Qualitative Feedback Research Articles (Page 1)

Novel Use of the ACGME Milestones and Resident Morbidity and Mortality Conference Presentation Feedback.

Introduction Mobile applications for eating disorders (EDs) offer flexible, cost-effective delivery of evidence-based interventions. Nevertheless, challenges persist in terms of user engagement and compliance. The INTERconNEcT-EDs program was developed as a guided self-help (GSH) intervention integrating multimedia content, peer-led support, and group therapy via the aChiral Content app. The present study evaluated the usability and user experience of the aChiral Content mobile application, which was utilized to deliver the INTERconNEcT-EDs program to individuals diagnosed with EDs or disordered eating symptoms. Methods A mixed methods design was employed. A total of sixteen participants, comprising eleven outpatients and five members of the community, utilized the application for a period of four days. Quantitative data were collected using the System Usability Scale (SUS), while qualitative feedback was obtained using “think aloud” tasks and a semi-structured interview. The interview-based data was subjected to thematic analysis. Results The application attained a mean SUS score of 73.3 (SD = 8.16), denoting satisfactory usability. The analysis of the qualitative feedback indicated that the self-help video-clips and workbook were perceived as being useful, emotionally resonant, and motivating, thus indicating high levels of engagement. The integration of content creators with personal experience of the condition was met with appreciation by users, who characterized this as fostering empathy and perceived support. The forum group and online interpersonal group sessions promoted a sense of community, emotional sharing, and peer support, helping users to feel less isolated. Moreover, certain usability issues were identified and addressed with a view to implementation. Conclusions The aChiral Content application exhibited satisfactory levels of usability and acceptability among individuals diagnosed with ED. The integration of user-centred design methodologies, multimedia resources, and the facilitation of peer involvement has been demonstrated to enhance engagement levels. These findings lend support to the potential of the app for wider implementation and scalable use in digital interventions for ED.

The purpose of this study is to provide insight into the experiences of social workers who have taken an Association of Social Work Boards (ASWB) licensing exam, while exploring the exam’s impact on individuals and offering recommendations for reform. The ASWB exams have faced criticism due to disparities in pass rates, raising concerns about potential bias that disproportionately affects people of color and underrepresented groups. Using a mixed-methods survey distributed via the National Association of Social Workers (NASW) Community Board and the Baccalaureate Program Directors (BPD) listserv, both demographic data and qualitative feedback were collected from 76 social work professionals. Thematic analysis of the responses revealed five key themes: alternative assessment methods, the need for anti-racism, diversity, equity, and inclusion (ADEI) integration in the exams, calls for exam elimination, alignment with Council on Social Work Education (CSWE) Educational Policy and Accreditation Standards (EPAS), and content relevance to practical skills. The results indicate a need for the ASWB exams to evolve in response to the diverse requirements of social work practice, ensuring the exam protects the public while doing so equitably. This study underscores the importance of revising the licensing process to better align with the values of the profession and the realities of social work practice.

Diabetic foot ulcer (DFU) care represents a significant challenge in plastic and reconstructive surgery. Oftentimes, patients encounter complex articles and websites to answer questions about their surgeries, including Anterolateral Thigh (ALT) flaps. Artificial intelligence (AI) represents a new and simplified resource for DFU patients seeking information regarding their care. To assess ChatGPT's utility as a patient resource, we evaluated the accuracy, comprehensiveness, and safety of AI-generated responses to frequently asked questions (FAQs) related to ALT flap surgery for DFU. Ten DFU and ALT flap care FAQs were posed to ChatGPT Model 3.5 in June 2024. Four plastic surgeons evaluated responses using a 10-point Likert scale for accuracy, comprehensiveness, and danger of ChatGPT's answers. Surgeons also provided qualitative feedback. Response readability was assessed using 10 readability indexes, averaged to produce a reading grade level for each response. Overall, ChatGPT answered patient questions with a mean accuracy of 9.1 ± 1.2, comprehensiveness of 8.2 ± 1.5, and danger of 2.0 ± 1.0. ChatGPT answered at a mean grade level of 19.8 ± 20.1. Qualitatively, physician reviewers complimented the organizational clarity of the responses (n=4/10) and the AI's ability to provide information on possible surgical complications (n= 4/10). While 1 response was noted to present explicitly incorrect information about pre-operative preparation protocols and when they should be initiated, the majority of responses (n=6/10) left out key post-operative information, notably dangle protocols and compression. ChatGPT provides accurate and comprehensive responses to FAQs related to patients undergoing ALT flap surgery for the treatment of DFUs. The AI-generated responses were praised for organizational clarity and informative content regarding surgical complications, but lacked essential post-operative care details. Therefore, while ChatGPT is a valuable informational tool, further refinement is necessary to ensure fully comprehensive information is provided to DFU patients.

Learners find it hard to master English pronunciation, especially when it comes to silent letters. This is because most of them only memorise words and don't get enough exposure to other types of learning materials. This new idea fills in the gap by creating an interactive digital flipbook that helps teachers and students learn and teach silent letters in English. This flipbook also has visual aids (pictures), audio pronunciation, and gamified learning through the built-in Wordwall exercises. It also has a sharing community where students may make and learn from examples made by other students. The invention was tested on undergraduate students at Universiti Poly-Tech Malaysia who were studying TESL. Qualitative feedback showed that the innovation improved several of these areas, such as increased engagement, clearer norms for pronunciation, and more independence for learners. The results show that the flipbook's multimodal design not only helps students remember the rules for silent letters, but it also motivates them because it allows them to connect with each other outside of class. The concept has significant potential for application in ESL contexts and can be commercialised as an expanded digital toolkit for teaching pronunciation in schools, language centres, and institutions of higher education.

Introduction: The UK Foundation Programme Curriculum [1] requires understanding of patient safety and incident management. While the NHS Patient Safety Incident Response Framework [2] advocates a systems-based approach, training often emphasises non-technical skills without deeper exploration of system-wide factors. To address this gap, the Simulation Team at University Hospitals of North Midlands (UHNM) integrated human factors teaching into one of the three simulation sessions they provide for Foundation doctors. The goal was to equip trainees with the tools to analyse incidents and appreciate how changes to the wider work system can affect patient safety. Methods: We created a course to enhance Foundation doctors’ understanding of human factors, with a focus on the SEIPS (Systems Engineering Initiative for Patient Safety) model [3] and Safety-II thinking. A mix of twelve Foundation year one and two doctors participated in each session, which included two interactive workshops and five simulation scenarios. -Workshops: The first introduces systems engineering and Safety-II principles; the second focuses on the practical application of the SEIPS model. -Scenarios: These span various clinical situations-from discharge errors to never events-each is designed with a specific human factor learning outcome. Debriefs emphasise how work systems might be improved rather than focusing on individual performance, differentiating this session from other sessions that consider clinical management. Results: To date, 107 of 160 Foundation doctors have participated, with full attendance by July. Preliminary feedback from those that have attended shows: 100% of participants reported understanding how to apply a systems-based approach to incident investigations. 100% felt confident using the SEIPS model to evaluate system changes. 100% stated the session would influence their clinical practice. Qualitative feedback indicated increased awareness of human factors and their influence on patient safety. The session received an average rating of 4.92 out of 5. 100% of participants reported understanding how to apply a systems-based approach to incident investigations. 100% felt confident using the SEIPS model to evaluate system changes. 100% stated the session would influence their clinical practice. Qualitative feedback indicated increased awareness of human factors and their influence on patient safety. The session received an average rating of 4.92 out of 5. Detailed analysis will be conducted upon course completion. Discussion: This simulation-based approach centred around patient safety scenarios has enabled trainees to analyse errors through the lens of system design rather than individual fault. It has fostered reflective dialogue on patient safety issues and how work systems can be improved. It has highlighted the need for a stronger training of human factors amongst Foundation trainees. A follow-up of the longer-term impacts is planned for the current Foundation Year 1 doctors when they return for simulations in Foundation Year 2. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

Purpose This paper aims to enhance communication and person-centred care in a low secure forensic learning disability service and describes a quality improvement project on developing and implementing a co-produced Combined Personal Passport (CPP). The CPP sought to replace fragmented documentation with a single, accessible, service user-led resource. Design/methodology/approach The project followed a Plan-Do-Study-Act cycle. People with learning disabilities and autistic people detained under the Mental Health Act co-produced the CPP, integrating communication, sensory and personal profiles into one document. Feedback was collected before and after implementation using structured forms and thematic analysis of comments from service users, multidisciplinary team members and Care and Treatment Review panels. Findings Qualitative data suggested that the CPP enhanced therapeutic relationships, increased professional understanding of individual needs and empowered service users to take more active roles in their care. Quantitative feedback showed improved clarity, usability and uptake by professionals. While some challenges were reported around digital access and consistency, the overall response was strongly positive. Research limitations/implications This quality improvement project had several limitations. The sample was small and drawn from a single service, which limits generalisability. The evaluation relied mainly on descriptive and qualitative feedback rather than outcome measures; the authors did not assess changes in staff behaviour or longer-term impact on care. Despite efforts to ensure accessibility, not all service users were able to contribute equally due to differences in literacy, communication and engagement. In addition, the project did not include follow-up to evaluate sustained use or impact over time. Future work should involve larger, multisite cohorts, longitudinal follow-up and structured outcomes (e.g. implementation fidelity, staff practice change, incident data and experience measures). Practical implications A notable finding was that people responded not only to the content of the passport but also being involved in shaping it. For some, this was the first time they had influenced how professionals talked about them. Co-production appeared to foster agency and wider therapeutic engagement. The team also observed a shift in staff mindset, from receiving information to collaborating around it, suggesting cultural benefits when personalised communication tools are embedded in routine practice. Originality/value This project highlights how co-produced tools can meaningfully improve communication and engagement in secure services. The CPP model is practical, low-cost and has the potential for broader application across services supporting people with learning disabilities and autism.

Introduction: Following funding from the Morgan Advanced Studies Institute (MASI) a pilot study was conducted with expertise from the SUSIM Simulation and Immersive Learning Centre at Swansea University. Healthcare professionals often lack the training and confidence to communicate effectively with d/Deaf patients, leading to miscommunication, reduced trust, and poorer health outcomes. Traditional simulation-based education (SBE) programmes rarely reflect the lived experiences of d/Deaf individuals or include British Sign Language (BSL) and deaf culture [1,2]. This project aimed to address this gap through the co-creation of immersive Virtual Reality (VR) learning modules with the d/Deaf community. The research question was: How can immersive simulation technologies be co-designed with the d/ Deaf community to enhance student understanding and inclusive communication in healthcare? Methods: Using an inclusive, values-led approach, the research team collaborated with d/Deaf community members, BSL interpreters, and healthcare students to co-design a suite of computer based and virtual reality (VR) learning packages. A series of structured workshops facilitated open dialogue about lived experiences in healthcare, barriers to communication, and priorities for professional education. Insights from these sessions directly informed scenario design, scripting, and visual storytelling. VR content was developed using 360° video, with bilingual (BSL and English) integration and d/Deaf individuals portraying themselves within the simulations. Qualitative feedback was collected throughout the process from both community participants and students. Results: A series of workshops from May 2024 to July 2024, revealed strong themes around disempowerment, safety, and the emotional toll of exclusion in clinical settings. These narratives shaped two pilot VR modules focused on first point-of-contact healthcare encounters. Deaf participants reported feeling valued and empowered in the co-design process. Using a mixed methods approach preliminary pilot student feedback showed increased awareness of the communication needs of d/Deaf patients, increased empathy and appreciation for learning directly through immersive, patient-led scenarios. A key outcome was the creation of a culturally respectful and pedagogically sound set of VR modules now embedded in pre-registration curricula at Swansea University [3]. Discussion: This initiative demonstrates that co-designed simulation with the Deaf community is both feasible and impactful. The approach moves beyond tokenistic inclusion to authentic collaboration, positioning lived experience as essential to the learning environment. The learner pilot highlighted the importance of cultural humility, developing simulation content that promotes thoughtful, patient centric reflection and care with VR enhancing their opportunity to experience realistic immersion. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

Introduction: Medical students repeatedly report a lack of confidence in their paediatric knowledge and clinical skills, which can adversely affect their learning experience [1]. Given the complexity and nuances of Paediatrics, coupled with limited placement exposure, creative and accessible teaching interventions are imperative [2]. This service evaluation aimed to assess whether delivering a dedicated Paediatric Knowledge and Skills Session (PKSS) early in training could improve student confidence and knowledge, while remaining sustainable and easily replicable. Methods: This service evaluation was created and delivered by a multi-disciplinary team of clinical educators and immersive technology experts at a teaching hospital. The PKSS included gamification, simulation, interactive quizzes, and lecture-based teaching within a single-day, providing an engaging yet challenging experience. It was designed with sustainability in mind, using existing departmental manikins, donated clinical equipment (e.g., non-rebreather masks, blood bottles), and recycled or reusable materials for games with no ongoing costs. Quizzes were delivered electronically to minimise paper use. Sessions were facilitated by educators experienced in paediatrics or simulation, requiring minimal staff training resources. Students completed digital pre- and post-session MCQs, self-rated confidence surveys, and qualitative feedback forms. Results: Of the 28 participating students, data from 22 were analysed due to incomplete or unmatched responses. The 22 students showed significant improvement in confidence across all items, with 5 questions reaching extreme statistical significance (p <0.0001). Knowledge scores improved in 6 of 8 MCQs, reaching a statistical significance (p ≤0.0423). Simulation performance improved between attempts, as evidenced by checklist assessments. Qualitative feedback described the PKSS as an informative and enjoyable day, with students requesting more sessions like it. Discussion: The PKSS demonstrated significant improvements in both confidence and knowledge, as well as overall enhancement in simulation performance. Importantly, the session was delivered in a low-cost, sustainable format using existing resources, donated materials, and minimal paper. Once developed, it required minimal upkeep, making it an ideal teaching model for other institutions. While long-term impacts of the PKSS need to be reviewed, current results indicate that teaching specialist disciplines like Paediatrics can be revolutionised into an impactful, creative and environmentally conscious model in healthcare education. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

Introduction: Effectively training healthcare professionals for complex elderly care is vital but often hindered by simulation costs. This project demonstrates a high-impact, low-fidelity simulation escape room designed for interprofessional groups of urgent care practitioners (nurses, paramedics). We aimed to enhance critical thinking, teamwork, and problem-solving by focusing on accessible, engaging pedagogical design incorporating gamification [1] and Visual, Aural, Read/Write, Kinesthetic (VARK) principles, demonstrating impact and creativity within resource constraints. Methods: A structured design process, involving subject matter experts (SME), aligned escape room puzzles with elderly care learning objectives (falls, medication, psychological assessment). The design intentionally integrated VARK learning styles and gamification principles to maximise engagement. AI tools aided development-phase scenario refinement. This low-fidelity simulation was implemented with nurse and paramedic participants undertaking a minor illness course between September 2024 and April 2025. A mixed-methods evaluation used pre/post questionnaires primarily assessing confidence and preparedness, alongside qualitative feedback exploring the learning experience and impact on collaboration. Data was collected in March 2025. Results: The low-fidelity, design-centric approach proved highly effective. Quantitative data confirmed uniformly high participant engagement (rated 4 or 5/5). Qualitative feedback revealed the simulation was highly enjoyable compared to traditional methods, with participants particularly valuing the problem-solving aspects inherent in the gamified design. Participants reported significant increases in confidence managing complex elderly care scenarios, with 75% stating they felt more prepared to manage elderly falls patients’ post-simulation. Further qualitative data suggested increased confidence in applying key concepts and skills, alongside improved interdisciplinary communication, teamwork, and appreciation for collaborative problem-solving, directly addressing cultural aspects of healthcare teams. Discussion: This study confirms that impactful simulation, fostering creativity and cultural competence in healthcare teams, does not necessitate high-fidelity setups. By prioritising robust pedagogical design (VARK, gamification) and co-production principles (SME collaboration), effective, engaging, and accessible low-fidelity simulations can be developed. The strong positive outcomes related to participant engagement, confidence, self-reported preparedness for practice, and improved teamwork and communication [2] demonstrate the simulation’s value. This pilot provides a scalable, resource-conscious model for interprofessional workforce development in specialized areas like elderly care. Ongoing refinement based on feedback continues. This approach strongly aligns with the need for creative, co-produced simulations that deliver measurable impact Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

Introduction: The role of the surgical multidisciplinary team (MDT), particularly surgical resident doctors and nurses, extends far beyond the confines of the operating theatre. The peri-operative ward environment presents unique clinical and communication challenges that demand a distinct skillset to manage complications in unpredictable, high-pressure situations. Formal team training in peri-operative complication management can lead to increased confidence among healthcare professionals, improved team cohesiveness, and positively impact on patient care [1]. Despite this, structured training for MDT members in managing such scenarios is limited. Simulation-based education provides a safe, reflective environment for healthcare professionals to develop these skills without compromising patient safety [2]. Recognising a gap in peri-operative simulation training for surgical MDTs, we developed a targeted programme to address this need. Methods: A structured simulation-based teaching programme was implemented at Newham University Hospital, within Barts Health NHS Trust. The programme was designed for the surgical MDT, with particular focus on resident doctors and nursing staff. Scenarios were based on the CCriSP (Care of the Critically Ill Surgical Patient) framework and aligned with the surgical portfolio’s learning outcomes. Scenarios focused on common peri-operative challenges, including clinical deterioration, communication breakdowns, and ethical dilemmas. Participants completed pre- and post-session confidence surveys using Likert scales, analysed using a paired T-test. Qualitative feedback was collected anonymously via an online feedback form. Results: Thirteen MDT members (12 surgical residents and 1 student nurse) participated in the simulation sessions. Of these, four submitted feedback forms. Preliminary analysis showed a statistically significant increase in self-reported confidence in managing peri-operative scenarios, rising from 50% pre-session to 95% post-session (p=0.0182). All respondents found the sessions and debriefs beneficial to their learning, and 75% expressed interest in receiving post-session summaries. Logistical barriers, especially concurrent clinical commitments, limited attendance during working hours. The small number of nursing participants also highlighted the need for broader MDT engagement. Discussion: Initial findings suggest that simulation is an effective educational method for improving confidence and preparedness in managing peri-operative complications among surgical MDT members. Despite the small sample of formal feedback, positive trends and qualitative responses indicate this model fills a critical gap in surgical education. Barriers to attendance and limited nursing involvement prompted plans to transition to in-situ simulation delivery within clinical areas. This shift aims to increase realism, reduce simulation artefact, and facilitate greater MDT participation. Ongoing evaluation will support iterative improvements and inform integration into broader surgical education frameworks. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable

Introduction: Ultrasound (US) guided, or Point of Care Ultrasound (POCUS) procedures are increasingly commonplace in healthcare. These procedures improve accuracy and benefit patient safety [1]. Simulation provides a safe environment for healthcare providers to learn how to use the US probe and carry out different surgical or medical interventions such as a kidney biopsy. An innovative US compatible model for kidney biopsies was created out of mixed materials using Aqueous Dietary fibre and Antifreeze Mix (ADAM) Gel [2], a porcine kidney and porcine muscle and skin. Methods: The model was created after two months of trialling different formulations of ADAM Gel, which was made from psyllium husk, anti-foam, propylene glycol and water. A porcine kidney was situated between two layers of ADAM Gel and a final layer of porcine muscle with skin attached was positioned on top. Both fresh and frozen kidneys were trialled. It was found that the kidneys that were frozen immediately after harvest and thawed before use yielded much better visual results under US in comparison to the fresh kidney used a day after harvest. Parts of the kidneys internal structures were well defined under ultrasound to assist in accurate identification of anatomical landmarks. The biopsy needle could be inserted through the layers and a tissue core, with visible glomeruli, was collected from the kidney. This could then be viewed under a microscope for diagnostic purposes. Results: The models were used at a national nephrology conference in Ireland. The mean learner (n=10) rating of the quality and performance of the models was 9.6 out of 10. The qualitative feedback on the models were that they were ‘very realistic’, ‘easy to use’ and that completing the procedure felt like a ‘true to real life experience’. Discussion: In summary, ADAM Gel allowed for the creation of a realistic synthetic base for learning how to carry out US guided procedures. It can be used alongside animal/biological tissue or other synthetic materials for a variety of different medical interventions and treatments. The ability to take tissue samples from the model means the procedure can be followed through up to diagnostic level rather than ending at the patient care level. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

Introduction: 38% of LGBTQIA+ individuals report negative experiences within healthcare in the United Kingdom [1], yet no mandatory LGBTQIA+ training exists for NHS staff post-qualification. Simulation-based training can provide a platform to promote culturally competent LGBTQIA+ care [2]. University Hospitals Dorset developed a livestream simulation to increase healthcare staff access to LGBTQIA+ education, with the aim of improving staff confidence in communicating with LGBTQIA+ people. Methods: The simulation was co-produced with LGBTQIA+ community members as knowledge experts with lived experience, including a Transgender woman contacted through the hospital’s Pride Network. The simulation was live streamed via Microsoft Teams from the simulation suite with 40 multiprofessional healthcare staff and students attending online, through voluntary self-selection. Two students participated in the simulation using a high-fidelity manikin voiced by a transgender woman. The scenario focused on pre-operative care, including pregnancy testing, sex assigned at birth, pronouns, and bed allocation in the context of single-sex bays. A facilitated debrief involved in-person participants, online participants through a monitored Teams chat and LGBTQIA+ contributors including a Transgender woman. Online pre- and immediate post-simulation questionnaires captured participant self-assessment and feedback for mixed-method evaluation focusing on accessibility and impact on staff. Results: Accessibility - 87.5% reported this as first time attending LGBTQIA+ training. Rated as easy to engage with, useful and recommendable. Participants included nurses, physicians, administrators, educators, students, OPDs and child health. 27 of 40 online participants actively communicated via Microsoft Teams chat. Confidence - Increased confidence communicating with LGBTQIA+ individuals’ post-session. Valued knowledge experts openly sharing feelings and lived experiences. Qualitative feedback indicated increased awareness of emotional impact of assumptions and importance of open, person-centred communication. Reported online participant disclosed transgender status to peers post-session. Discussion: This project addressed a training gap through accessible simulation that attracted multiprofessional attendees, demonstrating relevance across diverse roles, and increased staff confidence in communicating with LGBTQIA+ individuals. Participants valued the inclusion of diverse faculty and LGBTQIA+ experiences, highlighting the importance of co-production and collaborative facilitation from knowledge experts with lived experience. Feedback from 25% of participants provided valuable insights, and future efforts will focus on increasing response rates for online sessions. Faculty expressed concern about potential incivility in the online format, however none arose likely due to the voluntary session attracting people sensitive to the topic. Research into the process and impact of engaging healthcare staff who would not typically volunteer for such sessions would be valuable. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

Introduction: Emergency department thoracotomy (EDT) in children is a rare, high-stakes procedure performed primarily during traumatic cardiac arrest [1]. Training opportunities are limited, and current reliance on porcine models raises ethical concerns and lacks paediatric anatomical fidelity. This project aimed to develop and evaluate a low-cost, Aqueous Dietary fibre Antifreeze Mix gel (ADAMgel) based, synthetic model tailored to paediatric EDT, improving training accessibility, anatomical realism, and trainee confidence [2]. Methods: A novel thoracotomy model replicating the thoracic cavity of a 9-year-old child was constructed using synthetic materials, including ADAMgel-laminated soft tissues and a skeletal framework, Figure 1. The model underwent iterative development informed by expert focus groups. Final evaluation included two simulation sessions with doctors (n=11), who completed pre- and post-simulation Likert scale questionnaires assessing confidence and understanding. Data were collected between January and March 2025. Results were analysed using Wilcoxon signed-rank tests. Qualitative feedback was gathered from participants and faculty at the Royal College of Surgeons (RCS) Pre-hospital emergency resuscitative thoracotomy course. All procedures were conducted with appropriate institutional approval for educational simulation-based research. Results: Statistically significant improvements were observed across several domains: confidence in performing EDT increased from median 1 to 4 (p=0.027), understanding of the procedure (p=0.016) and anatomy (p=0.019) also improved. All participants unanimously agreed the model improved their confidence and was a useful training aid. Surface tissues were rated realistic by 91%, and bony structures by 82%. Feedback from RCS faculty highlighted the model’s advantages over porcine equivalents, including reusability, independent practice opportunities, and superior anatomical accuracy. Suggested improvements included stronger tissue fixation and simulated aortic control. Discussion: This ADAMgel-based model demonstrates a feasible, ethical, and effective alternative to animal models in paediatric EDT simulation. Improvements in learner confidence and anatomical understanding support its utility in early procedural training. Planned enhancements, including aortic occlusion simulation, will increase fidelity. Broader validation across experience levels will determine its future role in standardised trauma education. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

Introduction: Simulation-based training has been shown to significantly improve clinician performance in emergency front of neck access (eFONA), particularly among professionals in high-acuity settings [1]. However, traditional simulation options—including animal tissue models and commercially available part-task trainers—present notable limitations. Ethical concerns, unpleasant sensory experiences, high costs, and environmental impacts restrict their accessibility and scalability. In response to ongoing budget constraints within the NHS, we aimed to develop a low-cost, sustainable, and easily reproducible model for eFONA training using readily available materials. Methods: Inspired by commercially available part-task trainers [2], we developed a prototype using plaster of Paris (POP), washing machine waste pipe, sleek tape, silicone, and a balloon. The total material cost per unit was £1.65. During the design process each prototype was tested and adaptations were made to ensure functionality, such as minor increases in diameter of the ‘cricothyroid membrane’ to ensure compatibility with a size 6 endotracheal tube. Functionality was further validated by an anaesthetist prior to course deployment. The model was implemented in a trauma simulation course, where both quantitative and qualitative feedback were collected from participants regarding anatomical realism, tactile feedback, and overall usability (see Figure 1). Results: All participants rated the models realistic or very realistic in terms of anatomical landmarks and procedural feel, and all said that they would recommend using the models. Participants commented on specific features of the models: 1. “Landmarks easily identified and able to see if successful due to ballon inflation which have not seen on previous animal models/ models used” 2. “Able to practice procedure without needing animal models is great” Cost analysis revealed an average saving of £612 per unit compared to four commercially available part-task trainers. Discussion: This low-cost, ethical, sustainable, and reusable alternative to traditional part-task trainers represents a significant step forward in accessible simulation training. Its favourable cost profile and positive user reception support its integration into existing training programmes, particularly in resource-constrained healthcare environments. Such innovations demonstrate that high-quality simulation education need not come at high financial or ethical cost and can be easily reproduced in any simulation setting. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

Introduction: The introduction of the Patient Safety Incident Response Framework (PSIRF) marked a shift in how patient safety incidents are reviewed. Although external training opportunities are available, staff feedback highlighted a need for more practical understanding of PSIRF and human factors. To address this, we developed a bespoke, financially sustainable course, enabling staff to engage interactively with the changes in PSIRF. A key focus was on preparing staff to carry out swarm huddles, as the new learning response with the most local ownership. Methods: In collaboration with the patient safety team, the simulation team designed a full-day course combining lectures, workshops, and simulations to explore human factors and systems thinking (using the SEIPS tool [1]) before scaffolding this knowledge to carry out swarm huddles. We began with non-clinical examples such as “A Cup of Tea” developed by Epsom + St Helier [2], before progressing to analyse clinical scenarios using SEIPS. We created two videos of clinical scenarios: a deteriorating patient and a misplaced naso-gastric tube [3]. Participants then had the opportunity to conduct a swarm huddle with the involved characters, played by faculty members. Success was evaluated through post-training surveys, qualitative feedback, and observed improvements in incident response. Results: To date, 62 senior staff from diverse roles, including acute, community and non-clinical staff, have attended the training. 84% of attendees completed a post-course survey, leading to ongoing adaptations in course content. Feedback included Likert scale assessments of confidence as well as qualitative comments. Attendees highlighted the cultural shift that the course contributed towards, commenting: 1.“Fostering an environment where staff feels safe to be a part of the learning process” 2.“More talking and bringing people together,” 3.“A focus on meaningful actions that genuinely demonstrate learning.” A new swarm huddle template, developed during the course, is now used across the Trust. Staff, including those from the emergency department, have fed back successes of carrying out swarm huddles to learn from both events that have gone well and less well. Discussion: While PSIRF focuses on patient safety, it also promotes a just culture centred on systems thinking and continuous improvement. This approach moves teams away from a blame culture and fosters unity across the Trust. Our program has garnered attention beyond our Trust, with positive feedback from organisations including North London Hospice and NHS England South-West, particularly regarding the simulated videos. The course is being peer reviewed for quality assurance. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable

Introduction: Nursing and Midwifery Council (NMC) approved institutions can deliver up to 600 hours of Simulated Practice Learning (SPL) within the 2,300 practice hours, pre-registration nursing students are required to register [1]. Many approved Higher Education Institutions (HEIs) are using immersive technology-enhanced learning as part of a blended approach in their SPL delivery. Virtual Reality (VR) is commonly used to simulate immersive environments where learners can practise decision-making skills within different clinical contexts. Alongside this, there is a need for 3rd year nursing students to develop peer supervision and coaching skills in preparation for registration [2]. The purpose of this work is to report on an evaluation of a teaching intervention, utilising both VR and peer-to-peer learning. Methods: A peer-to-peer VR learning experience was delivered to 22, 3rd year children’s nurses using Oxford Medical Simulation (OMS) software. Students were paired, with one undertaking a simulation scenario using a VR Oculus headset, which was streamed to a computer screen. The second student observed this stream and made notes on their peers’ performance for feedback. The pair then had an unstructured debrief to explore ways to improve their performance. The roles were then reversed with the observing student completing the same scenario. Following this activity, the wider group came together for a facilitated debrief using the diamond debrief model [3]. Data collection included quantitative and qualitative student feedback gathered via a scannable QR code and quantitative data from the OMS platform’s feedback scoring system. Results: Qualitative findings brought up two main themes: translating theory to practice & and peer-to-peer support. Limitations of using immersive technology were also highlighted. Quantitative results showed an overall improvement in clinical practice between the peer attempts. These results are seen in Table 1. Out of the 11 pairs of participants, 7 scored, on average, 18.12% better than their peers. Of the 3 pairs of participants that scored lower, they were 4.64% lower than their peers. Discussion: Repeated peer-supported VR scenarios have the potential to improve knowledge and enhance peer supervision. Importantly, the post-scenario debrief was positively received by the majority of learners to consolidate their in-scenario peer learning. We suggest that the value of using this approach within SPL may be an effective way for 3rd year student nurses to acquire knowledge and develop peer supervision skills. Challenges arose surrounding the use of a VR headset and limitations in using a virtual platform. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

Introduction: A sense of belonging within the National Health Service (NHS) workforce is imperative in establishing a safe and effective working environment, as outlined in the NHS People Plan (2020) [1], ‘The NHS must welcome all, with a culture of belonging and trust. We must understand, encourage and celebrate diversity in all its forms’ (p.24). It can be challenging to establish a sense of belonging within the NHS where large teams are working under high pressures in inconsistent shift patterns. Incorporating lived experiences, a simulation workshop was designed to enhance participants’ knowledge and understanding of how to foster workplace belonging when interacting with colleagues with protected characteristics. Methods: The workshop was delivered twice and opened with an introduction, explaining the use of simulation, how scenarios will run, the timetable and an ice breaker, establishing psychological safety. The workshop contained a diverse variety of simulated scenarios, using a range of simulation techniques, including, observed simulation, forum theatre and character monologues. The scenarios focused on working alongside colleagues with a range of protected characteristics, including those with caring responsibilities, age and faith. The scenarios were followed by reflective debriefs, led by experienced facilitators, providing a psychologically safe space in which to explore the pre-set learning objectives, reflections, feelings and previous experiences. Two separate communication frameworks were shared with participants in order to assist them in preparing for supportive conversations. These are: STEPS (Start, Time, Empathy, Provision of Support, Sense Check) [2] and CUS (Concerned, Uncomfortable, Safety) [3] and Clean Feedback [4]. Results: Pre- and post-course rating scale evaluations were used following workshop delivery in April and May 2024, focussing on the individualised workshop learning outcomes, alongside free-text responses and were completed by a total of 9 participants. The feedback demonstrated an improvement in knowledge on the topics covered, with 46% of the participants expressing limited, neutral or no knowledge before the workshop and 99% expressing excellent or good knowledge after the workshop. Qualitative feedback highlighted the reflective value of the workshop, in addition to the authenticity of the scenarios, which were described as “real-life.” Discussion: The feedback supports the use of simulation training, containing embedded communication models in enhancing the ability of NHS employees to support colleagues with protected characteristics, in turn fostering a sense of belonging amongst the workforce. Specific feedback focussed on the value of ensuring that scenarios are authentic. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

Introduction: In high-pressure clinical environments, fostering a culture that encourages reflection, learning, and emotional wellbeing is essential. Hot debriefing offers an immediate, structured opportunity for teams to reflect on critical events, strengthen communication, and embed psychological safety into regular practice [1]. This teaching session aimed to educate resident paediatric doctors on the importance of a hot debrief and introduce relevant models that supports cultural transformation by normalising reflective practice. Methods: A multidisciplinary teaching session was delivered to 25 resident paediatric doctors, focusing on the practical application of hot debriefing. The session included a structured approach and a set of practical tools for initiating team-based hot debriefs. Through the use of videos and simulations we were able to embed principles of psychological safety, emotional recognition, and inclusive dialogue. In order to facilitate real-time feedback, gather the thoughts of the resident doctors and enable a collaborative environment we utilised Slido within this session. Pre- and post-session surveys were used to assess changes in experience and confidence, and to identify future training needs. Qualitative comments were collected to capture perceived cultural and emotional impact. Results: Pre-course data showed that 80% of participants had little or no prior experience with hot debriefing. Following the session, 84% reported feeling moderately or much more confident in asking for a debrief. Additionally, 84% expressed interest in receiving further training on how to lead debriefs. Qualitative feedback consistently highlighted a shift in attitude toward team communication and support, with participants valuing the normalisation of discussing emotional responses. Many viewed the session as a catalyst for change, helping to challenge existing cultural norms around silence after difficult events and learning from these. Discussion: The introduction of hot debriefing as both a concept and a structured practice contributed to a visible cultural shift within clinical teams. Rather than treating debriefs as optional or exceptional, the session repositioned them as integral to team-based care and resilience. By normalising immediate reflection, hot debriefing supports a compassionate, safety-oriented culture that prioritises emotional well-being alongside clinical outcomes. As healthcare organisations aim to address burnout, improve safety, and foster inclusive team dynamics, scalable interventions like hot debriefing can serve as foundational tools to drive cultural transformation from the ground up [2]. Going forward, we would like to deliver these sessions to all paediatric resident doctors and incorporate more simulation-based education within it to enhance a team culture that supports open communication, compassion, and continuous learning. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable.

Introduction: Recent reforms in undergraduate pharmacy education [1] mandate increased clinical exposure in primary care to support the development of prescribing competencies and consultation skills. However, capacity constraints in community care, driven by workforce shortages and service pressures challenge traditional placement models [2]. Observed simulation-based education offers a scalable and innovative solution. This pilot project explored the design and implementation of a virtual clinical experience (VCE) for third-year pharmacy students, using simulation to deliver standardised, high-fidelity, experiential learning. The aim was to implement and evaluate a hybrid simulation model that addresses placement shortages, reduces clinician burden, enhances student engagement, and supports interprofessional education. Methods: Seventy-four third-year pharmacy students from the University of Brighton participated in a pilot VCE day comprising simulated GP consultations delivered via livestream. The day was structured into: Prebriefing with defined learning outcomes Live observation of two distinct GP-patient consultations with simulated patients Facilitated debriefing sessions utilising experiential and social learning theories. Prebriefing with defined learning outcomes Live observation of two distinct GP-patient consultations with simulated patients Facilitated debriefing sessions utilising experiential and social learning theories. Half way through the day students were divided into subgroups with assigned observer roles focusing on clinical, communication, and patient-centred care dimensions. Supplementary workshops and a digital health session introduced prescribing workflows and electronic health records. The simulation design was informed by Kolb’s Experiential Learning Cycle and Bandura’s Social Learning Theory, promoting active observational learning. With the midway changes, debriefing was adapted to deepen engagement. Directed observer roles transformed passive observation into purposeful participation, fostering critical thinking, reflective practice, and peer discussion [3]. Results: 84% of students reported increased confidence in consultation skills and rated 4.5/5 for enjoyment; Qualitative feedback highlighted the value of real-time observation and communication strategies. Educators rated the day 4.8/5; 100% agreed objectives were met. Identified challenges included time management and AV logistics; key improvements suggested included extended debriefs and clearer observer instructions from the start. Discussion: VCE provides a scalable, immersive solution for clinical learning in pharmacy education, addressing placement limitations while supporting high-quality, standardised experiences. The model’s success supports future iterations incorporating longitudinal simulated patient journeys to encompass the continuity of patient care in primary care. Expansion to other institutions and disciplines is feasible, promoting sustainability, and collaboration in simulation-based learning. Future evaluations will explore the integration of learner-designed cases and interprofessional simulations across multiple institutions. This will assess long-term retention of consultation skills and model scalability, contributing to national pharmacy education reform. Ethics Statement: As the submitting author, I can confirm that all relevant ethical standards of research and dissemination have been met. Additionally, I can confirm that the necessary ethical approval has been obtained, where applicable