O31 Criticalcare simulation in undergraduate obstetrics & gynaecology at trinity college dublin: how this early application can make a difference

• Published in: BMJ simulation & technology enhanced learning Vol. 5; no. Suppl 2; p. A16
• Main Authors: Thompson, Claire, Daly, Ronan, Morrison, Gareth, Deane, Richard, Murphy, Professor Deidre
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group LTD 01.11.2019
• Subjects: Confidence; Critical care; Gynecology; Obstetrics; Simulation; Students
• ISSN: 2056-6697
• DOI: 10.1136/bmjstel-2019-aspihconf.29

IntroductionUndergraduate critical care training is often sub-optimal. Poor recognition combined with lack of knowledge, failure to appreciate clinical urgency or seek advice and poor communication have been identified as contributory factors. In a recent Year 4 student evaluation conducted by Trinity College Dublin (TCD), only 23% stated that current undergraduate training would prepare them adequately to care for acutely ill patients. To address this, a 2-hour simulation training session on critical care in Obstetrics and Gynaecology was designed.MethodsObservational study comparing student performance managing a critical care scenario before and following a new critical care simulation training session. This applied a systematic ABCDE approach with an Assess, Intervene and Review (AIR) strategy. Students then applied this in simulated cases.Ethics approval obtained through TCD Ethics Committee. Participation was voluntary and assurance that this study would not impact final examination results. Students within the last rotation of the academic year were invited. They completed an anonymised Pre- and Post-simulation session questionnaire on their confidence in assessing/starting basic management of Airway/Breathing/Circulation/Disability/Exposure. Rated as 1 (no confidence) till 5 (very confident).Two 8-minute OSCE structured assessments were designed (First held at the beginning of the rotation/pre-simulation and then at the end of rotation/post-simulation). Clinical scenarios were marked against a standardised proforma by trained TCD staff. Statistical analysis was performed via 2 tailed T-test.Results27 students took part. On pre-simulation questionnaires, 37% felt unconfident that current training prepared them for caring for critically ill patients. However, following the simulation training, student confidence levels rose in all areas and achieved statistical significance.ABCDE assessment: t–value 5.23273 p–value <0.00001.Airway: t–value is 3.64701, p–value 0.000316.Breathing: t–value is 5.20154, p–value <0.00001.Circulation: t–value 6.65139, p–value <0.00001.Disability: t–value 9.17396, p–value is <0.00001.Exposure: t–value is 8.28241, p–value is <0.00001.100% wanted more simulation in the undergraduate curriculum.Objectively students showed statically significant improvement in their OSCE scores and their global assessments. On comparison of the two assessments: t-value 6.37027, p-value <0.00001.Discussion/ConclusionsDespite the small study number, a clear statistical improvement in performance was seen following the new simulation session. Feedback from the entire year group has been positive.Early application of simulation is now essential in medical training. This includes undergraduate level, in order to prepare students adequately to provide effective and safe patient care. We therefore fully recommend this approach to expand in undergraduate training.