Simulated Training in Emergency Paediatrics (STEP)
Updates on the use of Simulation Based Medical Education within this Speciality
Emergency Medicine is an intense and complex environment.
As a senior clinician in the ED you can be making around 40 important clinical decisions per hour, this is usually combined with being interrupted a similar number of times. While you are managing a department from a quality indicator perspective and keeping ambulance handovers in time and avoiding breaches, you may be supervising juniors one year out of medical school, fielding queries from other specialties and seeing your own patient workload.
To be able to cope and be proficient in this role it is vital that you have good clinical skills to be able to diagnose the patient with a PE in room 1 and be comfortable sending home the patient in room 2 who has chest pain. What is less obvious are the non-technical skills that are needed to manage in this situation. The ability to communicate with other members of staff: to effectively delegate jobs and know they will be done, to ensure your team knows what the priorities are at this moment and how they might change in an hours’ time. The ability to make decisions clearly and precisely but also to review that decision in the light of new information. The ability to know how to work your team most effectively and know when they need a boost or a few minutes time out. And finally the ability to be aware of the department as a whole, how all these issues interlink and to try to predict what problems there may be in the next hour.
These are the non-technical skills that are difficult to teach but obvious in those who run the department well. It is only through awareness of what these skills are and by reviewing your own actions that they can be improved. The safest way of exploring these issues without affecting patient safety is through simulation. It can help practice drills for the rare but important clinical situations such as a peri-mortem caesarean section or for everyday situations such as an exacerbation of asthma and can focus on teamwork, decision making, and use of guidelines or practical skills.
To be a good Emergency Physician you need to know your strengths and weaknesses for non-technical skills and know that you have used every opportunity to practice those skills and your clinical skills in a simulated environment.
Dr James McFetrich
Consultant in Emergency Medicine
Northumbria Healthcare NHS Trust