P56 Multiple patient simulation in paediatrics – challenges for faculty and trainees

Background The use of simulation in Paediatric medical education is becoming increasingly well established. However, in almost all cases these are single patient scenarios which may not accurately reflect clinical practice. This is especially true at the middle grade level where management of the whole ward environment is crucial. There is little literature describing simulations of this nature, especially in Paediatrics. We designed and facilitated a scenario involving multiple patients in order to help junior doctors develop both clinical skills treating acutely unwell patients and non-technical and management abilities including prioritisation and delegation. Summary of work The multiple patient simulation session took place in a high-fidelity simulated ward environment, and was run as part of a whole day course for paediatric doctors ‘about to progress to the registrar grade. Faculty consisted of Paediatric consultants and registrars, and trained simulation staff including technicians and ‘planted’ nurses. The scenario included three main elements – an admission with severe asthma, an infant with sepsis, and new referrals and calls coming through to a bleep. The scenario was designed in such a way that each element could be tailored to either deteriorate or stabilise depending on the experience and progress of the candidate. Summary of results The multiple patient scenario has been run in five courses with 25 participants to date. It has been well-received – on Likert-scale questionnaires 100% of participants reported that the scenario was realistic, emulated a true on-call setting, and that they were better able to prioritise tasks in an acute situation. Free text feedback was overwhelmingly positive. Discussions and conclusions Both the scenario and faculty had to be flexible and adaptable to the myriad possible events in a multiple patient setting. Challenges for faculty included keeping an over-view of multiple patients with associated audio-visual support. It was also important to be aware of and prepared for the possibility of trainees becoming stressed if the scenario fell outside their previous experience or pre-existing expectations of simulation – as well as how to mitigate this and how their actions may change as a result. Feedback did not indicate any concern around this, and many requested more opportunity to do such scenarios. Recommendations The scenario adds a management aspect to the Paediatric registrar preparation course, and could be further developed to include nursing participants, ‘planted’ junior doctors for delegation and a larger variety of clinical problems including difficult conversations or absconded patients.