On-Call Simulation: A One-Day Comprehensive Simulation of Clinical Practice for Final-Year Medical Students

Abstract

Introduction Transitioning from a medical student to a foundation doctor presents numerous challenges, particularly in managing on-call duties that require quick decision-making, clinical skills, and prioritisation under pressure. The Simulation On-Call (SOC) program was developed as a one-day, immersive simulation event to equip final-year medical students with the skills and confidence needed for these responsibilities. Methods The SOC program is an annual event held for final-year medical students at the Royal Blackburn Hospital, Blackburn, UK. It is conducted over five days, with 80 final-year medical students rotating through nine stations that replicated common on-call scenarios. Each station required students to address critical medical situations, such as managing an acutely unwell patient, electrolyte abnormalities, and referring and communicating with colleagues, while managing realistic interruptions through a "bleep" system. Pre- and post-event questionnaires, featuring 25 Likert-scale items, were disseminated to assess student feedback and self-reported confidence across competencies, including communication, clinical decision-making, and task prioritisation. A retrospective review and analysis of the feedback was performed to assess the impact of the SOC program by assessing the pre- and post-session questionnaires. Results Of the 80 participants, 70 completed the pre-event questionnaire, and 72 completed the post-event questionnaire. Statistical analysis revealed a significant increase in students' self-reported confidence across all 25 Likert-scale items, with marked improvements in task prioritisation (rₛ = 0.74, p < 0.001), managing acutely unwell patients (rₛ = 0.60, p < 0.001), and escalation skills (rₛ = 0.49, p < 0.001). Effect sizes ranged from moderate to large, underscoring the practical impact of the Simulation On-Call program in enhancing preparedness and confidence for on-call responsibilities. Conclusion The SOC program provided a valuable, realistic, and supportive environment for final-year medical students to practice on-call responsibilities. The significant improvement in student confidence highlights the effectiveness of this program as a preparatory tool for foundation doctors. Future iterations will incorporate feedback to continually refine the simulation experience, ensuring its alignment with clinical demands.

Keywords: emergency simulation; medical edu; medical student teaching; simulation based training; simulation course; simulation design; simulation in medical education; skills and simulation training; student education; teaching by simulation.

Figure 1. Pre- And Post-Session Mean Confidence Scores With 95% Confidence Intervals

Figure 2. Improvement In Confidence Scores With Strongest Gains Highlighted

Q2 - How confident do you feel about working your first on-call shift Q5 - How confident are you in your ability to prioritise tasks during on-call shifts Q13 - How confident do you feel in managing a patient with an acute bleed Q21 - How confident are you in your ability to be part of the cardiac arrest team Q22 - How confident do you feel in starting initial management for an unwell patient

Figure 3. Effect Sizes (Rank Biserial Correlation) With Strongest Effects Highlighted

Q1 - How confident do you feel about starting your job as a foundation doctor Q2 - How confident do you feel about working your first On-Call shift Q5 - How confident are you in your ability to prioritise tasks during on-call shifts Q13 - How confident do you feel in managing a patient with an acute bleed Q18 - How confident do you feel in acting upon abnormal results