Award Candidate Poster Presentation


'Mini Sim' - Innovative bite sized simulation teaching in a busy Children's Emergency Department

Tuesday, May 15
09:45 - 10:45
Location: Jupiter 1&2

Context: : Emergency Medicine requires a highly skilled workforce who are passionate about delivering excellent patient care. Shift patterns linked with the ever increasing numbers of patients who attend Emergency Departments puts strain on educating the workforce and fostering team togetherness. This led to an imperative to design novel methods of educating workforce with minimal disruption to clinical patient care. Our objective in devising and instigating the “Mini Sim” programme was to embed regular in-situ simulation training to enhance the learning of all staff (medical and nursing) within our Emergency Department team, building a highly trained workforce to deliver excellent care within the remit of our busy department.

Description: : “Mini Sim” takes place on a weekly basis, every Tuesday morning from 0930-1000. This timing is to ensure maximum participation from all staff. The setup is a fifteen minute simulation (one nurse, one junior doctor, one senior doctor) followed by fifteen minutes of debrief. The format includes an assessment of the participants confidence prior to “Mini Sim” in the subject being practiced. This is rated on a numerical scale from 1 (being not confident at all) to 5 (being completely confident). The topics chosen are based on feedback from trainees and nurses on clinical skills they feel under confident in, (e.g. pelvic binder application), clinical incidents which have occurred around the Trust (e.g. seizures), National Patient Safety Alerts (e.g. phenytoin toxicity), protocols (e.g. abducted child) , governance issues (e.g. blocked tracheostomy) and curriculum ompetencies. The “Mini Sim” then takes place in situ within the ED resuscitation room, ED main department or our short stay observation ward using real equipment and drugs. After the simulation a debrief is held and any additional teaching is carried out to embed learning. Each medical participant is then offered the opportunity to complete a work place based assessment on the “Mini Sim” for their learning e-portfolio. They also complete a scoring rating for confidence after completion of "Mini Sim". Learning points are disseminated via a newsletter to the whole ED team.

Observation/Evaluation: : The work flow of the department has been unaffected. We have received excellent verbal and written feedback from participants about the programmes educational quality. “Mini” Sim also has involved other teams such as anaesthetics, spreading learning and expertise hospital wide. Likewise, through the process of using real time equipment and drugs, pertinent changes to the way we set up and run our Department have been made. Formal feedback, scoring and verbal comments, collated shows improvements in staff confidence in dealing with a variety of emergency situations.

Discussion: : The implementation of "Mini Sim" is complete. The programme has been running for a year now with achieving goals of no alteration to patient flow and excellent written feedback from participants. Our trainee satisfaction scores for education in the General Medical Council National Trainee Survey has improved. We would suggest this model could be used in other departments for similar gain.

Rachel Sunley, BMBS (Hons) BMedSci (1st) MRCPCH

Consultant Paediatric Emergency Medicine
Bristol Royal Hospital for Children
Bristol, United Kingdom

Dr Rachel Sunley is a Consultant in Paediatric Emergency Medicine at Bristol Royal Hospital for Children. The Department receives 40,000 children a year and is the Major Trauma Centre for the Severn Region. Rachel is Education Lead and is highly passionate about whole team learning within the Emergency Department.

The educational programme includes weekly “Mini Sim”, monthly “Big Sim”, weekly junior doctor teaching, weekly senior doctor teaching, creation of an Educational Contract for junior doctors and championing learning within the Department to inspire better patient care.

Alongside Karen Moloney, Nurse Educator, and the simulation staff led by Kirsty Brown, she has created a weekly programme of “Mini Sim” simulation that includes nursing staff, nursing assistants, junior and senior doctors. The “Mini Sim” is reflective, tailored to team objectives for learning and responsive, simulating recent clinical incidents within the Trust or nationally. Rachel’s other roles in the Department as Major Incident Lead and Mental Health Lead, have ensured innovative simulations in dealing with mental health issues and preparing for mass casualty situations and terrorist attacks. The whole team learning approach builds cohesiveness within a system relying on shift workers and has no impact on patient care happening concurrently within the Department.

Rachel teaches externally on internationally recognised courses including the European Trauma Course, Advanced Paediatric Life Support and Advanced Trauma Life Support.


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Karen Moloney, RN

Nurse Educator
Bristol Royal Hospital for Children, United Kingdom

My name is Karen Moloney, I am a Clinical education facilitator in the Emergency Department, at The Bristol Royal Hospital for Children, in the U.K. Working as part of a team, my role is to facilitate education to all levels of nursing staff, in our busy Children’s Emergency Department.
The team utilises simulation in a number of ways:
• Along with our Consultant colleague, Dr Rachel Sunley, we run a multidisciplinary education programme. This consists of a weekly, short, focused, in situ 'Mini Sim' and debrief to practice skills and/or policies.
• On a monthly basis, we also run a 'Big sim'. This is an hour long, in situ, multidisciplinary, real time, immersive simulation which allows the practice of resus skills in a safe environment. Following this, we have an hour of debrief to help consolidate the learning.
• Being the major trauma centre for children in the South West Severn and Peninsula network within the UK, we are involved in co-ordinating and delivering simulation training on the Major trauma nurses study days to our own nursing staff, and nurses from the region.
• As part of the Children’s Hospital’s Faculty of Children’s Nurse Education, we also participate in the utilisation of simulation in the nurse orientation programme and other educational projects.
We are fortunate to be aided in all of these sessions by the staff and equipment of the Bristol Medical Simulation Centre.


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'Mini Sim' - Innovative bite sized simulation teaching in a busy Children's Emergency Department


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