FY2 Simulation Teaching at Frimley Park Hospital

Dr Jess Wynter Bee Feb 2013

Simulation

Imitation of a real life situation to find the cause of a past occurrence (e.g. accident) or to forecast future events.

Simulation teaching for FY2 Doctors

Simulation sessions offered to all FY2s at Frimley park Hospital

Supervised by a consultant

Range of scenarios which cover a variety of areas including: Clinical judgement Team management Communication skills.

Benefits of Simulation

One-to-one feedback from a consultant

Peer feedback

Safe environment to practice and find areas to improve

Increases confidence in actual clinical situations

5 week course developed at CUH Aimed at medical students to help them feel more

confident in dealing with acutely unwell patients Covers common medical emergencies + how to

manage them

Simulation Teaching for Medical Students

Survey and quiz used to assess effectiveness

100% students who completed the feedback thought simulation should be used more in medical schools and would recommend the course.

Pre-course Post-course Confidence Ranged from 0-5/10 Ranged from 5-8/10 Quiz score 92% scored <50% 100% scored > 60%

Programme

Week 1 – How to manage the sick patient Week 2 – Chest pain + Palpitations Week 3 – Breathlessness Week 4 – Renal + Diabetic Emergencies Week 5 – Headache, Seizures + Confusion

Each session is divided into: Theory section Simulation Scenarios

DR ABCDE System Look Listen Feel Measure Treat

Airway Foreign Body Oedema, Blood Vomit, Trauma, Burns

Speech Gurgling Stridor

Air movement Airway adjuncts IM Adrenaline

Breathing Colour, SOB, Accessory muscle use

Breath sounds Crackles Wheeze

Trachea Chest wall movement

RR, O2 Sats ABG CXR

Oxygen Nebs

Circulation Colour, Oedema Raised JVP, Haemorrhage

Heart sounds Crackles

Pulse Peripheries Oedema

HR, BP Cap refill ECG

IV access + bloods IV fluids Antibiotics

Disability Pupils Confused speech No speech

Neuro exam Meningism

AVPU/GCS BM Head imaging

Glucose Insulin Naloxone

Exposure Rashes, Bruises, Pressure sores, Trauma

Hypovolaemic Shock Airway - NAD

Breathing - SOB - High RR, Low Sats - ABG - Oxygen

Circulation - Pale - Weak pulse, cool

- High HR, Low BP - IV fluids/Blood

Disability - Low GCS

Exposure - Haemorrhage - Where is the bleed?

Clinical Scenario: You are an FY1 covering the wards over night. A nurse has asked you to come and review Mrs Beryl Garden, a 75 year old lady who was admitted following a fall at home. She recovered well and is currently awaiting a package of care. However this evening she has become very confused and agitated. Please assess her condition using the DR ABCDE approach.

Instructions for Operator Danger Safe to approach Response Px awake but drowsy and confused Airway

Px is awake and speaking but only in confused sentences which do not make sense

Confused speech Airway clear

Breathing - Look - Listen - Feel - Measure - Treatment

No cyanosis, Symmetrical chest movement, Good air entry, No added sounds Trachea central, Good chest expansion RR 20, Sats 96% ABG: pH 7.30, PCO2 4.0, HCO3 11 High-flow oxygen via bag-valve mask

Circulation - Look - Listen - Feel - Measure - Treatment

Px looks flushed. No oedema, Normal JVP Normal Heart Sounds, No basal crackles Cap refill <2 sec, Regular rapid bounding pulse, Warm peripheries HR 110, BP 95/50, T 38.4, UO 25ml/hr, ECG sinus tachycardia Urine dip – nitrites + leucocytes 2 wide bore cannula Bloods (FBC, U+E, LFT, CRP, Ca, Phos, Mg, Glucose, Cultures) IV fluid + Antibiotics to treat urosepsis

If student gives IV fluid obs improve to: HR 90, BP 110/70, RR 18, Sat 98%, T 38.3

Disability - Look - Listen - Feel - Measure - Treatment

Pupils equal and reactive Confused speech No obvious abnormal neurology AVPU = A if fluids given, P if fluids not given GCS = 12 if fluids given, 8 if fluids not given BM = 7 Close monitoring in a quiet environment

Exposure - Look - Listen - Feel - Measure - Treatment

Flushed Ongoing management: IV fluids + antibiotics, Fluid balance chart +/- catheter, Senior review

Quality control

Senior review of teaching materials and observation of teaching sessions

Student feedback for individual sessions

“Interactive and very useful feedback” “Sim suite very useful”

“Pitched at the right level, relevant and helpful”

Pre + Post-course survey and quiz

Course booklet Discussions with medical schools

Other hospitals