On-call simulation: Evaluating cost and impact

Abstract

Background

On-call simulation has been shown to improve the confidence of prospective junior doctors in undertaking on-call shifts. Despite this, it is not mandated in UK medical school curricula, leading to variations in provision. Barriers to widespread implementation may include doubts surrounding effectiveness, feasibility of delivering on-call simulation across multiple sites and unknown costs. To address these gaps in the literature, we designed and implemented a multi-site on-call simulation programme. We aimed to evaluate it both educationally, using student preparedness to complete on-call shifts as our outcome, and economically, by performing a cost-outcome description.

Approach

An on-call simulation programme, ‘Bleep 101’, was developed and implemented at eight hospitals. Students were ‘bleeped’ around a circuit of written scenarios including clinical emergencies, prescribing and distractor tasks. Students could escalate to their facilitator on the phone for advice at any time. Sessions concluded with a 30-minute debrief focusing on prioritisation and communication skills.

Evaluation

Between 2018 and 2023, 217 students took part and completed feedback forms. Post-session feedback using Likert scales demonstrated a significant increase in preparedness to complete an on-call shift (pre-4/10, post-7/10, p < 0.01) with outcomes consistent across sites. A cohort of 20 students completed paired pre- and post-session feedback to evaluate the impact of the session on specific skills. This demonstrated increased confidence in using a bleep, prioritisation, gathering information and handing over. The costs of implementation at one site were reported, demonstrating a cost of £1.99/student/year or £99.48/student/year excluding costs saved by volunteers and room hire.

Implications

This study indicates that on-call simulation can be delivered at a low cost using existing medical education infrastructure within hospitals. Results suggested an improvement in medical students' preparedness for on-call practice. We therefore recommend on-call simulation be available to all medical students as part of medical school curricula.