Context We developed a half day programme of fully immersive simulation in a purpose built high fidelity centre to address confidence and training needs of paediatric ST doctors returning to clinical work after a break in practice.
Problem Returning to work after a break from clinical practice is daunting. Many trainees have up to a year away from clinical work on maternity leave or out of programme experience (OOP). Trainees undertaking research have up to 3 years away. Feeling under-confident, stressed and de-skilled can result in underperformance which ultimately puts patient safety at risk.
Assessment of problem and analysis of its causes Research suggests that the length of time away from clinical practice is a key factor affecting a doctor’s performance when returning to practice – the longer the time out of clinical medicine in years the poorer their performance. 67% of doctors absent from practice for more than 18 months require moderate to considerable re-education or training.
The RCPCH has written guidence to support trainees returning to work however simulation as a tool facilitating this process does not feature. We conducted a literature review but were unable to find any stand alone UK simulation programmes specifically aimed at helping paediatricians return to clinical practice safely.
Intervention A Paediatric Return To Work Simulation Programme was developed and piloted to address trainees confidence, skills and knowledge.
We used scenarios mapped to the RCPCH curriculum covering key areas of emergency management, safeguarding, leadership, communication skills and human factors.
Study design The effectiveness of our programme was assessed using pre and post programme questionnaires (Table 1). Two questionnaires were undertaken immediately before and after simulation training and a final questionnaire was undertaken 3 months later following their return to clinical practice.
Our primary outcome was aimed at evaluating the trainees confidence levels managing neonatal, paediatric and safeguarding problems and whether these improved following our simulation programme. We were also interested in the overall learning experience perceived by the trainees.
Strategy for change All OOP trainees within the deanery were emailed information about the pilot programme. 25 trainees participated in the pilot from September 2013–2014.
Measurement of improvement 88% of trainees expressed concern about returning to clinical practice prior to the simulation. Reasons given included lack of knowledge, technical skills, confidence, competence and senior responsibility.
Likert scales were used to assess confidence in managing acute paediatric, neonatal, and safeguarding problems pre and post intervention.
Results -confidence All trainees found the programme beneficial
100% found the training useful preparation for returning to work.
100% agreed the experience learned from the training had been useful in their clinical work.
Free text responses were all overwhelmingly positive.
Effects of changes This programme improves confidence and the perceived ability of trainees to manage acute clinical problems. This positive effect appears to be sustained.
As a result of this pilot “The Paediatric Return to Work Simulation Programme” has secured funding and been approved regionally for trainees to attend prior to their return to clinical work.
Lessons learnt Organisations must have clear support and training in place to enable trainees to return to clinical work safely. Paediatric simulation can effectively facilitate this process. Future development would be aimed at identifying whether these positive effects result in an improvement in clinical practice and safety.
Message for others Simulation training programmes facilitating safe return to work should be available nationally and within other specialities.
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