# Surgical and Medical Acute Response Training (SMART) Programme: Improving Preparedness Amongst Newly Qualified Doctors to Manage Clinical Emergencies

## TL;DR

A new training program called SMART improves newly qualified doctors' confidence in handling medical emergencies.

## Contribution

The SMART program is a novel near-peer interactive training session designed to enhance emergency preparedness in new doctors.

## Key findings

- Participants showed increased confidence in managing medical emergencies after the SMART session.
- Lowest initial confidence was reported in determining treatment escalation plans.
- No significant change was observed in confidence for A-E assessments post-training.

## Abstract

Background

Medical school curricula in the United Kingdom (UK) have been reported to inadequately prepare newly qualified doctors to manage medical emergencies. Near-peer practice has been proposed to enhance emergency medical training. This study describes the development of a training session to improve the knowledge and confidence of newly qualified doctors to manage medical emergencies.

Methods

A near-peer, interactive training session was developed to support newly qualified doctors in managing medical emergency scenarios. The Surgical and Medical Acute Response Training (SMART) session was delivered to newly qualified doctors in the induction week prior to their first clinical placements, which included medicine, surgery, psychiatry, and paediatrics. Pre-session and post-session questionnaires were used to assess the self-reported preparedness of newly qualified doctors to manage medical emergencies. Rank biserial correlation was used to estimate effect sizes. The Wilcoxon signed-rank test was used to identify statistically significant differences in ordinal data between the pre-session and post-session questionnaire responses.

Results

Forty newly qualified doctors attended the SMART session, all of whom completed the pre-session questionnaire (response rate = 100%). Thirty-four participants (85%) completed the post-session questionnaire. Thirty participants (75%) reported exposure to simulation training during their undergraduate training. Seven (17.5%) reported that they considered their undergraduate medical training had prepared them to lead medical emergencies. In the pre-session questionnaire, participants indicated the highest confidence in completing airway, breathing, circulation, disability, and exposure (A-E) assessments and situation, background, assessment, and recommendation (SBAR) handovers. The lowest confidence was reported for determining treatment escalation plans. In the post-session questionnaire, a significant and large positive effect was observed in multiple items relating to awareness of medical emergency teams (METs) and roles of allied health professionals, confidence in leading METs, and clinical management of acute scenarios. No statistically significant effect on confidence in completing an A-E assessment was identified.

Conclusions

This study revealed that newly qualified doctors report reduced confidence across several aspects of managing medical emergencies. Participants reported an increase in confidence in managing acute medical emergencies after participating in the near-peer interactive training session. Clinical educators may consider implementing the SMART session to support newly qualified doctors at the beginning of their post-graduate careers.