40 A beginner’s guide to designing a last days simulation scenario for medical students

<h3>Background</h3> Growing interest in simulation-based medical education opens opportunities for undergraduate palliative and last days learning in a safe environment. There is an increasing number of medical students requiring last days experience and a wider availability of simulation mannequins in hospital. The process of designing and delivering ‘last days’ undergraduate medical simulation requires palliative care clinicians to rapidly develop competencies in this style of medical education. <h3>Method</h3> The process of designing a 3 hour ‘last days’ undergraduate simulation session is explained in a flowchart. Developing the session for two different medical schools, learning outcomes where mapped to national generic and last days competencies.^{1 2} A single ‘narrative’ was chosen to develop a 3 part-session following the story of an individual patient from understanding the decision to provide last days comfort care, to discussion with relatives and prescribing medications, to performing verification and death certification. Generic competencies included telephoning a specialists for advice. A range of simulation reflection and evaluation tools were reviewed and chosen. <h3>Results</h3> Students reported high-fidelity in the scenario and positive learning experience. Learners engaged in the redesigning process with suggestions for improvement and further learning need identified. Faculty feedback included the challenges of programming the simulation mannequin in a dying and dead role. Central to the development of the scenario was the need to reduce the number of palliative medicine professionals required to deliver the simulation and develop a plan general medical educators could deliver longer term. <h3>Conclusion</h3> The use of last days simulation in undergraduate medical education provides a safe and positive learning experience for students. The process of writing simulation scenarios is multifaceted and requires new skills for palliative care clinicians who are unlikely to have previous experience of the simulation mannequin. The process displayed here could help guide palliative care professionals in the development of last days simulation training. <h3>References</h3> Association for Palliative Medicine (2014, February). Association for Palliative Medicine curriculum for undergraduate medical education. https://www.apmuesif.phpc.cam.ac.uk/apm-curriculum/ General Medical Council (2018, June). Outcomes for Graduates. https://www.gmc-uk.org/education/standards-guidance-and-curricula/standards-and-outcomes/outcomes-for-graduates/outcomes-for-graduates