Mishra V., Elankovan A., Winston I., Barts Health NHS Trust
Our team consisted of two simulation fellows and a final year medical student at the Simulation Centre in the Education Academy of Barts Health NHS Trust at The Royal London Hospital. We created an innovative immersive simulation course for medical students in their fourth year of training at Bart’s and The London School of Medicine and Dentistry. The course was designed to allow students to practice and improve upon their advanced communication skills making use of a range of clinical settings – GP, A&E, medical and psychiatric inpatient environments. The themes explored psychiatry, heightened emotional states and the biopsychosocial influences on mental and physical health.
We identified learning objectives and mapped the course to the university Year 4 curriculum learning outcomes as well as the Health Education England Future Doctor Vision and the Medical Licensing Assessment content map. Scenarios were then written by the trained simulation faculty on the team in conjunction with specialty experts across all core specialties for fourth year medical students including obstetrics and gynaecology, paediatrics, psychiatry, and healthcare of the elderly. The scenarios were created to reflect the demographics at The Royal London Hospital and its local area. Scenario design included the addition of detailed patient social history and population health information; this involved creating simulated patients from multicultural backgrounds, with limited English or other communication needs, as well as ensuring representation of gender expressions, sexual orientations, and a range of mental health and neurodevelopmental needs.
The pilot course was approved by senior simulation leads and undergraduate deans at the teaching hospital, and a group of 4th year medical students were recruited. The first simulation day took place on 2nd May 2023 with 7 student participants. Ahead of each scenario, students were briefed to differentiate between psychiatric symptoms and non-pathological human emotion. Following each scenario was a structured debrief session facilitated by an experienced debriefer and a subject expert. During the debriefs participants were encouraged to give consideration to how and why the patient in front of them presented the way they did, with regards to social determinants of their physical and mental state. They were also guided to reflect upon the technical and non-technical learning objectives of each scenario including use of Crisis Resource Management principles.
Qualitative and quantitative feedback was collected to determine success of the pilot course. The answers on a 5-point scale to all the following questions were increased following the course –
- I’m confident in my communication skills when talking to patients with a psychiatric diagnosis
- I am confident in my communication skills when talking to patients presenting with heightened emotions
- I feel confident differentiating between psychiatric symptoms and nonpathological human emotion
- I am able to perform a mental state examination
- I am able to perform a psychiatric risk assessment
- I am able to assess a patient’s capacity
- I can maintain an empathetic attitude when talking to patients with a psychiatric diagnosis / heightened emotions
- I can provide/explain relevant information to patients including around their condition and treatment
In view of this feedback and our observations on the day, we deemed the course beneficial for undergraduate training and feel that it meets its aims. Students felt this course enhanced their psychiatry experience and filled an educational need. The team are now in the process of securing the legacy of the course, including plans to formally approach the university to discuss implementation of the course into the core curriculum. Refinements could include further consultation with people with lived experience and use of actors to portray patients to ensure subjects such as immigration and neurodivergence are handled sensitively, ethically and accurately.
As early career educators, the process of creating and running this course was incredibly exciting for me and Archanaa. For me, this was by far the biggest project of my Fellowship year and probably one of the things I am proudest of in my career thus far. Creation of the course involved hard work, careful planning, and aspects of module design, curriculum mapping and liaison with stakeholders which taught me so much about the deeper underlying processes within Medical Education. It was really rewarding to see the work in action, the fruitful debriefs and the positive feedback from the students as outlined in the tables & graphs after so many months of work, and also to supervise a junior colleague through the process and feed forward all that I have learnt in my Fellowship year. I have been so proud to present this work at a number of conferences including ASPIH, RCPsych’s Annual Medical Education Conference as well as the RCPsych International Congress taking place in June, and we will also be running a workshop at the upcoming Maudsley Mental health simulation conference in May.