Simulating haematological emergencies eases trainees’ learning curve

Taking part in simulation exercises can help better prepare junior doctors starting haematology rotations, according to UK research.

In a pilot testing new recruits on three haematology emergency scenarios, simulation exercises improved confidence and knowledge of complex treatment protocols across the board, according to findings released for the British Society for Haematology annual meeting..

Speaking with the limbic, study leader Dr Lucia Chen, now a specialist registrar in haematology at Oxford University Hospitals NHS Foundation Trust, said junior doctors starting a haematology rotation faced a steep learning curve.

“I went into a job as a haematology [trainee] at a busy tertiary centre where you can have up to 100 patients and at night time on call you’re often the only doctor on site covering these patients.

“Haematology is quite different from general medicine, the chemotherapy agents may be very unfamiliar and they can become sick very quickly and infections can be very different. There are also conditions like sickle cell disease. There are a lot of acute emergencies.”

Dr Chen added that specialities like anaesthesia and intensive care used simulation training more frequently and the team wanted to test its use in haematology.

They designed a half-day simulation course for doctors new to haematology which included three potential emergencies – neutropenic sepsis, acute sickle cell chest crisis and acute transfusion reaction.

Nine trainees were put through their paces in the simulation exercises on a mannequin designed to replicate a real emergency situation supported by consultants and advanced nurse practitioners.

Evaluation done prior to the course found that 77% of doctors doing core medical training felt unprepared for managing haematological emergencies on-call.

Following the simulation training, every participant improved their score on knowledge of emergency management protocols and all had better confidence by at least one point on a five-point scale.

Feedback showed the trainee doctors particularly valued the multidisciplinary team involvement as it made the scenarios more realistic making them better able to put “key knowledge into practice”.

The comments made by participants about how they were feeling before the training showed there was a lot of concern about how quickly patients could deteriorate and the vast range and complexity of haematological emergencies they may have to deal with.

“Simulation training has had such great success in other lots of other specialties and there’s lots of potential for using it in doctors who are transitioning from one role to another and especially in haematology which is quite niche and some of the conditions are quite rare.”

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