Recognising the Sick Child
A Simulation-based Programme for Medical Students
Benita Morrissey, Michael Malley, Rebeca Carter, Rebecca Hewitson, Emily Martyn,
Paul Winyard, Caroline Fertleman
Background
•  Medical students lack confidence in recognising, assessing and managing acutely unwell children.
•  Death rates for acute illnesses in children, such as asthma and meningococcal sepsis, are higher in the UK than in comparable European
countries. The failure to recognise serious illness at presentation is a recurring avoidable factor in many of these deaths.
•  Only one half of medical students will do paediatrics again after qualifying as doctors, yet many will go on to assess and manage children in
emergency departments and general practice.
•  Undergraduate teaching in paediatrics and child health offers a short window of opportunity to teach medical students essential skills in the
recognition and management of serious illness in children.
Methods
•  We developed a tailored undergraduate simulation-based programme focusing on the
recognition, assessment and acute management of serious childhood illness.
•  The programme consisted of an opening session, teaching students a structured approach to
the acutely unwell child (the DR ABCDE framework,) and four simulation sessions, delivered
over a six-week period.
•  We piloted the programme with 16 medical students enrolled in the integrated BSc in
paediatrics and child health, and evaluated it using a mixed-methods approach.
•  Outcome measures included students’ confidence in recognising, assessing and managing
the sick child before, and immediately after the programme, then six months later. Students’
qualitative views on the simulation programme were also explored.
Results
Students assess and manage a child with suspected meningococcal sepsis
The programme generated a highly significant increase in students’ confidence in recognising the sick child (2.81/5 before versus 3.88/5 after
training; (p<0.001.) Students also showed significantly improved ability to assess the child with fever, rash and difficulty in breathing, and to
recognise and manage common paediatric emergencies (p<0.005). See table below.
Self-Assessed Confidence
(Out of 5)
Before Programme
Mean (95% CI)
After Programme
Mean (95% CI)
P
value
Recognition of the sick child
2.81 (2.37-3.26)
3.88 (3.49-4.26)
<0.01
Assessment of the sick child
1.81 (1.60-2.03)
3.44 (3.05-3.83)
<0.001
Knowing when and how to call for
help
1.81 (1.60-2.03)
3.44 (3.05-3.83)
<0.001
Awareness of roles of different team
members
2.25 (1.84-2.66)
4.19 (3.90-4.48)
<0.001
Assessing a child with fever
1.88 (1.44-2.30)
3.50 (3.16-3.83)
<0.001
Assessing a child with difficulty
breathing
2.13 (1.70-2.55)
3.75 (3.34-4.16)
<0.001
Emergency management of sepsis
2.25 (1.94-2.56)
4.19 (3.90-4.48)
<0.001
Emergency management of asthma
2.19 (1.79-2.59)
3.56 (3.23-3.90)
<0.001
Thematic analysis indicated students gained the following from the programme:
•  Confidence in recognising and assessing acutely unwell children
Students work as a team to assess and manage an acutely unwell child
Confidence in recognising acutely unwell children. Confidence in assessing a sick child.
•  Team-working and communication
Teamwork skills. Appreciation for the need to have a team leader. Better knowledge of how paediatric teams work together.
•  A systematic approach to assessing the acutely unwell child
A really good idea of how to take a systematic approach to managing a child using the ABCDE framework – good practice on this.
Gave us a framework to respond to scenarios, which builds confidence.
•  Increased confidence in a clinical environment
I feel much more experienced in a clinical setting. I learnt a lot and it was particularly interesting to learn more in a clinical setting.
It was really enjoyable and useful as we were given first hand experience. Although stressful at first, it is the best way to get you thinking on your feet and a
really good taste of what a real-life situation will be like.
Conclusions
•  A simulation-based programme is an exciting and effective method to introduce essential skills in the recognition and management of the sick
child to medical students, and is highly valued by undergraduates.
•  It also helps to develop important non-technical skills, such as teamwork and communication, and student’s confidence in a clinical environment.
Correspondence to: b.morrissey@ucl.ac.uk
Many thanks to the Whittington Hospital Simulation Suite for their support and expertise, and letting us
use the simulation suite. Thanks also to the iBSc students who took part and gave consent for their
feedback and photographs to be used.