfer. There is little best practice guidance for many emergencies seen in primary care. Evidence from secondary care shows improved non-technical skills when checklists are used in emergency simulations. We have previously presented early phases of the MAGIC project to design a Quick Reference Handbook (QRH) for GP teams and now present the final handbook along with plans for embedding it in primary care. Previous presentations at scientific conferences (ASPiH) covered the Delphi process used to develop the QRH and the pilot training programme incorporating in-situ simulation. We incorporated feedback from 14 GP teams who used the checklists in the context of in situ simulations and used a round of tabletop simulations at six GP practices to finalize the checklists in the handbook. The development process was guided by the ‘CLEAR’ principles proposed by Greig et al [1] and the design of the QRH for anaesthetic emergencies [2] which followed human factors principles. Since completing the GP QRH we have been focusing on plans for sustainability. The QRH will be incorporated into in situ simulation or tabletop exercises [3]. We have written standardized ‘MiniSim’ scenarios using low fidelity techniques and accompanied by the relevant checklist. They will be uploaded on the iRIS platform to ensure ease of access. We are working with colleagues in GP training hubs around the HEE South-East and South-West regions to embed the QRH and then share the work nationally. We have completed a GP QRH including 16 checklists: fourteen to guide clinical actions in acute conditions ( An example of a checklist from the GP quick reference handbook Checklists improve non-technical skills and team performance in emergency situations. We have developed the world’s first GP QRH to support safer care of emergencies in primary care. The GP QRH will be freely available together with training materials to embed it in 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.

A87Live Virtual Placements: An alternative to traditional ‘in person’ placements

The role of the paramedic is diversifying, and universities need to respond by developing curriculums that support paramedic graduates to meet future workforce needs. Placements are key to our students developing the necessary competencies to become qualified paramedics and the pressure is on universities to offer a wide range of placements to reflect professional diversification. In addition, Health and Care Professions Council’s new standards of proficiency acknowledge that paramedics of the future are likely to consult patients in the virtual world [1]. As universities strive to meet this demand, they are often faced with placement capacity issues. Rising student numbers, staff retention issues and competition for placements from other healthcare students can make it extremely challenging to secure placements, especially in desirable areas such as primary care. The author, with the support from colleagues, was successful in obtaining funding from Health Education England to pilot a series of live virtual placement experiences, the first of which was successfully delivered on 20th April. On this date, 30 learners from our paramedic degree apprenticeship programme, in a classroom on our Lancaster campus, virtually attended a live clinic in a primary care setting in the south of England. The clinic was rigged with various cameras and microphones, with real patients consenting to being filmed. The experience comprised of 5 patients, with the lead clinician providing a brief to the learners before each patient arrived for their consultation. Afterwards, the clinician would complete their clinical documentation before engaging in a two-way conversation with our learners and academic staff via Microsoft teams. Following the clinic, our apprentices had the opportunity to consolidate their learning via case study driven seminars which linked to the mornings experience. Overall, student feedback was supportive, with the majority stating they found the experience enjoyable and engaging. The video stream of the placement was recorded for reuse in the programme’s curriculum, and we hope that future live virtual placements will see other professions, such as physiotherapy and nursing, take part. Eventually, we want to develop the model for other disciplines and placement settings The academic team are looking forward to the second of three experiences, in May, with the view to contributing to the growing evidence base in this area, to reflect the value that we believe ‘Live Virtual Placement’ experiences have in the development of our future workforce. 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.

A10Pilot study looking at the benefits of Virtual Reality (VR) simulation for Physician Associates (PA)

Simulation is a vital part of medical education [1]. It requires many resources to run successfully [2]. Recently, following the COVID-19 pandemic, Virtual Reality (VR) simulation use has increased. There are advantages to using VR now that costs are more reasonable, saving floorspace and facilitators’ time. However, there are concerns about how useful the software is for Physician Associates (PA), the adverse effects of the headset and whether self-directed debriefing is valuable [3]. This study aims to pilot the questionnaire using VR simulation. As part of teaching during September 2022 and January 2023, VR simulation was incorporated into appropriate seminars. At the end of the session, Year 1 PA students were invited to complete an online questionnaire based on the Simulation Effectiveness Tool, which was modified for VR. Before the session, all students were on-boarded to use the Oculus Quest 2 and Oxford Medical Simulation software. Twenty-one out of 25 students completed the questionnaire. 71.4% strongly agreed that VR simulation helped prepare them to respond to a change in the patient’s condition and felt empowered to make clinical decisions. 85.7% felt more confident in providing interventions that foster patient safety. 66.7% felt more confident using evidence-based practice to provide care. When focusing on the self-directed debriefing, 66.7% strongly agreed that it contributed to their learning, and 71.4% strongly agreed that it provided opportunities for self-reflection on their performance. Concerning the headset and software use, 28.6% found it was not easy to log into the headset, but 65% found it easy to load the scenario. 57.1% were confident in navigating the virtual environment. This was after a briefing stage to orientate students to the environment. 70.6% felt safe in the virtual world, and 11.1% felt nauseous while in the scenario. The scenarios were also run via a desktop computer. 85.7% found it easier to navigate the virtual world, with 81% strongly agreeing that they felt immersed in the environment. Surprisingly, 52% of students preferred the desktop version, while 14% favoured it via the Oculus. VR simulation is an impactful method of providing simulation-based medical education without needing a simulation suite or facilitators. Interestingly, the desktop version can provide an experience that students prefer, but this requires further investigation. 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.

A72Using Simulation as a Method of Assessment in Further Education

While the use of simulation-based education (SBE) is embedded within clinical courses delivered in higher education, it’s use within further education is extremely limited, leading to a perception that students may be at a disadvantage, particularly those from a neurodiverse background, where kinesthetic learning is their preferred style [1]. The same principles also apply to assessment. Supported through funding from the NCFE (originally known as the Northern Council for Further Education), a pilot project was developed with the following objectives: To transform the assessment methodology within further education (FE) via the use of immersive technologies To facilitate collaborative development of bespoke virtual reality (VR) scenarios incorporating course learning outcomes (T level and Care Certificate) For digital technology students to work jointly with industry in VR development To gain feedback from students, employers and other key stakeholders with regards to using immersive technology as a method of assessment. Three prototype scenarios were developed in the iRIS platform to aid adherence to ASPiH and INACSL standards as well as collaboration across the development and project teams. The VR development was undertaken in Unity by digital students led by industry experts. The University of Huddersfield led on the evaluation of the project using a qualitative approach encompassing the three degrees of validity [2], using student and employer/stakeholder focus groups and 1:1 interviews both pre and post scenario testing. Discussions were transcribed and template analysis [3] applied. While final evaluation is still ongoing, initial findings are as follows: iRIS proved to be an invaluable platform for scenario development across organizations greatly aiding communication and decision-making Both students and faculty need have reached a minimum competency with the VR equipment and environment prior to assessment Course learning outcomes can be readily incorporated into bespoke VR scenarios VR would be a suitable mode for assessment for some learning outcomes but not all The prototype scenarios provided adequate realism, face and construct validity for assessing the identified learning outcomes VR simulation has the potential to be suitable and acceptable mode of delivery for assessment in health and social care. Funding applications have been submitted for phase two of the project which would include an impact study. 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.

A113A pilot course amalgamating the benefits of psychological safety, civility, and human factors in a structured debriefing model in simulation-based education

Simulation-based education (SBE) is one of the leading teaching methods in healthcare. Debriefing is the cornerstone of effective simulation-based medical education. Debriefing is considered vital part to learning from simulation, and for the transfer of learning so that it can be applied to other situations [1]. Feedback from four simulation faculty development days identified that debriefers lacked the confidence to address conflict or use the principles of civility to enhance their debriefs. Teaching which has structured debrief covering civility and human factors are the cornerstone to deliver sessions that instil confidence and patient safety within the organization [2]. Human factor principles that employ psychological safety were introduced in the debriefing course with the purpose of upskilling the debriefers. There are various models of debriefing however, the focus was to provide the three-phase conversation structure. The course covered human factor principles alongside debriefing techniques using the three-phase conversation structure and interactive workshops. We enlisted the services of a specialist human factor/civility lecturer, simulation lead and a simulation lecturer to deliver the course. At the end of the course, the participants had to undertake a debrief to consolidate their learning in a supportive environment and immediate evaluation was obtained using a structured questionnaire (see Evaluation themed responses Additionally, a pilot study of five participants who had attended the course were randomly selected for a face-to-face interview twenty-four hours after the course. Three open-ended questions were asked. These focussed on whether the application of psychological safety and human factors enhanced their debriefing skills and suggestions for further course development. The results highlighted the value of the inclusion of human factor principles. Both evaluation methods were positive. Attendees commented on the value-added to their simulation training and wanted these principles to be adapted as a structured course. Acknowledging the fact that the sample recruited was small and may not be statistically significant, a future study will include a bigger sample size. Currently, this is the only organization within the North-East of England that offers standalone debriefing course. There was an overwhelming demand for a course aimed at educators who are engaged in SBE with emphasis on debriefing to consolidate learners’ experience. This course is intended to be delivered to all educators across the North-East region and beyond. 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.

A35Simulated Undergraduate Interprofessional Training Ward – improving self-confidence and attitudes to interprofessional working prior to transition to clinical practice

Research suggests that interprofessional training wards (ITW) enhance student learning and patient satisfaction [1] but are resource intensive from governance and faculty training points of view. Given NHS pressures, we developed a simulated ITW to meet training needs of healthcare undergraduates and improve attitudes and confidence regarding interprofessional working prior to qualification. The session simulated a typical ward day, with nursing handover, ward-round, board-round, communication scenarios, and an acutely deteriorating patient. Final year medical, nursing and physiotherapy students attended, and formed interprofessional teams. After each scenario an interprofessional debrief took place. Students completed the readiness for interprofessional learning scale (RIPLS) [2] pre and post, also providing feedback using Likert scales and qualitative comments. 35 students participated, all completing RIPLS, and 32 completing Likert and qualitative feedback. Despite the small dataset, we demonstrated significant change (p<0.05) in 9 of the RIPLS statements, indicating a positive change in attitudes toward interprofessional learning. All students felt the session met their learning requirements. Likert feedback across professions demonstrated increased understanding and valuing of multi-disciplinary teams (MDT) (97%); appreciation of the relevance of multi-disciplinary working to their training (91%); belief that it would change their approach to MDT work (84%); and increased confidence prior to transitioning to a working role (81%). Profession-specific breakdown demonstrated highest confidence and increased understanding for physiotherapists, however they (alongside nurses) found the content more challenging. Summary of infographic for SUIT ward Thematic analysis highlighted several key themes: Interprofessional teamworking, patient-centred care, communication, professional readiness, technical skills, and satisfaction with session format and delivery. Interprofessional teamworking, patient-centred care, and communication bridged the categories of ‘valued aspects’ and ‘take-home messages’, demonstrating uptake of key learning points, and reinforcing the changes in the RIPLS data. While the feedback regarding the ‘suggested improvements’ category reiterated the challenges of catering to all learners, this category’s comments were overwhelmingly positive, with appreciation and importance of this learning event appearing frequently. One wrote, ‘I feel incredibly lucky to have had the opportunity to take part… and strongly believe every single healthcare student should have the chance to attend a similar session’. Our pilot program suggests that using simulated ITWs offers multiple benefits to students. The simulated ITW environment improved confidence and understanding of interprofessional roles in clinical practice; and was valuable and relevant to learners with early signs of improving attitudes towards interprofessional learning. A full study is needed to fully assess the learning benefits and cost-effectiveness of simulated ITW environments. 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.

A102Embedding Electronic Patient Records Into Routine Medical Simulation Training Across the South East of England, a Pioneering Regional Collaboration

Electronic patient record (EPR) systems are increasingly prevalent in clinical settings, yet UK medical simulation training continues to use outdated paper-based methods for training healthcare staff. While published literature has highlighted the training benefits of incorporating EPRs into medical simulation training [1, 2], the transition has previously been hampered by a lack of bespoke software. To address this, a novel educational EPR (named SimEPR) was created, a bespoke training software designed to be used on a computer at the manikin’s bedside, which features customizable clinical scenarios ( A preview of SimEPR, a novel educational electronic patient record system designed for UK medical simulation training This project aimed to incorporate SimEPR into routine medical simulation training in the South East of England, and report trainee experience using the software. Feedback data was collected from trainees who used SimEPR as part of their simulation training using an electronic feedback form. SimEPR was initially deployed in a medical school and two NHS trusts from 11th February 2021, before the project was scaled up to six additional educational centres (one university and five NHS trusts) from 3rd January 2023. Data from 209 trainees was collected, of which 16% were medical students, 82% were foundation doctors and 2% were post-foundation doctors. Out of these, 86% reported that, compared to using paper notes, the educational EPR created a more realistic training experience. Meanwhile, 83% reported that the use of SimEPR helped improve their clinical learning. Last, 87% reported that they would recommend the simulation department to continue using SimEPR. SimEPR is the first software of its kind designed specifically for UK medical education, and is the product of collaboration with a number of simulation leads and NHS-affiliated organizations. As well as data supporting a higher fidelity training experience, SimEPR incorporates digital skills into practical training, thus supporting the development of a digitally-ready workforce. In addition, by eliminating the use of paper, SimEPR contributes to the sustainable delivery of simulation-based education. Further evaluation work as part of this pioneering regional project aims to collect pre- and post-training feedback, feedback from medical educators and feedback from other healthcare disciplines. In the longer term, SimEPR offers to transform the delivery of simulation training for the NHS workforce. The software’s ‘scenario-sharing’ function allows sharing of simulated patient records between institutions, supporting the standardization of training while saving staff time in building training scenarios. Furthermore, features such as performance analytics for trainee feedback, and AI technology to generate interactive scenarios, are being explored. 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.

A53Simulation equipment - What do you have? What do you do with it?

Educators and workforce planners appreciate that clinical skills development and simulation-based learning are key strategic responses to safe and effective service provision and a sustainable workforce. However, some simulation-based experiences require simulators costing tens of thousands of pounds. In order to promote a ‘Once for Scotland’ approach, collaboration is essential to encourage sustainability by enabling sharing of equipment, training materials, processes, procedures and faculty between boards. Although there have been other scoping exercises [1], we believe that this the first to take place at a national level. This scoping exercise aimed to: Establish what equipment is available in the territorial health boards; Clarify the types of skills-based courses being run across NHS Scotland; Connect and encourage collaboration between simulation providers Information was gathered via Teams discussions and questionnaires. The responses were collated into Excel spreadsheets. These have been linked into an application to present the data in a more user-friendly manner online ( Interactive map of simulation resources in Scotland Responses reveal that: All health boards in Scotland have invested in simulation-based learning. There is pioneering work with the establishment of medical and surgical bootcamps as well as national pharmacy simulation. Additional work needs to be carried out to ensure that resources are invested wisely to areas of greatest need and that resources are shared within and between health boards. It is clear where abundant simulation activities are taking place, as well as where there are gaps in equipment and faculty. Distribution of the information gathered will reduce duplication of effort, increase collaboration and encourage the sharing of equipment between health and social care workers across Scotland. It is hoped that this scoping project will support the creation of new relationships between people, not just for their mutual benefit, but for the benefit of the people of Scotland. The results are a first step to providing a detailed inventory of the resources available to help ensure best value for money. We hope to see an increase in the sharing of equipment across Scotland similar to the use of the NES surgical cut suit which was purchased by the Scottish Centre for Simulation and Clinical Human Factors and recently used by the simulation team at NHS Lothian to provide a multi-professional immersive paediatric training session. The plan is to update this database on a regular basis and to widen the results to incorporate all health boards as well as universities. 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.

A68Remote Simulation in Cardiothoracic Surgery

Simulation is integral to the recovery of surgical training in the UK after the COVID pandemic. Physical constraints on traditional simulation training can affect access. We sought to understand if cardiac and thoracic simulation training remotely is feasible and effective. It has been demonstrated in other settings and has potential in the surgical setting [1]. We completed simulation training sessions using the Teams and Zoom online platforms with single one on one and group simulation training sessions covering Video-assisted-thoracoscopic-surgery wedge resections and lobectomy as well as coronary anastomosis. We had 15 participants in the thoracic arm and 5 participants over 4 sessions in the cardiac arm. All participants found the remote simulation training useful and improved their confidence in surgical skill. We did not have any technical connection difficulties during sessions but challenges for simulation in this format included standardizing the equipment and setup pre-sessions. Participants found in 89% of cases that feedback on performance was superior to face to face simulation and/or surgical theatre experience. Remote simulation is feasible and effective in cardiothoracic surgery in our pilot study. Further studies are needed to better clarify who this resource should be targeted at included experience of trainees and level of competence. 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.

A62Mini in Disruption, Major in Impact: The Use and Sustainability of ‘Mini-Sims’

Simulations can be important for wider learning and patient safety [1]. However, the delivery of traditional simulations is not always feasible [2]. We developed an alternative ‘Mini-Sim’ to deliver high quality teaching with a sustainable approach, aimed to save time and resources. The simulation team delivered traditional ward-based simulations every Wednesday. Where this was not possible, due to timing or staffing constraints, we delivered ‘Mini-Sims’. This involved participant verbalizing their assessments to a pre-written scenario with a facilitator asking follow-up questions as opposed to physically acting out. Data collected over 5 months included the type and duration of simulation, how many participants were involved, and resources required. Across the 5 months, between 0 to 16 participants were reached monthly using traditional simulations, whereas ‘Mini-Sims’ reached 4 to 14, Comparing participant numbers from ‘Traditional Sims’ with ‘Mini-Sims’ delivered between October 2022 to February 2023 Where resources and time are limited, the minimalistic approach of ‘Mini-Sims’ provide consistent teaching opportunities and promotes sustainability in man-power, time, and costs. Whilst humble in appearance, ‘Mini-Sims’ show sizeable potential for sustainable learning. 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.

A4Development and evaluation of a chest cavity simulation model for teaching surgical chest drain insertion

Surgical chest drain insertion is indicated in pneumothorax or haemothorax secondary to thoracic trauma. It is a mandatory emergency procedure that is incorporated as a part of the core medical training curriculum [1]. However, sparse training opportunities result in low clinician competency and increased risk of complications. While simulation training can offer a solution, the affordability of commercial models and hygiene and ethical implications of animal carcasses are significant limiting factors. The aim of this project is to build a reusable, high-fidelity, low-cost human chest cavity model excluding animal use for simulation-based teaching of surgical chest drain insertion. To construct the model, plaster gauze, metal wires and u-channel rubber trims were used to build a ribcage. Soy-protein-based sausage casing was used to create the pleural layers, and the muscles and subcutaneous fat were represented with ADAMgel (Aqueous Dietary fibre Antifreeze Mix gel), a novel material with tactility and dissection sensation similar to human soft tissue [2]. Synthetic chamois leather was used to represent skin. The resulting model allowed locating the safe triangle using anatomical landmarks, blunt dissection of muscles, pleural puncturing and advancement and suturing of the chest tube. The model cost less than £130, and it could be repaired after over 20 uses with less than £15. Verbal consent on study participation was obtained from all participants who performed chest drain insertion on the model and evaluated its fidelity and educational value using an anonymized Likert scale questionnaire. All questionnaire responses were converted to numerical values for data quantification, as shown in Median and range of questionnaire responses collected from study participants Sixteen senior clinicians with multiple experience on chest drain insertion and 11 junior clinicians with limited experience took part in the study. Anatomical and haptic fidelity of the model was evaluated very highly amongst experienced clinicians. Junior doctors stated increased confidence in performing the procedure, overall assessing the model as an appropriate learning tool. Twenty participants with previous training experience compared the quality of this model to other commercial or animal-based models, and 18 rated this model to be of the same or superior quality. This chest cavity model is suitable for simulation training of chest drain insertion. Importantly, the model excluded the use of animals under the principle of replacing, refining and reducing animal use in research [3]. Further training opportunities that utilize this model can increase clinician competence in the procedure, which can improve clinical practice and reduce patient mortality. 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.

A49Five Year Review of Paediatric Multidisciplinary In-Situ Simulation on a General Paediatric Ward

In the United Kingdom, trainee doctors rotate through different specialities during their training. They are often unfamiliar with systems, environments, and personnel. Working on a general paediatric ward in a district general hospital can be anxiety inducing for those new to paediatrics. Fortnightly low-fidelity simulation scenarios are embedded in our local teaching schedule to improve confidence amongst the medical and nursing team. These are performed on the ward addressing varied scenarios, aiming to increase confidence with clinical cases, improve local environment and systems awareness, and enhance communication between professionals. Fortnightly 30-minute simulation sessions are run by the paediatric simulation team on the paediatric ward at our trust. The wider multidisciplinary team are invited, including nurses and health care assistants. The emergency buzzer from a bed space is pulled, and those involved attend and a scenario is undertaken. The scenario is structured to involve the wider team to improve interdisciplinary working and non-technical skills, as well as address clinical outcomes. Equipment is provided using a grab bag. Once the scenario has ended, a debrief is performed involving candidates and observers of all disciplines, to discuss technical and non-technical skills. Post session feedback was collected on each occasion with quantitative data via Likert scales and qualitative data by free text questions. In-situ simulation has been part of the departmental paediatric teaching rota since 2009 but has been a regular fortnightly occurrence since 2018. This is because it has been rostered into our working hours before the medical team assume clinical duties. We have collected feedback since September 2018. We have had 616 participants and delivered 82 scenarios in the clinical environment. This includes during the Covid pandemic. The weighted average confidence recorded by candidates pre-scenario was 2.51 with confidence post-scenario recorded as 3.69. 83% reported improved confidence following the scenario. This is an important finding as 45% had never encountered the scenario before in their practice. Thematic analysis has highlighted key aspects including communication, escalation, teamwork and available resources. In-situ, low fidelity simulation is an effective tool to improve human factors amongst the multidisciplinary team on a paediatric ward. By regularly simulating clinical practice in their daily working environment, all candidates have demonstrated improved clinical confidence and better familiarity with the ward environment. Additionally, the fortnightly in-situ simulation has improved working relationships through recognition of the roles of the ward multidisciplinary team, communication skills and team and leaderships 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.

A67Advanced cardiothoracic Simulation -how to do it and who is it for?

There is a large backlog in surgery due to covid as well as surgical training [1]. We explored the feasibility of a dry lab simulation environment to teach advanced surgical specialty skills to learners with different levels of experience. Session description: We ran 5 cardiothoracic surgical simulation courses over 2021-2022 with a total of 61 delegates. We covered coronary anastomosis, aortic valve replacement, video-assisted-thoracoscopic-surgery (VATS) lung wedge resection and pulmonary vessel dissection. Each skill station ran for 40 minutes including a 15-minute description and real-time demo. Target audience: Participants included 36 medical students, 14 specialty doctors and 11 foundation doctors. We used synthetic plastinated and resin printed models with modular metal frames to help with retraction and suspension of the area of interest for the cardiac models. For the VATS models a laptop with connected angled endoscopic camera was utilized. The lung models were 3D printed. 88% of all participants were able to complete all procedures successfully under supervision. 96% of all participants increased in confidence with the procedure following simulation compared to before. Interestingly only 44% of specialty trainees described themselves as confident in some procedures prior to simulation. Of the medical student cohort 95% had not had any previous simulation or surgical experience prior. We have demonstrated the feasibility of a dry lab simulation programme for candidates of all experiences in cardiothoracic surgery. Confidence in surgical technique is low during the COVID era. Simulation improved confidence in surgical technique and must be offered more widely to enhance training experiences. No experience is necessary for successful simulation. 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.

A14Does everyone see it the same? An evaluation of the alignment of perceived benefits of virtual simulation between undergraduate pharmacy students, faculty and stakeholders

In the aftermath of the COVID-19 pandemic, where access to traditional simulation environments and experiences was necessarily restricted, increasing focus has been placed on the use of technology in simulation. The use of virtual patient simulations has been shown in literature to increase interest as well as provide opportunities to practice clinical reasoning [1]. Opportunities to develop clinical reasoning are of notable importance in undergraduate pharmacy education currently owing to ongoing changes in pharmacy education, where newly qualified pharmacists will be annotated as independent prescribers from 2026 [2]. Evidence on the extent to which views on the perceived uses and benefits of virtual simulation align between different user groups is limited. In a UK university, a programme of virtual simulation has been utilized since 2020 as a part of the undergraduate pharmacy curriculum. A mixed-methods study was run which aimed to evaluate the alignment of views of students, faculty and stakeholders (who were individuals involved in the design or implementation of virtual simulation products) on the potential uses, intended learning outcomes, and perceived benefits and weaknesses of virtual simulation. Following approval by the school research ethics committee, an electronic questionnaire was sent to final-year undergraduate pharmacy students who had experienced a programme of virtual simulation including a mixture of qualitative and quantitative questions relating to student perceptions of the use of virtual simulation in the curriculum. Semi-structured interviews were conducted with faculty members and stakeholders exploring their views on virtual simulation. Quantitative data were analysed by simple descriptive statistics, and a critical review of free-text responses was performed through grounded theory to identify emergent key themes. A total of 25 responses to student questionnaires were received. A total of seven interviews were performed, including three members of academic staff familiar with virtual simulation and four stakeholders responsible for the design or implementation of virtual simulation products. Students most commonly believed that virtual simulation could benefit their development of consultation skills, clinical history taking and physical assessment. Significant alignment between the perceptions of stakeholders and students on the uses and benefits of virtual simulation was demonstrated, but faculty members articulated a more limited list of perceived uses and benefits. The views of final-year undergraduate pharmacy students aligned strongly with stakeholders involved in the design or implementation of virtual simulation. The more limited views of faculty may represent a barrier to the full implementation of virtual simulation. 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.