The COVID-19 pandemic has led to disruption and missed educational opportunities for Internal Medicine (IM) Year 2 trainees who shall progress to the second stage of their training in August 2021, stepping up to the medical registrar role. It had become apparent that some of these trainees may not be currently performing at the level expected for this stage of their training and may encounter some difficulties during this transition period.We were tasked by Health Education England (West Midlands) to design and implement an innovative region-wide medical registrar preparation course, utilizing simulation-based education. The courses required standardized content that could be delivered by either face-to-face or virtual modalities across multiple centres in the region.Two separate high-fidelity simulation courses were designed to deliver key aspects of the IM training curriculum with a clear focus on the behaviours, attitudes and skills required to perform as a junior medical registrar: ‘Thrive’. A 1-day course designed for trainees who are expected to be able to progress to IM year 3 without any concern. These courses were planned to be run by other regional centres to their local trainees using either a face-to-face or virtual format. ‘Strive’. A 2-day course designed for those trainees who have been identified as needing extra support to be able to progress to IM year 3. These courses were planned to be run via a face-to-face format at our SimWard to trainees from across the region. Course content included a mix of high-fidelity simulation scenarios as well as workshops focussing on key areas for medical registrar preparation as identified by IM trainees: Leading cardiac arrestsDebriefingBreaking bad newsPrioritization and delegationGiving adviceEscalating careAll content was designed and produced in house to then be provided electronically to region-wide centres facilitating standardized delivery, including pre-recorded simulation scenarios to allow virtual delivery. A webinar was held to aid roll out and provide training on course delivery and content to participating centres. Courses were delivered during the spring and summer of 2021. Initial feedback has shown an increase in perceived trainee confidence in dealing with all topic areas at the registrar level and has illustrated that learning has already been utilized in clinical practice. Courses are ongoing until the end of July 2021, after which a full analysis of region-wide impact can be made.

Simulation-based education (SBE) as a learning tool is becoming more prevalent, as is the recognition of the importance of non-technical skills. With this insight comes a desire to improve clinical practice using these techniques. ‘AOSim’ has arisen from an intrinsic desire to achieve this from within an Acute Oncology Service (AOS). Wishes to improve confidence, decision-making and teamwork have guided the design and implementation of a novel simulation course in this field.The purpose of the course has been guided by the candidates. The hope is to be able to provide a safe learning environment to explore decision-making, improve confidence in clinical practice and strengthen teamwork.The course design was informed by direct stakeholder analysis. Pre-course surveys aided in planning the course and scenario design. The course would run over half a day and comprise three scenarios, each followed by a debrief. The candidates invited were nurses working in the local AOS and the AOS coordinator. Each scenario was designed with a particular focus in mind; ‘Respectful Challenging’, ‘Clinical Prioritisation’ and ‘Treatment Escalation’. The clinical context of the scenarios was based on oncology to provide a familiar environment for the candidates. This would also enable the focus to be paid to the non-technical skills related to the aims of the course. The scenarios were to be run in a high-fidelity setting using a mixture of role players, mannikins and plants. Faculty roles had been assigned prior to the course date.A course overview was sent to the candidates including the planned date for running the course to allow the candidates to plan for handover of their clinical duties; this allowed protected time for the course to run. ‘AOSim’ was run in a simulation suite in the high-fidelity setting with an experienced faculty. The candidates were introduced to the simulated environment and the importance of psychological safety was explained. The three scenarios ran as planned to include subsequent informative debriefs. Immediate and post-course feedback were positive, particularly with increased confidence levels and team-working ability. This has led to aspirations to run the course again for a different candidate group in the future.