"It’s not just putting them off to sleep!" Using simulated patients in training novice anaesthetists how to talk to their patients during the pre-operative assessment visit

Background: Pre-operative assessment visiting is an essential part of delivering safe and effective anaesthesia. Information needs to be collected and assessed allowing the anaesthetist to make an anaesthetic treatment plan as well as identifying any specific patient related issues. It is an opportunity to establish rapport, discuss concerns, explore expectations and obtain consent. Pre-operative assessment visiting is often undertaken under significant time pressures. Post foundation doctors are assumed to be competent in communication and history taking and anecdotally novice anaesthetists receive little face to face training on the pre-operative visit. Simulation training is well-established in training anaesthetists to manage emergencies and in developing technical skills. Using simulation to develop communication skills for anaesthetists is less well-recognised. We evaluate an innovative training package for novice anaesthetists in how to conduct pre-operative assessment visiting using simulated patients (SPs). The ASPiH Standards for Simulation-based Education in Healthcare (1) guided the quality assurance components of this training.

Methodology/Project Description: A communication focussed training package was developed to train novice anaesthetists how to conduct pre-operative assessment visiting using SPs. The participants were asked to complete the relevant online E-Learning for Anaesthesia training (2) prior to attending the face to face session. Faculty comprised two consultant anaesthetists and two SPs who played a number of roles in a safe and supportive environment. Participants practised two different separate pre-operative consultations and observed two others. Structured group debriefing was facilitated by all members of the faculty. The participants were encouraged to reflect upon their own performance in addition to providing feedback to their peers Written reflective feedback was obtained from participants and faculty.

Results/Outcomes: All participants agreed/strongly agreed that the session was relevant to their training and a valuable and formative learning experience. Incorporating SPs and listening to their feedback was valuable in identifying a number of themes that had not been seen as important or even considered by both participants and the consultant facilitators. The participants received positive feedback about their empathy, consultation and listening skills. They were encouraged to find time to explore the individual as well as recognising them as a patient.

Conclusions and Recommendations: This training package allowed novice anaesthetists to practise and consolidate training received. Using SPs adds value in a number of ways: The consultations feel ”real” but the environment provided is safe. SPs are able to provide feedback not considered by peer group or medically trained members of the faculty.