We've been on quite a journey. Back in 2004 the flagship course at our centre was 'Medsim'. This was a one day simulation based course for medical students in their 5th year. It was mandated by the University of Liverpool, and mapped to the undergraduate curricula, and we trained 360 students per year over 30 days. It always ran on a Friday in the early days and was a great way to round the week off.
The day would run the same way every time, same four scenarios same four lectures, and it has to be said the same excellent scores from the students in the post course evaluations. By 2010 it had become a comfortable old friend, beloved by all. Actually that's not strictly true, The post course evaluations were beginning to mention how the scenarios were predictable. Students talk to each other, and it is no surprise that we lost the element of.......well, surprise. Aside from that an increasingly common suggestion from the students was "This would be so much better if we had real nurses in the scenarios".
Undergraduate nursing and medical students train together
At the time centre faculty would play the role of a junior nurse in the scenario, but even though we went to great lengths to 'blend in' we were always seen as at best a facilitator or worse an instructor. The students were telling us that they didn't understand what the role of the nurse in an emergency was. They also had anxieties about how they should interact with nurses, what tasks could they delegate and how skilled were the nurses?
There was also a perceived inequity on the part of the undergraduate nursing schools in Cheshire and Mersey. Although the higher Education Institutes were providing their nursing students with simulation there was only limited access to the Regional Simulation Centre for them.
Then along came 2010 and a renewed focus on Inter-professional Learning, or Team Based Learning in the region. As it happened we had a great deal of experience of delivering Team based Simulation, nearly all of our courses focused ensuring that teams who work together train together. Examples of this multi-disciplinary approach to simulation included, paediatric intensive care, trauma, and outreach teams amongst others. Ironically we only ran two single speciality courses and one of those was 'Medsim'.
However, we had managed to build up strong links with Higher Education in the six years since the centre opened, including the nursing schools. In 2010 we piloted nurse sim, and three Universities participated. It was time to start exploring these links, and in particular their appetite for inter-professional Simulation. looking back it seemed a 'no brainer'. The nurses were coming to the centre, the medical students were coming, why not combine them into one course. Hey Presto! Team Based learning delivered.
Of course it wasn't that simple. logistically there was a lot to consider. 450 Nursing students across three Universities, and 360 medical Students. Coordinating that lot into 60 one day courses from September to June was quite a headache. Fortunately we were able to get the key stakeholders around the table. Somehow after pouring over spread sheets and crunching numbers we were sort of able to cobble together a pilot project. Funding for this was forthcoming after a successful application to the local Health Education Innovation Cluster.
The students loved it. We ran 10 days to test out our programme, and iron out the kinks. One of the big advantages was that we were able to place the students into scenarios in a realistic skill mix, and explore issues of communication, team work and shared mental models. students were able to better appreciate each others roles, and reported increased confidence at the end of the course. there were also opportunities to identify gaps in knowledge, feedback to the university anonymously, and develop interventions to address these.
STABILISE 1 was born (Simulated Team Based Learning 1). We also run a STABILISE 2 which puts foundation year doctors and junior nurses together on the same basis. It is our aim to develop a continuum of simulation based education in the region. We have now developed a library of 24 scenarios and randomly pick 6 on each course day. This minimises the anticipation of scenarios by students.
We have now been running the courses for two full years. They are not without problems. The course is mandated for medical students, but not yet for the nurses. This has meant turn out is variable. It is also important to mix the students at the start of the day to avoid the formation of an 'Iron Curtain' down the middle of the lecture room, nurses on one side medical students on the other. Ice breakers are also important.
The challenge for us now is providing opportunities for inter-professional learning for other undergraduate groups. We are already exploring the possibilities with student midwives, paramedics, and pharmacy students. This will require imagination and strong buy in from the Universities, but we are not daunted. The journey goes on.
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