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Virtual On-Call (VOC): Using simulation based teaching to prepare final year medical students for their first on -call shift
C.Halevy1 , R. Evans1 , X. Lee1
1 King’s College Hospital, London, United Kingdom
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Background
The COVID-19 pandemic has had an unprecedented effect on medical education in the past 2 years, affecting 2 cohorts of final-year medical students. In particular, a study completed by Choi et al1, found that, on average, 59.3% of the student cohort felt less prepared to start FY1. In particular, they felt that the postponement or cancellation of student assistantships had the largest impact on this.
Tolsgaard2 described a framework of “continue, postpone, adapt, drop, and add”, to consider how aspects of medical education could be changed. Taking this into account, a ‘Virtual On-Call’ simulation session was set-up at King’s College Hospital to develop a COVID-safe environment for in-person teaching. The sessions, facilitated by current foundation doctors, allowed final year medical students to experience an ‘on-call’ with case-based scenarios. Students were asked to review patient, by means of a case file, thus allowing them to consider the management of an acutely unwell patient. They also had opportunities to learn how to prioritize jobs, along with giving and taking handovers.
CYCLE 1: Aug 2021 – Oct 2021
Establishing ‘VIRTUAL ON-CALL’
P• Set-up weekly simulation-based teaching sessions facilitated by juniors doctors.
• Design feedback form to measure pre- and post- session confidence levels of students
• Introductory talk given at Induction
D• Liaise with PGDME* about attendance
• Created WhatsApp group for facilitators
• Created QR codes for easy access to feedback form
LOGISTICAL:
• Low uptake of feedback forms
• Inconsistent attendance
S• Difficult punctual 5pm start time
TEACHING CONTENT:
• Identified out-of-date scenarios/materials
OUTCOME MEASURE:
• Global improvement in confidence levels
LOGISTICAL:
• QR code re-displayed with weekly WhatsApp reminders
A• PGDME staff to send weekly reminders
• Start time moved to 5.15pm
TEACHING CONTENT:
• Updated scenarios with up-to-date clinical guidelines
Results And Discussion
“
Aims
▻ To adapt an in -hospital simulated teaching program to a COVID-safe classroom setting and continue to provide equally high-quality teaching.
▻ To improve final year medical students’ confidence in managing the acutely unwell patient, prioritizing tasks, giving an effective handover, and knowing how to escalate.
Method
▻ The level of confidence along with other data was collected using a pre - and post-session feedback form between August 2021 and April 2022.
▻ The QI project used the model for improvement methodology, there were 3 PDSA cycles completed within this period.
CYCLE 2: Nov 2021 – Jan 2022
P• Continue weekly VOC and feedback collection
• Implement changes identified in Cycle 1
D• Refresher introductory talk given at induction
• Changes implemented from Cycle 1
LOGISTICAL:
• Improved feedback uptake and attendance
• Difficulties with facilitator engagement
STEACHING CONTENT:
• Students wanted formal handover teaching
OUTCOME MEASURE:
• Nil adverse impact on confidence levels from changes implemented
LOGISTICAL:
A• Email sent to foundation/IMT doctors for recruitment, with certificate incentive
TEACHING CONTENT:
• SBAR handover teaching at start of sessions implemented
"Some of the notes could be replaced/information has worn off
CYCLE 3: Feb 2022 – Apr 2022
P• Continue weekly VOC and feedback collection
• Implement changes identified in Cycle 2
D• Refresher introductory talk given at induction
• Changes implemented from Cycle 2
LOGISTICAL:
• Difficulty with real-time communication between facilitators/students
STEACHING CONTENT:
• Students wanted takeaway written material to support teaching given OUTCOME MEASURE:
• Continue overall improvement in confidence as reported by students
LOGISTICAL:
A• Virtual Noticeboard created to facilitate communication for real-time logistics changes
TEACHING CONTENT:
• A4 summary document drafted about SBAR handovers, job prioritization.
“ We had great facilitators who ran the session well and had great tips for us. I found having done the on-call session a second time I felt better and more confident.
“ [I would like] More practical advice e.g. how to contact colleagues, chain of escalation, writing a jobs list
Each question asked the students to rank their confidence in that particular skill on a scale of: ‘very unconfident’, ‘unconfident’, ‘neutral’, ‘confident’ or ‘very confident’. These answers were then allocated a numerical values from -2 to 2 respectively. An average was taken pre- and post- session for each cycle of students to demonstrate thetrend and allow comparison from cycle to cycle. Results demonstrated consistent improvement in confidence across all aspects. Due to the small number of students involved, it is difficult to prove statistical significance. Free-text answers also provided qualitative data and specified teaching content feedback.
WHAT WENT WELL:
• We were able to identify and adapt teaching content to student feedback, allowing appreciation of:
▻ Autonomy of managing simulated patient scenarios
▻ Reviewing practical aspects of on-call logistics with facilitators
▻ Effective handover techniques
• Effective use of technology to improve ease of organization and access to teaching materials/feedback
AREAS TO IMPROVE:
• Communication between VOC leadership team, facilitators, PGDME, and students to relay realtime logistical challenges and unforeseen delays
• Identifying methods to ensure consistent facilitator engagement across the year
• Feedback was student-focused, there is a gap for facilitators to feedback on barriers to effective teaching delivery
NEXT STEPS:
Introduce a feedback form for facilitators to identify barriers to delivery of teaching
Set-up real-time communication platform to triage logistical issues
Post COVID/ COVID-safe reintegration into hospital setting
PDSA 4: Formal handout sheet for distribution post-session (SBAR handover, prioritization)
