Emergency Department Clinical Skills Assistant
Background:
Throughout the pandemic, medical students have gained less clinical exposure, reporting a lack of confidence in clinical and non-technical skills. The Clinical Skills Assistant (CSA) volunteer project addresses the lack of consistent opportunity for medical students to practise the skills expected of all junior doctors. We aim to improve competence and confidence in technical and non-technical skills by providing regular opportunity to perform these skills in a busy emergency department with timely feedback from experienced nursing mentors.
Methodology:
We secured funding to recruit medical students from the University of Nottingham in their early clinical phase. A 2-day induction provided training on core clinical skills using task trainers, hosted by a multi-professional team from a mixture of healthcare backgrounds and including patient and public involvement. These skills were rehearsed in scenarios with simulated patients using hybrid simulation. Mentors were recruited from ED nursing staff, and training was followed by a supernumerary period with regular mentor review for assessment of practice, working towards independent proficiency, as part of the multi-professional team. Students sign up for a weekly shift, outside of routine placements, for a minimum of 6 months.
Results:
The CSAs completed an initial questionnaire, prior to commencing, which showed a lack of confidence in both technical and non-technical skills. 71% of CSAs lacked confidence in carrying out IV cannulation and obtaining blood cultures, whilst 57% lacked confidence with handing over care of a patient, 50% with communicating effectively in challenging situations, and 43% with working as part of the multi-professional team within ED.
Conclusion:
We are performing a service evaluation to assess student and staff perceptions of the impact of this project upon CSAs competence and confidence across several domains including practical skills, communication skills and team working. We plan to evaluate the progress of the CSAs once they have completed their supervised period and after 6 months.
Implications:
We believe this initiative will engender increased confidence in technical and non-technical skills and generate more collaborative future junior doctors. The project design has intentionally utilised the ED multi-professional team to enhance learning opportunities. ED nurses and clinical support workers were recruited as mentors, utilising their frequently untapped expertise and providing them with opportunities for leadership and career progression. We anticipate that integrating the CSAs into the multi-professional team will also inspire a greater sense of ownership and therefore advocacy and investment from staff towards medical students in ED.
