Simulation Teaching in Psychiatry

Simulation Teaching in Psychiatry

Elizabeth Shaw | ST6 General Adult / Old Age Psychiatry

Beginnings…

• 2015

• Director of Medical Education, Mersey Care NHS FT

• Core Psychiatry Trainees to develop and lead a novel teaching session

• Local context:– FY2s on standard 1st on call rota

– FY1s on tailored on call rota

– Anecdotal feedback from doctors/nursing staff of difficulties….

Aims / Requirements

• To prepare doctors new to psychiatry for on call work

• To cover a range of situations, from routine/basic, to more complex/specialist

• Locally focused

• To provide a teaching opportunity for psychiatry CTs/STs

• Low cost (free!!)

• Sustainable

• Potentially transferable to other localities

The Teaching Session

• 3 hour AM or PM session, delivered as part of induction, mandatory for ALL doctor grades

• Teaching delivered by CT2s and above – STs/consultants completing WBPAs for those delivering

teaching

• Large room, with 6 ‘simulation stations’

• FTs/GPSTs/CT1s form small groups, moving around the simulation stations, a different trainee taking the lead on each new scenario

Example Timetable

0900 Organisers and

facilitators arrive

Explanation of session to facilitators. Assign facilitators to

scenarios they feel able to teach, providing guidance if

required.

0930 Learners arrive Explanation of session, distribute learners into 6 groups,

completion of pre-session feedback.

0945 Scenario 1 Each scenario should be led by one learner, however

ensuing discussion should include the whole group and be

dynamic, addressing issues as they arise.0910 Scenario 2

0935 Scenario 3

1000 Break

1030 Scenario 4 Higher trainees may ‘rotate’ through the scenarios,

providing AOTs and evaluation to more than one facilitator.1055 Scenario 5

1020 Scenario 6

1145 Feedback and close

session

All feedback forms to be completed (learners and

facilitators). Certificates distributed.

Scenarios

1. Medication chart (stinger – provided GP summary has old and new antidepressant listed)

2. Rapid tranquilisation3. Section 5(4) and 5(2)4. Patient clerking and alcohol misuse (includes

prescription of detox regime)5. Task prioritisation6. Agitated elderly (stinger, the patient is lithium toxic)

(6 additional and more complex scenarios developed which include CAMHS ward, Methodone, Section 62, S136 and A&E assessment)

Example Scenario

Facilitator HandoutSimulation 5: Task Prioritisation

Scenario Details: The trainee is the on-call doctor covering multiple psychiatry wards, including General Adult, Old Age and a High Secure Forensic Unit. It’s 7:30pm and they have two hours remaining until handover at 9:30pm. They have tasks 1-4 in-front of them and have been asked to prioritise them.

When they have done this you should introduce tasks 5 and 6.

Example Scenario

Task 1: Nurse concerned as although she’s been off for a week thinks patients bilateral leg oedema is more swollen than normal. Known cardiac failure, on furosemide, has cardiology OPD in 2 days. Obs stable, sat comfortably.

Task 2: Rewrite a few drug cards, there is no space left.

Task 3: New admission arrived, medically fit in A&E, detained under Section 2. Floridly psychotic, agitated, known heroin user. One previous admission last year, known to both substance misuse and home treatment team.

Task 4: Positive MSU result (sensitive for trimethoprim) patient not currently prescribed antibiotics.

Example Scenario

Task 5: You play a nurse on an old age ward 10 minutes away ringing to ask for a 75 year old gentleman who has been on the ward for 2 weeks with possible dementia to be reviewed due to the following results which concerned you: BP 135/85, RR 14, SATS 90%, Pulse 90. If enquired you reveal: his observations have been stable for the last 2 weeks, he is otherwise alert and well with no known past medical history or medication other than a Tiotropiuminhaler.

Task 6: You are the duty manager at Ashworth 30 minutes away ringing at 7:30pm to remind the trainee of seclusion reviews due at 9pm and to confirm that you are planning to attend.

Feedback

• Pre- and post- training feedback• Likert scale (1-10) on confidence within psychiatry on

calls• Free text boxes

• Session 1 (Aug 2015)– 14 FTs– Average likert increase of 3 points (4 to 7)– ALL stated their concerns/anxieties around on calls had

been addressed, and that they had met their aims for the session

– ‘innovative’ ‘enjoyable’ ‘very good’ ‘a great idea for new doctors’

Feedback

• Aug 2017

– 17 FTs

– Average likert increase of 4 points (2 to 6)

– 15/17 felt their anxieties were addressed, 17/17 felt they gained what they wished to from the session

– ‘very good’ ‘very useful’ ‘this needs to be a whole day’ ‘very well run’

– Similarly positive feedback from GPSTs, CT1, and the facilitators

Progression

• Simulation Teaching now mandatory at induction at all three ‘Mersey’ Mental Health Trusts– Mersey Care NHS Foundation Trust– Cheshire and Wirral NHS Foundation Trust– North West Boroughs NHS Foundation Trust

• Free• Tailored to local protocols, policies, and problems• Consistently receives good feedback from FTs• Development and organisational roles passed on

to new CTs

Thank you