2.4. Module design

Delegates were allocated into groups of five based on their country of study. Prior to the NTS module, students went through teaching on a systematic method for managing acutely ill patients, the ABCDE approach [22]. Each group participated in one low- and one high-fidelity NTS session twice; the first run was considered a mock and the second the ‘actual’. Groups were given a scenario and had 20 min to stabilise a simulated patient-actor. The modulator would prompt or aid the participants during the mock attempt. After the mock, a dedicated 20-min slot was allocated for case-based discussion, non-technical skill teaching and constructive feedback. Sufficient time was allowed for the participants to rest and reflect before the actual attempt.

The scenarios were developed by the authors to challenge students at the undergraduate medical level without requiring any specialist knowledge (Fig. 1). Low-fidelity scenarios included management of an emergency case on a simulated-patient; liver laceration or spleen rupture. The actor was debriefed in advance on how to respond to questions and examination. Students could ask the session modulator for any patient observations (e.g. heart rate) or investigation outcomes (e.g. x-ray). Information that was obtained from the history, examination and investigations was used to conclude on a probable diagnosis and management plan for stabilising the patient. High-fidelity scenarios constituted of multiple-trauma cases where simulated-patients wore a hyper-realistic suit (Fig. 2). The specialised suit allowed for a range of practical skills to be performed, including a surgical tracheostomy, chest drain insertion and bleeding control (Fig. 2). In addition, a monitor would display the vital observations of the patient; which were adjusted wirelessly by the group modulator using a tablet.

Student-groups went through one mock and one actual scenario in both low- and high-fidelity settings.

Hyper-realistic training suit by PPA-International Medical a) Suit for multi-trauma cases on a simulated-patient b) Surgical tracheostomy performed by a student during the high-fidelity scenario.

The aim of the groups in all scenarios was to stabilise the patient, work and communicate effectively within the team. Practical skills performed, including examination and surgical interventions, were not assessed.