6101 Paediatric outpatient simulation: bridging a gap in training

Objectives Paediatric training aims to produce doctors who understand the variable conditions facing children, and the application of this to both acute and outpatient settings.1 However, with greater workforce demands influenced by admission rates,2 morbidity,3 and staff recruitment and retention issues,4 exposing trainees to adequate learning opportunities is becoming more difficult. One particular concern is the exposure to paediatric outpatient experience, ranging from opportunistic at best to non- existent at worst. The result is a generation of trainees with less hands-on paediatric outpatient experience, yet a patient cohort that demands a greater skill set for effective management. Striking the balance between service-need and training to prepare future consultants has never been more important.5 We outline a simulation initiative that aims to readjust this balance, preparing trainees for issues arising in the outpatient setting. Methods We created four outpatient simulated scenarios around different themes; explaining a diagnosis, difficult communication, conflict resolution, and safeguarding. These themes were identified iteratively through a panel of experts as being most relevant to paediatric trainees. All paediatricians in speciality training years 4–5 were invited to attend the half-day of simulations. This cohort was chosen because stepping up to the middle grade rota can be daunting with minimal time for outpatient clinics. The sessions consisted of four scenarios, each led by a different trainee. A simulated patient played the part of the primary caregiver and there were two senior facilitators co-ordinating. Once the trainee had brought their consultation to a close, a facilitator led debrief utilising advocacy-enquiry6 helped to promote critical reflection. The content was shared region-wide to enable different trusts to provide the training. Results A total of 7 sessions were provided across 3 trusts providing the outpatient simulation to 28 trainees. 100% of the candidates rated the simulation as 'excellent', with comments such as 'innovative session with practical and relevant scenarios', and 'the way the scenarios and debrief was conducted helped me a lot'. Conclusion Paediatric training faces significant challenges in the context of attending outpatient clinics. Our innovative approach using outpatient simulation scenarios has helped to bridge this gap in training, providing paediatric trainees with increased confidence and skill when managing these patients. Our approach using centrally developed content which was then distributed to educators further afield allowed multiple trusts and trainees in the region to benefit from the resource. References RCPCH Progress+, RCPCH, Aug 2023. Dick, et al. Interventions to reduce acute paediatric hospital admissions, Archives of Disease in Childhood, 2022. State of child health: England, RCPCH, 2020. RCPCH Workforce census report, RCPCH, 2022 Training time and learning opportunities, Hodgson, 2022. www.rcpch.ac.uk/resources/training-principle-7 Cheng, et al. Debriefing: The state of the art and science in healthcare simulation, 2017.