Ambulance mental health placements via virtual simulation: a novel hybrid approach

Introduction: Rising mental health-related emergency calls and inconsistent, under-confident application of mental health frameworks by paramedics underscore the need for improved training and practical experience.1 However, shortages in mental health nursing and high vacancy rates in mental health settings impact the availability, quality, and consistency of practical placements for paramedic students and ambulance employees. Consequently, newly qualified paramedics often feel underprepared for managing mental health issues. This quality improvement study investigated whether simulated mental health placements can enhance practical learning and confidence among both students studying to become paramedics and professionals already working in the field. Aim: Explore the feasibility and acceptability of a simulated mental health placement to consolidate knowledge and improve confidence. Methods: Between June and September 2023, a series of one-day simulated placements using a novel hybrid approach, took place in a university classroom. The placements involved a total of 42 participants, which included 32 final year undergraduate students who were studying to become paramedics and 10 practitioners who specialise in mental health and work for an emergency ambulance service. The placement included live scenarios, delivered remotely by actors via conferencing software. The content of the scenarios were co-produced with paramedic students, university faculty responsible for delivering the undergraduate BSc Paramedic Science programme, ambulance service Learning and Development officers, and mental health and simulation experts from Maudsley Learning. The co-production element was important for ensuring that scenarios addressed student needs, met course outcomes, and were sensitive to both common and unusual mental health presentations found in the prehospital emergency ambulance context. The scenarios were followed by expert-led, trauma-informed debriefs. During the study we iteratively refined the placement using the Plan, Do, Study, Act (PDSA) Quality Improvement cycle, incorporating feedback from After-Action Reviews and participant surveys. Results: Participants were asked to complete questionnaires before and after they participated in the placement. Participants reported increased confidence and knowledge in understanding and managing mental health conditions, including psychosis and suicidal ideation. Based on the feedback received, an optimised model for delivering the placement was developed (See Figure 1). Discussion: Simulated mental health placements appear to be effective and well-received, offering a practical solution to geographical and resource barriers often associated with traditional placements.2 Moreover, this approach plays a crucial role in standardising care and enhancing student experiences. Maintaining a psychologically safe learning environment with tailored debriefing methods is key. Figure 1. Optimised Delivery Model for Hybrid Mental Health Simulation Placement. References: 1. Green A, Pound A. Undergraduate paramedics’ understanding of mental health insight placements. Journal of Paramedic Practice [Internet]. 2020 [cited 2024 Mar 25]; Available from: https://www.paramedicpractice.com/features/article/undergraduate-paramedics-understanding-of-mental-health-insight-placements 2. Sim JJM, Rusli KD Bin, Seah B, Levett-Jones T, Lau Y, Liaw SY. Virtual Simulation to Enhance Clinical Reasoning in Nursing: A Systematic Review and Meta-analysis. Clin Simul Nurs [Internet]. 2022 Aug 1 [cited 2024 Mar 25];69:26. Available from: /pmc/articles/PMC9212904/ Funding: NHSE/HEE AHP Clinical Fellowship