In 2008 the National Patient Safety Agency reported 12 patient deaths directly related to chest drain insertion over a 3-year period. Since then there have been calls from publications highlighting the need for better education for clinicians [1]. Simulation has been shown to improve chest drain insertion technique [2], and multi-disciplinary simulation can encourage teamwork and communication skills [3]. Given that this procedure is an essential requirement for anaesthetic, intensive care, emergency medicine and internal medicine trainees, we decided to introduce a multi-disciplinary simulation course for the insertion of chest drains. A basic needs analysis was carried out with stakeholders. Initially the course was designed to run for half a day, with a maximum of 12 candidates and a minimum of 3 faculty. A course timetable, course manual, equipment list and pre- and post-course feedback questionnaires were created. The course begins with a lecture, followed by three simulation-based workshops, which the candidates rotate between. These cover seldinger and surgical chest drain insertion, and the basics of chest ultrasound, using ultrasoundable chest drain manikins. Feedback from the first course in July 2022 suggested that there should be a designated faculty team leader and healthy volunteers for the ultrasound workshop. We implemented this feedback and ran the course again in December 2022. Candidates were asked to rate their post course confidence at performing the procedure, with a score ranging between 1 and 7 (each number was assigned a qualitative value with 1 being unable to perform the procedure and 7 being extremely confident in performing the procedure). After the first course, the average score was 5 points. After the second, the average increased to 5.5. The course ran for a third time in April 2023, during which the duration of the workshops was increased and a lecture on aftercare was added. The average post course confidence score was 5.7. All candidates felt that the session fully met the learning objectives and would recommend the course to others. After implementing changes to our course including assigning a faculty team leader, recruiting healthy volunteers, increasing the time spent in workshops and adding a session on aftercare, there has been an improvement in the candidates’ average post course confidence at performing chest drains and qualitative candidate feedback was positive. We would recommend our course structure to others designing a chest drain course. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.

The UK medical profession is becoming increasingly diverse as the number of international medical graduates (IMGs) joining the UK medical workforce increases every year. However, IMGs face a number of significant sociocultural and educational challenges. Recent studies show that IMGs lack insight into the system and lack clarity in relation to the role of a supervisor, career pathways, and medico-legal and ethical issues [1,2]. They exhibit differences in clinical practices and team dynamics. Recent studies suggest the introduction of dedicated induction programs in the form of formal teaching sessions, or tailored online induction for IMGs prior to their first job [1–3]. Most IMGs have minimal exposure to simulation and human factors training with international medical schools favouring more didactic methods of education. We have designed a high-fidelity simulation course with frequently encountered clinical scenarios to improve inclusion and a harmonious transition for the IMGs. This provides an opportunity to familiarise themselves with the healthcare system and team dynamics within the NHS and instils confidence to perform to the best of their ability in their respective roles. The course has been designed specifically tailored to the needs of IMGs who may find it daunting at first to make their place in a completely new system. We employ high-fidelity simulation encompassing multiple frequently encountered clinical scenarios. The scenarios are followed by a debriefing, with a special focus on human factors, interpersonal and communication skills, and understanding of authority gradients. The attendees are also encouraged to reflect on their performance and to participate in the discussion, share their professional opinions, experiences, and cultural influences. The attendees are asked to fill a pre-course and post-course questionnaire. Two pilot courses were conducted with a total of 22 attendees. Pre- and post-course feedback with reflective questions about various aspects of the course was obtained. The scenarios assessed 5 categories, which the IMGs graded on a Likert scale. Pairwise comparison was performed between pre- and post-course feedback, showing a statistically significant increase in confidence levels related to all assessed categories; basic management skills (p <0.001), clinical skills (p=0.006), communication skills (p<0.001), teamwork (p<0.001), and leadership (p<0.001). Based on the positive feedback from attendees we believe that this induction simulation course can greatly help IMGs have a smooth transition into the NHS, and ensure inclusivity by equipping them with confidence, a knowledge of the system, and human factors. 1. Rasquinha M. Difficulties and educational challenges faced by international medical graduates in trust grade roles in the UK. British Journal of Hospital Medicine. 2022;83(4):1–7. 2. Hashim A. Educational challenges faced by international medical graduates in the UK. Advances in Medical Education and Practice. 2017;8:441–445. 3. Emery L, Jackson B, Oliver P, Mitchell C. International graduates’ experiences of reflection in postgraduate training: a cross-sectional survey. BJGP open. 2022.

BackgroundThe Civil Contingencies Act (2004) requires organisations such as the emergency services, councils and hospital trusts to prepare for emergencies by undertaking ‘live’ Major Incident exercises every three years¹. In the summer of 2017 our organisation took part in ‘Operation Orange Falcon,’ a multiagency live Major Incident Exercise. This involved teams from Hull and East Yorkshire Hospitals, Yorkshire Ambulance Service, Humberside Fire and Rescue, Humberside Police and the Royal Logistics Corps and more than 60 casualty volunteers. Hull Institute of Learning and Simulation (HILS) led the debriefing element of the exercise.Project summaryThe challenge in debriefing such a large-scale exercise came in providing meaningful immediate feedback to participants while also providing useful feedback to the involved organisations as a whole. We approached this by using two forms of debriefing; a ‘hot debrief’ on closing the exercise and a ‘cold debrief’ several weeks later. It was impractical to deliver a hot debrief to all of the participants in the exercise together. We agreed within the participating organisations to establish key areas of focus and placed debriefing teams in each of those key areas. They could then provide immediate feedback to participants on close of exercise. The debriefing teams consisted of a content expert, with expertise in the particular area being observed and an experienced debriefer from HILS. The agreed areas of focus included: Decontamination at the scene of the incident. The incident command team on–site. Decontamination at the hospital. Triage at the Hospital. Hospital control room. Casualty volunteers were debriefed separately by a team that included a psychologist from the Humber Mental Health Trust. The cold debrief was held eight weeks after the exercise and all participants were invited to attend. It focused on the same key areas, with the addition of video footage of the day to illustrate key points and revisited the issues raised in the hot debriefings.ResultsThe feedback from the other agencies was very positive. They reported that the standard debriefings they had attended before focused on finding fault or assigning blame. Use of on-site hot debriefing provided a deeper understanding of how the Trust’s Major Incident Plan worked in practice.DiscussionThe skills of debriefers from a healthcare background can be transferred outside of the healthcare environment when paired up with content experts in the field. Debriefing teams improved the experience of participants in a multiagency Major Incident Exercise.ReferencesCabinet Office. ‘Emergency Preparedness: Guidance on Part 1 of the Civil Contingencies Act 2004, its Associated Regulations and Non-statutory Arrangements.’ (2005).

Introduction The Simulation Partnership for Advancing Regional Knowledge (SPARK) was formed in February 2016 and represents partnership working across North East Yorkshire and North Lincolnshire. The group joined forces to enhance and strengthen simulation partnerships across the region. The group meet quarterly, across Hull, York, Scunthorpe and Scarborough to explore ideas and models to enhance simulation based delivery. SPARK has now approached its first anniversary which provides opportunity to look back on the achievements of the past year. Methods The last 12 months have been busy for SPARK as the group have focused on creating its identity and agreeing the priority projects. The first task was to raise the profile of SPARK, our website was created (www.spark-neynl.org.uk) and Twitter page @SparkNEYNL to enable us to communicate together as a group and with individuals who have an interest in SPARK across the region as well as creating newsletters to keep our followers up to date with latest news and developments. Showcasing our resources and educational capabilities was an important reason for setting up our website. Towards this end we commenced a regional Simulation Audit and gathered information of our regional centres and facilities. This is accessible via the SPARK website. To ensure high quality and consistency of our courses across the region we agreed to standardise the courses to ensure that the same is being delivered in each centre. We are proud to announce that our first SPARK badged course is the Chest Drain. It is hoped that this method will provide better value for our learners and more importantly a greater positive impact for our patients. Encouraged by the positivity of our first collaboration we are now working on the CVC insertion course. The group held its inaugural conference on Tuesday 23rd May 2017, Applying Human Factors for Improved Patient Safety, which was sold out (free event) and attracted national and international speakers. Results Website with resource platform, Twitter – 57 Followers, 5 Face to face meetings, SPARK badged Chest Drain Course, Regional Simulation Audit Document, Inaugural Conference. Conclusion The group have had a successful first year and the quality of our simulation based education is improving through working together. Since the formation of SPARK; information from the partnering organisations is easily accessible through the website such as facilities and resources available in each centre. Our chest drain courses are now being delivered in the same manner which for the first time across our region is ensuring high quality and consistency. Reference www.spark-neynl.org.uk