LAUSR

Background We created a high-fidelity simulation course to target discrepancies in the induction of non-training overseas doctors. A number of barriers were identified during course development, which required review. Summary of work Through extensive surveys, we identified work-based challenges not covered in local induction and incorporated these into high-fidelity simulation scenarios and debrief, with a focus on ethical and legal dilemmas. Topics such as ‘Effective Referrals’ and ‘Difficult Communication’ were covered using additional workshops and tutorials. The one-day course was directed at five foundation-year two (FY2) grade equivalent doctors facilitated by four faculty members. This meant all candidates could ‘lead’ and ‘assist’ in the scenarios. Summary of results and discussion Barriers to initially implementing the programme included financing and obtaining study-leave for attendance. We used the positive feedback from the pilot sessions to secure funding with the support of the Medical Education department. Confidentiality issues meant that we were unable to acquire a list of non-training overseas doctors within the trust. We therefore relied on contacting individual consultants to identify potential candidates. Unfortunately, this meant that we could not capture all the overseas doctors within the Trust. 94% of the participants (n=16) had not participated in simulation-based training before. This created several issues, such as, presuming that the course was an assessment or misunderstanding the teaching format. Consequently, we send pre-reading materials and links to our informative simulation-suite website to each candidate. More time is also allocated to introduce the manikin and simulation room. Adhering to recommended simulation standards,1 both the candidates and faculty sign a confidentiality agreement. However, the pilot sessions highlighted some unsafe practice. We have since altered our confidentiality forms, so individuals are directed to their supervisors for additional support if needed. Interestingly, differences were noted during debrief with this diverse multi-cultural group. Phrases from the observing candidates such as ‘You were rubbish!’ and ‘You killed the patient!’ were much more common, and we as a faculty, were not used to such direct judgmental phrases. We had to reinforce debrief rules to ensure that all candidates would feel comfortable during debriefing. Conclusions and recommendations We discussed a number of challenges in the development of such a faculty-intensive course. Despite this, for both faculty and candidates the course was extremely fulfilling. All candidates reported the course as ‘essential’ for their induction and were keen for further simulation-based learning, which we are endeavouring to secure into Trust Induction. Reference Dieckmann P. Simulation settings for learning in acute medical care. In: Dieckmann P (ed.), Using simulations for education, training and research 2009. Lengerich: Pabst: 40–138.