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0095 Simulation: A Truly ‘safe’ Learning Environment?
  1. Tracey Stephenson,
  2. Davinder Singh,
  3. Makani Purva
  1. Hull and East Yorkshire NHS Trust, Hull, UK


Background Simulation-based education in healthcare is promoted as a safe learning environment where knowledge, skills and attitudes can be developed without the risk of patient harm.1 However, debate exists regarding how safe simulation should be for participants who underperform, particularly when it is not being used as a formal assessment tool.

Doctors have a professional obligation to put patient safety first at all times. The General Medical Council (GMC) advocates early identification of potential doctors in difficulty and intervention to avoid adverse consequences for patients, colleagues and the doctor concerned.2 Whilst simulation has been employed to formally assess performance of doctors deemed to be in difficulty,3 it has not conventionally been used to identify and escalate trainee underperformance. Having experienced this difficulty within Paediatrics recently, we sought to explore the thoughts of Paediatric Consultants within our region.

Methods A survey of 12 questions was sent electronically to 297 Paediatric Consultants in Yorkshire and the Humber to uncover attitudes regarding escalation of Paediatric trainee underperformance in immersive simulated environments. A time limit of a month was given and Consultants answered anonymously with the opportunity for free text comments.

Results The survey elicited a 33% response rate. 37% reported considerable experience in simulation. Overall, 63% of Consultants agreed or strongly agreed that underperformance of Paediatric trainees in immersive simulated environments should be escalated. Escalation consideration was more likely after underperformance on more than one occasion. Whilst only 9% considered there to be appropriate guidance, the majority would escalate to clinical and educational supervisors.

Conclusions and recommendations Doctors in difficulty should be identified early to enable timely intervention. Paediatric Consultants in our region consider escalation would be an appropriate course of action for trainee underperformance in immersive simulated environments. However, formal guidance is needed.


  1. Lateef F. Simulation-based learning: Just like the real thing. J Emerg Trauma Shock. 2010 Oct-Dec; 3(4): 348–352

  2. The General Medical Council (2013). Managing Trainees in Difficulty (version 3): Practical Advice for Clinical and Educational Supervisors. [online]. Available Accessed 12th June 2014

  3. Stirling K, Hogg G, Ker J, Anderson F, Hanslip J and Byrne D. Using simulation to support doctors in difficulty. Clinical Teacher 2012 Oct;9(5):285–9

  • Category: Course or curriculum evaluation/innovation/integration

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