Update on Simulation Training for Medical Trainees

Simulation strategies for specific specialties continue to be developed

Find out more about some of these developments below. 

Acute Care Common Stem (ACCS) simulation training

Over the last 6 months there has been an explosion of simulation opportunities for ACCS trainees. During their medical or EM placement ACCS trainees have joined the IMT2s in attending the mastery skills training course of which there are 7 dates in Glasgow and 2 in Aberdeen. This provides mastery learning in arterial line, US guidance PVC, central line and seldinger chest drain as well as non-invasive ventilation training. 

ACCS trainees during or close to their ICM block attended our 1^st 'critical care skills drills and simulation course in August. A further course will occur on 16^th February. This course gives a great introduction to critical care with a number of skills covered (open chest drain, cardioversion, pacing), drills (RSI, procedural sedation, ventilator use, tracheostomy emergency) as well as immersive simulation.

Internal Medicine (IMT) simulation training 

The IMT simulation team are constantly evaluating and improving existing programs based on feedback and focus groups. As such we have developed 2 new shadowbox sim sessions on 'shock' and 'agitation' alongside a 'tracheostomy for medical registrar' session which we are excited to implement in the IMT3 registrar ready course from March 2024.

Intensive Care Medicine (ICM) simulation training

The ICM national simulation strategy is now in full swing with the 1^st Paediatric Emergency Management and Stabilisation for ICM Trainees (PEMSIT) course taking place in October and the 1^st 'Cardiothoracic ICM sim day' and 'Organ Donation simulation course' taking place in January and March respectively. 

Paediatrics 

NHS Lothian have also been piloting a supportive simulation-based course to support those trainees who are making the transition onto Tier 2 level rotas.  There are ongoing discussions about how we can widen the access to this experience to all Tier 1 level trainees across the country.  Updates to follow as discussions progress. There is also ongoing work on a Back-To-Work course to supports paediatricians who have spent time away from clinical work for any reason.

Featured courses

Endovascular aneurysm repair (EVAR) workshop for vascular surgery trainees and interventional radiology trainees

Cross-specialty simulation training in aortic aneurysm stent procedures

Cross-specialty environments such as complex trauma care, major obstetric haemorrhage, surgical oncology and complex aortic intervention have all been shown to benefit from high-fidelity simulation training. Simulation environments allow professionals from different specialties to come together, share ideas and iron out potential challenges in challenging scenarios. 

A number of very successful simulation courses have been run with trainees from interventional radiology and vascular surgery. These cross-specialty collaboration courses have focused on endovascular aneurysm repair (EVAR) and how these are best deployed by a collaborative cross-specialty team. The trainees gain experience in case planning, stent sizing and then move to the simulators where they deploy the stents in an immersive environment. 

The faculty lead interactive discussions about key stages of the EVAR procedure, and the trainees are encouraged to share troubleshooting experiences and on-table complication management. The issues raised can then be practiced on the simulators, thereby providing learner-centred experience of real-life problems. 

The collaborative aspect of having interventional radiologists and vascular surgeons present at these sim courses has been a great experience. These health professionals are coming at such complex cases from very different standpoints and training experiences. Training in a simulated environment allows cross-specialty sharing of ideas and troubleshooting strategies. 

These courses have had excellent feedback and will be run on a biannual basis around Scotland:

Industry involvement has been key to the setup of these courses. EVAR planning demands specialised software to analyse CT scans and a typical course will require one laptop per attendee with a software package loaded on. With 8-10 delegates per course, it is very helpful to have industry support for up-to-date software. The clinical specialists who work for the stent companies also have a wealth of specific experience and the trainees find it very valuable to learn from the industry team. As regards simulated deployment, the industry team also provide complex, bulky and very high-fidelity simulators which are a key part of the sim experience.

Mr Bryce Renwick FRCS
NES Associate Dean for Simulation - Vascular and Cardiothoracic Surgery
Consultant vascular and endovascular surgeon
Aberdeen Royal Infirmary

Pilot Trauma Surgical Skills Course – Suttie Centre Aberdeen 

In order to attain their Certificate of Completion of Training, HSTs are required to attend at least one trauma course. Advanced Trauma Life Support, recertification, European Trauma Course and Definitive Surgical Trauma Skills are all available across the UK, however places are limited, and the course fees can be high.

The aim of this pilot was to deliver a course (as a ‘proof of concept’) that was a combination of cadaveric surgical skills and simulated trauma team training that would meet the General Surgery HST trauma curriculum requirements.

The course was designed to facilitate realistic Trauma Team training (i.e., multi-speciality and multi-professional) as the participants are senior trainees in Surgery, Anaesthetics, Orthopaedics & Emergency Medicine along with nurses from Theatre and Emergency Department.

The course was delivered in the Suttie Centre, Aberdeen, where the departments of Clinical Skills and Anatomy are co-located and have an established relationship in delivering cadaveric training.

On the initial pilot, 6 HSTs and 4 nurses (ED and theatre based) were joined on Day 1 for simulated trauma team and thoracic cadaveric training by 2 Emergency Medicine senior trainees and 2 senior Anaesthetic trainees. All surgical trainees had some previous experience of cadaveric training.

Overall feedback has been extremely positive but with some good suggestions for development. One particularly positive comment was

It was also particularly encouraging to see that when attendees were asked for their top three take home messages/thoughts they frequently included non-technical skills and team working within these.

This pilot has demonstrated that this course achieved its aim of delivering a combination of cadaveric surgical skills and simulated trauma team training that would meet the General Surgery HST trauma curriculum requirements and could be delivered locally. In addition, it has reinforced the benefits of multi-speciality (and multi-disciplinary) trauma training.

This type of course has the potential both to become an important adjunct to HST trauma training and to develop as a multi-speciality trauma course Whilst this approach would increase the complexity of the course, it will also significantly increase the collaborative training opportunities and could be more cost efficient.

Dr Angus Cooper
Director of Clinical Skills Centre
University of Aberdeen