Pioneering simulation-based medical teaching

Arron Thind, GP Trainee, Guy’s and St Thomas’ NHS Foundation Trust and Digital Pioneer Fellow.

Overview of project:

Simulation-based medical teaching forms a core aspect of practical clinical training for healthcare professionals and medical students. It involves the use of a mannequin and various hospital paraphernalia to recreate an acute or emergency clinical situation.

However, to maximise the benefits obtained from this type of training, the simulation must replicate a true clinical environment. Electronic patient record systems (EPRs) are becoming increasingly prevalent in the NHS, but are yet to be incorporated into practical clinical training. In fact, a survey of 122 junior doctors and medical students trained across 80 hospitals and 19 medical schools revealed that none had used EPRs during simulation training.

As a result, many medical students will have completed their training with minimal experience navigating a computer system under pressure, recognising patient safety issues and clinical deterioration from electronic information. Further, when eventually working as a doctor, this lack of exposure to EPRs may increase the risks of errors attributed to improper data entry or information retrieval. Considering that errors associated with the use of EPRs are among leading causes of patient harm, inadequate integration of these digital systems into training represents an avoidable patient risk.

Using Java programming skills Arron learned alongside clinical commitments as a junior doctor, he independently created a novel educational electronic patient record (SimEPR), featuring customisable and interactive clinical scenarios, purpose-built for simulation training.

With support from the DigitalHealth.London Fellowship, SimEPR has been deployed in multiple teaching hospitals in London and the South East for the delivery of medical student and junior doctor simulation training.

Simulates real life environments well, waiting for results to come back is great!

– CT1 Doctor, Croydon University Hospital

Impact of project:

As a result of this project, a novel teaching software has been developed that digitally transforms the delivery of simulation training for current and future NHS staff, whilst offering a higher fidelity clincial training experience and enhanced learning of clinical skills. In turn, SimEPR is anticipated to therefore offer benefits to patient safety and digital readiness of NHS workforce.

In terms of adoption, the development of SimEPR was completed in September 2020 and it was initially deployed at East Surrey Hospital’s simulation department for St George’s University medical student training. With excellent feedback, SimEPR has since expanded to Croydon University Hospital and The Royal London Hospital.

The most realistic sim we have ever done because of the availability of EPR.

– F2 Doctor, The Royal London

Feedback data was recorded as part of a multicentre study. Out of 40 medical students and junior doctors who completed simulation training using SimEPR at these sites, 87% reported that SimEPR created a more realistic training experience, and 80% reported that the system augmented clinical learning. From the perspective of medical educators, all five simulation leads and managers (100%) reported that SimEPR helped deliver a more realistic training experience and that it integrated well into simulation training. 

Given its clear benefits to the delivery of medical education, SimEPR has attracted commercial interest from other institutions. A commercial agreement has been recently entered with Brighton University’s Simulation Centre. In addition, Arron has secured a place on the NHS Clinical Entrepreneur Programme, which has supported SimEPR’s growth as a commercially viable product.

Increased realism. In real life, tests are requested via an EPR interface. If ‘real-time’ simulation is the aim, then SimEPR is an asset here.

– Medical Registrar and Former Teaching Fellow at East Surrey Hospital

Key learnings from the project delivery to date:

Reflecting on his experiences building and deploying SimEPR has highlighted for Arron how healthcare professionals have enormous potential to transform and improve health services through digital technology. To facilitate this, they must be equipped with the digital skills to understand, adopt, create and improve digital services.

With this in mind, in February 2021, Arron co-found Code Med, a start-up which teaches healthcare professionals how to code through a 12-week course (https://codemed.co.uk).

An aspect unique to the course is the use of medical examples to explain programming concepts and delegates build computer apps with real clinical utility. Since its launch, Code Med have taught dozens of doctors across the UK (across various specialties and ranging from junior doctor to consultant level). Many delegates who have completed the course are now working on bringing their own innovative ideas to life, and they have continued to mentor them on this journey beyond the course.

Overall, not only does the Code Med course aim to equip healthcare staff with the skills to address everyday service issues for their trust using digital innovation, but also it offers an opportunity for individuals to diversify their clinical career in ways they never thought they could! For Arron, combining his clinical experience with understanding of software and technology proved pivotal when he was appointed Deputy Lead of Emerging Technology at the Department of Health and Social Care between January to July 2021.

Alongside his GP training, Arron looks forward to continuing to combine his clinical experience with digital skills gained through programming and as a DigitalHealth.London Fellow to create a digitally ready NHS workforce capable of using technology to enhance patient care.