Table 2.

Educational objectives during a typical scenario “acute myocardial infarction (AMI)”

Educational objectives
Objectives and grading based on ability to:
• Take a good targeted history, examination, and take appropriate investigations.
• To interpret clinical findings and results.
• To correctly manage and treat and refer when appropriate.
• To establish correct prioritization with efficiency.
• To demonstrate appropriate communication skills with patient and colleagues.
• To demonstrate good teamwork skills.
Grading system:
• Pass/fail
Introduction of clinical scenario
• Tutor sets clinical scenario to all trainees in particular the two trainees being assessed.
• For example, “70-year-old male known case of hypertension presents with central compressing chest pain to the casualty department. You are the doctor seeing the patient. Please take a focused history, examination, investigations and manage accordingly. If you have any difficulty you can call your senior (trainees are given a mobile pager and number)”.
Focused history taking
• Trainee takes targeted history from simulator mannequin.
• Tutor dubbing simulator mannequin responds.
• For example, site, onset, character of pain and any associated symptoms, past medical and surgical history, drug history, social and family history.
Physical examination
• Trainee examines simulator mannequin.
• Tutors alter heart sounds, breath sounds, and added sounds according to scenario presented.
• For example, clear chest and normal heart sounds heard in patient having an AMI.
Targeted investigations
• Trainees able to request parameters such as temperature, pulse, BP, and oxygen saturation which can be altered during the clinical scenario by the tutors and displayed on a monitor next to the simulator mannequin.
• Trainees able to request any relevant urgent and routine investigations such as a 12 lead ECG. For example, 12 lead ECG would show ST elevation in the anterior leads.
• Trainees able to practice practical skills – venous cannulation and arterial and venous blood can be taken by the trainees from a separate venipuncture training arm which is placed close to the simulator mannequin.
• For example, serum troponin and routine bloods requested.
Management
• Trainees able to request oxygen, fluids, or drugs as necessary.
• For example, oxygen, dual antiplatelets, anticoagulation, and pain relief.
• Trainees able to request senior help when deemed necessary they are given pager mobile and are able to call medical senior. For example, on-call cardiology senior contacted by trainee for further medical advice and to consider urgent percutaneous coronary intervention in a patient having AMI.
• One of the tutors will be assigned the role of the medical senior and will respond on pager mobile. Any conversation held between trainees, nurse, and seniors can be heard from the observation room.
Debriefing
• Following the end of the scenario all trainees and tutor gather for a debriefing session were trainees are given feedback on the scenario, have time for reflection and can discuss any problems they encountered.

Abbreviations: AMI, acute myocardial infarction; BP, blood pressure; ECG, electrocardiogram; ST, segment elevation.