University Hospitals Sussex NHS Foundation Trust, Brighton, UK.
Brighton and Sussex Medical School, Brighton, UK.
BMC Med Educ. 2024 Jun 5;24(1):623. doi: 10.1186/s12909-024-05495-y.
Final year medical students and postgraduate doctors regularly contend with feelings of under-preparedness when transitioning into new areas of clinical practice. This lack of confidence is most evident in the context of on-call work which frequently requires sound clinical prioritisation, rigorous decision making and the management of acutely unwell patients, often with reduced senior support and staffing. This has prompted the emergence of on-call simulation which seeks to enhance participant confidence in performing on-call tasks and facilitate the development of key clinical and non-technical skills. This narrative review examined the use of on-call simulation in medical student and newly qualified doctor cohorts, its effectiveness in achieving its stated outcomes and to identify novel areas for the development of existing models.
A search strategy was developed in conjunction with a specialist medical librarian. OVID Medline and Embase searches identified articles related to the use and design of on-call simulation in medical education with no restrictions placed upon date or language of publication. Key findings from articles were summarised to develop comprehensive themes for discussion.
Twenty Three unique publications were reviewed which unanimously reported that on-call simulation had a positive effect on self-reported participant confidence in performing on-call roles. Furthermore the value on-call simulation when used as an induction activity was also evident. However, there was limited evidence around improved patient and performance outcomes following simulation. It also remains resource intensive as an educational tool and there is a distinct absence of interprofessional education in current models.
We concluded that on-call simulation must adopt an interprofessional educational approach, incorporating other clinical roles. Further studies are needed to characterise the impact on patient outcomes. It remains highly useful as a confidence-boosting induction activity, particularly in specialities where clinical exposure is limited. Virtual and tabletop simulation formats, could potentially address the resource burden of manikin-based models, particularly with ever growing demands on medical educators and the expansion of training posts.
在向新的临床实践领域过渡时，医学生和住院医师经常会感到准备不足。这种缺乏信心在值班工作中最为明显，因为值班工作通常需要合理的临床优先级排序、严格的决策制定以及对病情急剧恶化的患者进行管理，而此时往往缺乏高级别的支持和人员配置。这促使了值班模拟的出现，旨在提高参与者执行值班任务的信心，并促进关键临床和非技术技能的发展。本叙述性综述检查了值班模拟在医学生和新获得资格的医生群体中的使用情况，及其在实现既定目标方面的有效性，并确定了现有模型发展的新领域。
与专业医学图书馆员合作制定了搜索策略。OVID Medline 和 Embase 搜索确定了与医疗教育中使用和设计值班模拟相关的文章，对发表日期和语言没有限制。对文章的主要发现进行总结，以形成综合的讨论主题。
共回顾了 23 篇独特的出版物，这些出版物一致报告称，值班模拟对参与者在执行值班角色方面的自我报告信心产生了积极影响。此外，作为入职活动使用值班模拟的价值也很明显。然而，关于模拟后患者和绩效结果的改善，证据有限。作为一种教育工具，它的资源密集度仍然很高，而且目前的模式缺乏跨专业教育。
我们得出结论，值班模拟必须采用跨专业教育方法，纳入其他临床角色。需要进一步的研究来描述对患者结果的影响。作为一种增强信心的入职活动，它仍然非常有用，特别是在临床暴露有限的专业领域。虚拟和桌面模拟格式可能可以解决基于人体模型的模型的资源负担问题，特别是在医学教育者的需求不断增长和培训岗位不断扩大的情况下。
