CATE 2023: Using simulation-based education to enhance quality and safety in healthcare

We are a group of educators and researchers who feel passionately about the use of simulation for student and staff development, and system design in healthcare. The Collaborative Award for Teaching Excellence has given us a chance to reflect in depth on what we have achieved since our simulation centre - Oxford Simulation Teaching and Research – OxSTaR - opened in 2008, and to realise how far we’ve come. 

Why our team works so well together 

We began life as a group of four multidisciplinary clinical educators and over 15 years have expanded to a wonderfully diverse group of over 50 faculty from healthcare, psychology, human factors and technical backgrounds, over 30 researchers and teaching fellows and our 14 core staff.  

OxSTaR is embedded in the University of Oxford and situated in the Oxford University Hospitals NHS Foundation Trust (OUHT) with whom we have a very strong relationship. The team ethos of collective competence, where collaborations lead to accomplishments that would not otherwise be possible, underpins our successful partnerships with healthcare organisations, other universities, students, teachers and academics in the UK and beyond. We thrive together because we value everyone’s opinions, encourage constructive criticism and take enormous pride in what we do.  

What we have achieved 

We have developed innovative, award-winning simulation-based education using many modalities (including hi-fidelity manikins, virtual reality and table-top simulation exercises) with the overarching aim of delivering outstanding educational programmes in healthcare to support safer patient care. Our work has impacted the education of tens of thousands of students and healthcare professionals in the UK and internationally over the years, and evaluation of our feedback shows how much it has been appreciated. 

Of course, nothing we have achieved would be possible without the educators, researchers, technicians and support staff in our team. We take development of our people very seriously and have a robust programme of faculty development for simulation educators including opportunities for healthcare students to begin to develop these skills.  

We have also supported over 20 educational fellows from all healthcare professions, 12 of whom have undertaken further qualifications in adult education whilst with us (five to distinction). Our technical team are all supported to achieve professional registration with the Science Council and we have implemented an innovative apprenticeship scheme to teach new simulation technicians. 

Our research group focuses on two key themes: clinical education and patient safety and we currently have four PhD students, one post-doctoral student and two simulation fellows in the group. Examples of current projects include improving multidisciplinary team performance, artificial intelligence to assist decision making and virtual reality simulation as a tool for education and assessment.  

The work in virtual reality has been a truly collaborative endeavour. Six medical students worked with the core team to co-design a new VR Special Study Module between 2019 and 2021; the students’ and their enthusiasm and energy were a vital support to team members who were all frontline clinicians during Covid-19. Along with three doctoral students in the extended team, the undergraduates developed case studies based on their experiences of using VR; through the team’s links across departments, these studies formed the basis for innovative debriefs as part of tutorial teaching for medical students during the pandemic. 

What we are most proud of 

Looking back there are many things to be proud of but, perhaps not surprisingly, our response during the pandemic stands out. The resilience of the whole team and its ability to work collaboratively under pressure was exemplified in the extreme in 2020 when clinical members of the team were redeployed to the front line in response to the first wave of Covid-19.  

The core team were able to capitalise on their close working relationships developed over the years across the OUHT to design and implement a new ‘Simulation and Technology Enhanced learning for Up skilling in a Pandemic’ (STEP-UP) project. The OxSTaR team led the STEP-UP project, which included the design and development of a wide variety of educational interventions to rapidly implement Covid-safe protocols across hospitals and wider healthcare settings at a time when there were no vaccinations yet available. This included the development of over 90 short educational videos for clinical staff which were co-created in partnership with medical students and foundation doctors.  

None of this would have been possible without the existing bedrock of trust and mutual respect for each other's expertise, so that the lessons from the frontline could inform the design and development of the STEP-UP project outputs. We recognised the importance of sharing this work to support others in improving healthcare during unprecedented times, and we made all our resources freely available worldwide via our website and social media. Since the start of the pandemic, hits on the OxSTaR website have gone from approx. 4,000pa to over 10,000pa (40,000 hits total since the beginning of Covid-19). Through website statistics and testimonials we know that over 31,000 healthcare professionals and students from over 165 countries used the freely accessible resources from our STEP-UP project. 

What the future holds 

The extraordinary experiences of the pandemic brought about some collateral benefits, including a recognition of the benefits of simulation both as a tool for education and for designing and stress-testing new care pathways for patients. We are optimistic about the future and are already developing new educational and research projects but are also mindful of the current high levels of burnout amongst healthcare staff and educators. We know that working in simulation-based education promotes happy and healthy working relationships and a strong sense of contributing something positive to the wider healthcare community. Our wider team and our students confirm this but we’d love to hear what you think – please contact us at oxstar@ndcn.ox.ac.uk if you’re interested in what we’re doing.