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Confederates in competency-based learning for general surgical trainees in SET: CIS SET
Bruce Waxman & Debra NestelFaculty of Medicine, Nursing and Health Science, Monash University
Background
CIS SET is a research project, involving ‘confederates’ as simulated participants. That is, acting the role of healthcare professionals or patients’ relatives.
The confederates interact with general surgical trainees in an office setting using clinical scenarios reproducing common confronting situations.
The learning objectives are embedded in the RACS core competencies.The research question is: Are confederates effective in teaching competency-based
skills for general surgery trainees in SET?
CIS SET
The project used 4 different confederates to recreate 4 clinical situations, over 4 separate sessions. Six trainees and two faculty members were present at each session. Each session was comprised of one scenario running twice. A different
trainee participated in each scenario. Confederates were trained actors. There was a briefing before and a debriefing after each run.
Research method, analysis and ethics
Two focus groups were conducted after each session. Trainees were in one focus group and the confederate and faculty in the other. Focus groups were audio
recorded and transcripts to be made.Thematic analysis of transcripts will be conducted.
Field notes were taken during CIS SET and focus groups.All participants: actors, surgeons and trainees, completed a consent form after
reading an explanatory statement.The project has been approved by Monash University Human Research Ethics
Committee, RACS Ethics Committee and General Surgeons Australia which governs trainees.
Preliminary results
Field notes indicate:The scenarios were seen as realistic and reproduced situations in
which the trainees could identify themselves being involved. The debriefs were valuable in identifying strengths and weaknesses in communication skills and reinforcing the
objectives and relevant competencies. The surgeons were impressed with the concept and could envisage a role in SET training, without too many barriers.
The confederates were seen as making a valuable contribution to achieving the learning objectives.
The scenarios with confederates enabled access to competencies rarely formally taught in SET.
Summary
Confederates may have a role in the teaching of competency based skills for general surgery trainees in SET
References
Nestel D, Mobley BL, Hunt EA & Eppich WJ Confederates in healthcare simulations: Not as simple as it seems.
Clinical Simulation in Nursing 2014 ; 10 : 611 – 616
Nestel D & Bearman M Simulated Patient Methodology: Theory, Evidence and Practice
December 2014, Wiley-Blackwell ISBN: 978-1-118-76100-7
ScenariosScenario 1: Daughter of patient dying in ICU from
complications of surgery. Trainee to interview daughter with focus on open disclosure, and demonstrate knowledge of advanced care
directives.
Scenario 2: Surgical Supervisor asks trainee to provide support to a fellow SET trainee on drugs and underperforming, and demonstrate
knowledge of available support services, AHPRA guidelines on mandatory reporting and RACS policies of dismissal from training.
Scenario 3: NUM on surgical ward concerned about a non-coping
intern. Trainee to give advice and demonstrate knowledge of services available, role of intern supervisor, peer support, mentoring
and a way forward.
Scenario 4: Intern being bullied by consultant. Trainee to give advice and demonstrate knowledge of the hospital and RACS Bullying and
Harassment policies.
Photo: This photo was taken during the pilot for Scenario 1. The participants in the photo were not involved in CIS SET.
