The doctor who performs poorly in simulation: An approach

Dear Sir

As large scale clinical simulation programmes roll out, we are forced to confront the scenario where the performance of a trainee in simulation falls short of what is expected. Whilst policies and guidance are in place to address such an issue occurring in clinical practice, we are aware of no such guidance when applied to simulation. There is a responsibility on us as clinicians and educators to raise concerns about the performance of a colleague where patient safety is perceived to be threatened. Our protocol has been accepted for use in a region wide medical emergencies course (GMC 2013; National Association of Clinical Tutors 2013).

The maintenance of a safe psychological learning environment, whilst assessing competence and identifying potential threats to patient safety is a difficult balance. It must also be recognised that the learner may respond differently in simulated scenarios to clinical practice. There may not be the opportunity to observe a learner on multiple occasions.

Recognising these difficulties, we have agreed that where serious issues are identified (as defined by practice likely to lead to patient harm, or unprofessional behaviour likely to lead to patient distress), or the learner fails to recognise their own learning needs, the ‘red’ pathway is followed. Where available, all facilitators on the course will discuss and triangulate their views, with an action plan to be followed. The trainee will have face to face feedback with facilitators away from other trainees and the concerns will be recorded on a Mini-CEX and ACAT assessment tool. The course director will liaise with the trainee’s educational supervisor and an action plan will be agreed with support provided as required.

For areas of poor performance which do not meet the criteria above, and where the trainee recognises learning needs, there is discretion available to the facilitators as to the course of action to be taken. Once again, the Mini-CEX and ACAT assessments are completed to document concerns, and an action plan is agreed. This is usually followed by repeat assessment once agreed actions are completed.

Declaration of interest: The authors report no declarations of interest.