Learning to manage "The Floor": pilot study of a tabletop simulation
Background:
Learning to manage the shop floor in emergency medicine training is key. The Royal College of Emergency Medicine curriculum states that trainees must be able to “lead, manage and supervise others, ensuring the safe running of an emergency department (ED)”. This involves overseeing patient flow and disposition, staffing issues and troubleshooting the changing landscape of the ED as well as supporting junior colleagues. The current practice for learning these essential skills is through observation and shop-floor experience, but is this enough?
Aim:
To introduce a new method of teaching shop-floor management that is realistic, repeatable and easily modified to allow for changing scenarios.
Method:
The tabletop simulation ‘board’ is formed of three A1 sheets designed to mirror our ED, including the resuscitation bay, majors and clinical decisions unit. Candidates are tasked with managing incoming patients through the ambulance bay from disposition, through investigation and ongoing management as well as prioritising patients to be reviewed by junior members of staff. Simulators can alter the situation through lifelines like ‘5 medical beds have become available’ or deteriorations like ‘there are three ASHICEs en route’, as appropriate. The simulation can be run to mimic a ‘normal’ shift in ED or can incorporate infrequent, serious incidents such as major incidents.
The simulation has been piloted with three different staffing groups; our ED juniors (from foundation year 1 to first year acute care common stem (ACCS) trainees), our ED registrars and at a regional simulation day for ACCS trainees. Each session lasted between one and two hours, and participants tackled the simulation in pairs. Qualitative feedback was gathered to assess the applicability of the tabletop format for this sort of training, to assess participant satisfaction and to inform the future of the project.
Outcome:
All three groups found the tabletop simulation engaging, entertaining and relatable to managing the real shop floor. Some of our junior group found the experience stressful but appreciated the insight it gave into the many aspects of managing a department. The ACCS trainees felt this type of training should be included in their curriculum, particularly prior to managing an ED independently overnight. Our registrars praised the addition of a major incident to their session, particularly the incorporation of a pre-hospital sieve and in-department sort.
Although all three groups appreciated the simulation, they felt that incorporating our nursing colleagues in some way would be beneficial as well as finding a way to check patients into the department to ensure the 4 hour target is a factor. The registrars also requested more clinical decisions be included, though this was not the scope of the project.
The Future:
This tabletop simulation will form part of our junior and registrar teaching sessions for the coming year, as well as being piloted among our consultant body. New patient scenarios are constantly being developed, including major incident scenarios. Ultimately, computerising this simulation to facilitate the 4 hour target monitoring and the limit physical pieces may be the easiest and most adaptable solution.
