Foundation Doctors’
Simulation at CHFT
Dr Sarah Hoye
Simulation Opportunities
• Training days
– Combined:
• FY1 Day 4 (Human Factors & simulation)
• Fy2 Day 3 (Leadership & simulation)
• Simulation Spring
– Run during mandatory weekly teaching 1-2pm
Training Day
• The practicalities
• Theory of Human Factors
• (Have you ever…., Swiss cheese, buckets – self, context, task)
– “Distracters and errors” video & role play (scripted)
• SUI’s & RCA’s & Incident reporting & Dennis’ Story
• Handover – theory, simulation & discussion
• Theory of effective leadership
– Bromiley Video
• Medical crises simulation – authoritarian approach
• Reflections, conclusions, learning outcomes review
Combined Training Days
• 9 sessions from January – March 2014
• 5 FY1s & 4 FY2s per day
– Combined as 1 years experience supports others’
learn, encourages discussion (not all new) & eases
burden on CHFT time-wise.
• How we prepared?
– Venkat & I wrote PowerPoint after brainstorming
around the Aims & Objectives distributed by the
Foundation School
• Many SPA & OOH work
Training Day Incorporates…..
1. DVD, role play and script
2. Handover simulation
3. Medical crisis simulation (based on sepsis)
What we developed
• An 82 page PowerPoint that has instructions as to how to
explain content or proceed with interactive material
• Focussing on the sim components…….
– Sim in my eyes is not just mannikin use
– But should be flexible in definition, as long as interactive learning.
Therefore:
1. DVD, role play and script
2. Handover simulation
3. Medical crisis simulation (based on sepsis)
– As day progresses, sim work gets harder but their
confidence is built up and repetition used.
DVD, Role Play and Script
• DVD extract “Distractors and Errors”
– Highlights 3 buckets: self, context, task
• They then do 4th run-through – the perfect
management of how to deal with distractions
& Human Factors when reviewing a septic
patient
Handover Simulation
• SBAR & components of a good handover
• Focus areas – leading simulated handover
– Presentation skills
– Situational judgement
– Risk assessment
– Prioritisation
Leadership Simulation
• Theory – how hard it is to be authoritarian etc.
– Elaine Bromiley video
• Then practical – they get to lead the team
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all 9 people involved: patient is an FY
FY stands back and instructs them in sepsis scenario
repeat+++
LIFELINES! – show cards
REFLECTION really important to support learning
(example – not prescribing antibiotics but talking about it)
ASK THE
AUDIENCE
PHONE A
FRIEND
50:50
Challenges
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Faculty recruitment
Faculty training
Faculty quality control!
FTPD time to support session delivery
Enthusiastic groups better for interactive
approach
• Sim is ‘scary’ as on the spot reaction needed,
immediate feedback and variety of skills levels
Plan for the future
• Spread days more evenly round the year
– 1 per month avoiding winter
• Reduce number of days from 9 to 6
– Less pressure on faculty
• Try to ensure FTPDs are on ‘lighter’ clinical days in case of ‘emergency’
– Means more trainees (14 per day)
• Split afternoon: 1 group does handover / 1 sim than swap?
• Suggestion: trainees to make handover with info given
• more challenging & last longer
• Develop 2nd simulation scenario for afternoon?
• Split larger group functions into 2 for sepsis sim, but keep together
– half to observe and reflect on HF issues & half to sim
• Use new simulation suite +/- sim man
Simulation Spring
• Run during weekly teaching 1-2pm
– 4 sessions over 8 week period
– Alternate sites – Calderdale / Huddersfield
• Learning outcomes based around
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Prioritisation
Communication with MDT
Task delegation
Patient review & management planning
Knowing when to seek support
Acutely ill patient common scenarios