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SLSN Conference 2016 Friday 26th February 2016, Kia Oval, Vauxhall, London

Harmonised concepts; What if? We connect, we share and we learn... A simulation collaboration conference for the SLSN

Workshop & Poster Abstracts

Morning Workshops 1- 4

Pages 2-5

Afternoon Workshops 5 - 8

Pages 6-9

Poster Presentation Sessions 1 - 4

Pages 10-33

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Workshop 1 10:55 – 12:10 | Ashes Suite

Expert Debriefing: The Right Tool for the Job

Peter Jaye, BSc, MBBS, MRCP, FCEM Director of Simulation, Simulation and Interactive Learning Centre, Emergency Medicine Consultant, Guy’s and St. Thomas’ NHS Foundation Trust Demian Szyld, MD, EdM Associate Medical Director of NY Simulation Centre, Assistant Professor, Ronald O. Perelman Department of Emergency Medicine EFAA Jennifer Blair MB BCh FFARCS. Trust Lead for Multi-professional Simulation, Consultant Anaesthetist Epsom & St Helier University Hospitals NHS Trust

Medical Simulations occur in a wide variety of locations (in situ, hospital, community based) for a wide variety of learners (students, qualified staff, and all specialties). Many simulation faculty have been unable to define which simulation strategy they use to debrief post simulation events. This has reflected a relative paucity of described simulation debrief models in the literature. Increasingly however there has been an increase in published debrief models. We are now left with the question of which model is most appropriately used for which learning episode. In the absence of study data that defines the benefits with quantitative or qualitative data we cannot define which model is most appropriately used in any situation. We suggest a methodology for use based on a visual representation of the relative merits of different models as represented on a grid. The grid can be populated by experts in different simulation debrief models and then used for novice debriefers to define which modality is recommended. A blank grid can also be used as a reflective tool to stimulate discussion amongst faculty as they try and apply their favoured modality of debrief to any situation. In this way it can stimulate and question advanced debriefers. Expert debriefers can use it as a development tool to guide which areas of debrief they require further skills within. In this session, participants will:

• Examine and evaluate their own debriefing practice and consider their impact on learners

• Consider the Debrief Grid as a new methodology for analysing debriefing modalities

• Consider how to apply this grid to individual learning environments, student’s cohorts and desired learning outcome

• Be able to apply the Debrief Grid in practice, to evaluate their own debriefings or in a faculty development context.

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Workshop 2 10:55 – 12:10 | Double Box 56/57 Circle of Care: a model for compassionate Human Factors in healthcare

Dr Suzy Willson, PhD Artistic Director of CLOD Ensemble and Performing Medicine, Honorary Non-Clinical Senior Lecturer at Barts and The London School of Medicine and Dentistry Colette Laws-Chapman, RGN, PgDip- Advanced Practice Deputy Director and Simulation Lead for non-medical staff, Simulation and Interactive Learning Centre, Guy’s and St. Thomas’ NHS Foundation Trust

The Circle of Care model was created as result of the pioneering collaboration between the Simulation and Interactive Learning Centre (SaIL) and Clod Ensemble’s Performing Medicine Project, supported by Guy’s and St Thomas Charity. The partnership creates unique arts-based training programmes designed to enhance care and compassion in healthcare professionals, focusing on skills such as resilience, self-care, teamwork, stress-management, non-verbal communication, decision-making, and care and compassion.

This practical session will introduce The Circle of Care, a model for integrating

compassionate human factors into simulation training.

In this session participants will:

• Be introduced to the concepts and ideas underpinning the model, considering the relationship between caring for yourself, your colleagues and your patients

• Experience how arts-based learning methods work in practice

• Be invited to consider how this model can be integrated into their simulation activities

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Workshop 3 10:55 – 12:10 | Pakistan Suite

Writing Scenarios and Learning Outcomes for Simulation-based Education

Gabriel Reedy PhD CPsychol FAcadMEd SFHEA Senior Lecturer in Clinical Education, King’s College London Programme Director—MA in Clinical Education Educational Research Lead—King's Health Partners Simulation and Interactive Learning (SaIL) Centres Gary Francis MA, BA (Hons), RN (Adult), RNT, SFHEA Associate Professor; School Lead for Practice Skills Learning & Simulation, School of Health & Social Care at London South Bank University Vaughan Holm MSc (Med Ed), BHSc (Nursing), RN Simulation & Clinical Skills Lead / CSSC Manager, Clinical Skills & Simulation Centre (CSSC), Croydon University Hospital

This session will focus on some of the basic skills for simulation educators: how to imagine, design, and write scenarios that enable meaningful learning from participants. Using a workshop style format, the facilitators will begin by encouraging delegates to explore and highlight some of the issues facing them with respect to simulation scenario design. Facilitators will then pose some underpinning theories and approaches which might inform these issues, and further encourage delegates to practice some of the approaches and share their learning with small groups of colleagues. Finally, small groups and then the large group will work together to develop a series of learning points to take back to their practice. In this session, participants will:

• Collaborate with colleagues to develop a list of common problems facing simulation educators when designing and writing scenarios

• Explore some of the underpinning theories and approaches that can inform simulation scenario design

• Develop a shared toolkit for tackling problems in simulation scenario design

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Workshop 4 10:55 – 12:10 | Debenture Lounge

Immersion: improving fidelity in simulation based-education Dr Libby Thomas MCEM, PGDipClinED PhD Student in Simulation, Kings College London, SpR Emergency Medicine, South Thames

Colin Parry BA(hons) GSS, Simulation Technician, Simulation and Interactive Learning Centre, Guy's & St Thomas' NHS Foundation Trust

Simulation training has become widespread in the education of both undergraduate and postgraduate participants from a wide variety of professions and clinical backgrounds. Creating a simulated environment that appears real can be important in enhancing participant learning and the transfer of that learning back to clinical practice. There are many aspects that contribute to the fidelity of a simulation and each of these has a different impact on how authentic a simulation feels. In this workshop we will look at the different areas of fidelity and how each one impacts the participants’ scenario “buy in”.

In this session participants will:

• Explore the different types of fidelity

• Consider how fidelity impacts on the participants immersion in simulations

• Work in small groups to come up with innovative ideas to improve immersive simulated experiences

• Learn tips and tricks to improve fidelity from the technician who had “been there and done that!”

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Workshop 5 15:00 – 16:00 | Ashes Suite

Mobile Simulation: The WOMBAT Experience Nicholas Gosling, Head of Department Chris Broom & Jasmine Burnett, Clinical Simulation Specialists Andrew Sykes, Senior Technician & Engineer Robert Colson, Clinical Skills Coordinator David Mason GAPS Project Manager St George’s Advanced Patient Simulation & Skills Centre (GAPS) St George’s University Hospitals NHS Foundation Trust Mobile simulation gives us two opportunities: to reflect on everyday team performance in the real work place and to critically evaluate responses to clinical events which cross disciplinary and other boundaries. As for any educational exercise, successful mobile simulation should not confuse realism with relevance. Rather, simulation should be treated as a ‘fiction’ with a purpose. The art of mobile simulation is to deflect the focus of attention away from the technology towards the educational experience. The realism is in the environment and simulation technology needs to support this rather than distract from it. We will share our experience at St. George’s University Hospitals NHS Foundation Trust and invite others to contribute to the discussions rotating round our three exemplars. Our message will be to emphasise how bringing simulation to the clinical area can improve patient safety.

In this session participants will:

• Be introduced to three examples from our experience of mobile simulation.

• Explore educational elements including rationale, goals, design and outcomes

• Consider technical solutions including kit, set up, troubleshooting & tricks of the trade.

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Workshop 6 15:00 – 16:00 | Double Box 56/57 Twitter enhanced Simulation – how to integrate twitter in sim

Charlotte Davies MBChB, MCEM, Med Education Fellow at PRUH Education Centre and Emergency Medicine SpR at Kings College Hospital Catherine Mungalsingh MBBS, MRCP, PGCert Education Fellow and Geriatric SpR, King’s College Hospital

Social media in education is becoming an increasingly popular resource. Twitter is regularly used to disseminate information, and share learning points. Our simulation centre uses twitter to signpost resources, and highlight important learning points. Many people engage with these tweets. If a particularly strong learning point has been made, the tweet gets re-tweeted many times, sharing our information very widely. Questions get asked on twitter. Many faculty members feel they do not know how to use twitter, or how to embed it into their simulation practice. Some have concerns about the educational validity of the content, and how to critically appraise it. This workshop aims to enable all attendees to: know “Twitter basics” - what a hashtag is, what a twitter handle is, how to follow people, how to use lists, how to re-tweet, and how to tweet; To discuss some of the literature about what makes a “good” tweet; discuss how to embed twitter into simulation practice; appraise some existing tweets made by simulation centres and think about whether they are “good” tweets. We will also discuss any obstacles you may have in using twitter, and provide suggestions for how to overcome these. In this session, participants will gain:

• Awareness of how twitter can be used to support delivery of education in twitter

• Awareness of some of the obstacles that need to be surmounted.

• Awareness of some of the social media and FOAM resources that can be signposted to.

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Workshop 7 15:00 – 16:00 | Pakistan Suite Development of Simulated Electronic Patient Records

Karen Elliot RN, PGCE Senior Lecturer in Simulated Learning and Clinical Skills at Kingston University and St Georges University Dr Sally Richardson Associate Professor, Kingston University

In 2013 NHS England announced a vision for a fully integrated digital patient record across all care settings by 2018 to achieve safer hospitals and safer wards. Our team within the School of Nursing decided to incorporate Electronic Patient Record EPR into our simulated learning environments and clinical skills teaching to ensure we reflect the reality of clinical practice but also to provide students with the opportunity to develop their skills in the management of EPR in the safety of the simulated setting. We had discussions with the main NHS provider CERNER to utilise the educational package that they’ve developed and use in America. During these discussions it became clear this model was not focused towards a UK market and the needs of nurse education. We were unable to identify another package for educational use. We therefore developed an EPR system we could incorporate into our simulated ward environment. Our focus was to meet student and the facilitator’s needs with the emphasis remaining on the successful use of role-players as simulated patients within our simulated learning environments. The result is the development of an EPR app created in conjunction with the KU web and multimedia team. The EPR app’s been designed to work within and support our simulation experience and engages the students to work with and become familiar with the principles of EPR. We have used the app within our simulated learning environments with great success and are now working toward developing tools for assessment to enhance its function and capability. This workshop aims to provide an overview and demonstration of the Simulated Electronic Patient Record (EPR) design and implementation into the simulated teaching environment. In this session, participants will:

• Discuss how the EPR system was designed and developed using student and staff feedback

• Discuss how the EPR system has been integrated into pre-registration nurse simulation training.

• Demonstrate the use of the Sim EPR using a simulated scenario

• Gain an overview on future development and planned use.

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Workshop 8 15:00 – 16:00 | Debenture Lounge Preparation of faculty for Interprofessional simulation based education: challenges and opportunities

Jane Frisby RGN, Registered HV, Registered nurse tutor, Lecturer in Interprofessional Education at Kings College London Carol Fordham Clarke RN Lecturer in Nursing at Kings College London

Interprofessional simulation-based education is becoming increasingly popular within both undergraduate and post graduate healthcare education, however, simply bringing students from differing health care professions into the same learning space should not be assumed to result in beneficial Interprofessional education (IPE) experience. The development of faculty has been seen as key to the success of IPE initiatives, with particular emphasis on developing Interprofessional facilitation skills. (Hall and Zieler 2015) Ruiz et al (2013) report that faculty members working as facilitators of IPE find their role challenging as they need to adjust their teaching strategies to interact with and direct the learning of students from different professions. This workshop has two-fold aims: to explore the challenges associated with the delivery of effective Interprofessional learning within simulation based education; and to identify strategies to enhance the facilitation of Interprofessional groups. In this session, participants will:

• Reflect upon their own experiences and attitudes to Interprofessional learning

• Identify the barriers to Interprofessional learning

• Devise strategies to enhance learning in Interprofessional groups within simulation – based education

• Discuss how they will consider the above in their own professional context

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Poster Presentation 1 12:25 – 13:15 | Ashes Suite (bar) Inpatient, Acute and In Situ 1. Safer Catheter Care- Reducing avoidable harm. An inter-professional course to reduce avoidable harm in patients with catheters. Marie McDonnell, Guy's & St Thomas' NHS Foundation Trust Background: CAUTIs are the leading healthcare-associated infection and have a devastating impact on patients (HINSL, No Catheter No CAUTI, 2015). The Health Innovation Network, South London (HINSL) and GSTFT have collaborated to reduce catheter-associated infections and to improve patient safety and quality of care for this patient group. Aims: To design a half day inter-professional simulation course exploring technical and non-technical skills & patient safety around the catheter care passport aimed at community and hospital healthcare workers. Methods: Using focus group techniques with specialist staff the course objectives and content were devised. A half day course was designed with a mixed educational modality of clinical scenarios & a catheter workshop. The course has continued to run into its second year (16 courses in total) Results: An increased confidence in management of catheters around the 4 areas of the catheter bundle and 1-2 non-technical skills learnt. Further results/evaluation to follow. Discussion: The course successfully allowed delegates the opportunity to practice competence in using the catheter care bundle through relevant home or hospital scenarios with confidence increases most significant in the technical areas Conclusions: Feedback from delegates was largely positive, however statistical analysis does show some decrease in confidence around some non-technical areas. This may be a phenomena of a half day course. 2. Integrating simulation within pre-registration nurse education. Carol Fordham-Clarke, King's College London Background: Access to meaningful learning experiences that support the development of well prepared Registered Nurses remains a constant challenge in today’s complex healthcare arenas. The option to include simulated learning as an integral component of nurse education programmes endorsed by the NMC (2007) provides a unique

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opportunity to review how student nurses can be best equipped to learn about, and rehearse, core nursing skills and values in a supportive environment but without direct patient contact.

The challenge is to ensure limited resources in terms of time, equipment, environment and faculty can provide meaningful learning opportunities based upon module learning outcomes.

Simulated opportunities enable students to reflect upon their cognitive, psychomotor and affective skills which can be applied in clinical placements (Alinier et al, 2004). Faculty development to facilitate giving feedback is essential to enable students to recognise their strengths and weaknesses and prepare for future practice (McGaghie et al, 2010). 3. Using Simulation to increase confidence in recovering paediatric patients (in situ and in simulation centre). Efua Hagan King's College Hospital NHS Foundation Trust

Background: Unit September 2015 Inpatient Theatre Recovery was staffed by only adult nurses and one Operating Department Practitioner (ODP). Since becoming a major trauma centre, King’s has seen an increase in the number of paediatric patients resulting in a need that practitioners need some additional support as they lacked confidence in managing paediatric patients. Aims: To increase confidence and skills of adult practitioners recovering paediatric patients using simulation. Methods: A working group was set up including the Theatre Practice Development team (PDT), Child Health and the on-site simulation team. Scenarios were written based around common paediatric procedures and the study day structure agreed. Each scenario required participation of 2 practitioners and structured debriefing occurred after each scenario.

Aims: To demonstrate the integration of simulation within pre-registration modules in the BSc and PG diploma programmes involving approximately 500 nursing students per year. Methods: Each clinical focused module within the programmes now includes simulation experiences. The complexity of simulation experiences develops across the programme, from using traditional role play and part task training to complex patient scenarios involving simulated patient manikins. Results: Student evaluations are positive both at a module level and from national surveys with requests to increase simulated activities within the programmes even further. Discussion:

Conclusions:

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Results: In-situ training in recovery took place monthly from September-November 2015 covering 2 scenarios a time and 2 full days training also took place in the SIM suite covering 4 scenarios. For the full day, external departments (Day Surgery, Interventional Radiology and Endoscopy) were also included as they have also seen an increase in paediatric patients. Discussion: This course has proved a huge success with 100% of participants responding that the course has increased their confidence in managing paediatric patients. Conclusions: To date, 27 practitioners have participated in the training and all areas report an increase in confidence. This has resulted in a reduction of stress in the allocation of practitioners to recover paediatric patients and improved patient care. Feedback has shown that more sessions are needed to continue to increase confidence and include all staff.

4. Using in situ simulation to identify latent threats during critical care airway management. Dr Shardha Chandrasekharan, Guy's & St Thomas' NHS Foundation Trust Background: Tracheal intubation within critical care is more challenging due to patients’ limited cardio respiratory reserves and urgency. Staffing skill mix and rotational staff present additional challenges related to familiarity with intubation setup in this local environment. Insitu simulation can address these gaps, improving patient safety. Aims:

1. Identify latent threats when preparing for intubation in Intensive Care (ICU) and High Dependency Units (HDU).

2. Rehearse the management of the unexpected difficult intubation. Methods: Two scenarios were designed to rehearse an urgent intubation and an unexpected difficult intubation. These were practiced in critical care environments with debriefs exploring positive actions and latent threats. Results: Multidisciplinary teams were familiarised with the set up of intubation trolleys and the existing cognitive load reduction strategies (Equipment dump sheets and checklists). Latent Threats were identified:

1) Battery malfunction in a video laryngoscope 2) Shortage of intubation checklists 3) Delays in getting skilled help to distant HDU sites. 4) Absence of immediate-equipment for a Can’t Intubate, can’t Oxygenate

situation. Discussion:

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Insitu practice of emergency airways was positively received by both nursing and medical staff as well as patients and their relatives. Strengths included familiarity with infrequently used kit, protocols and airway-trolley design with options to improve to needs. Sharing our identification of latent threats with improvement strategies formed an important part of improving patient safety. Conclusions: The benefits of Insitu practice allow important staff development and systems testing of high-stakes procedures. Future directions of Critical care simulation need to focus around overcoming barriers to delivery surrounding bed spaces, time pressures and staff availability.

5. In situ Simulation in the Paediatric Emergency Department: The initial steps. Dr Ayham A-Masri, Guy's & St Thomas' NHS Foundation Trust

Introduction: In situ simulation is a practical method for detecting latent safety threats and reinforcing team training behaviours. (1). Objective: An inter-professional simulation in the Paediatric Emergency Department (ED) at St Thomas’ Hospital, London, with aims of implementing simulation within departmental teaching, improving team training, and exploring latent safety risks and uncommon presentations in paediatric emergencies. Method: The simulation is integrated into protected teaching time involving doctors, nurses and other health professionals. One scenario was run within an hour during a scheduled teaching session. The scenario was debriefed by using the Diamond model of debrief (2). A post-experience questionnaire discussing learning points and areas for improvement was collected. Results: Three scenarios have run since October 2015. Analysis showed simulation matched the participants own learning needs without being negatively judged for performance or contribution and improved knowledge in managing undifferentiated presentations. The facilitated debrief helped to probe non-technical skills. The outcome of the simulation was circulated to the team as a memo and any latent safety risks raised were discussed with the senior team. Conclusion: This is a description of the initial results of in situ in our ED, which are promising in terms of adopting inter-professional in situ simulation to explore and improve technical and non-technical skills among health professionals. The future plan is to run in situ regularly, improve participants’ experience in debriefs and to establish it as a platform for research.

6. Using Simulation to introduce a new ABCDE checklist for Recovery Nurses. Dr Despoina Liotiri, St George's University Hospital NHS Foundation Trust

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Conclusions: In-situ simulation can be used as an effective tool to test usability of checklists, and cultivate a safety attitude of acceptance of and compliance with checklists.

Background: Despite their introduction as a safety initiative to improve patient outcomes, checklists are underused in healthcare, the main reason being lack of training and a safety culture (Sevdalis et al., 2012). Aims: We created an evidence-based ABCDE checklist specifically designed for Recovery Nurses to re-enforce their ability to manage unexpectedly compromised patients. Our objective was to introduce this tool using simulation-based training (SBT) and to evaluate the effectiveness of this method. Methods: We implemented the use of our checklist (as a guide, and for peer-observation and feedback) in the context of recovery in-situ simulation (5 SBT sessions; 25 recovery nurses; August 2015). Each session (prebrief; scenario; debrief) lasted around 30 min and involved Fishbowl small groups (OHCHR, 2011). Evaluation data gathered from informal feedback and an online survey (100% response rate). Results: Data analysis revealed the effectiveness of our method at all four levels of Kirkpatrick’s model. Compliance with other checklists also occurred. Discussion: The introduction of our checklist using in-situ simulation was very well received. SBT has been shown to have a greater impact than didactic instruction and distribution of printed materials alone (Bluestone et al., 2013). SBT may also overcome the obstacles in the use of checklists. Furthermore, involving the learners in the development process generates a feeling of ownership which may improve implementation in daily practice.

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Poster Presentation 2 12:25 – 13:15 | Double Box 56/57 Interprofessional and Community

1. Good to Go: Enhancing care transfers from hospital to home for older people with complex needs. Dr Beth Thomas, Guy's & St Thomas' NHS Foundation Trust Background: Care transfers for older people with complex needs should be person-centred with effective teamwork (Bolsch et al. 2005). This poster presents simulation-based, inter-professional training to enhance care transfers within Southwark and Lambeth Integrated Care (SLIC). Aims: � Use shared experience/knowledge promoting best practice for safe transfer of

care. � Enhance discharge planning skills including effective communication and multi-

agency working. Methods: Course design reflected a patient journey from hospital to community care, based on real-life scenarios, aimed at health/social care professionals with roles involving care transfers of older people. Results: 49 multi-agency staff attended enabling them to build relationships and improve understanding of each other’s roles. Evaluation was based on Kirkpatrick’s (1994) model: reaction to training; learning; application of learning; results and outcomes. Participants completed pre-course (n=44) and post-course (n=47) questionnaires. Pre-course, 30 (68%) participants reported difficulty in transferring or receiving the care of a patient with complex needs. Post–course, 44 (91%) intended changes to their practice, and all believed these would enhance MDT working. Open text comments included increased understanding of roles and communicating effectively. Discussion: Aims achieved with positive evaluation. The value of inter-professional learning was evident. Further evaluation in progress using semi-structured interviews exploring perceived application and impact on practice (Kirkpatrick’s model, levels 3 and 4). Conclusions: This course could be transferred to other settings. Staff turnover across London is high but staff could transfer learning to new organisations. Evaluation is essential as simulation course delivery is labour-intensive and has to be justifiable in economically constrained times.

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2. A Simulation Course Aimed to Help Improve Mental Health Awareness within Police and Paramedics. Dr Megan Fisher, South London and Maudsley NHS Foundation Trust# Background: Metropolitan Police Service (MPS) and London Ambulance Service (LAS) are often the frontline staff for people suffering from mental health crises out of hours. However, there is evidence to suggest that MPS and LAS require further training in mental health. It is noted that the MPS lack in training in suicide prevention and there are problems with interagency working. Recommendations have been made to suggest that the police force should have mandatory training available for staff and this should be developed in partnership with experts.1

In 2014, a report highlighted the need for ‘ further education for ambulance clinicians in mental capacity, how to assess it and how to apply appropriate aspects of the mental health legislation.’2

In an attempt to address these concerns, we developed an inter-professional simulation course for these frontline staff.

Aims: For the police and LAS attendees to gain improved knowledge and awareness of mental health disorders. Methods: Pre and post questionnaires will be given to participants to evaluate for any change in knowledge, awareness and confidence managing patients experiencing a mental health crisis. Results: As the courses are due to take place in early January 2016, the results, discussion and conclusion points will be available before the time of conference. Discussion: Our hypothesis is that both quantitative and qualitative evidence will demonstrate that awareness, knowledge and confidence will be increased. Conclusions: Our hopes are this new simulation training will demonstrate the value of inter-professional training between MPS and LAS to address mental health issues. 3. Interprofessional Simulation to Improve Collaborative Working for Young People with Physical and Mental health Needs Dr Chris Kowalski, South London & Maudsley NHS Foundation Trust Background: A large proportion of young people with mental health needs present to general hospitals. Recent UK government reports have highlighted the importance of joined up

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care in these cases, whilst there appears a general lack of confidence in paediatric staff when managing them. We developed an Interprofessional simulation (IPS) course, the goals and objectives were: - To increase participants’ confidence in managing young people with mental health needs - To achieve capabilities for effective Interprofessional, patient-centred collaborative practice between paediatric and CAMHS staff. Methods: A one day course was developed and piloted, with 99 participants attending over 10 courses. The course is, to our knowledge, the only one of its kind being delivered in England. Data was collected from course evaluation forms, pre- and post-course questionnaires and focus groups. Results: Quantitative data demonstrated a statistically significant increase in participants' confidence scores (p=.0005). Additionally, participants' attitudes score improved (p=.0005). The eta squared statistic indicated large effect sizes, .62 and .35 respectively. Thematic analysis of qualitative feedback demonstrated participants appeared to have enhanced their capabilities in collaborative working, including clarification of roles and responsibilities, improved competency in collaborative decision-making and team functioning, and appreciation of different professionals’ perspectives. Conclusion: Our findings demonstrate that it is possible to employ IPS to promote collaborative working at the mental-physical interface for the care of young people with both mental and physical health needs. As a result, there is a plan to roll out the course to other areas of London, delivering at scale and pace and with backing from relevant agencies. The expected benefits of delivering the course across London will be in keeping with the findings of the initial pilot course evaluation. 4. Hands up for Health: Extending simulation to community education. Dr Beth Thomas, Guy's & St Thomas' NHS Foundation Trust Background: Care transfers for older people with complex needs should be person-centred with effective teamwork (Bolsch et al. 2005). This poster presents simulation-based, inter-professional training to enhance care transfers within Southwark and Lambeth Integrated Care (SLIC). Aims: � Use shared experience/knowledge promoting best practice for safe transfer of

care.

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� Enhance discharge planning skills including effective communication and multi-

agency working. Methods: Course design reflected a patient journey from hospital to community care, based on real-life scenarios, aimed at health/social care professionals with roles involving care transfers of older people. Results: 49 multi-agency staff attended enabling them to build relationships and improve understanding of each other’s roles. Evaluation was based on Kirkpatrick’s (1994) model: reaction to training; learning; application of learning; results and outcomes. Participants completed pre-course (n=44) and post-course (n=47) questionnaires. Pre-course, 30 (68%) participants reported difficulty in transferring or receiving the care of a patient with complex needs. Post–course, 44 (91%) intended changes to their practice, and all believed these would enhance MDT working. Open text comments included increased understanding of roles and communicating effectively. Discussion: Aims achieved with positive evaluation. The value of inter-professional learning was evident. Further evaluation in progress using semi-structured interviews exploring perceived application and impact on practice (Kirkpatrick’s model, levels 3 and 4). Conclusions: This course could be transferred to other settings. Staff turnover across London is high but staff could transfer learning to new organisations. Evaluation is essential as simulation course delivery is labour-intensive and has to be justifiable in economically constrained times. 5. Peri-operative human error - a target for high-fidelity inter-professional simulation training? Dr Petrut Gogalniceanu, Guy's & St Thomas' NHS Foundation Trust Background: Human error in high-risk professional groups is actively prevented through continuous professional training. Operating room teams undertaking complex surgery do not routinely undertake crisis prevention and management training as an inter-professional group. Aims: To estimate the incidence and significance of peri-operative human error, in order to ascertain the need for inter-professional high-fidelity simulation training for small teams undertaking complex or high-risk interventions (nurses, anaesthetists and surgeons). Methods: The Datix database of a major London healthcare was retrospectively reviewed over a period of 4 months. The study endpoints were the incidence, nature and severity of the events reported, as well as the professional groups involved. Results:

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389 events were reported in a 4-month period, of which 19.5% were thought to have the potential to lead to harm (16.5% minor harm; 78.9% no harm). 80.2% of events were reported by medical or nursing staff. Communication, behavioural or organisational errors accounted for 29% of incidents, with 8.5% of reported events posing a risk to staff. Only 53.7% of incidents were reported as having a clinical nature (errors related to diagnosis, interventions or treatment) and only 11.6% of incidents were related to medical equipment errors.

High-fidelity inter-disciplinary simulated training may improve efficiency and outcomes in operating theatre teams. 6. Interprofessional to inter-organisational simulation: challenges and opportunities. Luke Cox, Guy's & St Thomas' NHS Foundation Trust The value of Interprofessional education has been widely recognised (Palangas 2014),

yet often the training and education of staff occurs within organisational silos (Sheilds

& Flin 2012). For instance, pre-hospital emergency services rarely train alongside their

hospital counterparts except for in preparation for major incidents and other specific

exercises.

Rising emergency admissions dictate that healthcare organisations do all they can to

facilitate treatment in the community, and this requires the development of new

pathways of communication between diverse organisations (Kings Fund 2015).

The ‘Hospital to Home’ course at SaIL, GSTT, has been created with these

considerations in mind, and allows staff from GSTT’s @Home, Community and ED

services to learn alongside pre-hospital professionals from LAS and SECAMB.

Participants engage in Simulation scenarios which focus on aspects of

interorganisational communication and human factors.

This poster presents some of the findings from evaluation of the first series of course

dates. Eight further course dates are due to run in March and April 2016, and this

poster further presents some of the challenges in designing and running a course

which includes stakeholders and participants from different organisations.

Discussion: Current data suggests that peri-operative incidents are common. Although the majority of these don't lead to patient harm, their nature is often linked to team communication, organisation and staff interaction Conclusions:

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7. The CRISIS course, a multi-professional course in patient care, recognition and initial stabilisation in simulation. Jessica Wadsworth, Epsom & St Helier University Hospitals NHS Trust Background: Epsom and St Helier’s simulation team successfully won a bid in the Sign up to Safety campaign to develop the new CRISIS course aimed at the early care, recognition and initial stabilisation of the deteriorating patient. Aims: The CRISIS course was designed to improve skills and confidence in managing deteriorating patients with a strong focus on multi-professional team working and the importance of human factors. Methods: Scenario design was informed by analysis of trust adverse incidents and patient safety themes. Each course incorporated a sepsis workshop and three scenarios. The course accommodated a maximum of 12 multi-professional candidates. Pre and post questionnaires were completed. Results: Nine courses ran between September and December 2015 with 57 candidates in total. Candidates NHS experience ranged from 1 month to 38 years. In all questions analysed using a scale of 1-10 there was an increase in median score. An increase from 7 to 9 was noted in confidence of initiating management of the deteriorating patient. An increase from 8 to 10 was noted in confidence in recognising the deteriorating patient. Conclusions: Attending the CRISIS course increases confidence in both the initial recognition and management of the deteriorating patient. Future initiatives include obtaining further feedback three months post course and facilitating HCAs to attend. Surviving Sepsis Campaign; International Guidelines for Management of Severe Sepsis and Septic Shock: 2012; http://www.sccm.org/Documents/SSC-Guidelines.pdf

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Poster Presentation 3

12:25 – 13:15 | Pakistan Suite E-Learning, Technical Innovation and Faculty Development

1. Creating an e-learning programme for an introduction to simulation based education for participants and faculty. Dr Jacqueline LeGeyt, Guy's & St Thomas' NHS Foundation Trust

The Simulation centres across King’s Health Partners (KHP), an Academic Health Sciences Centre, are developing an electronic learning resource for participants and faculty. Aims: To collaboratively create a generic e-learning modular programme to improve the quality of the learner’s experience, enhancing psychological safety, providing follow up learning opportunities and improve cost efficiencies.

Working collaboratively is a time consuming approach. Liaising across four partner organisations with differing strategic priorities and variability in a number of core simulation practices including course debriefing, delivery modalities and target demographics provides unique challenges. Overcoming these has been a steep but rewarding learning curve. To date the project is behind schedule but is enhancing our

Background:

Methods: An inter-professional editorial board agreed the overall structure. Writing module content was then assigned to specific teams across the KHP simulation centres. Centralised editing and design was undertaken to ensure consistency in writing and flow of content. Collaboratively writers and e-learning designers have created interactive elements to make the e-learning engaging and educational. Product testing is planned using individual and focus group feedback, prior to a launch in April 2016. The e-learning platform is structured into two zones; a “delegate zone” and a “faculty zone”. Delegate zone;

• part one has 2 compulsory pre-course modules, an Introduction to Simulation and Familiarisation with the simulated environment.

• Part two has 5 modules covering Introductions to human factors, human factor skills and debriefing.

Faculty zone;

• Part one includes Part two of the delegate zone

• Part two has 6 advanced modules which include How to facilitate debriefs, Educational theory and How to facilitate human factors.

Discussion:

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knowledge and understanding of how e-learning can be blended to a simulation-based modality. 2. Enhancing the technician role in supporting academics to improve and develop pre-registration nurse simulation activity. Gary Francis, Associate Professor, London South Bank University Background: Increasing concern that low-high fidelity simulation related activity was declining in use among pre-registration student nurses. Following a review of simulation activity among academics it was found that inconsistent technical support was a key factor. Others included a lack of understanding/fear of simulation and large student numbers and consistency of experience. Aims: To find ways of enhancing technical support for academics to improve and develop pre-registration nurse simulation activity

3. Teaching the Tech-ing. Sunil Chadha, King's College Hospital NHS Foundation Trust Background: For successful simulation to run, lots of faculty members are needed. Most faculty can complete any of the available roles. In most simulation centres, only the simulation technician can perform the role of the technician, meaning that if they are absent, it is difficult to run simulation.

Methods: Interventions undertaken; 1) training days, 2) 1:1 with academics, 3) new request form, 4) intro use of virtual learning environment Results: - greater involvement of the technicians in preparation and advice - more simulation episodes/varied set-ups - enhanced satisfaction from academics Discussion: Technical support in low to high fidelity simulation is without question important to the effectiveness of the simulated experience (Alderidge, 2012; Hellby, 2013). Having established new approaches to providing greater support, we have seen a renewed enthusiasm from academics to consider simulation as part of the teaching, learning and preparation for practice of pre-registration nursing students. It is anticipated that such interventions will continue to provide a high level of technical support that will allow development of service (Forrest et al, 2013). Conclusions: Technical support is improving. Plans to advance technician presence in class with additional training to help run in class scenarios. Greater use of the audit request form to tailor academic support. Develop a future proof academic environment to support better preparation of students leading to improved safety and human factor awareness on practice.

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The role of the technician is difficult, with faculty not always appreciating their knowledge, and their role. Aims: This pilot session aimed to enable simulation faculty members to experience the role, with its inherent frustrations and pleasures, of the simulation technician using an apprenticeship learning model. It also aimed to integrate simulation technicians more firmly into the simulation faculty team. Methods: During a scenario, the simulation technician role was allocated to one of the regular faculty members at the PRUH. The existing simulation technician supervised, providing a briefing, direct supervision, and a debriefing. After the session, both the simulation technician and “novice” technician were asked to highlight what they had learnt about the role of simulation technician. Results: The simulation technicians found it hard to be “hands off. They realised how skilled they had become. The wider simulation team enjoyed playing the role of technician, and found it was harder than they thought. Some took their role very seriously. They felt more confident that if the simulation technician was absent, they could take on the sim tech role, and the course would still run. Conclusions: The technician is an important part of the faculty team, and the wider faculty should ensure they are familiar with the role, and prepared to take the role of technician on

4. Should the pre course e-learning be course specific? – Feedback analysis of attendee’s experience of pre-course e-learning for Team Based Trauma Life Support Simulation (TTLS). Dr Collins Ekere, King's College Hospital NHS Foundation Trust

Aims: To analyse feedback from all three courses for attendees experience of the e-learning material.

Background: Team Based Trauma Life Support Simulation (TTLS) Course is a multi-disciplinary course incorporating pre-course learning, high-fidelity simulation, and human factors teaching with team-training and replaces Trauma Team Member (TTM) and Trauma Team Leader (TTL) courses, unifying material into single trauma team course. This resulted in TTM e-learning being used for TTLS pre-course work.

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Figure1.

5. Practice nurse educator’s train the trainer or coaching in the use of simulation in education? Christopher Broom, St. George's University Hospitals NHS Foundation Trust Background: 1. Financial restrictions cancel all non-mandatory training for nurses. 2. Inter-professional patient safety training and nursing professional development becomes very challenging to provide. 3. Practice Nurse Educators struggle to provide local, clinical area specific training for nurses and clinical teams. Aims: To design and deliver a two day Train the Trainer course, aligned to the needs of Practice Nurse Educators, specifically to enhance their current training programmes to use technology as an educational tool. (Population: 48 PNEs) Methods:

Methods: Analysis of post-course feedback collected from attendee paper questionnaires, including e-learning access and use, appropriateness to individual and group learning needs, appropriateness to the aims of course as well as how interesting the material was to the user. The responses were graded on a Likert scale of 1(disagree) to 5(agree) and graph plotted for each feedback area to aid comparison. Results: Feedback from 82(of 88) in TTLS (Jan2015-Oct2015), 24(of 26) in TTL (2013-2015) and 146(of 156) in TTM (2013-2014). We found TTLS had lowest % attendees agreeing to “material being easy to access and use” (Figure1.). All had similar feedback on appropriateness to individual and group learning needs (Figure2.), appropriateness to the aims of course (Figure3.) as well as how interesting the material was to the user (Figure4.).

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Recruitment: PNEs were contacted by email and the project was presented during governance meetings. Needs Analysis: Pre-course questionnaire and focus groups with main stakeholders. Networking: Allocated into clinical groups that would be able to support each other. Sustainability: The course produces 3 reusable simulation based activities per cohort to be shared amongst their peers. Variety of Simulation: Part-task trainers, Mannequin, Patient Actors and hybrid. Results: 20 PNEs attend the courses and 50% start to regularly use simulation within educational programmes. Discussion: The courses have produced several reusable, shared scenario design templates for in-situ simulation and training. The new working relationship between PNEs & GAPS has resulted in further collaborative work in current, new and innovative programme developments. Laboratory based courses now have an increased nursing interest in programmes. Conclusions: Investing in clinical educators as simulation providers, increases use of simulation resources, reusable scenario packages, sustainable training programmes and 'clinical team' exposure to simulation based learning. Low cost/free in situ training occurs regularly when staff are empowered with the use and application of technology enhanced learning

6. A novel course in Non-Invasive Ventilation (NIV) - from conceptualisation to completion. Dr David Rouse, Guy's & St Thomas' NHS Foundation Trust

To improve patient safety through the implementation of a course which;

1. Improves the clinicians’ knowledge of NIV & respiratory failure. 2. Informs clinicians of the best practice evidence base. 3. Forms part of the NIV Competency ‘sign off’ which includes:

a. Safely initiating NIV b. Strategies for troubleshooting. c. The ethical challenges in delivering NIV.

4. Teaches non-technical skills. 5. Delivers effective inter-professional training.

Background: Non-Invasive Ventilation, (NIV), is known to improve the outcome of patients with acute type two respiratory failure, and is increasingly utilised as an alternative to intubation1. Demand for NIV is growing, leading to NIV being instigated outside the traditional ICU setting. This has resulted in a need for more ‘NIV Competent’ clinicians to ensure patient safety. Aims:

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7. Evaluation of feedback from the Team Based Trauma Life Support Simulation (TTLS) Course. Dr Collins Ekere, King's College Hospital NHS Foundation Trust

Aims: Feedback evaluation to compare attendee’s experience of TTLS to individual predecessors: TTM and TTL. Methods: Feedback collected by questionnaires included pre and post course confidence on assessment & management of the trauma patient, your role on the trauma team, understanding the work institution and resources available, appropriateness of course scenarios and overall worthwhile nature of attendance. Responses were graded on Likert scale of 1(disagree) to 5(agree) and graph plotted for each feedback area to aid comparison. Results: Feedback from 82(of 88) in TTLS (Jan2015-Oct2015), 24(of 26) in TTL (2013-2015) and 146(of 156) in TTM (2013-2014). TTLS had highest % of attendees becoming confident in their role on the trauma team and understanding work institution and resources available (Figure1.). All had similar feedback in post course confidence on assessment & management of the trauma patient (Figure1.), the appropriateness of the scenarios to the learning needs of the participants overall and the individual

Methods: The course was designed for clinicians from Medicine, Nursing and Physiotherapy utilising UK and international guidelines. Multiple teaching methodologies are used, including high fidelity simulation, to maximise learning. Results: The course pilot was successful with excellent feedback. Several further courses are commissioned. Discussion: Whilst the need for NIV is growing, a British Thoracic Society Audit demonstrated that patients are increasingly acidotic when starting NIV and mortality is increasing2. This may represent a delay in recognition of the indications for NIV highlighting a need for increased educational opportunities. Conclusions: A comprehensive NIV course has been successfully produced and is attracting delegates from the whole Multi-Disciplinary Team. Audit will be performed to ensure learning is transferred into clinical practice. Further courses are planned with a view to expansion across the whole of South London.

Background: Team Based Trauma Life Support Simulation (TTLS) course is a multi-disciplinary course consisting of e-learning, high-fidelity simulation, human factors teaching and team training. It replaced Trauma Team Member (TTM) and Trauma Team Leader (TTL) courses.

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attendee (Figure2.). TTLS had 92% of attendees in full agreement that attendance was worthwhile compared to 77% for TTL and 73% for TTM (Figure3.)

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Poster Presentation 4

12:25 – 13:15 | Debenture Lounge Debriefing, Collaboration and Faculty Development

1. Evaluating the learning of non-technical skills in simulation training. Dr Mary Lavelle, Guy's & St Thomas' NHS Foundation Trust Background: A central feature of simulation based training of health care staff is human factors, providing staff with the ‘non-technical’ social and cognitive skills to cope with demanding clinical situations. Non-Technical Skills (NTS) include: situation awareness, decision making, communication, teamwork, leadership, care and compassion and stress and fatigue management. They underpin many aspects of clinical working and are critical in supporting the technical skills and reducing the risk of errors occurring. Although the value of NTS training in health care is well recognized, training evaluation methods have lagged behind. Despite some advances in observer rated evaluation in specific specialities such as anaesthesia [1] or surgery [2], there remains no assessment of knowledge and learning of NTS in health care training more generally, which limits evaluation and development of current health care simulation training. Aims: To develop, pilot and evaluate structured surveys to assess knowledge of, and learning about, NTS that can be used pre and post simulation training in health care. Methods: Alone, NTS categories are abstract definitions lacking descriptive content. Human factors research has unpacked these definitions and provided meaningful behavioural elements for each category [3]. Through consultation with experts in the field of simulation and human factors, we have these translated the behavioural elements into survey items relevant to health care contexts. Results: The survey is currently being piloted with course participants at Simulation and Interactive Learning (SaIL) centres and Maudsley Simulation. The reliability and dimensionality of the survey will be investigated and the findings will be presented. 2. Debriefing the debrief – if you can give it you need to take it. Dr Sam Thenabadu, King's College Hospital NHS Foundation Trust Background: Care transfers for older people with complex needs should be person-centred with effective teamwork (Bolsch et al. 2005). This poster presents simulation-based, inter-professional training to enhance care transfers within Southwark and Lambeth Integrated Care (SLIC).

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Aims: � Use shared experience/knowledge promoting best practice for safe transfer of

care. � Enhance discharge planning skills including effective communication and multi-

agency working. Methods: Course design reflected a patient journey from hospital to community care, based on real-life scenarios, aimed at health/social care professionals with roles involving care transfers of older people. Results: 49 multi-agency staff attended enabling them to build relationships and improve understanding of each other’s roles. Evaluation was based on Kirkpatrick’s (1994) model: reaction to training; learning; application of learning; results and outcomes. Participants completed pre-course (n=44) and post-course (n=47) questionnaires. Pre-course, 30 (68%) participants reported difficulty in transferring or receiving the care of a patient with complex needs. Post–course, 44 (91%) intended changes to their practice, and all believed these would enhance MDT working. Open text comments included increased understanding of roles and communicating effectively. Discussion: Aims achieved with positive evaluation. The value of inter-professional learning was evident. Further evaluation in progress using semi-structured interviews exploring perceived application and impact on practice (Kirkpatrick’s model, levels 3 and 4). Conclusions: This course could be transferred to other settings. Staff turnover across London is high but staff could transfer learning to new organisations. Evaluation is essential as simulation course delivery is labour-intensive and has to be justifiable in economically constrained times. 3. Simulation Faculty Development: When do team members become unconsciously incompetent? Dr Charlotte Davies, King's College Hospital NHS Foundation Trust Background: An in-house faculty development day was constructed to enable cross site faculty to actively participate in simulation scenarios while displaying specific personality traits and conflicting roles adopted by simulation candidates based on the journal by Chang et al 2015 presented in a local journal club. At present there is no platform for faculty to develop and test their clinical and educational knowledge. Aims: To provide an opportunity for faculty to reflect on current simulation techniques, practice and strategies for personal and departmental development. Methods: A half day simulation programme has been devised and all current active simulation facilitators for the trust were invited to attend. There was a positive response and a good multi-professional group of attendees expected.

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The day has been divided to outline the expectation from the ‘faculty’ and ‘candidates’ and the journal article was circulated. Two scenarios have been written covering clinical presentations which are familiar to the ‘candidates’ who have been pre-allocated to one or the other. With their identified roles ‘candidates’ may also have been allocated specific personality traits to adopt during the scenarios and during the debrief. Some candidates are chosen to debrief and ‘faculty’ members will perform an evaluation of the debrief. Results: To be carried out on Wednesday 23rd December 2015 Discussion: We predict that candidates will gain a further insight into being a wider part of simulation faculty-adopting roles they may not have previously been exposed to as well as enhancing difficult debrief strategies and developing a solid structured approach for further practice. Conclusions: TBC 4. Can you feel me now? What does a collaborative approach to simulation based education mean? Vaughan Holm, Croydon University Hospital Background: Developing an organisational culture of educational collaboration and sharing is challenging at the best of times. Simulation based education poses further complications secondary to the cost and the technology itself. Croydon Health Services Simulation Faculty Group represent Simulation Leads from various specialties and professions from throughout the Trust set up with mandated charter to share our simulation learning initiatives and collaboratively develop future programmes to address the shared needs of the Trust. The Simulation Faculty group meet quarterly to review what training has occurred, identify areas of need or focus and collectively review how as a faculty these can be addressed. Aims: To share the effects of such a unique Simulation Faculty on how SBL can be developed and learning shared. And to share what this has meant to the various Leads and their respective areas. Methods: A presentation of feedback and results of how a joined up simulation service can benefit patient safety and how that then leads itself to benefiting training in different specialties. This will be in the form of faculty reflections and course feedback / surveys of how this novel approach has changed attitudes and behaviours of our teams. Conclusions: Having a motivated and interactive faculty has not only benefited the simulation service, and individual simulation leads specific clinical areas of practice but have also introduce and encourage cross departmental inter-professional collaboration that for a lot of centres is a challenge too far.

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5. Setting simulation ablaze, New Collaborations for Patient safety. David Mason, St. George's University Hospitals NHS Foundation Trust Background: Fire Chief Mark Duggan recently joined forces with a London based Simulation Manager to design a COLLABORATIVE training day that infused Medical Education simulation with proactive Fire Fighters. Recent financial support from Health Education South London has been given on the proviso^^ that teams show collaborative work, this pilot allowed managers to test the waters of uncharted alliances and partnerships. In London on average 500 Road Traffic Collisions per month involve a brigade vehicles*, with a 6% increase per year^ in casualties related to RTCs, It is therefore paramount that Fire Officers are adequately trained in emergency medicine. Aims: • Fire fighters to gain a new perspective on training and assessment. • To create new bridges of collaboration. • Strengthen team communication skills in order to improve Patient Safety at RTCs. Methods: Using a combination of Simulators and Actors, the day was broken down into two scenarios that involved different teams in action and allowed room for peer review and observational feedback. Applying Human Factor theories that are frequently used for onsite courses, the session allowed a wonderful opportunity for both groups to learn from each other and understand the importance of collaboration. Results: “…introducing and emphasizing the human factor for me was a plus.” Fire Officer "The learners were really engaged during the whole process! it appeared to me that they did what they would do normally.” Faculty Member Discussion & Conclusions: 1. Small group discussion following the exercise is more effective in encouraging open discussion. 2. Successful simulation programmes require a collaborative approach in designing and development. 6. Medical student simulation and debrief – are we teaching them to run before they walk? Dr Sam Thenabadu, King's College Hospital NHS Foundation Trust Background: Medical students curricula have evolved to include simulation as a modality for delivering information and learning. Human factors in particular have been introduced and explored. Aims:

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A qualitative review of student feedback to explore whether this mode of teaching was deemed efficient and effective Methods: A review of feedback forms and informal comments from year 4 and 5 medical students over a 1 year academic period 2014-15. Results: Prior to the simulation sessions 4th and 5th year students deemed small group sessions as the most popular mode of learning with didactic seminar teaching their second preferred format. After the simulations they universally wanted more sessions but many students commented that more scenarios and less discussion was wanted. Discussion: Debriefs dissecting the description phase is useful to explore and highlight within the larger group the events that unfolded. More succinct didactic analysis and application phases however may be better suited for students to embed new learning. Miller’s pyramid should be recalled as the students may only enter the simulation at Level 1 of ‘know’ and thus a more sophisticated approach and debrief may outstrip their current learning potential. Conclusions: Simulation training is a welcomed format for medical students however faculty must be aware that simpler scenarios and shorter debriefs may be appropriate as the students stage of learning and professionalism may not yet be developed enough to fully embrace longer debriefs or to translate detailed human factors to their future working lives. 7. A study of medical simulation training for junior doctors in UK neonatal Units. Dr Clare Bell, East & North Hertfordshire NHS Trust Background: The use of medical simulation training has grown dramatically in the last 10 years but data on its prevalence in training is lacking. Aims: The objective of this study is to determine whether junior neonatal doctors receive simulation training. Methods: 158 NICU Registrars in England and Wales completed a phone questionnaire. 23 locum respondents were excluded from analysis. Results: When asked where simulation training took place; 66.9% had received simulation training. 42.2% had training in their NICU only, 13.3% had training in a simulation centre only, and 10.3% had training in both NICU and a simulation centre. Of this 42.7% was low fidelity, 38.2% was high fidelity and 15.7% was a mix. All training recipients reported it helped their clinical practice.

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The prevalence of simulation training was highest in London with 90%receiving training, followed by the Northern region with 73.3%, Wales with 58%, and the South East and the South West regions both with only 50%.

Simulation training occurred in 76.5% of the level 3 NICUs compared to only 58.4% of the level 1 NICUs. Discussion: Simulation training is an essential adjunct to doctors’ training recommended by the DoH and RCPCH. Here we report that a third of junior neonatal doctors across England and Wales are not offered any clinically beneficial simulation training, and this figure depends on hospital location and NICU level. A large proportion of junior doctors are therefore inadequately prepared for acute emergencies.