P-36 Introducing a palliative care simulation day for final year medical students
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Abstract:
Background
Simulation-based medical education recreates challenging end-of-life scenarios to teach key palliative medicine skills, enhance patient safety and promote participant psychological safety. A palliative medicine week for Queen's University Belfast final year medical students was designed to support application of the palliative medicine undergraduate curriculum, incorporating blended learning of communication skills, simulation, and clinical immersion.Methods
A multidisciplinary teaching faculty of consultants, registrars and specialist nurses developed four simulation scenarios on opioid toxicity, breathlessness, constipation, and agitation. Learning outcomes were mapped to Outcomes for Graduates (General Medical Council, 2018) and the Palliative Medicine Curriculum for Undergraduate Medical Education (Association for Palliative Medicine, 2014). Facilitators received simulation instruction and ran practice sessions with volunteer simulation staff and students. Each scenario includes a debrief and opportunity for repeat simulation, reinforcing skills and boosting confidence. The simulation session is delivered using high quality manikins on simulated wards and contemporaneous feedback is collated.Results
Expert advice, scenario practice and volunteer feedback enhanced scenario development, identifying a key focus for each, therefore spotlighting main learning outcomes and maximising impact. Early qualitative feedback has been unanimously positive. Students identified that scenario complexity and novelty increased value and engagement. Students felt facilitators were supportive, the feedback mechanism was safe, and multidisciplinary input added benefit. Facilitators found the students enthused and engaged. The opportunity to repeat challenging simulations saw students develop confidence and skill in palliative care competencies.Conclusions
Expert advice and trialling scenarios enhance simulation development and promote alignment with student expectations and priorities. Facilitator training, especially debriefing, and opportunities to repeat simulations maximise the learning experience and may be particularly important in palliative care simulation. A multidisciplinary approach highlights the significance of effective interprofessional competency and collaboration. Feedback is crucial in enriching the quality of palliative care simulation in education.References
Association for Palliative Medicine (2014, February). Association for Palliative Medicine curriculum for undergraduate medical education. https://www.apmuesif.phpc.cam.ac.uk/apm-curriculum/ General Medical Council (2018, June). Outcomes for Graduates. https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/outcomes-for-graduates/outcomes-for-graduatesKeywords:
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Debriefing is widely recognized as a critically important element of simulation-based education. Simulation educators obtain and/or seek debriefing training from various sources, including workshops at conferences, simulation educator courses, formal fellowships in debriefings, or through advanced degrees. Although there are many options available for debriefing training, little is known about how faculty development opportunities should be structured to maintain and enhance the quality of debriefing within simulation programs. In this article, we discuss 5 key issues to help shape the future of debriefing training for simulation educators, specifically the following: (1) Are we teaching the appropriate debriefing methods? (2) Are we using the appropriate methods to teach debriefing skills? (3) How can we best assess debriefing effectiveness? (4) How can peer feedback of debriefing be used to improve debriefing quality within programs? (5) How can we individualize debriefing training opportunities to the learning needs of our educators?
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The article is the first of two describing the contingencies that drive and influence the operations of multidisciplinary palliative care teams. Australian research into the management of multidisciplinary palliative care teams is introduced and appropriate elements of a wide-ranging literature review are reported. A model of the management and operation of multidisciplinary palliative care teams is presented to provide a context and to indicate the scope of the research completed so far.
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Context Simulation is commonly incorporated into medical and health programs as a method of skill practice and evaluation and can be effective at improving athletic training student learning outcomes when purposefully designed. Objective The purpose of this study was to determine what level of impact participation in supervised practice after debriefing within a simulation-based cardiovascular emergency scenario using the Laerdal SimMan in a university simulation center in the United States had on athletic training students' clinical performance. Design Quantitative quasi-experimental cohort design with repeated measures study. Patients or Other Participants Convenience sample of undergraduate athletic training students (n = 46) enrolled in a professional program at a university in the Midwest. Intervention(s) Participation in supervised practice of cardiopulmonary resuscitation skills after debriefing in a simulation. Main Outcome Measure(s) Clinical competency with associated cardiopulmonary resuscitation skills using the Laerdal Learning Application software program that interfaces with the simulation hardware. Results There was a statistically significant interaction between groups (F1,10 = 18.70, P < .05, η = 652) indicating participants in the supervised practice after debriefing group were significantly higher (mean = 0.72, SD = 0.05) than those that did not have supervised practice after the debriefing (mean = 0.17, SD = 0.05). Conclusions The design and development of a simulation experience is optimized when there is deliberate consideration of what components and exposure to these learning components will lead to certain outcomes. Even though supervised practice after debriefing has been identified as optional for skill-based simulations, the current study demonstrates that the supervised practice of clinical skills component is vital within emergency cardiovascular simulation encounters for participants to increase clinical competency.
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