Development of a Geriatrics Simulation Programme to Address the Educational Needs of Locally Employed Doctors

Introduction: 

Locally employed doctors (LEDs) frequently care for older people yet may lack structured education. National physician curricula identify core geriatric medicine capabilities including frailty, multimorbidity and end-of-life care. Our initial LED survey (n=22) revealed learning needs in managing acute deterioration (20/22), prioritisation (11/22), and appropriate escalation (10/22). We, as Clinical Teaching Fellows, therefore developed a simulation project to improve confidence in complex care of older people by integrating geriatric medicine core capabilities into acute scenarios.

Method:

From December 2025 to June 2026, we delivered 7 monthly simulation sessions, each comprising two high-fidelity SimMan and actor-based scenarios with structured facilitated debriefing. Topics included pulmonary embolism with anticoagulation refusal and capacity assessment, urosepsis with end-of-life care, acute stroke and treatment-escalation planning. Scenarios required learners to integrate frailty, multimorbidity, cognition, capacity, prognostic uncertainty and goals of care while practising communication, teamwork, leadership and escalation. Surveys evaluated pre- and post-simulation confidence in managing the scenarios, usefulness and quality of sessions using Likert scales. Free-text feedback underwent inductive content analysis.

Results:

Across 7 monthly sessions, 24 pre- and post-session evaluations were completed by LEDs below ST3 level. Mean confidence increased from 3.42/5 to 4.50/5, a mean gain of 1.08/5. Median confidence increased from 3 to 5. Confidence rated ≥4/5 increased from 10/24 to 23/24. All 24 evaluations rated usefulness 5/5, and 23/24 rated session quality 5/5. Among 22 free-text comments, recurrent themes were clinical realism and relevance (9/22), interactive learning (8/22), and complex communication and decision-making (7/22). 

Conclusion:

This programme addressed identified gaps in LED geriatrics education, successfully combining acute management with the ethical and communication complexity of geriatric medicine, producing consistent improvements in self-reported confidence. Integration into LED induction will enhance sustainability. Other hospitals could implement similar CTF-led models to support LEDs working with older people.