Pandemically challenged: Developing a ward‐based cross‐skilling programme

1. WHAT PROBLEMS WERE ADDRESSED?

Due to the coronavirus disease 2019 (COVID‐19) pandemic, North Bristol National Health Service (NHS) Trust (NBT) doctors were redeployed to unfamiliar clinical teams, where they would work at the level of a fully registered Foundation doctor. As undergraduate clinical teaching fellows, we were repurposed to rapidly produce a training programme to refresh the medical knowledge of doctors who were from a wide variety of non‐medical specialities and grades. Building on our experience of facilitating medical students, we devised medical ward‐based scenarios in an informal objective structured clinical examination (OSCE) style to promote focused active learning and prompt further independent study.

2. WHAT WAS TRIED?

The OSCE stations included interpretation of arterial blood gases, chest X‐rays and electrocardiograms (ECGs) as well as COVID‐19 treatment escalation planning and palliative care guidance. A further station provided up‐to‐date information regarding local personal protective equipment (PPE) guidelines and resuscitation policies. ¹ Faculty members acted as both facilitators and formative assessors at individual stations. We piloted training with a small group of eligible consultants before commencing optional training across the NBT to 289 doctors.

3. WHAT LESSONS WERE LEARNED?

Several challenges arose in developing and delivering training. Notably, delivering face to face training when adhering to social distancing proved challenging. Training was carried out in a large room, with each station over 3 m apart, with each chair set 2 m apart. Candidates were asked not to move furniture. To comply with infection control measures, we laminated all materials and wiped them with Clinell® wipes between use. Regular hand washing was strongly encouraged for faculty members and candidates, with supplemental alcohol gel available at each station.

Further challenges related to frequent changes to NBT and national PPE and resuscitation guidance during the delivery of training. This was overcome by keeping informed with daily NBT PPE guidance, allowing real‐time adaptations to training. Similarly, through liaising with the NBT resuscitation team, who provided faculty members, we kept abreast of up‐to‐date resuscitation guidance and reflected this in our training. The biggest challenge arose when guidance from Public Health England (PHE) and the Resuscitation Council (UK) contradicted each other concerning chest compressions (by a first responder) during resuscitation of a patient with confirmed/or suspected COVID‐19. An active pursuit of discussions at NBT management level allowed us to harmonise local decision making and adapt training to the Resuscitation Council (UK) Advanced Life Support in COVID‐19 guidelines. ¹

The feedback received was widely positive, with 85% (n = 134) of respondents finding the medical scenarios an adequate refresher; 15% noted they would have found additional scenarios useful. In situ assessment by faculty members suggested improvement of candidates’ abilities and confidence for redeployment, although this was not formally evaluated. Sessions acted as formative assessments to signpost adult learners to areas that required further study, and they were given access to an NHS approved e‐learning package. As trainers, we have rarely developed a training course for significant numbers at such short notice. Essential to ensuring this programme's success was effective communication between trainers and redeployment team leaders, facilitated by the Royal College of Physicians’ chief registrar. Initially, this delivered clear aims and objectives of training, and regular dialogue thereafter allowed multiple challenges to be resolved comprehensively.