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“Visiting Uncertainty Together” an immersive home visit simulation for final-year medical and GEMS nursing students

Oral Presentation 1
Dr Davina Carr, Prof Gerry Gormley, Miss Alison Smart, Dr James Reid

“Visiting Uncertainty Together”- an immersive home visit simulation for final year medical and GEMS (Graduate Entry Masters Students) nursing students

Newly qualified healthcare professionals are required to be able to care for patients who are acutely unwell in a variety of settings, including the patient’s home. Patients who require urgent care in their own homes are at risk of acute deterioration. Differentiating acute deterioration from self-limiting conditions is challenging, even for experienced clinicians. Preparedness for practice is directly linked to opportunities for experiential learning and there are many barriers facing healthcare students accessing suitable experiences of acute care in all clinical environments: one being the patient safety culture that can counterproductively reduce students’ active contribution to patient care. Furthermore, students are offered few opportunities to confront their own professional uncertainty on clinical placements.

Simulation has been used in healthcare education as an adjunct to experiential learning in clinical environments since the 1950s. At present, the utilisation of immersive simulation in primary care for healthcare students is less common than other clinical environments. Simulation in primary care offers many opportunities for senior students to gain opportunities to develop skills in assessing patients who are acutely unwell, in recognising the gravity of these situations and in initiating prompt management plans that minimise further harm to patients. Decision-making when there is clinical uncertainty or ambiguity requires situated cognition and students should be offered suitable opportunities to reflect on the multitude of factors influencing the process of shared decision-making between clinicians and patients. Being able to successfully manage clinical uncertainty and ambiguity has a significant impact on healthcare resources and staff wellbeing.

Faculty at Queen’s University aspired to address the lacuna of experiential learning opportunities to manage uncertainty in acute, critical and emergency care by developing a simulated home visit scenario on an “Acute Care Course” for final year medical and GEMS nursing students. Students were presented with an authentic simulated scenario where students had to assess a simulated patient and agree a suitable management plan within a short timeframe.

Debriefing discussion between students, faculty and simulated participants focused on the cognitive, emotional and ethical impacts of uncertainty and how recognising, accepting and navigating uncertainty influenced the clinical decision-making process and potentially, patient outcomes and healthcare experiences.

A simulated interprofessional home visit is a valuable learning activity for healthcare students to participate in decision-making when there is clinical uncertainty. It encourages students to make their clinical judgments explicit and have a curiosity and understanding of the reasoning of others.