International Journal of Healthcare Simulation

Background:

Cervical spine (C-spine) injuries are a significant cause of morbidity and mortality, particularly in the elderly population ^[1]. The Canadian C-spine Rule is sensitive in determining which patients require immobilization and radiological investigation ^[2]. Junior clinicians entering Emergency Medicine (EM) may not have had previous career exposure to trauma and may be uncomfortable approaching such injuries or using similar assessment tools. In situ simulation offers an opportunity to build confidence and learn from human interactions, typically only encountered during ‘real-life’ exposure.

Aims:

The aims of the study were to identify clinician knowledge gaps when starting EM, create a simulation-based teaching program to address these weaknesses and to improve multi-disciplinary systems relating to C-spine injury immobilization and management.

Methods:

A sample of 20 clinicians finishing their EM rotation in April 2021 at Queen Alexandra Hospital, Portsmouth, completed a survey listing conditions/procedures they would have appreciated simulation scenarios on as part of induction. A 30-minute C-spine simulation station was designed focussing on knowledge gaps identified, incorporating Canadian C-spine rules, immobilization, radiological investigation and treatment. Sessions were delivered in situ to groups of 5–10, including doctors, trainee acute care practitioners, nurses, healthcare assistants and physician associate students. Feedback was collected gauging enjoyment, confidence levels before and after the session as well as the likelihood of application of the topics covered soon. Data were collected from candidates at the end of their rotation to assess the lessons learnt.

Results:

About 70% of surveyed candidates included ‘C-spine’ within conditions/procedures they desired simulation teaching on. Candidate feedback suggested high levels of enjoyment with 100% of candidates scoring 7 or 8/8. The mean confidence of candidates before and after the session increased by 30.6% (52%–82.6%). 100% of candidates felt that the session was useful in improving day-to-day practice and 67.7% of candidates envisaged implementing teachings within the next week (96.8% within the next 3 months).

Implications for practice:

In a busy department, it is important to prioritize education and address workforce knowledge gaps. Trauma and C-spine injury appear to be an area of under-confidence in junior clinicians starting in EM. Short in situ simulation sessions were an effective and flexible way of improving confidence and multi-disciplinary systems, avoiding disruption during busy periods. We believe that repeating similar teaching programmes at the start of a new clinician intake can aid in identifying gaps in knowledge and effectively addressing these early and improved systems operation throughout the rotation.