Improving Medical Students' Confidence in Caring for Acutely Unwell and Dying Patients Using Simulation-Based Training

Background and Aims

The GMC specify foundation doctors must be competent assessing medical emergencies and making appropriate decisions during end-of-life care. However current literature identifies medical students’ confidence in palliative care skills, including communicating with dying patients and families is low, and many feel unprepared to attend emergencies. With an ageing population, and prevalence of frailty expected to rise significantly, competence in assessing acutely unwell older adults is essential for foundation doctors. This teaching programme aims to improve students’ confidence in assessing acutely unwell patients, with a focus on geriatric medicine, and communicating with patients and families during end-of-life care.

Methods

Small group simulated teaching sessions were delivered for final year medical students using high-fidelity mannequins and doctors acting as patients and relatives. Students’ confidence in clinical and communication skill domains was self-assessed using anonymous surveys before and after sessions, using a Likert scale (0-10).

Results

Students initially had low confidence in their ability to care for dying patients (mean 5.6) and to start work as foundation doctors (mean 5.4), with many citing concern about managing emergencies. Students’ confidence increased in all domains after teaching, with mean improvement of 2.1 in clinical domains and 1.8 in communication domains. Students’ confidence improved most in their ability to perform a post-falls medical assessment (mean 2.3), initiate DNACPR discussions with patients and relatives (mean 2.3) and urgent interventions for acutely unwell patients (mean 2.7). All students strongly agreed the sessions improved their confidence for starting foundation training and 100% felt more prepared to care for dying patients.

Conclusions

Results correlate with existing literature, demonstrating students feel unprepared for several aspects of foundation training. Simulation-based training can improve confidence in these essential skills. Formal assessment is required to demonstrate whether this also improves competence.