title: Simulation in undergraduate paediatrics: a cluster-randomised trial.
abstract: BACKGROUND
  Medical students lack confidence in recognising, assessing and managing unwell patients, particularly children. Our aim was to evaluate the impact of a 1-day novel paediatric simulation course on medical students' ability to recognise and assess sick children, and to evaluate medical students' views on the use of simulation in child health teaching.
  
  
  METHODS
  We conducted a cluster-randomised trial with a mixed-methods design. Students were cluster randomised into the intervention (simulation) group or control group (standard paediatric attachment). Students in the intervention group attended a 1-day simulation course during the last week of their attachment. The primary outcome measure was students' self-reported ability and confidence in recognising, assessing and managing sick children.
  
  
  RESULTS
  There were 61 students in the study: 32 in the intervention group and 29 in the control group. Self-assessed confidence in recognising, assessing and managing a sick child was higher after the simulation course, compared with controls (p < 0.001). Six key themes were identified, including: increased confidence in emergency situations; the value of learning through participation in 'real-life' realistic scenarios in a safe environment; and an appreciation of the importance of human factors. Students found the simulation useful and wanted it offered to all undergraduates during child health attachments.
  
  
  CONCLUSIONS
  A 1-day simulation course improves medical students' confidence in assessing and managing unwell children, and is highly valued by students. It could be used to complement undergraduate teaching on the management of sick children. Further studies are needed to evaluate its impact on real-life clinical performance and confidence over time. Students lack confidence in managing unwell patients, particularly children.
authors.affiliation: Whittington Hospital NHS Trust, Magdala Avenue, London, UK. benita.morrissey@nhs.net.|UCL Institute of Child Health, London, UK. benita.morrissey@nhs.net.
authors.forename: Benita
authors.initials: B
authors.lastname: Morrissey
authors.affiliation: Homerton University Hospital NHS Foundation Trust, London, UK.
authors.forename: Hannah
authors.initials: H
authors.lastname: Jacob
authors.affiliation: Whittington Hospital NHS Trust, Magdala Avenue, London, UK.
authors.forename: Erika
authors.initials: E
authors.lastname: Harnik
authors.affiliation: Whittington Hospital NHS Trust, Magdala Avenue, London, UK.
authors.forename: Kate
authors.initials: K
authors.lastname: Mackay
authors.affiliation: Whittington Hospital NHS Trust, Magdala Avenue, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Moreiras
mesh_terms: D001291:Attitude of Health Personnel; D002648:Child; D002983:Clinical Competence; D004504:Education, Medical, Undergraduate / Q000379:methods*; D004521:Educational Measurement; D006801:Humans; D010372:Pediatrics / Q000193:education*; D013337:Students, Medical / Q000523:psychology; D011795:Surveys and Questionnaires