Simulated Ward Research Articles

Mesh Refinement for Dynamics Airflow in Health Care

This studyexplores using computational fluid dynamics(CFD) tooptimize ventilation in healthcare, with a focus on mesh refinement for accurate airflow analysis. The goal is to reduce airborne contaminant spread, which is crucial during COVID-19. Ventilation in healthcare ensures air quality and minimizes pathogen transmission. The research analyzer analyzes mesh element size's impact on airflow accuracy in simulated hospital wards with two coughing patients. The optimal mesh size is determined for reliable predictions. Mesh refinement enhances accuracy in critical zones. The k-epsilon turbulence model is chosen for low error. Experimental validation shows temperature discrepancies, likely due to simulated manikins lacking clothing insulation. Air velocity measurements show minor variations within an acceptable range. Further research on various ventilation configurations and airflow rates in real hospital conditions is crucial. Addressing these limitations optimizer optimizeshealthcare ventilation, enhancing safety and infection control.

Modeling and analysis of propagation characteristics of WBAN in hospital ward scenarios

AbstractTo explore the feasibility of high‐frequency indoor wireless body area network (WBAN) communications, the propagation characteristics of WBAN in simulated hospital ward scenarios at 11 GHz are studied. Based on the extensive measured data, the impact of the patient's lying angle (LA) on channel characteristics has been analyzed, such as statistical characteristics of path loss (PL), shadowing effect, and root mean square delay spread. Moreover, a PL model with LA factor is presented for the hospital ward scene, and the influence of LA on PL in the presence of height difference is also analyzed. The research results indicate that, the PL caused by LA (abbreviated as PLA) follows a power function with respect to the LA in case of a fixed distance between the transmitter and receiver. When the LA is fixed, PLA exhibits a cubic function relationship with the distance between the transmitter and receiver. In addition, the presence of patient's LA can cause more significant multipath effect. However, the impact of LA gradually weakens as the height difference increases when there is a height difference. The research results provide a theoretical basis and practical basis for utilizing the 11 GHz frequency band in indoor WBAN in the future.

WP6.4 - General Surgery Bootcamp: Improving Induction for Higher General Surgery Training

Abstract Aim To create an introductory course or “bootcamp” to assist new ST3s transition from working at core trainee to General Surgical Registrar level. Method Using previous expertise of “bootcamps” delivered in the region in similar specialities, a 3-day programme was designed to offer training in areas aligned to the curriculum and considered useful to newly starting higher surgical trainees. The course involved a mix of simulation-based workshops, lectures and skill-based labs. The programme was delivered by a senior faculty directing activity with support from industry partners and medical education/simulation expertise. A range of skills were targeted using animal, virtual and augmented reality models, low and high-fidelity simulation, and non-operative technical skills (NOTSS) in simulated ward and theatre environments. Results 26 trainees (23 new General Surgery ST3s, 3 returning to training) completed the bootcamp. Feedback questionnaires using a likert scale demonstrated clear improvements in trainees’ own skill perception in endoscopy, laparoscopy, open surgery and NOTSS. 100% of responding trainees’ were confident or strongly confident post course, compared to 69% before. We also showed an increase in confidence in laparoscopic suturing (77%), duodenal ulcer repair (69%) and operating in a stressful environment. Conclusions A transitional “bootcamp” can provide both tangible and intangible benefits. This project showed clear improvement in trainee confidence both in key practical and non-practical skills such as communication. It also enabled registrars to familiarise themselves with new colleagues, facilitating an early welcome from the region and embedded support network.

All hands on deck during the COVID-19 pandemic. Maintaining face-to-face medical education and clinical placements.

Medical students must have robust educational experiences, graduate and commence timely employment. Here, we describe how the Royal College of Surgeons in Ireland (RCSI) delivered clinical placements in medical programmes over the first three waves of the COVID-19 pandemic in Ireland, including a student-centred, holistic approach to students' educational, social and health needs with strong student involvement, re-organising the university's primary care team, developing COVID-19 PCR testing on site and re-focusing communications and student services. This resulted in re-arranging the students into learning communities, and students and staff electronically recorded their COVID-19 symptom status daily. In-person observed structured clinical examination and other clinical exams progressed. No lockdown of any campus occurred. Over the two senior years, 693 students completed 15,000 weeks of clinical and experiential learning across 104 sites, similar to previous years, including anatomy practicals, procedural skills training, simulated ward rounds and patient encounters, case-based presentations and small group tutorials. The compliance rate with the daily symptom tracker was 91%. The percentage response rate and the number of students providing feedback from October 2020 to April 2021 was as high as 50%. The overall response rate was 33%. By mid-May, 93-95% of students in the two senior years had had at least one dose of the SARS-CoV-2 vaccine, with 99% fully vaccinated by the start of the next academic year in autumn 2021. Over the period of testing for SARS-CoV-2, just over 22,000 samples were processed, of which 0.79% were positive; no medical student acquired COVID-19 or was associated with nosocomial transmission. The total investment by the RCSI in Dublin, was €9.3m (€1.2 in capital expenditure and €8.1 in operational expenses). Continuing face-to-face clinical placements during a pandemic was possible through a multi-model approach that prioritised two-way communication, compliance with national public health advice and student screening.

The Impact of Simulated Ward Rounds on the Clinical Education of Final-Year Medical Students: A Systematic Review

(1) Background: Final-year medical students often feel under prepared for their transition into clinical practice. Clinical ward rounds and shadowing approach this issue by building transferable skills; however, they are highly variable, with teaching clinicians experiencing a large number of work-related interruptions. Simulated ward rounds have garnered significant interest by translating clinical encounters into standardised educational opportunities for students. This review evaluates the impact of simulated ward rounds in promoting the clinical competencies required for work in final-year medical students and assesses the impact of simulated ward rounds on the experience of clinical learning for medical students. (2) Methods: A computer-assisted search was performed in the Medline, Embase, and CINAHL databases. Studies that evaluated simulated ward rounds in final-year medical student cohorts were included. (3) Results: In total, 107 articles were identified by the search and 26 articles were eligible for full-text analysis. The analysis of these studies showed that simulated ward rounds were effective in improving confidence, as well as the technical and non-technical skills of final-year medical students; however this is on the basis of highly heterogeneous and lower-quality evidence. (4) Conclusion: Our systematic review highlights that simulated ward rounds provide final-year medical students with increased confidence and preparedness for clinical work and identifies the need to pursue more methodologically rigorous research to inform the best practice delivery of simulated ward rounds.

Rapid Transformation from Face to Face to Virtual Simulation During the SARS-CoV-2 Pandemic: Impact on the Simulation Process during “The Little Room of Horrors”

Objective1. To explore the feasibility of a rapid transformation from face to face to virtual simulation and its impact on the simulation process 2. To explore the efficacy of a rapid transformation from face to face to virtual simulation and its impact on the simulation process. MethodsThe simulation process (preparation, pre-briefing, simulation, and debriefing) was investigated for feasibility and efficacy from the perspective of the educators and students. This study took place very early in the pandemic, thus highlighting the speed at which it needed to be conducted and acknowledging the limitations of technology at the time. The faculty (n = 3) involved in the virtual simulation experiment and year one medical students(n = 61) were invited to participate in the study voluntarily. The module chosen for this study was the Introduction to the Practice of Medicine, where the students were introduced to the concept of patient safety using simulation-based education. The “Little Room of Horrors” – is a simulation based educational session emphasising the importance of patient safety. Students were taken into a simulated medical ward that demonstrated common hospital-based errors. The learners were timed and asked to identify and document as many patient safety hazards as possible. The semi structured questionnaire was analysed using descriptive statistics and thematic analysis. ResultsThe Educator's perspective reflected that virtual simulation was technologically dependent and had limitations during debriefing but was also a sustainable and portable standardised process. The student's perspective revealed that the objectives were met, and the session helped them support the theory previously learned. The average rating was 4.09 on a 5-point scale. InnovationWhen resources of the simulation center like space, mannikins, and faculty cannot be accessed for reasons like social distancing during a pandemic, virtual simulation was developed and used as a feasible alternative for our students without impacting the learning objectives. ConclusionThis study demonstrates the use of virtual simulation as a valuable option for teaching when face to face simulation is challenging or not possible.

A106‘FY1 for a day’ an immersive programme to prepare final year medical students for foundation training

Final year medical students are often anxious about commencing foundation training and feel underprepared for the practical responsibilities they are expected to conduct independently [1]. Consequently, a full day programme was created to facilitate immersive simulation of a typical working day of a Foundation Year 1 (FY1) doctor. Aim: To provide an enriching programme empowering final year medical students to experience the practical aspects of foundation training (including areas of expressed difficulty), whilst creating a safe and realistic learning environment and providing opportunities for interprofessional learning and near-peer teaching. Junior doctors from FY1s to Medical Registrars delivered the programme’s content. In the morning, three interprofessional simulation scenarios were delivered to the medical students and included nursing students for added realism. Each scenario reflected common ward-based and acute-setting situations that had minimal coverage in their undergraduate curricula. Afternoon stations were created to attenuate the medical students’ anxieties about the aspects of foundation training they perceived as difficult. Using a simulated ward, a mock handover was conducted. Students were then expected to complete the tasks of death verification, complex prescribing and female catheterization. The other stations simulated interpreting blood results, discussions with a microbiologist and requesting and discussing radiological imaging. During completion of all stations, the medical students carried and answered a bleep mimicking realistic distractions. Morning and afternoon debriefing occurred in small groups. Following programme completion, all the medical students ( ‘FY1 for a day’ is an effective and sustainable educational programme to potently prepare final year medical students for their foundation training whilst safeguarding psychological safety and fortifying multidisciplinary relationships. 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.

A57Simulated Practice as a Method to Promote Legitimate Peripheral Participation

Simulated sessions are widely used within medical education. Despite the potential benefits of simulated learning, it suffers from a narrow scope of practice; acute, emergency presentations and procedural skills. There is less research for its utility in sub-acute and chronic disease management. To develop expertise in medical practice, learners require sufficient foundational knowledge to facilitate more complex behaviours [1]. Within ward environments, lack of foundational knowledge in both ‘hard’ (knowledge) skills, and ‘soft’ (organizational) skills can limit learners’ potential for development. Considering legitimate peripheral participation theory, learners require ‘enculturing’ into an institution to develop ‘soft’ skills. Examples of ‘soft’ skills include understanding problem solving approaches, language, values and norms of the profession [2]. To design and assess the educational impact of simulated ward round teaching sessions on medical students in semi-acute settings, focussing on ‘enculturing’ skills. This was a prospective study. We created a ward round-based simulation session, with six simulated patient scenarios, designed for clinical placement level medical students. Ten students were included in the study. We utilized an induction exercise to familiarize students with medical documentation, a simulated ward round, and a consolidation exercise reviewing discharge paperwork and prescriptions. A simulated patient was present in each scenario, with a member of faculty facilitating. Simulated ward round entries, nursing handover queries and investigations were provided to students. Scenarios were 20 minutes; with objectives to produce ward round documentation and generate holistic clinical management decisions. Students participated in a ‘board round’, which served as a forum for station specific feedback. Enculturing values were assessed via a 40-point, knowledge based formative assessment, covering the main themes of the session: appropriate documentation, medical abbreviations, and clinical decision-making. Assessment was administered both pre- and post-session. Qualitative feedback of the session was obtained from learners to identify themes for further development. There was a significant improvement in knowledge following the session (see Results of pre- and post-intervention knowledge assessment Our results demonstrate an increased sense of empowerment in the study population. Simulated practice can be used effectively to enhance learning in sub-acute medical situations. Enculturing skills were particularly enhanced; promoting future learning through orientation within zones of legitimate peripheral participation. 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.

10 Ward and Hospital Simulation in Unity

Abstract Aims To investigate ward and hospital design and its effects on efficiency and queues. Methods A starter project in C# and Unity simulates two different ward designs and the effects of gender on waiting times. Results Initial results show the queue for single bed bays can be substantially reduced (possibly by up to a half) in appropriately designed wards. Video: https://youtu.be/Hw9NXONCRTc Conclusions Due to gender issues, it is common for bays to be assigned single genders which can create virtual ring fencing of beds which can impact on waiting times. Current models are often Excel based and are static and do not reflect the actual physical properties of the hospital. This project shows the potential of a dynamic simulation in new ward designs. It is possible that each hospital in the NHS could have its own model, linking its physical attributes (the actual building) to a mathematical model and these can be compared for efficiency. New buildings could be simulated and compared for costs and efficiencies substantially reducing guesswork and challenge building orthodoxy and introduce evidence into hospital design.

Investigating the adjacent patient radiation dose received during a simulated ward chest X-ray examination

Introduction: A patient having a chest X-ray will inevitably be exposed to radiation from the primary beam. Using a light beam diaphragm (LBD) on the X-ray tube reduces scattered radiation at the X-ray tube through longitudinal and horizontal collimation. But not scattered secondary radiation resulting from interactions of the primary beam. This study aimed to investigate whether lead protection on simulated hospital ward inpatients (opposite and adjacent to a simulated chest X-ray examination) would change the secondary scattered radiation dose received.
 Method: Two rando phantoms (simulated patients) were positioned at different distances from the simulated patient receiving the chest X-ray. The phantoms were positioned one metre adjacent (either side of the phantom being X-rayed) and two metres opposite. The scattered radiation dose to radiosensitive organs (thyroid, breast, and gonads) was recorded using Thermoluminescent Dosimeters (TLDs). Six exposures were conducted, three with lead protection and three without. The mean radiation dose and standard deviation were compared using a paired two-sample t-test for statistical significance (p>0.05).
 Results: The lead protection reduced the radiation dose to the radiosensitive organs by 64%-100% (p=0.51-0.18) one metre adjacent and 65%-100% (p=0.65-0.18) two metres opposite. Noticeably the phantom two metres opposite had substantial individual organ dose reductions due to the distance from the primary beam.
 Conclusion: Lead aprons, thyroid collars, and distance reduced the radiation dose to the radiosensitive organs of the surrounding phantoms (simulated patients) from an adjacent chest X-ray examination and present opportunities for dose reduction techniques during ward chest X-ray examinations.

The impact of simulation on undergraduate nursing students’ confidence and learning satisfaction over time and practice: A pretest, post-test study design

The study examined the effect on the confidence and learning satisfaction of final year nursing students when a clinical story is told over a weekly series of simulated ward experiences. A pretest, post-test study design was undertaken inside a cohort of 237 students enrolled in a 3-year Bachelor of Nursing program. Participants completed an online survey prior to and following participation in five weekly simulation workshops. The effect of serial simulation was evaluated with students self-reporting confidence and learning satisfaction adhering to a checklist for reporting of survey studies. A sample of 96 nursing students completed a pre- and post-test survey. Results revealed that nursing students’ overall learning satisfaction remained unchanged. In contrast, overall self-confidence among students had improved. Confidence in playing the role of registered nurse improved over time as students became familiar with what would be expected of them during a series of simulated experiences.

A low-cost ward team simulation method.

Medical EducationEarly View REALLY GOOD STUFF A low-cost ward team simulation method Michael Rose, Corresponding Author Michael Rose [email protected] orcid.org/0000-0003-1270-9036 Correspondence Michael Rose, Mid and South Essex Foundation Trust, Medical Academic Unit, Broomfield Hospital, Court Road, Chelmsford, Essex CM1 7ET, UK. Email: [email protected] Contribution: Conceptualization, Data curation, Formal analysis, ​Investigation, Methodology, Supervision, Validation, Writing - original draft, Writing - review & editingSearch for more papers by this author Michael Rose, Corresponding Author Michael Rose [email protected] orcid.org/0000-0003-1270-9036 Correspondence Michael Rose, Mid and South Essex Foundation Trust, Medical Academic Unit, Broomfield Hospital, Court Road, Chelmsford, Essex CM1 7ET, UK. Email: [email protected] Contribution: Conceptualization, Data curation, Formal analysis, ​Investigation, Methodology, Supervision, Validation, Writing - original draft, Writing - review & editingSearch for more papers by this author First published: 16 March 2023 https://doi.org/10.1111/medu.15076Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Education During Ward Rounds: Systematic Review.

Enhancing the educational experience provided by ward rounds requires an understanding of current perceptions of the educational value of rounds. This systematic review examines perceptions of education in ward rounds, educational activities in ward rounds, barriers to learning, and perceptions of simulation-based ward rounds. The 2020 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. MEDLINE (EBSCO), Cochrane, and Scopus were searched on May 29, 2022, for studies assessing learning during ward rounds. The search terms included "ward rounds," "education," and "trainees." Then, the selected articles were reference searched. In total, 354 articles were retrieved. The articles were assessed for eligibility by 2 independent reviewers who screened titles, abstracts, and full-length texts. Articles addressing trainees' education in all ward rounds were included. Articles were excluded if they were specific to certain disciplines, were reviews, were not published in scholarly journals, were published before 2015, were published in languages other than English, or did not concern human participants. Following the removal of 63 duplicates, a total of 268 articles were excluded. The risk of bias within the selected articles was also assessed via the Critical Appraisal Skills Programme checklist for qualitative research. Qualitative data were used to describe results in a narrative synthesis and in tables. A total of 23 articles were included. Perceptions of teaching in rounds were addressed by 6 studies, of which 3 showed negative perceptions among participants, 2 reported ambivalent perceptions, and 1 showed positive perceptions. Perceived barriers to teaching during rounds were assessed by 7 studies. The reported barriers included time constraints, workloads, schedules, interruptions, the service-oriented nature of rounds, the lack of feedback, hierarchies, the lack of opportunities to ask questions and be engaged in patient management, and divergent learner needs. Further, 8 studies identified types of educational activities, including observation, patient-specific teaching, and discussion. Perceptions of learning through simulated ward rounds were assessed by 8 studies, and a consensus of satisfaction was noted among learners. The interventions that were explored to improve education included using teaching frameworks, involving clinical librarians, and changing the setting of ward rounds. The main limitations of this review are the predominant use of qualitative data in the included articles and the lack of standardization for the educational compositions of ward rounds among articles, which made the articles hard to compare. In conclusion, learning opportunities in ward rounds are often missed, and trainees perceive rounds to have low educational value. It is important to recognize the barriers to education during ward rounds and address them to maximize the benefits of ward rounds. Finally, there is a need to develop plans that incorporate teaching regularly during ward rounds in the inpatient setting. PROSPERO CRD42022337736; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=337736.

Effects of Return Air Inlets' Location on the Control of Fine Particle Transportation in a Simulated Hospital Ward.

The COVID-19 pandemic has made significant impacts on public health, including human exposure to airborne pathogens. In healthcare facilities, the locations of return air vents in ventilation systems may have important effects on lowering airborne SARS-CoV-2 transmission. This study conducted experiments to examine the influence of different return air vents’ heights (0.7 m, 1.2 m, and 1.6 m) on the particle removal effects in a simulated patient ward. Three different ventilation systems were examined: top celling air supply-side wall return (TAS), underfloor air supply-side wall return (UFAS) and side wall air supply-side wall return (SAS). CFD simulation was applied to further study the effects of return air inlets’ heights (0.3 m, 0.7 m, 1.2 m, 1.6 m, and 2.0 m) and air exchange rates. The technique for order of preference by similarity to ideal solution (TOPSIS) analysis was used to calculate the comprehensive scores of 60 scenarios using a multi-criterion method to obtain the optimal return air inlets’ heights. Results showed that for each additional 0.5 m distance in most working conditions, the inhalation fraction index of medical staff could be reduced by about 5–20%. However, under certain working conditions, even though the distances between the patients and medical personnel were different, the optimal heights of return air vents were constant. For TAS and UFAS, the optimal return air inlets’ height was 1.2 m, while for SAS, the best working condition was 1.6 m air supply and 0.7 m air return. At the optimum return air heights, the particle decay rate per hour of SAS was 75% higher than that of TAS, and the rate of particle decay per hour of SAS was 21% higher than that of UFAS. The location of return air inlets could further affect the operating cost-effectiveness of ventilation systems: the highest operating cost-effectiveness was 8 times higher than the lowest one.

Simulated patients' experiences and perspectives of an interprofessional ward simulation: An exploratory qualitative analysis

Interprofessional simulation-based education (IPSE) prepares healthcare students for future collaborative practice. Whilst experiences of IPSE have previously been reported by students and faculty, there is a limited understanding of simulated patients’ (SPs) experience. This study explored SPs’ perceptions of the quality of an interprofessional ward simulation (IPWS); experiences of the interprofessional care (IPC) they received, and their perceptions of effective IPC. Undergraduate nursing, medical and pharmacy students participated in an IPWS. Focus groups were used to collect data from 27 SPs following their participation in the IPWS. IPC was perceived to vary between groups of students. Recognition of roles, responsibilities and boundaries to prevent overlap of workload and improve efficiency of teamwork were perceived as important for making IPC effective. Findings suggested that SPs may not be fully aware of the changing scope of practice in healthcare. SPs reported that they would have liked more involvement in the creation of their role and how this played out in the simulation. SPs play an important role in IPSE in healthcare education and recognise that understanding roles and responsibilities contributes to effective IPC. An additional finding of this study was that the public may not be aware of the changing scope of professional practice.

Experimental study and CFD modelling of four-bed hospital ward with all-air wall induction unit for air-conditioning

This study focuses on a prototype all-air wall induction unit. While maintaining the non-reheating and power saving conveying characteristics of the induction systems, this unit is water pipe free and has a low air supply velocity, and is therefore suitable for application in hospital wards. However, its ventilation and thermal performance have not been sufficiently investigated for further improvement. Thus, this study performs a full-scale experiment in which induction units are vertically installed in the ward's four corners. CO2 is generated to represent pollutants from a sample patient, and the steady-state temperature and CO2 concentration distribution are measured and analyzed under different supply conditions. Moreover, computational fluid dynamics (CFD) modeling methods are proposed and validated for this unit. The results show that the wall induction system can maintain a normalized concentration near the hospital beds that are away from the pollution source of less than 0.7 by producing displacement ventilation (DV). Supplying the air from the bottom half of the wall corner with a low supply rate while the bed is surrounded by a curtain can halve the CO2 concentration in the occupied zone by improving the efficiency of the DV. The vertical distribution of room temperature ranges from Δ3 °C to Δ4 °C depending on the supply volume, which is considered acceptable in the ward usage. Furthermore, in the ward CFD simulation, the accuracy of the Standard k-ϵ (SKE) model with specific heat transfer boundaries has been proved to be nearly identical to the low-Reynolds calculation results.

Teaching Undergraduate Medical Students Non-Technical Skills: An Evaluation Study of a Simulated Ward Experience.

PurposeResearch suggests that medical students in the UK report a need to be better prepared for the non-technical skills required for the role of a junior doctor. A Simulated Ward Experience was developed in an attempt to address this need. The purpose of this study was (1) to evaluate the effectiveness of the Simulated Ward Experiences by examining students’ reactions regarding the quality of teaching and (2) to examine the main drivers of learning and the extent to which students felt it helped them prepare for their future training.MethodsA mixed method evaluation study was conducted using a questionnaire and focus groups. Final year students who participated in the Simulated Ward Experience were invited to contribute to the evaluation, out of which 25 completed the questionnaire and 13 took part in focus group interviews. Data analysis were conducted by means of descriptive statistics for questionnaire data and thematic analysis of focus group transcripts.ResultsThe median Likert scores for quality of teaching Non-Technical Skills were either very good or excellent, demonstrating that students were highly satisfied with the way in which these were taught. Qualitative data provided further insights into the aspects of the intervention that promoted learning, and these were categorised into four themes, including realism of the simulation; relevance for the role and responsibilities of the Foundation Year 1 Doctor (including Non-Technical Skills); learning from and with others; and supportive learning environment.ConclusionThis evaluation study provides further evidence of the value of learning in a simulated setting, particularly when it is closely aligned to the real clinical context and creates opportunities to practice skills that are perceived to be relevant by the learner. Study limitations are recognised and suggestions for further studies are provided.

Influence of noise manipulation on retention in a simulated ICU ward round: an experimental pilot study

BackgroundNoise exposure leads to a reduction in cognitive abilities in diverse settings, however, only limited data exist examining the effects of environmental ICU noise on the cognitive performance of ICU professionals. A frequently occurring and demanding retention task in ICUs are ward rounds, which are considered key for the provision of medical care. Here, we investigate the influence of noise on information retention in a simulated ward round.MethodsICU professionals were exposed to a recorded, ICU ward round, simulated partly with and partly without environmental ICU noise. Ward rounds were followed by specific questions about previously provided information.Results56 ICU professionals (aged 26–59 years) were included. A logistic mixed model showed a reduction of 27% (P < 0.001) in the ward round test performance when participants were exposed to environmental ICU noise. Furthermore, advanced age was associated with reduced retention (− 28%, P < 0.001), questions containing important information performed better (+ 36%, P < 0.001), and higher stress led to better performance in retention (+ 24%, P = 0.01).ConclusionsOur data showed a considerable negative influence of environmental ICU noise during a simulated ward round. Therefore, reduction of environmental ICU noise is recommended. The influence of additional factors, including stress, priorities, and demographic factors should be pursued in subsequent investigations.

Perspective of a Teaching Fellow: Innovation in Medical Education: The Changing Face of Clinical Placements During COVID-19.

The Mid Essex teaching team have adapted and innovated to ensure delivery of the curriculum to over 150 students from two medical schools during COVID-19. A fully immersive education experience was created through protected teaching time, the introduction of a simulation package (virtual reality simulation, ward simulation and bleep simulation), the proactive recruitment of fourteen dedicated teaching fellows, and the procurement of technology-based platforms. The blended learning approach we designed supplemented student-patient interaction on the ward with virtual and face-to-face teaching sessions where appropriate. Preliminary data from student feedback suggests that the pandemic induced adaptations, technological innovations and simulation-based teaching have been successful. Students have rapidly gained confidence, knowledge and skills that they need to progress. It may be a consideration for teaching hospitals elsewhere to consider such methods to ensure students are prepared for life as a doctor both in the midst of and after the pandemic.

10 Introducing a Virtual Ward Round in Times of COVID-19

Many medical students feel unprepared for starting as FY1 doctors, and often report low confidence in taking responsibility for patients and working independently, and lack self-assurance in common FY1 skills, including assessing unwell patients and initiating management, task prioritization, referrals, documentation, ordering imaging and on-call shifts. These skills are developed during clinical placements; however, access to these opportunities during placements has diminished due to COVID-19 and concerns around patient safety. Simulation‐based teaching allows students to take responsibility and work within complex clinical environments without posing a risk to patients The aim of the study was to evaluate whether simulated mock ward rounds increase final-year medical students’ overall confidence and feeling of preparedness for starting as FY1 doctors.In total, 20 final-year medical students took part in the programme in two whole-day sessions. This was comprised of a simulated ward round of 10 patients. Students acted as FY1 doctors on the ward and carried out jobs, reviewed patients who deteriorated and had a number of tasks such as updating families, ordering radiology, initiating management and discharge summaries. Students’ confidence and preparedness was measured using pre- and post-course questionnaires. The questionnaires consisted of a 10‐point Likert scale for students to rate their confidence in key skills and overall preparedness for FY1 (1 = not at all confident, 10 = completely confident). These scores were matched and analysed using the Wilcoxon signed‐rank test. Additionally, there was blank spaces for feedback on the course which were analysed thematically.Pre- and post-course questionnaires demonstrated that students felt significantly more prepared for FY1 after the course (p &lt; 0.001). There was also a significant improvement in nine other domains deemed important for FY1 that students had reported low confidence in (see Figure 1). Qualitative data revealed that students appreciated the programme. They stated its superiority to other educational methods such as shadowing or didactic teaching sessions.Students mean confidence score in overall preparedness and key skills before and after the programme. P &lt; 0.001 for all domains.Simulated mock ward rounds can be used as an adjunct to clinical placements to increase medical students’ confidence about starting work, and to teach them valuable skills regularly utilized by FY1 doctors.