Improving undergraduate patient safety teaching using a simulated ward round experience

1. Improving undergraduate patient safety teaching using a simulated ward round experience Mr Ian Thomas Clinical Teaching Fellow

2. Background • Medical error is common • Most occur on hospital wards • As a result of human factors • Distractions play a major role • Ward rounds have lost their importance

3. Innovation Simulated ward round experience for final year medical students at the UoA Focus is on medical error and distraction

4. Why is this important? • Potential to improve patient safety. • New doctors do not feel prepared for graduation. • Currently we teach non-technical skills didactically rather than practically. • Simulation is the only safe way to practically train undergraduates in these skills. • The WHO and GMC are calling for this style of training. • First study to assess change in patient safety behaviours in medical undergraduates.

5. Student = FY1 • Lead the ward round: diagnosis & management plans • Staff nurse • Accompanies ward round – handover of patients Ward round has a number of error-prone tasks built in! • Volunteer patients • 3 patients with medical & surgical problems

7. Number of medical errors and management of distractions recorded Deployment of distractions

8. Method Prospective control study Intervention group Control group N = 14 Pre-test WR N = 14 Pre-test WR Sept 2013 Nov 2013 Feedback on distraction management No feedback N = 14 Post-test WR N = 14 Post-test WR Oct 2013 Dec 2013

10. Results 168 patient encounters and 28 hours of simulation

11. Spearman’s co-efficient = 0.663 P-value = 0.01

14. 42% 76% 68% 33% < 0.0001 < 0.0001 0.0001 0.0108

15. Simulation with feedback confers a 1.8 fold benefit in medical error making P-value = 0.0016

16. 2% improvement P-value 0.7929 86% improvement P-value <0.0001

17. Student acceptability • 27/28 students completed electronic questionnaire on the experience. • Highly acceptable and valued. Survey Monkey 2013

18. Discussion • Medical students are not inherently equipped to manage distractions to mitigate error. • These skills are required for safe foundation doctor practice. • Didactic teaching fails to teach these skills to students. • These skills can readily be taught through simulation. • Simulation with feedback is critical to gain most benefit.

19. Recommendation • Consider integrating this experience into the final year curriculum • Cost of 1 day of simulation = £100 – 400 • Cost of simulation/student = £7.14 - 28.50 • Arguably cost-effective teaching tool • Modalities to increase student capacity & reduce faculty burden exist • Further research opportunities exist and should be explored

20. Thank you for your attention