Using low fidelity simulation in interactive workshops for undergraduate medical and midwifery students

There is recognition of the need to continuously improve inter-professional relationships within clinical practice. Mutual respect, effective communication and working together are factors which will contribute to higher standards of care (Miers et al, 2005; Begley, 2008). An inter-professional education initiative, using low-fidelity simulation has been piloted and subsequently embedded within a pre-registration midwifery curriculum. The aim of the collaboration is to enhance inter-professional learning by providing an opportunity for final year midwifery students and 4th year medical students within a non-threatening environment to interact and communicate prior to obstetric clinical placements. The midwifery students are provided with an outline agenda for the workshop, but are encouraged to use creative license with regard to workshop delivery. Preliminary evaluations have been positive from both midwifery and medical students. The teaching sessions have provided an opportunity to learn about and respect each other’s roles. The midwifery students have commented on the enjoyable aspects of team working during preparation and the confidence gained from teaching medical students. The medical students felt that the sessions lowered their anxiety levels going into the labour setting. This workshop will demonstrate how low-fidelity simulation can effectively enhance the students experience promoting team working and self-confidence.

"Should I prioritize medical problem solving or attentive listening?": the dilemmas and challenges that medical students experience when learning to conduct consultations

Objective: Communication skills can be trained alongside clinical reasoning, history taking or clinical examination skills. This is advocated as a solution to the low transfer of communication skills. Still, students have to integrate the knowledge/skills acquired during different curriculum parts in patient consultations at some point. How do medical students experience these integrated consultations within a simulated environment and in real practice when dealing with responsibility?

Methods: Six focus groups were conducted with (pre-)/clerkship students.

Results: Students were motivated to practice integrated consultations with simulated patients and felt like 'real physicians'. However, their focus on medical problem solving drew attention away from improving their communication skills. Responsibility for real patients triggered students' identity development. This identity formation guided the development of an own consultation style, a process that was hampered by conflicting demands of role models.

Conclusion: Practicing complete consultations results in the dilemma of prioritizing medical problem solving above attention for patient communication. Integrated consultation training advances this dilemma to the pre-clerkship period. During clerkships this dilemma is heightened because real patients trigger empathy and responsibility, which invites students to define their role as doctor.

Practice Implications: When training integrated consultations, educators should pay attention to students' learning priorities and support the development of students' professional identity.

The impact of a simulated intervention on attitudes of undergraduate nursing and medical students towards end of life care provision

Background: The concerns of undergraduate nursing and medical students’ regarding end of life care are well documented. Many report feelings of emotional distress, anxiety and a lack of preparation to provide care to patients at end of life and their families. Evidence suggests that increased exposure to patients who are dying and their families can improve attitudes toward end of life care. In the absence of such clinical exposure, simulation provides experiential learning with outcomes comparable to that of clinical practice. The aim of this study was therefore to assess the impact of a simulated intervention on the attitudes of undergraduate nursing and medical students towards end of life care.
Methods: A pilot quasi-experimental, pretest-posttest design. Attitudes towards end of life care were measured using the Frommelt Attitudes Towards Care of the Dying Part B Scale which was administered pre and post a simulated clinical scenario. 19 undergraduate nursing and medical students were recruited from one large Higher Education Institution in the United Kingdom.
Results: The results of this pilot study confirm that a simulated end of life care intervention has a positive impact on the attitudes of undergraduate nursing and medical students towards end of life care (p < 0.001).
Conclusions: Active, experiential learning in the form of simulation teaching helps improve attitudes of undergraduate nursing and medical students towards end of life. In the absence of clinical exposure, simulation is a viable alternative to help prepare students for their professional role regarding end of life care.