Coffee & Cases: Peer learning in prehospital care.

Abstract

The prehospital care programme (PCP) at King's College London Medical School is a student-run programme that arranges for medical and nursing students to shadow clinicians from the London Ambulance Service. The programme aims to increase interprofessional understanding of the roles and expertise within prehospital medicine, as well as observing the patient journey and the prehospital clinical environment. As the programme's organisers, we recognise that whilst creating excellent learning opportunities, there is an additional emotional burden on students, particularly when they are exposed to complex or distressing prehospital patient cases.1 Students in a prehospital environment, compared to hospital settings, may be more likely to sustain ‘moral injury’,1 a term which describes the transgression of moral codes. Therefore, it has been suggested that more debriefing opportunities should be made available to these students.1 Where there is a lack of formal debriefing opportunities, informal near-peer debriefing can potentially play a protective role against moral injury. However, we felt that creating a rigid or overly formal debriefing process could discourage students who would otherwise engage well, as they may shy away for fear of apparent authority.2 In addition, traditional case discussions at nursing and medical schools focus mainly on the clinical aspects of a case, without time being spent looking at either the emotional burden on those involved, or considering the interprofessional relationships during the incident. In recognition of this need to review, learn and reflect, during the academic year of 2019–20 we started ‘Coffee and Cases’ (C&C), a monthly peer-led case review group for PCP students. The aim was to create an informal environment of case discussion, run by nearpeers also on the PCP programme, at differing stages of their medical education. We hoped that C&C would become an opportunity for students to reflect on the more challenging patient presentations and learn from this as shown in Figure 1. The small meeting of up to 15 students took inspiration from a Balint group: a structured forum to discuss the patient's treatment and emotions arising from the experience. One student would share their experience in detail and after clarifying questions, the other members of the group would reflect and discuss the events.3 This reflection focussed on both the emotional understanding of the encounter and learning from the actions of the prehospital clinician.We hoped that C&C would become an opportunity for students to reflect on the more challenging patient presentations One of the main objectives of C&C is to allow the PCP team to check on students’ well-being, especially if they attended to patients in situations which may need further debriefing such as road traffic collisions, mental health crises and deaths. The depth of discussion and willingness of students to contribute indicated C&C to be a safe platform. We noted with interest that what junior medical students found distressing was not what we expected, for instance, complicated patient-family relations and difficult communications with patients and their families.