Title : Enhancing foundation doctor confidence in acute surgical management through a structured simulation programme
Abstract:
Background: UK Foundation doctors rotating through surgical specialities have reported low confidence in assessing and managing acute surgical presentations[1]. High-fidelity simulation provides a safe and supportive environment in which trainees can practise the recognition and management of acute clinical presentations, facilitating the development of clinical reasoning, decision-making and non-technical skills.
At Medway Maritime Hospital, a district general hospital in Kent, no structured simulation-based teaching programme existed for Foundation Year 1 (FY1) or Foundation Year 2 (FY2) doctors undertaking a general surgery rotation. This represented an opportunity to provide targeted, specialty-specific training to support trainees in managing common acute surgical presentations.
Aims: To design, implement and evaluate a structured surgical simulation programme for Foundation doctors during their four-month general surgery rotation, assessing its impact on confidence in managing common acute surgical presentations.
Methods: All Foundation doctors rotating through general surgery (n=19; 18 FY1, 1 FY2) attended a high-fidelity simulation programme comprising three scenarios based on common acute surgical presentations: postoperative bleeding, post-ERCP pancreatitis with sepsis, and postoperative deterioration. Scenarios incorporated technical skills (A-E assessment, Sepsis Six and major haemorrhage protocol) and non-technical skills (situational awareness, communication, prioritisation and escalation).
Matched pre- and post-course surveys assessed self-reported confidence across seven domains using a 1-10 numerical rating scale: assessment of acutely unwell surgical patients; time-critical decision-making; reviewing patients in A&E and on the wards; accepting and rejecting referrals; and adding patients to the CEPOD list without senior review. All responses were matched (19/19). Mean scores and percentage change were calculated for each domain. Post-course evaluation assessed scenario realism, course level, faculty facilitation and debriefing, and overall course quality.
Results: Self-reported confidence improved across all seven domains. The greatest relative improvements were observed in adding a patient to the CEPOD list without senior review (2.63 to 4.21; +60.0%), rejecting referrals (2.58 to 4.00; +55.1%), and making time-critical surgical management decisions (4.53 to 6.95; +53.5%). Confidence in assessing acutely unwell surgical patients increased from 5.42 to 7.16 (+32.0%).
Mean composite confidence across all seven domains increased from 4.49/10 pre-course to 5.92/10 post-course (+31.8%). Individual confidence increased in 18/19 participants (94.7%), with one participant reporting no change.
Course evaluation was strongly positive, with mean ratings of 7.9/10 for scenario realism, 9.0/10 for course level, 9.4/10 for faculty facilitation and debriefing, and 9.6/10 for overall course quality. All participants (19/19; 100%) would recommend the course to colleagues at their level. Free-text feedback highlighted improved escalation skills, clearer application of an A-E assessment and greater confidence in managing acute postoperative deterioration.
Discussion: A structured high-fidelity simulation programme was associated with improved self-reported confidence among Foundation doctors across all assessed domains of acute surgical management. The greatest improvements occurred in areas involving referral decision-making and CEPOD listing, suggesting value in addressing challenging aspects of the Foundation surgical role. Embedding specialty-specific simulation early within the general surgery rotation may enhance trainee confidence and clinical decision-making, with potential benefits for patient safety.
