Using Fully Immersive ‘In Situ’ Simulation to Prepare New Foundation Doctors to Work in an Acute Setting

Introduction: Patient safety around the time of medical changeover day is of interest worldwide. Negative perceptions have now been supported by evidence that patients who are admitted on the first Wednesday in August in England with a medical primary diagnosis have a higher early death rate. Junior doctors are often the first to assess deteriorating patients. Delay in admission to intensive care due to suboptimal recognition and resuscitation of the acutely unwell patient increases morbidity and mortality. Methods: Foundation Year One Doctors (FY1) at our institution were invited to participate during the start of their induction period. There were 34 participants in August 2014 and 27 in November 2014. The study was divided into 3 phases; (1) a fully immersive in-situ simulated scenario in an actual clinical area followed by an immediate video assisted debrief focusing on severe sepsis, acute kidney injury and non-technical skills, (2) a lecture outlining any latent errors discovered and also recapping the treatment of pneumonia, sepsis and acute kidney injury and then (3) a further simulation 3 months after starting their post. Post scenario questionnaires collected demographic data and information on confidence and views on simulation as an educational modality on a Likert scale. Results: Data was collected around the management of the ‘sepsis six’ (oxygen therapy, fluid administration, blood cultures, antibiotics and lactate). Confidence in dealing with sepsis in August was rated as 3.41 and in November as 4.15. Key themes around environment, communication and technical skills were identified in the post scenario debrief. Discussion: This study showed that many of Foundation Year One Doctors were unable to implement the Sepsis bundle, prescribe the correct antibiotic treatment or summon the Medical Emergency Team for a patient with severe sepsis during a fully immersive in-situ simulation at the start of their medical careers. This pilot study identified key deficits in knowledge and familiarity of the new working environment that impacted on best treatment for the patient in the scenario. Further research is required to aid provision of a tailored programme to enable new medical graduates to provide safe and timely treatment to patients in an environment they feel confident to work within.