It’s a crisp, winter’s morning as my colleagues and I stand by the roadside watching paramedics attend to the victim of a suspected heart attack. The patient is carefully strapped to a stretcher, transported into the back of an ambulance and then taken to the emergency room, where the paramedics seamlessly transfer him to the care of the nursing staff. The tension is real. But for all the sense of urgency, the danger is not. Why? Because this is just a hyper-realistic simulation.
The Edge team is visiting a state-of-the-art simulated healthcare environment at University of Sunderland. Designed to provide students with realistic hands-on training opportunities, the university’s Living Lab is one of the country’s largest and best-equipped facilities of its kind. It includes a simulated training ambulance, a hospital ward, a community pharmacy, and a dental clinic – not to mention a highly-trained technical team working behind the scenes. The lab allows students to practice their clinical skills using the latest technologies, in a safe, controlled environment, all guided by practitioner lecturers. This is the cutting edge of real-world learning.
Preparing students for real-world practice
Simulated training isn’t unusual in healthcare education, but University of Sunderland is pushing the boundaries of what’s possible. Conducting everything from punchy patient evaluations (designed to prepare students for their official assessments) to full-day multi-disciplinary scenarios with volunteer actors in high-stakes settings, the healthcare courses at University of Sunderland are all co-produced with employers and are underpinned by interprofessional learning (IPL). IPL involves student doctors, nurses, pharmacists and paramedics – among other healthcare students – working in teams just as they would in real-world settings.
“It’s about giving students the chance to experience something as close to the real world as possible,” says Sue Brent, Head of the School of Nursing and Health Sciences. “But behind the scenes, it’s more complex than that.”
Sue’s colleague, Mark Willis, Associate Head of School – Paramedic Practice, explains how the infrastructure, medical mannequins, high-tech equipment, technical teams and student preparation all require extensive work. Before any simulation takes place, students are trained in risk assessment, safety, confidentiality, and of course, practical theory. This is especially important for the university’s large-scale scenarios, which may involve simulated road traffic accidents or complex clinical decision-making simulations (unofficially referred to as ‘ward from hell’ days, for their realistic portrayal of unpredictable healthcare scenarios.)
So realistic are the simulations that members of the public have mistakenly called the emergency services in the past (the university now has clear signage to prevent this!) The benefit of all this realism, however, is the impact on students. When they go on their first placements, the university consistently receives the same feedback: “Our students are considered the best-prepared for practice, because of the training they’ve had,” Sue explains. “Plus, they’ve been working with patients from day one.”
Patient-centred community-connected learning
The patients Sue refers to are not just actors but real patients. As part of their simulated training, Sunderland works with volunteer patients from across the local community. Their involvement ensures that training scenarios are as realistic as possible. But it goes beyond that. While patient involvement is a statutory requirement in all healthcare education settings, Sunderland’s patient, carer and public involvement (PCPI) programme is part of their wider commitment to having an impact on the local community.
One of the university’s senior lecturers is Dr Lesley Scott, whose work involves developing patient and carer involvement. She works with a wide range of individuals, including those with learning disabilities, long term physical (e.g. Parkinson’s, diabetes) and mental health conditions as well as mums-to-be – to ensure that students meet and work with the types of people they will encounter in the real world.
“We educate patients on the expected symptoms and outcomes of each scenario to make the simulations more realistic,” Mark explains. “It’s a lot of work, but it’s always worth it when the end product is so good... you can see the benefits to the students.”
The benefits aren’t limited to the students, though. The university’s 245-strong patient, carer and public involvement group (PCPIs) do far more than just roleplay in simulations. They participate in student interviews, provide feedback in debriefings and even help shape new programme development. “Our volunteers are like members of staff,” Sue explains. “They are giving so much back to the students and to society. Sometimes they get quite emotional about it – they are so proud of the work that they do with us.”
As Sue says, for many patients, this is about giving back. For others, though, it is a lifeline. The university’s PCPI programme supports rehabilitation and recovery of patients with for example, severe mental health issues such as psychosis. By volunteering to work with the university, they are helping deliver more realistic scenarios for students based on their lived experience, while also reintegrating into society. The university has been nominated for awards in this area.
“When you have patients sharing how their condition affects them, it brings theory into practice for students, too,” Mark says. “It’s so much better than looking at a PowerPoint. Students probably learn as much from our patients as they do from our staff.”
Addressing skills shortage in the North East
Perhaps the most profound community impact of Sunderland’s work, though, is in tackling skills shortages in the North East (as often addressed in Edge’s skills shortage bulletins).
“The reason Sunderland started offering this provision in the first place was to address the skills gap,” Sue explains. “Previously, universities outside the region were sending students on placements to NHS Trusts in our area. But afterwards, the students would leave. We set up the first programme in 2016 to train our own and keep them.”
Following three years of training, students are now guaranteed an interview with the Trust they’ve undertaken a placement with, helping reduce the shortage of nurses and paramedics in the region. In part due to the level of community integration, most students now stay in the region, Mark says. The ambulance service, for example, manages its workforce directly from University of Sunderland’s job-ready graduates.
While both Sue and Mark acknowledge that the university is lucky to be in such a unique position, there are nevertheless signs that their approach is being acknowledged in wider policymaking circles as more than just an outlier. A case in point is the Nursing and Midwifery Council, which has recently doubled the allowance of simulated training time from 300 to 600 hours. Sue believes this signals a potential shift within healthcare education to place high-quality simulations on par with real-world placements.
To support this shift, University of Sunderland is now planning to invest more in evaluation, research and reporting around the work that they do. “There is a huge wealth of data around the employability and experience of our students,” Sue says. “It’s time to pass this on.”
Olly Newton is Executive Director of the Edge Foundation.
Sue Brent is Head of the School of Nursing and Health Sciences and Mark Willis is Associate Head of School – Paramedic Practice at University of Sunderland.