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Background The Intensive Care Unit of the Royal Berkshire Hospital, Reading, is a 17-bedded general critical care unit with over 1000 admissions per year. Since 2015, multidisciplinary in-situ simulation has been delivered approximately twice per month and is now a well-established part of the unit’s education programme. In-situ simulation continues to develop as an educational tool (Rosen et al, 2012), and has been shown to be effective in the critical care setting (Theilen et al 2017). Summary of work In-situ simulation forms part of a weekly teaching programme on the Intensive Care Unit. Scenarios are led by a consultant intensive care physician with experience in delivering simulation education. They are supported by a member of junior medical staff working in a clinical fellow post with an emphasis on simulation and education. Doctors and nurses participate in each session, occasionally with allied health professionals. Simulation is delivered using a mannequin with monitoring in an empty clinical bed space. Participants use actual equipment and medications (with the exception of controlled drugs). Scenarios cover a broad range of topics, from high frequency events to infrequent medical emergencies (e.g. intubation of a septic patient with pneumonia, obstructed and/or displaced tracheostomy). The debrief covers the clinical aspects with a strong focus on the human factors, team working and practical issues. Participants and observers are invited to provide feedback following the sessions. Summary of results Over 70 feedback responses have been collected over the course of the programme to date. Respondents are consistently positive, agreeing that the scenarios are relevant, useful for learning and improve confidence. Free-text responses frequently referred to realism, learning about team work and the benefit of practicing infrequent emergencies. Improvements suggested included removing observers from the bed space to avoid confusion, clarity of what equipment can be used and the opportunity to improve fidelity with mock patients on the electronic patient record. Discussion, conclusions and recommendations In-situ simulation is an acceptable and useful format for teaching in the intensive care unit. Learning for staff covers both the clinical topic of the emergencies, as well as human factors. Future initiatives will aim to improve patient safety further by acting on latent threats identified during simulations, developing scenarios in response to safety incidents reported locally and nationally, and identifying risks associated with the physical structure of the area. References Rosen, M. A., Hunt, E. A., Federowicz, M. A. & Weaver, S. J.,. In situ simulation in Continuing Education for the Health Care Professions: A Systematic Review. Journal of Continuing Education in the Health Professions 2012, 32(4), pp. 243–254. Theilen, U., Fraser, L., Jones, P.,Leonard, P. & Simpson, D., 2 017. Regular in-situ simulation training of paediatric Medical Emergency Team leads to sustained improvements in hospital response to deteriorating patients, improved outcomes in intensive care and financial savings. Resuscitation, 115, pp. 61–67.

Background At any moment approximately one in ten doctors in training are taking approved time out of their programme. Returning to training after a break from clinical work can be daunting, with many trainees expressing anxiety about readjusting to the workplace. Recognising this, the Department of Health allocated £10 million nationally to Health Education England to support doctors as they return to training. Summary of education programme The educational programme in Thames Valley was developed collaboratively by a network of educationalists across our region. Trainees themselves had input into the design of the programme, and the educational materials provided. We created a modular suite of activities incorporating technical and non-technical skills training orientated towards medicine, surgery, anaesthetics, critical care, paediatrics, and retrieval. Sessions cater to various learning styles, incorporating tutorials, skills workshops, and high-fidelity simulation. Sessions run quarterly throughout the year. Summary of results To date we have trained 71 doctors; feedback has been excellent. Trainees particularly value the tailored range of educational activities provided, and 93% would recommend the programme to colleagues. We also collect data from trainees after they have returned to work. Thus far only 5 trainees have returned to work and provided us with feedback. They reported benefit from the training, particularly highlighting the practical aspects such as emergency drills and simulation. Discussion The training is valued by our participants, but barriers to delivery exist. The main challenge has been identifying eligible trainees to invite. Our most successful publicity has been trainee-driven via social media, as it has been difficult to compile comprehensive contact lists from centrally held data. New communication strategies are in place via Training Programme Directors and Educational Supervisors to better advertise these resources. Some participants also reported that they found it difficult to arrange childcare to cover these sessions, and Health-education Thames Valley have generously provided additional funding to provide creches at some modules. This has been highly popular with those returning from maternity leave and this has been a decisive factor in some trainees’ attendance. Conclusion Targeted, bespoke training designed for returning trainees is a national priority, and highly valued by trainees. Flexibility in provision is essential to cater for the varying needs of trainees as they return. Recommendations Modular training is popular and valued by trainees Communication and targeted publicity is essential Addressing barriers such as childcare can provide a significant boost to recruitment