Context Musgrove Park Hospital is a district general hospital in Taunton, Somerset, in the South West of England. A total of 15 Internal Medical Trainees (IMTs) work there, rotating through a variety of medical specialties as part of their post graduate medical training.

Issue/Challenge The shape of training report within the UK changed the way medical trainees complete their core medical training, transitioning to a curriculum that aims to reduce the knowledge and skill gap between core medical training years, and becoming a medical registrar. Minimal formal training exists to help bridge this gap, which is often perceived by trainees to be a difficult step up.

Assessment of issue and analysis of its causes

Progressing from a medical trainee to a medical registrar requires the development of higher level clinical knowledge as well as non-technical skills (such as delegating, team management and inter-specialty communication) to be able to competently manage the medical take as well as specific medical emergencies such as a stroke. We therefore aimed to develop 2 simulation courses to address these knowledge gaps and empower trainees to feel more confident to manage these clinical conditions.

Impact Medical trainees valued the simulation courses, praising the ‘mixture of theory and practice via simulation’, ‘real world advice’ and ‘time to ask questions’. They appreciated the ‘relatable and familiar scenarios’ alongside ‘discussions to dispel concerns’ and opportunities to ‘gain experience and confidence’. Average confidence of ability to be the medical registrar was 3.17/5 prior to the course, rising to 3.67/5 after the course. 100% of attendees would recommend the day to other trainees. 100% of candidates noted increased confidence in completing an NIHSS score, and in leading stroke thrombolysis calls. All attendees completed identical pre and post-course quizzes on the acute management of stroke, with 100% of scores increasing after attendance at the course.

Intervention A full-day simulation course was developed, comprising of 6 common scenarios that a medical registrar would be expected to manage, with both clinical and communication cases. Each participant completed 2 scenarios, with debriefing sessions held throughout the day to discuss points of interest. Participants were IMT2s and ACCS trainees, shortly due to start work as medical registrars. Alongside this, a half-day on the specific management of acute stroke and thrombolysis was also developed as this is a skill required of a medical registrar that often provokes anxiety.

Involvement of stakeholders, such as patients, carers or family members:

IMT2 trainees at our hospital were asked what their biggest concerns were about stepping up to the role of medical registrar, and these suggestions were incorporated into the scenarios we developed. We also spoke to current medical registrars to ask what they wish they had been taught, as well as acute medical consultants to gauge what conditions or problems they are most asked for help with managing.

Key Messages Simulation remains integral to the education and development of postgraduate doctors in training, allowing acquisition of theoretical knowledge alongside non-technical skills combined with repeated real-time practice in a safe environment, increasing clinical confidence and patient safety.

Lessons learnt Post-graduate medical training can be improved with simulation courses such as this, allowing the practice and acquisition of skills that are required to move to higher levels of responsibility without the risk of patient safety. We would like to expand the simulation we can offer to include more scenarios, and invite more participants for this years programme.

Measurement of improvement Medical trainees were asked to rate their confidence in undertaking the role of the medical registrar, as well as specifically their confidence in managing acute strokes, both before and after the course. Identical pre and post course quizzes specifically on the management of acute strokes were also distributed to track the knowledge change.

Strategy for improvement The simulation courses will be repeated in this working year for medical trainees within our trust and our neighbouring trust. Feedback from the initial courses was overwhelmingly positive but we will continue to review and adapt our scenarios to address trainee concerns, as well as liaising with other relevant specialties to develop realistic, high-fidelity simulations, such as the critical care team. We will also aim to follow up with those who completed the course after 2 months of being a medical registrar to ask if there’s anything else that wasn’t covered that would be helpful to include.