1HR ON-CALL Dr Jyo Manalayil Collaborators: Dr A Ball, Dr D Chevalier, Dr A Muston
To use simulated on-call to underpin experiential learning in final year medical students at Blackpool Victoria Hospital. Aim To better prepare them for their on-call experience as Foundation Year (FY) Doctors.
Critical stage in career progression. Limited training in being on-call. Background Undergraduate medical education should prepare you for your first day (GMC Tomorrow’s Doctors). On-call is noted to be a stressful time for doctors.
Voluntary simulation teaching programme What we To allow final-year medical students to experience the pressures of being on-call hoped to achieve Emulate internal and external stressors Within a safe environment
Identified needs Students held a and perspectives at bleep for an hour an individual level Relatively simple tasks - revolved Sent throughout around the hospital resourcefulness, communication and triage skills Methods FOCUS: support their development and the non- Various resources technical skills, were available for rather than students assessment of their performance in the individual tasks The final station Ended with was an unwell facilitated patient feedback session
17 students over three years. Six in 2017, nine in 2018, two in 2019 All students report an increase in confidence Results 100% of students recommended both individual and cohort repetition Open feedback session - students valued using actual wards and having to navigate unfamiliar areas of the hospital
Free text comments from feedback questionnaire 2017 2018 2019 “G “Great introduction to holding a “R “Really useful, realistic bleep” bl simulation” si What were the “L “Lots of support when required” “Good feedback + real life “G “Several tasks to “S positive features pr prioritise” situations” si s” “Good opportunity to navigate “G of this simulation? ar around the hospital al an and “G “Good to go around the prioritise” pr hospital” ho What could we do “I “Individual feedback on paper” “M “More sessions” “More sessions” “M to improve this “R “Repeat once or twice” “Individual feedback” “I simulation? “O “One of the most useful learnin le ing experie ience in in pr prepa paration for being a Any further ju junior doctor” “Excellent session” “E “Excellent session” “E comments: “H “Helped realise the im importance of pr prioritising jobs”
Being on-call is an inevitable part the job role. Significant increase in preparedness over the last decade, however main areas of worry are clinical practical skills, and the emotional, mental and physical stress expected (Goldacre 2010, 2012, 2016). Discussion There is scope for better preparation within undergraduate training. Tradition of learning on the job (experiential learning theory).
Patient safety Standardized education Growing evidence for Hone skills in a controlled simulation. environment Skill retention The “lightbulb moment” Guide learners actively working through their As teachers we are not trying to experiences. impose ideas or form habits, but Adult learning theory to assist then in properly (Taylor and Hamdy). responding to the influences. Child learning is still present in adults (Piaget). Without support students Focus on how learners get may not be able to make to the answers – adequate sense of their experiences (Kolb). especially the wrong Reflection and ones. conceptualisation occurs in their head.
Experience alone is not Theory of the zone of proximal development. enough – also need social Also improves leadership and interaction (Vygotsky). team collaboration (Lewin). Reflection is also crucial for the active process of learning - guided Gibb’s reflective cycle to enhance student learning. Debrief allowed students to better make sense of their role as an on-call doctor and assisted them in the prioritising and accomplishment of tasks. Our results show it is an effective approach in bridging the gap between theory and practice regarding on-calls (Bloom’s taxonomy).
Bloom’s Taxonomy Figure from teachthought.com
Participants were self-selected (volunteer bias) Small sample size One small aspect of practice in the future Limitations Lack of a validated self confidence tool Taking over a project introduces various new considerations Not all people are the same Above theories are what should Practice can be different to what is taught happen in ideal practice: in medical school
We have developed an effective and sustainable simulation that has shown excellent results at the time of teaching and two years on. Due to the positive reaction, low Conclusions maintenance, and reproducibility of the project, we aim to cement our teaching programme as a permanent feature. We aim to expand this to involve other essential skills required by an FY doctor as part of a larger programme.
Validated self-confidence tool – pre- and post- teaching. Formal statistical analysis. Future Having taken over the Ethical approval: project, this was not thought of initially. Ward round simulation – trying to get students to take part in service delivery to give them a sense of satisfaction from useful contribution.
gmc-uk.org. (2018). Tomorrow's Doctors: Outcomes and standards for u undergraduate medical education . [online] Available at: http://www.gmc-uk.org/Tomorrow_s_Doctors_1214.pdf_48905759.pdf [Accessed 29 Oct. 2019]. Goldacre, MJ., Lambert, T . and Evans, J. (2003). Preregistration house u officers' views on whether their experience at medical school prepared them well for their jobs: national questionnaire survey. BMJ , 326(7397), pp.1011-1012. Kellett, J., Papageorgiou, A., Cavenagh, P ., Salter, C., Miles, S. and u Leinster, S. (2015). The preparedness of newly qualified doctors – Views of Foundation doctors and supervisors. Medical Teacher , 37(10), pp.949- 954. References Yardley, S., Teunissen, P . and Dornan, T . (2012). Experiential learning: u Transforming theory into practice. Medical Teacher , 34(2), pp.161-164. Morgan, J., Green, V . and Blair, J. (2017). Using simulation to prepare u for clinical practice. The Clinical Teacher , 15(1), pp.57-61. Fisher, J., Martin, R. and Tate, D. (2014). Hands on + hands free: u simulated on-call interaction. The Clinical Teacher , 11(6), pp.425-428. Dickinson, M., Pimblett, M., Hanson, J. and Davis, M. (2014). Reflecting u reality: pager simulations in undergraduate education. The Clinical Teacher , 11(6), pp.421-424. Esteban-Guitart, M. (2018). The biosocial foundation of the early u Vygotsky: Educational psychology before the zone of proximal development. History of Psychology , 21(4), pp.384-401.
Thank you!
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