Beth Thomas, MD and Gabriel Reedy, PhD describe one of their simulation programs that involves potential learners and helps establish positive partnerships in the community.

Medical simulation is not just for the clinical learner; rather, it can have far reaching impact and can contribute meaningfully to the community. The value of simulation in healthcare training is well recognized. Literature shows a growing trend that simulations empower participants to take on responsible roles, find ways to succeed and solve problems, which drives deeper learning (Issenberg et al., 2005) and that experiential learning is a highly effective alternative to traditional learning (Kolb, 1984).

However, as part of a larger effort within our simulation centre to consider the ways that simulation can be used more broadly, we have found that a thoughtfully designed simulation program can equally be used to provide meaningful learning experiences to potential learners in our wider community.

This article describes the innovative work of Hands Up For Health at King’s Health Partners Simulation and Interactive Learning (SaIL) Centre in London, UK, which uses the power of simulation to reach young people. The program shows that extending simulation to community education can foster strong positive partnerships, and break down traditional barriers between the hospital and the community. In doing so, it helps to promote transparency, openness, improved health, and aspirations for careers in healthcare among urban youth in inner London. The program also supports ongoing collaboration between the hospital and wider community.

King’s Health Partners, London, UK

King’s Health Partners Simulation and Interactive Learning (SaIL) Centre is a state-of-the-art simulation centre based within an Academic Health Sciences Centre (AHSC) in central London. The AHSC partnership consists of the university and four large hospital systems with 21,000 students and over 25,000 employees; it serves a highly diverse local population of over two million people while providing specialist services for a further five million. The population of this urban area has a high level of income inequality and deprivation, as measured by a number of indicators, and consists of a high proportion of ethnic minorities, first generation immigrants, and people for whom English is not their first language.

The Centre plays a key role in the education and training of the current and future health professionals who are part of the AHSC, but we also recognized a need to make connections with our wider community and considered this to be a valuable part of our work. In this spirit, we wanted to turn our centre into an open institution in which our wider community, including patients, local residents, schools, youth organizations, local governments, and other organizations, could explore health and healthcare in an exciting, friendly, fun and safe environment.

What is Hands Up For Health?

Hands Up For Health (HUfH) is a charity-funded innovative interactive learning experience designed for inner-city young people at risk of social and economic disadvantage. It uses experiential simulation activities set in a healthcare context and facilitated by inter-professional healthcare faculty, to engage young people in health issues with which they can identify. The programs’ key aims are to:

  • Increase enthusiasm and knowledge of science and health
  • Strengthen ‘life skills’ for employability and positive health behaviours
  • Widen participation to healthcare careers
Background

Across the UK, but especially in the inner-London area where our centre is located, there are high levels of child poverty and low levels of social mobility (Social Mobility and Child Poverty Commission, 2013). The links between child poverty and social mobility are clear; poorer children fall behind in development before the age of three and do not catch up, creating educational attainment gaps resulting in low social mobility. Whilst more people in the UK are in work than ever before, the number of young people that have been unemployed for more than two years is at a 20-year high. Presently, one-fifth of 18-24 year olds are not in full-time education or employment. Not only does this negatively impact these individuals; employers are also missing out on talent and potential that could make a major contribution to the economy.

Specific attention has been given to social mobility within “the professions”, these being roles with recognizable entry points (e.g. standard qualification requirements), codes of ethics, systems for self-regulation and a strong sense of vocation and professional development, which have typically been seen as the more elitist career paths. Healthcare is the third largest profession, therefore is deemed a priority for increasing social mobility.

There is a particular focus on medicine, which is lagging behind many other professions. Furthermore, the British Medical Association has made the case for having a workforce that is representative of the society it serves to provide the best possible care to the UK population (Milburn, 2012). Increasing social mobility in healthcare, therefore, should be a priority of those in the profession.

Schools across the UK are now responsible for providing careers advice. A survey of UK schools in 2013 by the Office for Standards in Education (Ofsted) highlighted a need to create stronger and better links between employers, employees and young people, and to improve the provision of both careers insights and careers guidance provided by qualified professionals.

Health and poverty are inextricably linked, so tackling social mobility and improving youth employment will have long-term positive effects on health across the population, reducing demand on health services in the future.

HUfH addresses all these issues and offers an innovative way of engaging with this often hard-to-reach population, to increase access to health and healthcare education for young people with a goal of intervening in a life course that could lead to becoming socially disadvantaged as an adult.

Program Design

HUfH has been developed by a multi-disciplinary team of healthcare professionals in collaboration with simulation experts, students and teachers. A multi-pilot, iterative design shaped the content and final design of the program, which responds to the educational and health needs of the local population. The learning outcomes of the program also align with national strategies and curriculum aims for health education in the UK.

The program has features that will be recognisable to anyone engaging in designing or leading simulation learning experiences for healthcare professionals. Indeed, that was one of our goals for the programme. Learners engage in two days of activities spread between their school or youth club and the hospital simulation centre. Day 1 is delivered at the school or the youth club, and the program consists of half-day of first aid skills training and a half-day of ‘life skills’ activities. The latter is centred around experiential learning activities followed by small-group discussions to explore non-technical skills relevant to adolescents, like communication, teamwork and leadership.

The second day of the program consists of a visit to the clinical simulation centre of an inner-city tertiary hospital, where learners engage in a full day of immersive and life-like simulations using various modalities. The simulations are set in a hospital-like environment, using real-life clinical equipment, state-of-the-art manikin technology, and actors serving as simulated patients. All the scenarios are designed to facilitate exploration of topical health issues that adolescents can relate to, such as drug and alcohol abuse, teenage pregnancy, and knife trauma. Participants put the life support, communication and team-working skills from Day 1 into practice at the centre.

The design of Hands Up for Health gives young people the chance to learn valuable life skills and to empower young people to make informed, responsible and voluntary decisions about their own wellbeing. They do this while gaining insight into what it is really like working in healthcare, which helps to raise their aspirations for a career in health professions. As the whole process is facilitated by diverse inter-professional teams, and all learning is framed using personal experiences and integrating opportunities for reflection, the learning is relevant and transferable. This challenges their social views and enhances their ‘life skills’, something which can often be neglected in the classroom setting.

The innovative program, illustrated in Figure 1, is the only known use of simulation to combine the teaching of health skills with ‘life skills’ - those “abilities for adaptive and positive behavior that enable individuals to deal effectively with the demands and challenges of everyday life” (WHO, 1997) - while also widening access to healthcare. It is also the only simulation program that is specifically aimed at positively impacting the lives of underprivileged inner-city youths.

 Evaluation and Impact

All participants complete anonymous feedback forms, which consist of a mixture of open- and closed-ended questions, to explore their experience in the programme.

To date, more than 500 children and young people (aged 9–24 years) have participated in the program, and we have seen a 43% reported increase in the number considering careers in healthcare after participation in the program.

Learners report taking away valuable learning that is regarded as relevant, meaningful and congruent with the intentions of the programme design.

They specifically value the opportunity for hands-on learning with real-life applications, and the realism of the simulation experience. Literature shows this to be a highly effective alternative to traditional approaches, and even more so with students who are disadvantaged economically or academically (Bredderman, 1982). As one respondent explained, ‘practicing in a real life situation is the best way to learn’.

Learners responded well to the design of the simulation activities being oriented to their age, commenting on how the scenarios being ‘connected to young people’ made them more relevant and useful to them. This is important because literature tells us that learning is more persistent and meaningful when it is relevant to the learner (Dewey, 1938).

They also value the opportunity to learn from real healthcare professionals, who positively influenced their learning and attitudes toward healthcare careers. Students show an increased awareness of, and in some cases, aspirations to, healthcare careers, as a result of participating in the program. This supports literature that shows role modeling to have a measurable effect on career choice and aspiration (McHarg et al., 2007).

As we continue to explore the impact of the programme, we are conducting a further in-depth analysis of the nature of participants’ learning and their experiences in the programme. Our evaluation strategy includes both focus groups and observational studies, as well as interviews with students who have attended the programme in previous years, to see what longer-term impact their participation may have had.

Simulation in Community Education

Simulation is a valuable part of healthcare professionals’ training, but in this program, we have shown that the approach can also be used to engage in open dialogue with wider communities and directly improve the health and aspirations of the populations we serve. HUfH is an example of a carefully designed community education program, offering youth-focused, experiential learning in a meaningful, fun, and innovative way, whilst also being responsive to the educational and health needs of the local population.

 Acknowledgements

Guys’ and St. Thomas’ Charity Dr. Peter Jaye, King’s Health Partners Simulation Lead

About the Authors

Dr. Beth Thomas, MBBS, BSc, is a Clinical Simulation Specialist Educator at the Simulation and Interactive Learning (SaIL) Centre at Guy’s and St. Thomas’ Trust and part of King’s Health Partners, London, UK. Following her personal experiences as a patient, she left clinical practice in 2009 to dedicate her time to clinical education. She has extensive experience in health professions simulation and teaching. In her role at King’s Health Partners, she designs, delivers and evaluates mixed-modality clinical simulation courses. She is passionate about using simulation to engage with the broader community, and leads an innovative simulation-based health education program for inner city youths, known locally as Hands Up for Health.

Gabriel B. Reedy, M.Ed., Ph.D., C.Psychol., is a learning scientist and cognitive psychologist at King’s College London. He is the Director of Clinical Education Programs at King’s Learning Institute, King’s College London, where he leads an innovative interprofessional graduate program for clinician educators. He is also the Educational Research Lead for the Simulation and Interactive Learning (SaIL) Centres of King’s Health Partners, London, UK, where he helps to design, deliver, evaluate, and research simulation-based educational interventions.

References

Bredderman, T: What research says: Activity science - the evidence shows it matters. Science and Children 1982; 20:1, 39-41.

Dewey, J: Experience and Education. Collier Books, New York, 1938.

Issenberg S, McGaghie W, Petrusa E, Gordon D, and Scalese R: Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Medical Teacher 2005; 27:1 10-28.

Kolb D: Experiential Learning: Experience as the Source of Learning and Development. Englewood Cliffs, New Jersey, Prentice-Hall, 1984.

McHarg, J., Mattick, K., Knight, L: Why people apply to medical school: implications for widening participation activities. Medical Education 2007; 41:8, 815-821.

Milburn, A: Fair Access to Professional Careers, A Progress Report by the Independent Reviewer on Social Mobility and Child Poverty. 2012. Available from: <https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/61090/IR_FairAccess_acc2.pdf> [Accessed December 2013].

Office for Standards in Education (Ofsted): Careers Guidance Commissioned Survey. 2013. Available from: <http://www.ofsted.gov.uk/sites/default/files/documents/surveys-and-good-practice/c/Careers%20guidance-commissioned%20survey.pdf> [Accessed December 2013].

Social Mobility & Child Poverty Commission: State of the Nation 2013: Social Mobility and Child Poverty in Great Britain. Available from: <https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/292231/State_of_the_Nation_2013.pdf> [Accessed December 2013].

World Health Organization (WHO): Life Skills Education in Schools. Geneva: WHO, 1997. Available from: <http://www.asksource.info/pdf/31181_lifeskillsed_1994.pdf> [Accessed July 2013].