1HR ON-CALL Dr Jyo Manalayil Collaborators: Dr A Ball, Dr D - - PowerPoint PPT Presentation
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
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. 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. 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 To allow final-year medical students to experience the pressures of being on-call Emulate internal and external stressors Within a safe environment
Identified needs and perspectives at an individual level Students held a bleep for an hour Sent throughout the hospital Relatively simple tasks - revolved around resourcefulness, communication and triage skills FOCUS: support their development and the non- technical skills, rather than assessment of their performance in the individual tasks Various resources were available for students The final station was an unwell patient Ended with facilitated feedback session
17 students over three years. Six in 2017, nine in 2018, two in 2019 All students report an increase in confidence 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
2017 2018 2019 What were the positive features
“G “Great introduction to holding a bl bleep” “L “Lots of support when required” “G “Good opportunity to navigate ar around the hospital al an and pr prioritise” “R “Really useful, realistic si simulation” “G “Good feedback + real life si situations” s” “G “Good to go around the ho hospital” “S “Several tasks to pr prioritise”
What could we do to improve this simulation?
“I “Individual feedback on paper” “R “Repeat once or twice” “M “More sessions” “I “Individual feedback” “M “More sessions”
Any further comments:
“E “Excellent session” “E “Excellent session” “O “One of the most useful le learnin ing experie ience in in pr prepa paration for being a ju junior doctor” “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).
There is scope for better preparation within undergraduate training. Tradition of learning on the job (experiential learning theory).
Growing evidence for simulation.
Patient safety Standardized education Hone skills in a controlled environment Skill retention The “lightbulb moment”
As teachers we are not trying to impose ideas or form habits, but to assist then in properly responding to the influences.
Guide learners actively working through their experiences. Adult learning theory (Taylor and Hamdy). Child learning is still present in adults (Piaget).
Focus on how learners get to the answers – especially the wrong
Without support students may not be able to make adequate sense of their experiences (Kolb). Reflection and conceptualisation occurs in their head.
Experience alone is not enough – also need social interaction (Vygotsky).
Theory of the zone of proximal development. Also improves leadership and 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).
Figure from teachthought.com
Participants were self-selected (volunteer bias) Small sample size One small aspect of practice in the future Lack of a validated self confidence tool Taking over a project introduces various new considerations Above theories are what should happen in ideal practice:
Not all people are the same Practice can be different to what is taught 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 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. Ethical approval:
Having taken over the 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
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