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Effect of In Situ High-Fidelity Simulation Training on the Emergency management of Pneumonia (INSTEP): a mixed-methods study
  1. Owain Michael Leng1,
  2. Charlotte Rothwell2,
  3. Annamarie Buckton3,
  4. Catherine Elmer3,
  5. Jan Illing2,
  6. Jane Metcalf3
  1. 1Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
  2. 2School of Medical Education, Newcastle University, Newcastle upon Tyne, UK
  3. 3Department of Medicine, University Hospital of North Tees, Stockton-on-Tees, UK
  1. Correspondence to Dr Owain Michael Leng, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP, UK; o.leng{at}


Background The patient safety agenda has propelled the rise of simulation education, but relatively few evaluations of simulation-based educational interventions have focused on patient outcomes.

Objective To evaluate the impact of an in situ, high-fidelity simulation teaching intervention on the management of community-acquired pneumonia in the ambulatory care unit of a district general hospital.

Methods This study used a mixed-methods approach to evaluate the impact of a programme of 10 in situ high-fidelity simulation education sessions delivered to a total of 10 junior doctors, nine nurses and seven healthcare assistants. Participants were tasked with managing a manikin simulating a patient with pneumonia in real time in a working clinical area. Subsequent structured debrief emphasised key themes from the national guidelines on pneumonia management. The intervention was evaluated through an immediate feedback form, follow-up semistructured interviews by independent qualitative researchers that underwent content analysis and triangulation with audit data on compliance with national pneumonia guidelines before and after the simulation intervention.

Results The in situ simulation intervention was valued by participants both in immediate written feedback and in follow-up semistructured interviews. In these interviews, 17 of 18 participants were able to identify a self-reported change in practice following the simulation intervention. Furthermore, most participants reported observing a change in the clinical practice of their colleagues following the training. Collected audit data did not show a statistically significant change in compliance with the guidelines for the management of pneumonia.

Conclusion This study found evidence of a change in both self-reported and observed clinical practice following a simulation intervention, supporting expert opinion that simulation education can impact clinician behaviours and patient outcomes in complex clinical scenarios. Furthermore, this feasibility study provides a transferrable method to evaluate the real-world impact of simulation education that merits further investigation through an appropriately powered study.

  • high fidelity
  • simulation
  • medical education
  • sepsis
  • pneumonia

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  • Contributors OML designed the simulation education intervention, helped to deliver the education intervention, designed the postintervention feedback form, analysed the feedback form data and drafted and revised the paper. He is guarantor. CR conducted telephone semistructured interviews with participants, undertook thematic analysis of this data and contributed to the drafting and revision of the paper. AB helped deliver the education intervention, collected audit data on pneumonia outcomes and revised the draft paper. CE provided specialist advice to develop the simulation education intervention, oversaw the audit data collection and revised the paper. JI advised on the process of the semistructured interviews and thematic analysis, oversaw the semistructured interviews and revised the paper. JM developed the study’s aims, advised on the development of the method and contributed to the drafting and revision of the paper.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests CE has received funding from Pfizer for three smoking cessation talks.

  • Ethics approval The project was approved by the North Tees and Hartlepool NHS Foundation Trust Research and Development Manager through the local Trust process. It was determined that Caldicott approval was not required for this study.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Further details of regional audit data may be obtainable through contacting CE.

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