Designing and creating a simulated bleep

Introduction

MediSim is a centre of excellence for simulation based education (SBE) training based at the Royal Surrey County Hospital, England. It provides training for undergraduates from Southampton and St. George’s Medical Schools, and postgraduate training for almost all hospital specialties for trainees from across the Kent, Surrey and Sussex region. SBE is now well established in both medical school and specialty doctor curriculums, but a candidate’s engagement can vary depending on the fidelity of simulation. We strive to improve our fidelity and therefore increase the candidate’s engagement, to obtain the most from an expensive resource.

Currently most hospitals require clinical staff to carry electronic bleeps. Key members of urgent response teams receive notice that there is an emergency through an emergency (or on-call) bleep. Despite this, medical students and specialty doctors are often placed into simulated scenarios where they are emergency responders and yet they are not in possession of a bleep. Furthermore, if that candidate places an emergency call, there is no replication of the emergency sound that would be emitted from their own bleep. The lack of audio response to an emergency bleep being placed can diminish the fidelity of the scenario. Medical students who have yet to hold a bleep also miss out on a learning opportunity, prior to it occurring during their first on calls.

Methods

We surveyed 31 medical students and foundation doctors who attended our SBE sessions to assess whether there was an appetite to incorporate a simulated bleep. Although 65% of respondents had held a bleep in some form, only 25% had held an emergency bleep. Ninety-four per cent agreed that it would be beneficial to hear emergency bleeps in their sessions.

Our aim was to replicate a bleep that was fully within our control, allowing us to emit emergency calls as required within a candidate’s scenario. We were able to use a de-commissioned bleep by removing its internal components, and then fit the housing with a Bluetooth board connected to a speaker and lithium-ion battery (figure 1). This is controlled by a switch that is accessible through the battery access slot on the housing. The simulated bleep is then connected to a control device (an iPad in our centre) in the control room, which holds the pre-recorded emergency sounds. The emergency calls, which the candidate activates during the scenario, can then be selected from our control device and the sound is then emitted from the Bluetooth bleep.

Figure 1.

Creation of the simulated bleep: (1) – Bleep housing. (2) – Bleep components (labelled). (3) – Components in position. (4) – Completed simulation bleep.

The emergency sounds were created through capture of the existing emergency sound in our hospital, and this was combined with key phrases that are stated in emergency calls with open source audio editing software (online supplementary audio file 1). To add further realism to the sounds, distortions were added to the voices in the sound files, as they are rarely crisply heard through a bleep. The sound of a non-emergency bleep was also captured to allow our simulated bleep to function as a regular bleep.

Results and discussion

Anecdotal evidence suggests the bleep is well-received, both adding to the realism, but also for the experience of holding a bleep for those without experience.

The creation of the simulated bleep has created several new options for enhancing SBE within our current practice. There are the potential benefits for increasing engagement through increased fidelity, but also it allows us to start a scenario with an emergency call, following a ‘handover’ of the bleep. This has the potential to increase the realism of a scenario where a candidate arrives to an ongoing emergency with no prior information, which can mimic the experience of the on-call doctor. There is also the ability to create extra cognitive load in candidates by adding extra distractions through our simulated bleep. This can include bleeping the candidate when they are focusing on a task, or when they are in a discussion with a colleague.

Previously we have utilised unused bleeps that are integrated into the hospital paging system. This has the advantages of not being limited by distance from the connection to the control device and being able to display a variety of numbers generated on the liquid-crystal display (LCD) panel within the bleep. However, to be able to place emergency calls (which are frequently used in SBE) would require us to use the hospital’s emergency line, and request individual calls be placed to our bleep. This would create a significant burden on our hospital switchboard, which would put the patients at risk if it coincided with a real emergency request. A Bluetooth connection keeps the simulated bleeps function separate from the hospital switchboard allowing us to provide the experience without the patient risk.

Due to the proliferation of Bluetooth technology and its use in portable speakers, the cost of producing the bleep was under £35. The most expensive component would have been the housing for the components, had it not been for the recycling of a disused broken bleep, facilitated by our hospitals Electronics and Medical Engineering Department.

Areas for future exploration to improve the simulated bleep further would be the inclusion of a functional LCD board that can display numbers or text as desired. This would further increase the fidelity of the bleep, but would significantly increase the cost of manufacture, while also requiring additional technological skills to incorporate it. However, as a spring board for new ideas, the simulated bleep we have created will unlock new potential for making our scenarios more exciting and realistic for candidates.