LAUSR

Background Simulation teaching in the Leeds Teaching Hospitals’ Trust Acute Medicine department began as sessions in a dedicated, non-clinical, sim suite however we quickly recognised limitations with authenticity and attendance, with people often struggling to leave their respective wards. The concept of the teaching was well received, which spurred on our desire to develop the programme. Following reconfiguration of an acute medicine ward to include a High Observation Area, we seized the opportunity to trial in-situ simulation in a clinical space. A significant barrier to overcome was the constant bed pressures of an acute admissions ward - something that has always been a limitation to simulation in Acute Medicine previously. This was achieved by clinical leaders and patient flow coordinators agreeing with the importance of a protected space and recognising the potential to reduce team anxiety when caring for higher acuity patients. Summary of education programme Our in-situ SIM programme is a once weekly afternoon session involving medics (predominantly Core Medical Trainees), nursing staff and allied health care professionals. It follows a format of pre-brief, handover and real time clinical practice. The session is completed with a detailed debrief, focussing on areas of good practice and human factors education. Summary of result The programme is in the early stages of development, however initial results are promising, particularly relating to MDT involvement. There is a greater feeling of empowerment to voice concerns and ideas in real time, improved communication amongst team members, with better understanding of each others’ skill sets and limitations to practice. This results in a more collaborative approach to enhance patient care. Additionally, all participants have reported feeling more confident in managing a wider range of medical emergencies, and trainee clinicians describe feeling more prepared for the transition into a leadership role in high acuity circumstances. Recommendation Future development includes enhancing realism to improve immersion in the clinical scenario. We hope to instigate this by removing observing delegates and faculty and live streaming the session to a neighbouring room. We believe this will help to alleviate anxieties of the active participants and thereby decrease the cognitive load to achieve better learning outcomes. Conclusion To date, moving simulation teaching to an in-situ setting has been well received, allowing a more realistic teaching platform for all healthcare professionals. It has promoted an attitude of ‘work together, learn together’ and created a greater sense of team in a fast-paced, high-stress environment.