Delivering Simulation in

Psychiatry
Dr Emma Barrow, ST6, General Adult Psychiatry
Dr Jayne Greening, Associate Medical Director
Medical Education, BSMHFT
Drivers for development …
• Use of simulation across a wider range of specialties (not
just ‘acute’)
• Attention of RCPsych
• Focus of undergraduate and postgraduate medical
education locally & nationally
• Focus of multiprofessional training in other regions
• Focus on patient safety and August changeover
In Birmingham …
• Junior doctors (FY2, CT1-3, GPST1&2) work across several
different rotas covering 3 large geographical areas
• Residential and Non-Residential
• A&E out of hours assessments
• Inpatient units, adult, older adult and PICU
• Complex and challenging situations out of hours
• Many will not have previous psychiatry experience
• ‘skills’ can’t be gained from textbook or lecture
Timeline to development …
• September 2014 – February 2015
• Core development group (3 x trainees, 1 x consultant)
• Focus groups with trainees in each region
• Identify potential scenarios from focus groups
• Write, develop and pilot scenarios on existing trainees
who volunteered
• Service user and carer input
• Write and develop feedback materials
Timeline to development …
• February 2015 – February 2016
• In total 77 trainees have participated in simulation
training
• Mix of FY2, CT1/2/3, GPST1&2, BBT
• August 2016 onwards
• Reduction in number of scenarios from 6 to 4
• Increased length of time for feedback
• 8 minutes to 20 minutes
• Formal part of induction programme (“best bit”)
• Build in training for facilitators in feedback and debriefing
• Reading materials sent out in advance
Developing the scenarios …
• 3 authors, overseen by consultant
• Ran 2 focus groups with approx. 30 trainees following routine JD forum
• Identified 8 core themes which elicited anxiety, difficulty or distress
amongst trainees
• Practically able to develop 6
Section 5(2)/suicide risk Aggressive patient/rapid tranquillisation
Dementia and UTI Relative of alcoholic wanting admission
for detox
NMS/acutely ill patient Risk assessment for self-harm in
personality disorder
Developing the scenarios …
• Calgary – Cambridge model as initial template
• Designed for ‘physical illness’ scenarios with
signs/symptoms
• Over time further developed actor/simulated patient
instructions
• Trainee instructions
• Actor/Simulated Patient instructions
• ‘Nurse’ or Facilitator instructions
• Script for ‘Consultant on call’ advice (SpR)
Developing the scenarios …
Developing the scenarios …
Developing the scenarios …
Developing the scenarios …
Developing the scenarios …
Developing the scenarios …
Setup and design …
Setup and design …
• Each scenario would run for max 30 minutes
• 15-20 min with actor and ‘nurse’ facilitator
• Remaining 8-10 mins for feedback and debriefing & move to next
station

• ‘Do one, see all’

• Pre and post evaluation of individual confidence level
• Guidance for feedback and debriefing
Feedback and Evaluation …
• Pendleton’s rules
• Performance descriptors
• ‘Ground rules/Vegas rules’
• Questions to guide debriefing

• Evaluation forms pre and post (paired data)

• ‘Process of simulation’ evaluation forms
• Qualitative feedback
Debrief Diamond …
Key phrases to remember
Description
• “Let’s not focus on
performance, focus on what
happened
• “And then what happened,
how did it happen?”
Application
• “What other situations might
you face that could be similar”
• “What are you going to do
differently in your clinical
practice tomorrow because of
this?”
Analysis
• “How did that make you feel?”
• “Why?”
• ”Why did you take that action?”
• “What I am hearing from you is
that …”
• “We refer to that as a human
factor or non-technical skill
which means …”
• “So what have we agreed we
could do?
Feedback and Evaluation …
• The process of simulation was clearly
explained to me
• I was given the opportunity to ask
questions or clarify my
understanding before the simulation
activity began
• The facilitator clearly explained the
purpose of simulation and how this
supports my medical training
• The purpose of debriefing following
the simulation activity was fully
explained to me
• I found the debriefing handout
useful
• I understood what was expected of
me when actively participating in the
simulation activity
• I understood what was expected lf
me when observing the simulation
and participating in debriefing and
feedback
• I felt able to share my thoughts and
experiences
• I received constructive feedback and
guidance on my performance
• The process of debriefing helped me
to explore what was thinking during
the simulation event
• The proves of simulation helped
build my confidence in managing
patient encounters in the on call
setting
• The process of simulation will change
my future practice
Summary of
the results
so far …
Qualitative feedback …
• Thematic analysis:
Organisation and set up
• “Well organised” and “supportive”
• “Anxiety provoking” or “like an exam” (small number)
Scenarios
• “Found myself immersed in the scenario, forgot it was
simulation”
Feedback
• “Appreciate Consultant feedback on performance”
Educational value
• “Useful” and “valuable”
• “will definitely help in future with real patients and relatives”
Where we are now …
• Process of writing up the initial results from evaluation
• Feb 2015 – Feb 2016 (inclusive)

• Consultant facilitators Receive training in facilitation and

debriefing
• Trainee facilitators

• Reduction in number of scenarios from 6 to 4

• Increased length of time for feedback from 8 minutes to 20 minutes
• Formal part of induction
• Reading materials sent out in advance
• Looking to develop more scenarios from different specialties
References …
• Jaye, Thomas and Reedy, (2015) ‘The Diamond’: a structure for
simulation debrief. The Clinical Teacher 12: 171-175
• Thomson et al, (2013) How we developed an emergency psychiatry
training course for new residents using principles of high-fidelity
simulation. Medical Teacher 35: 797-800
• Carthey and Clarke (2009) Implementing Human Factors in Healthcare
www.patientsafetyfirst.nhs.uk version 1
• Rudolph et al, (2007) Debriefing with Good Judgement: Combining
Rigorous Feedback with Genuine Enquiry. Anesthesiology Clinics 25:
361-376.
• Rudolph et al, (2006) There’s No Such Thing as “Nonjudgmental”
Debriefing: A Theory and Method for Debriefing with Good Judgement.
Simul Healthcare 1: 49-55