Background
Simulation has been adapted from the airline industry into healthcare, becoming a standard part of many post-graduate training curriculums over the UK. Through simulation health professionals learn technical and more importantly human factors, a key aspect of healthcare errors (1). Barking, Havering and Redbridge University Hospitals trust (BHRUT) has been providing high fidelity in-centre simulation for 7 years to F1, F2 and more recently Core Medical Trainees. We conducted a retrospective 4 year analysis of our simulation program to assess its impact on participants and how we could structure future simulation training. 

Summary of Work
The BHRUT simulation program has been running since 2013. The sim training is run over 1 day, with 8-10 participants. This was exclusively for Foundation trainees and has incorporated core medical trainees from 2019. The day begins with an hour of theory in the morning, followed by 5 scenarios involving 2-4 doctors. After each scenario a 20 minute de-brief is carried out with focus on human factors. Feedback is gathered before and after the simulation program. A total of 276 pre-simulation feedback and 290 post-simulation feedback was audited. 

Summary of Results 
There was no trend of increased exposure to sim from 2016-2019 before the training day. Exposure ranged from 65% (2019 cohort) to 83% (2018 cohort). 

There was significantly increased satisfaction with the training program from foundation doctors when core medical trainees were included in the program. The most common learning objective was technically orientated, with practicing DR ABCDE being the primary goal for a majority of candidates, especially F1s. However, 100% of post-simulation responses regarding objectives learnt related to human factors and acknowledged its importance in their future clinical practice, with 76% of participants reporting good knowledge of human factors after the course. The most prevalent single responses for improvements were to have more frequent simulation sessions (13.2%) and more scenarios (10.8%).

Discussion & Conclusion
There is still a wide variance of exposure to simulation. With simulation becoming an increasing part of undergraduate curriculum future trends of previous simulation experience should be observed. Through this, it can be seen i) doctors have an increased awareness regarding human factors ii) they understand knowledge and practice of human factors to be important in clinical practice. Our data shows a strong desire from junior doctors to have more sim throughout the year, which can be provided via in centre or in-situ methods. To improve the course, more scenarios could be included by reducing participant numbers and having more in-centre days throughout the year. The data shows simulation training to be a strongly beneficial aspect of doctors training and development. With this overwhelmingly positive information we would like to recommend a national standardised simulation program for doctors as a compulsory requirement for training and development. 

Take-Home Message
As our data shows, high fidelity simulation is growing into a key part of training and development for doctors. At our trust this is shown to translate to real changes in clinical practice for doctors.  

Reference
Reference for: Retrospective analysis of in-centre simulation program running for 7 years at Barking, Havering and Redbridge University trust abstract www.england.nhs.uk/wp-content/uploads/2013/11/nqb-hum-fact-concord.pdf