12 Clinical emergencies in a hospice setting: can simulation-based training improve objective clinical performance?

<h3>Background</h3> Simulation-based training has gained recognition as an effective educational tool in medical and nursing education. Given the relative rarity of clinical emergencies in hospice settings, relying exclusively on real-world practice for the development of competency is impractical. Existing evidence supports the successful translation of skills acquired through simulation into clinical practice. This project built on the previous success of our simulation-based training programme which has been shown to improve confidence and self-reported competence. <h3>Method</h3> The objective of this project was to assess the impact of simulation-based training on objective clinical performance managing an emergency scenario in a hospice setting. The training programme was delivered to nursing and allied healthcare professionals, enabling them to practice essential clinical skills for managing palliative care emergencies. Topics covered included opioid toxicity, catastrophic hemorrhage, status epilepticus, anaphylaxis, hypoglycemia, and airway obstruction. Participants’ clinical performance was assessed pre- and post- training using an Objective Structured Clinical Examination (OSCE). The marking framework encompassed evaluation of the following domains: consultation and history taking; physical assessment; diagnosis and management; non-technical skills. OSCEs were marked by two independent members of the hospice medical team. Participants also completed a short Multiple Choice Question (MCQ) assessment pre- and post- training. Statistical analysis was conducted using paired t-tests. <h3>Results</h3> 17 participants took part in the programme. Statistically significant improvements were achieved in all assessment domains, with non-technical skills showing the largest improvement (p &lt;0.001). MCQ scores also demonstrated a statistically significant increase post training (p &lt;0.001). Feedback evaluations from participants were overwhelmingly positive, with participants reporting that they enjoyed the session and felt their clinical practice would improve. <h3>Conclusion</h3> Participation in simulation-based training designed for palliative care emergencies in a hospice setting may improve objective clinical performance and theoretical knowledge. Further work assessing whether this improvement in performance is sustained over time would be valuable.