Trainee’s Perceptions on Simulation-Based Education and Its Impact on Transitioning to the Role of Medical Registrar: A Qualitative Study

Abstract

Background and aim In 2019, a three-year internal medicine training (IMT) program replaced the two-year core medical training program in the United Kingdom, incorporating the first year of medical registrar (MR) training into the same curriculum. In light of the considerable evidence supporting the effectiveness of simulation-based education (SBE) and the challenges inherent in transitioning, the design and delivery of SBE are now ideally positioned to facilitate this transition process and assess its impact. However, trainees' perceptions regarding the effectiveness of SBE in the IMT curriculum for transitioning to the MR role are not well-documented. This study aimed to explore and examine trainees' views on SBE in the IMT curriculum to prepare them to transition to the role of the MR. It sought to identify the critical qualities and skills that IMT trainees believe SBE should address to enable them to successfully fulfill the MR role, as well as to assess the extent to which internal medicine year three trainees perceive that SBE in its current form within the IMT curriculum has prepared them for the role of MR. Methods This qualitative study employed focus groups to explore individuals' perspectives on SBE in the IMT curriculum and its role in preparing them for the transition to the MR position. Four focus groups were conducted, two with core trainees (CTs) and two with MRs. Sessions were recorded, transcribed verbatim, and analyzed using a thematic analysis approach. Results Eleven trainees participated in the study. Seven of them were CTs, with the remaining four in their first year as a MR. Six main themes emerged from the data, grouped into two main headings. The heading titled "Perceptions of SBE" included the themes "Valuable Teaching Tool," "A Squandered Resource," and "Avoid Over-Reliance." In contrast, the heading "Areas/Suggestions for Improving SBE" included the themes "Quantity and Scheduling," "Feedback," and "Draw on Others’ Experiences." Conclusion The value of SBE was recognized, alongside the vital role of high-quality feedback. Other medical specialties and industries were highlighted for their effective implementation of SBE, offering a possible standard for educators involved in the IMT curriculum to pursue. There was a perception that SBE did not adequately support the ongoing maintenance of skills, placing considerable reliance on real-world clinical practice to fulfill this need. The limitations inherent in SBE were acknowledged, and educators are encouraged to explore ways to optimize the use of all educational tools at their disposal, which may include the formal introduction of a shadowing period for trainees.