An evaluation of a simulation-based training programme to support the prescribing education of foundation grade doctors and junior clinical fellows

Abstract Introduction Prescribing is a high-risk task with doctors describing feeling unprepared for prescribing practice with education needed to support their prescribing skill development.1 Simulation-based training (SBT) is an educational tool used widely in healthcare education, with potential to support prescribing practice,2 and a SBT programme was designed to support Foundation year (FY) grade and Junior Clinical Fellow (JCF) doctors with their prescribing education. Aim To evaluate the views and experiences of resident doctors of a SBT prescribing programme and how it may have supported their prescribing practice. Methods A SBT programme was designed and facilitated by a multi-professional team of clinicians and educators and delivered over a 12-month period. Simulation scenarios were designed to reflect the Foundation curriculum and priority medication safety themes. Individual doctors completed the scenarios with others watching via a live stream. Each simulation was debriefed by a clinical education pharmacist. A 15-item survey was designed to explore perceived value of the SBT and application of learning to practice. Self-administered surveys were distributed to all doctors at the end of the training year who had participated in the SBT (FY1 = 42, FY2 = 42, JCF1 = 27, JCF2 = 13). Questions combined five-point Likert-scale (strongly disagreed to strongly agreed), with open-ended statements to explore prescriber views of the training and how it had influenced their prescribing practice. Data were entered into Excel with agreement scores calculated and analysed descriptively. Free text responses were analysed thematically for common themes. Results Ninety-nine participants responded (79.8% response rate). The majority of participants strongly agreed/agreed that they were satisfied with the training (n = 88, 88.9%), which was valuable (n = 90, 90.9%), supported their prescribing development (n = 91, 91.9%), was applicable to practice (n = 92, 92.9%) and relevant (n = 94, 94.9%,). Doctors also agreed that they had applied the learning in their prescribing (n = 89, 89.9%), and it had supported their patient care (n = 92, 92.9%). Three key themes were identified from open-ended responses—training modality, impact on practice, and programme improvement. Doctors suggested that SBT was an appropriate training modality with realistic scenarios and practical, experiential learning supporting their learning in a safe environment. Doctors described the positive impact of SBT on their prescribing confidence with the realistic scenarios allowing application in practice, especially in similar or complex scenarios, or out of hours. Doctors described raised awareness of prescribing errors, seeking more information to inform their prescribing, and learning how to manage complex and challenging prescribing scenarios. Others suggested they felt more comfortable prescribing in difficult situations following their training. Doctors suggested the SBT could be improved with more scenarios, team-based simulations and presentations to complement the SBT. Conclusion SBT is valued by resident doctors to support their prescribing practice in complex situations, with potential to reduce prescribing error. This survey had a high response rate, providing greater accuracy in representing the FY and JCF doctor cohort responses. There are limitations to this study with it being a single site study whilst the impact on prescribing competence is also unknown, with further work required to explore the impact of SBT on prescribing error rates.