Simulation can help us get the basics of care right

Michael Alcorn is a Geriatric and General (Internal) Medicine Specialty Registrar at the Southern General Hospital, Glasgow and Honorary Clinical Teacher at the University of Glasgow Medical School. You can view the poster of Dr Alcorn and team at this week’s BGS Scientific Conference, at exhibition space 66.

In common with other UK doctors in training, I have been taught in many different environments by many different teachers with differing understandings of what it means to teach and to be taught.   

In my experience, the most valuable learning experiences I have enjoyed have been those in which the teacher was well informed, motivated and passionate about their subject, as well as able to engage with me by taking time to find out what I needed to know. (I should mention that in my experience, geriatricians were very good at this, perhaps ultimately explaining my contribution to this blog today). Additionally, the experiences I remembered most clearly and learned from most lastingly were the ones in which I was in a position to make a real clinical decision and in some instances, even make mistakes.

In a year spent as a Clinical Teaching Fellow, one of the main educational projects I began was to become known as SimFYSS – Simulation for Foundation Year Survival Skills – in which we aimed to prepare final year undergraduate students to recognise and care appropriately for older inpatients in commonly encountered scenarios, such as multi-morbidity/frailty decompensation, hyperactive delirium and end-of-life care. A need for such specific teaching was identified by ascertaining that many Foundation doctors are not gaining experience in these areas as undergraduates.  This point has been underlined by the failings in care for older inpatients reported by the Mid-Staffordshire Public Inquiry.

Many readers will already be aware of the concept of simulation-based teaching methods. The basic premise of treating a simulated patient (mannequin/actor) and reviewing the process afterwards with expert feedback and insightful critique has become part of standard practice in certain acute/specific task-orientated environments. In SimFYSS, we aimed to leave behind the emphasis on high-acuity situations and place it more on day-to-day encounters on the hospital wards.

We paired enthusiastic and knowledgeable teachers with an innovative method of teaching that places appropriate responsibility on the student and provides an opportunity to make clinical decisions (and even mistakes) in a controlled environment. The decision making process is then explored and built upon in a realistic and memorable way, ensuring that future Foundation doctors are better equipped to face the challenges of caring for elderly inpatients much better, without reaching for clunky labels like “acopia” or sedative drugs – caring more holistically.

The course itself comprises four simulated scenarios and two interactive workshops, taking place as a single day of teaching in a simulated ward environment which is equipped with video surveillance, used for feedback provision. Our early results are strongly positive in terms of the confidence gained by students in dealing with the specific challenges of caring for elderly inpatients. Some of the most significant results were noted in the hot-topic domains of Dementia and End-of-life care. Keep an eye out for our poster at the BGS Harrogate meeting in November! We hope to expand the numbers of students who undertake the course next year and further explore the educational impact in due course with follow-up surveys in the months ahead.

Most significantly, we hope we have been able to contribute to better understanding of older inpatients’ complex care needs by Foundation doctors and spread clinical excellence in caring for this vulnerable population.

You can view the poster of Dr Alcorn and team at this week’s BGS Scientific Conference, at exhibition space 66.