A mixed methods study on simulation-based undergraduate medical education for preparedness for practice from multiple stakeholder perspectives.

Medical undergraduates express underpreparedness for Foundation Programme (FP).
Objectives:
Investigate
1. Impact of simulation intervention on student confidence for clinical practice;
2. Preparedness and value of simulation with medical students and educators.
Methodology:
A mixed methods study. Final year students (n=94) from two UK universities underwent a simulation course with structured debriefing using Sim Man 3G® and part-task trainers. Learning outcomes mapped to Tomorrow’s Doctors (TD) and FP curriculum. Confidence scores in 19 TD and FP mapped domains were collected at four time points: Baseline, pre-course (1 = None, 10 = very confident), immediately post-course (n = 94), one-week post (n = 79) and one month into FP (n = 58). Data analysis was by ANOVA with Bonferroni correction applied (SPSS 21).
Focus groups were conducted with students (n=19) and semi structured interviews (n=10) with UK simulation experts (purposive sampling). Thematic analysis was performed on triangulated data with framework in Nvivo10.
Findings:
Confidence scores increased significantly; post-course (F (2.48,148)=49.98, p = <0.001). Mean baseline confidence score was 5.88 (SD 1.2) (range 3 - 8), immediate post-course mean 7.22 (SD 1) (p<0.001), 7.4 (SD 0.8) at one week (p = 0.655) and 7.8 (SD 1) one month into FP (p = 0.15).
Medical students interpret preparedness as confidence.
Overarching emergent themes were practice under pressure and human factors leading to enhanced self-regulation and competence.
Preparedness was enhanced by understanding the work culture and the hidden curriculum, authentic meaningful interprofessional learning, belonging, mentorship, role modelling, responsibility through experiential and consequence learning and individualised facilitated debriefing.
Conclusions:
Simulation improved preparedness by allowing students to experience complexity, responsibility and practice under graded pressure. Human factors education and embracing complexity supported preparedness through enhancing self-regulation, emotional intelligence and resilience. Guidelines for developing undergraduate simulation curriculum at the correct level of pressure are presented.