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Background We developed an interprofessional simulation-based training (SBT) to promote collaboration when caring for patients in mental health crisis in the Emergency Department (ED). The intervention was run both in vivo and in a purpose-built simulation suite. The primary analysis of educational outcomes has been presented elsewhere. 1 Aims To compare participant learning outcomes and experiences from in vivo versus simulation suite delivered SBT. Methods A SBT was developed in which participants engaged in three scenarios of a simulated patient’s journey through the ED followed by structured debriefs. One course was delivered in vivo whilst three courses, with identical content and format, were delivered in a simulation suite. Participants completed pre- and post-course questionnaires, measuring changes in knowledge, confidence and attitudes. Individual participant overall change in knowledge, confidence and attitudes were compared for both participant groups using Independent-Samples T and Mann Whitney U Tests. Post-course focus groups were conducted to gather qualitative data on participant experience. Results 12 participants engaged in in vivo training versus 25 participants in simulation suite training. The professional mix was similar for both groups. The distribution of change in knowledge and self-rated confidence scores and attitudinal shift was not significantly different for in vivo and simulation suite groups ( p = 0 .64; p = 0 0.92; p = 0 .58). Views on the relative merits of in vivo versus simulation suite training were divergent. Participants from both groups recognised the tension between achieving environmental fidelity with in vivo simulation and the potential detrimental impact of managing distractions on learning. Conclusion Previous work has demonstrated that SBT effectively increases participants’ self-rated confidence and leads to positive attitudinal changes when caring for patients in mental health crisis in the ED. 1 Our results suggest that the effectiveness of learning does not appear to be different for in vivo versus simulation suite delivered training. Reference Humphreys RA, Piette A, Wilson C, Kowalski C, Cross S. Mental health crisis in the emergency department: outcomes from a new interprofessional simulation. Royal College of Psychiatrists International Congress, 2015

Background Simulation has not been widely integrated into the core educational program of mental health trusts. In order to ensure sustainability of simulation in mental health, integration into the routine fabric of healthcare delivery is key. 1 Rigorous measurement of outcomes is essential in ensuring that simulation is adopted by managers and policy makers. We aimed to develop, run and evaluate a number of simulation courses for community mental health staff across NHS mental health trusts ensuring that learning objectives matched the desired outcomes for key stake-holders. Methods We designed and developed an inter-professional training course for community mental health workers in line with desired learning outcomes at a time of service reorganisation within the trust. We developed questionnaires measuring knowledge and confidence, which were completed before and immediately after the training course. 9 participants from different disciplines took part in semi-structured interviews 2–3 months after the course. Transcripts were analysed using thematic analysis. Results This course ran on six occasions (n = 49). Knowledge scores increased from ( M = 5.05, SD = 1.56) to ( M = 6.24, SD = 1.60) p = 0 .000, with a large effect size (0.36). There was a statistically significant increase in confidence scores following the training, z = –4.728, p = 0 .000, with a large effect size ( r = 0 .54). Iterative improvements were made to the course as a result of evaluation. Emergent themes from interviews were; learning from others, reflection on ways to improve systems, staff wellbeing and appreciation of the patient perspective. As a result of this evaluation, the course has been embedded as mandatory training within one South London mental health trust. Conclusions Simulation for community mental health teams can improve knowledge and confidence in clinical skills and was valued by staff at a time of service reconfiguration. By involving stake-holders in course design and demonstrating outcomes, simulation can be embedded within mental health service training and delivery. Reference Gaba DM. The future vision of simulation in healthcare. Simulat Healthc 2. 2 2007;126–135