The effects of an enhanced simulation programme on medical students' confidence responding to clinical deterioration.
BACKGROUND
Clinical deterioration in adult hospital patients is an identified issue in healthcare practice globally. Teaching medical students to recognise and respond to the deteriorating patient is crucial if we are to address the issue in an effective way. The aim of this study was to evaluate the effects of an enhanced simulation exercise known as RADAR (Recognising Acute Deterioration: Active Response), on medical students' confidence.


METHODS
A questionnaire survey was conducted; the instrument contained three sections. Section 1 focused on students' perceptions of the learning experience; section 2 investigated confidence. Both sections employed Likert-type scales. A third section invited open responses. Questionnaires were distributed to a cohort of third-year medical students (n = 158) in the North East of Scotland 130 (82 %) were returned for analysis, employing IBM SPSS v18 and ANOVA techniques.


RESULTS
Students' responses pointed to many benefits of the sessions. In the first section, students responded positively to the educational underpinning of the sessions, with all scores above 4.00 on a 5-point scale. There were clear learning outcomes; the sessions were active and engaging for students with an appropriate level of challenge and stress; they helped to integrate theory and practice; and effective feedback on their performance allowed students to reflect and learn from the experience. In section 2, the key finding was that scores for students' confidence to recognise deterioration increased significantly (p. < .001) as a result of the sessions. Effect sizes (Eta(2)) were high, (0.68-0.75). In the open-ended questions, students pointed to many benefits of the RADAR course, including the opportunity to employ learned procedures in realistic scenarios.


CONCLUSIONS
The use of this enhanced form of simulation with simulated patients and the judicious use of moulage is an effective method of increasing realism for medical students. Importantly, it gives them greater confidence in recognising and responding to clinical deterioration in adult patients. We recommend the use of RADAR as a safe and cost-effective approach in the area of clinical deterioration and suggest that there is a need to investigate its use with different patient groups.
School of Medicine, University of Dundee, Dundee, Scotland, UK. g.x.hogg@dundee.ac.uk.|School of Education and Social Work, University of Dundee, Dundee, Scotland, UK. g.x.hogg@dundee.ac.uk.|Clinical Skills Centre, University of Dundee School of Medicine, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK. g.x.hogg@dundee.ac.uk.
George
http://orcid.org/0000-0001-6187-4412
G
Hogg
School of Medicine, University of Dundee, Dundee, Scotland, UK.|School of Education and Social Work, University of Dundee, Dundee, Scotland, UK.
David
D
Miller
D001291:Attitude of Health Personnel; D002983:Clinical Competence / Q000592:standards*; D003422:Critical Care / Q000592:standards; D006801:Humans; D007858:Learning; D016544:Patient Simulation; D018794:Problem-Based Learning / Q000379:methods*; D012606:Scotland; D012720:Severity of Illness Index; D013337:Students, Medical; D011795:Surveys and Questionnaires
Critical illness; Failure to rescue; Patient simulation; Simulation training