Daniel Malone
Thao Vu¹, Harjit Khera, Vivian Nguyen¹, Kiirtikka Kumar, Sangeun Lee¹, Ryan Guo¹ and Anoushka Sharma¹
 1 Monash University

Background
Medication-related errors have the potential to harm patients1. MyDispense is a pharmacy dispensing simulation developed to reflect real life pharmacy practice, whereby students can utilise their clinical decision making and dispensing skills without real patient consequences2. 

Summary of work
This pilot study aimed to assess pharmacy student performance in simulated clinical scenarios with or without interruptions. The data included MyDispense responses from 14 third year pharmacy students who voluntarily completed all scenarios in a community pharmacy setting within 30 minutes. A total of five virtual patients were presented either sequentially or were timed to interrupt the pharmacy students. Students performed history taking, made decisions regarding dispensing or recommending an over the counter product, created an accurate pharmacy label and provided patient education, or justified their decision not to dispense where applicable. Student answers were scored using a marking rubric. 

Results
There was a significant reduction in accuracy of history taking (t-test, p = 0.047), but no significant difference in labelling accuracy or clinical decision making in scenarios with interruptions compared to scenarios without interruptions. 

Discussion
Whilst results showed no effect of interruptions on decision making ability, the research finding could have been affected by the limited number of collected responses, and lack of incentive for students to complete the scenarios. 

Conclusions
Apart from a reduction in history taking accuracy, there was no association between student performance and interruptions. However, this pilot study demonstrates that MyDispense is a feasible simulation to assess whether interruptions affect pharmacy student performance. 

Take-home messages
Future plans include optimising incentives for students to complete MyDispense scenarios fully. MyDispense can be used as a learning and assessment tool to pre-expose students to interruptions in simulated clinical scenarios. 

References (maximum three) 

Thomas Gale¹
Nicola Brennan¹, Natasha Keates¹, Nicola Langdon¹, James Read² and Karen Mattick³
1 Peninsula Medical School
2 Cardiff University
3 University of Exeter 

Background
Clinical decision making is a core part of high-quality patient care and a fundamental activity for new doctors. But what makes clinical decisions ‘complex’ and how well prepared are graduates for making them? Monrouxe et al identified clinical decision making as a core skill underpinning preparedness for practice of Foundation doctors (1) but further exploration by other investigators has been limited. This study explores 1). Stakeholder perspectives on what makes clinical decisions complex for newly graduated doctors and 2). Ways that medical graduates are prepared for making complex clinical decisions. 

Summary of work
We conducted a national mixed methods study, funded by the General Medical Council, involving simulation scenarios, self-assessment using debriefing templates and semi-structured interviews with multiple stakeholders across the UK. Interviews lasting 45-60 minutes were conducted with 67 stakeholders including doctors in the first two years of practice, educational and clinical supervisors, postgraduate Deans, programme leads, medical educators and other healthcare professionals. Interviews were audio recorded, transcribed, coded in NVivo and analysed thematically. 

Results
Types of complex clinical decisions that new graduates made included those relating to; acute or time-pressured situations, end of life and do not resuscitate. Graduates felt prepared for understanding their own knowledge and professional limits and knowing when to escalate. There was mixed preparedness reported for dealing with uncertainty and prioritising tasks. Doctors were less well prepared for leadership in acute scenarios and complex clinical decision-making in acute settings or ‘out of hours’ situations. 

Discussion and conclusions 
Current medical education provision is producing doctors that are prepared for many aspects of future anticipated practice. More focus could be applied to: Complex clinical decision making in acute settings, Difficult / complex communication and Leadership / followership. 

Opportunities to improve training include more use of Interprofessional education, simulation training and clinical experience ‘out of hours’. 

References (maximum three) 

1. Monrouxe L, Bullock A, Cole J, et al. How prepared are UK medical graduates for practice, 2014. https://www.gmc-uk.org/-/media/gmc-site-images/about/how- prepared-are-uk-medicalgraduates-for- practice.pdf?la=en&hash=1D87E30FB8A260AB20D662629D0F654FB64695FA.