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Introduction Intrathecal injection of the wrong drug during chemotherapy treatment of cancer patients has been identified as a major patient safety issue, prompting an update of the national guidelines 1 in 2008 and an NPSA rapid response report. 2 In situ simulation helps in identification of latent errors (potential hazards in the system) 3 and effective training. We conducted an in situ simulation exercise to deliver training of safe administration of intrathecal chemotherapy. Methods An unannounced in situ simulation activity was carried out in the Haematology intrathecal day-unit. Low fidelity simulation in the form of an actor as patient was employed. Haematology consultant, nursing staff and pharmacist were available to provide assistance to the candidate during the scenario. 4 participants from the Haematology department (2 consultants, 2 registrars) were involved. The participants completed a pre- and post-simulation questionnaire. Video debriefing was performed immediately after each scenario, focussing on adherence to guidelines, decision making, team working and leadership. Results Three latent errors (2 equipment, 1 knowledge) were highlighted and recommendations were made to rectify these issues. Knowledge deficits were identified and addressed during the debrief. Feedback from the candidates was very positive, with unanimous appreciation of realism of the scenario. Impact on practice Two of the latent errors were resolved promptly, leading to improved patient care. This pilot study has been well received and the results are encouraging. We believe this is the first endeavour of its kind: using In situ simulation to improve patient safety in intrathecal chemotherapy. We plan to deliver this exercise as a regular training session for the Haematology department. References Department of Health (DH). HSC 2008/0 01 updated national guidance on the safe administration of intrathecal chemotherapy . London: DH, 2008 National Patient Safety Agency. National Patient Safety Agency, Rapid Response Report, Using Vinca Alkaloid adult minibags (adult/adolescent units) (NPSA/2008/RRR004), 2009. [Accessed on 05.05.2015] Patterson MD, et al . In situ simulation: detection of safety threats and teamwork training in a high risk emergency department. BMJ Qual Saf. 2013;22:468–477

Background In spite of doctor-patient consultations being a fundamental part of clinical practice, poor communication is cited consistently as a factor in patient complaints. 1 Effective consultation skills have been extensively linked to many positive patient outcomes. 2 Unfortunately, consultation skills teaching receives little attention in most specialist training. Simulation based learning (SBL) is becoming a widely used methodology in medical education. In this project, we aim to assess the effect of SBL on consultation skills compared to traditional teaching methods. Methods This is a prospective, randomised-controlled, multi-site trial. Subjects are trainee doctors recruited from within the Yorkshire and Humber Deanery, at Foundation year 2 or Core trainee level. Subjects undergo a video-assessed consultation with a patient presenting with chest pain, either in an outpatient chest pain clinic or on a medical admissions unit. The videos are then assessed using the MAAS-Global and mini-CEX consultation assessment tools. Subjects are then randomised to undergo either traditional teaching, in the form of a tutorial, or a simulation course. Both groups are reassessed in the same way as at the initial assessments. Results/outcomes The principal outcome will be a comparison of the change in the MAAS-Global assessment score for the 2 groups between baseline and after intervention. Subsidiary outcomes will include comparison of the change in score in the patient-survey for the trainee performance, the consultant-survey and qualitative analysis of the perceptions of trainees and trainers of the utility and acceptability of the training. Conclusions Results of this study will be used to further inform the debate around the use of simulation training in healthcare. There are still those that are cynical about the potential for transfer into the clinical environment, and a positive result from this study would help to inform that debate. References Kelly M. A practical guide for teachers of communication skills. A summary of current approaches . Radcliffe Publishing, 2007 Kurtz, SM, Silverman J, Draper J. Teaching and learning communication skills in medicine . Radcliffe Pub, 2005