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Table 1 Main themes, subthemes and quotations related to the first-year doctors’ reactions and reflections on transfer of learning from the course to the clinical setting

From: Simulation-based training of junior doctors in handling critically ill patients facilitates the transition to clinical practice: an interview study

Main themes Subthemes Quotations
Preparedness for clinical practice Handling critically ill patients, e.g. sepsis [INT6]’… When you are there with your first critically ill patients you really need to know where to start and that is what you learn from this course’
’…At first you maybe panicked a little - but then you calmly started to work…’
  [INT14]’… You have to go and see a patient you don’t know who is really not feeling well and then you have this systematic approach…’
  [INT12]’…I think the patient transfer part of the course totally changes your way of working, totally. And you feel more confident. Previously, I have been thinking “I don’t even know this patient” and emphatically browsed the patient chart while heading for the scanner’
Maintaining an overview [INT7] “…You maintain an overview and remain calm in the situation”…often it is the nurse who loses grip of the situation’
Feedback, debriefing [INT11] ‘After this course, I’ve had use of feedback/debriefing afterwards, in the sense that we have evaluated after cardiac arrest situations, for example’
Organisational readiness The organisation is not ready to receive [INT12] ‘This thing with closed loops and to think aloud, I think it was really good and I have really tried to use it afterwards. Some of the older colleagues think it gets a little too weird and start to give too many inputs, but the younger nurses have really liked it and responded positively’
Algorithms – useful tools that work in clinical praxis ABCDE approach for assessment [INT5]’…Patient with dyspnoea… and then you do and ABCDE-assessment and because you do it systematically you find out it is actually a… which you wouldn’t have done just as fast otherwise’
ACCEPT approach for transfer of critically ill patients’ [INT4]’…When transferring a patient from the ER to the ward I used this ACCEPT approach prior to the transfer. And it worked really well. I felt more secure about having the equipment with me, but also it actually worked as a kind of debriefing for the nurses who had been in the resuscitation room in the ER when he arrived’
SBAR format for structured communication regarding a patient [INT9] ‘I have used SBAR a lot and I have implemented it, so I don’t really think about it anymore’
’…Need a basic structure to keep track of who you are talking to, what the situation is about and stuff like that’
Communication Capability of talking aloud [INT6]’…And talking aloud about the things and doing a systematic evaluation’
Giving orders [INT2]’…To keep on saying what you are doing and to say I need this and that. You can feel the positive feedback afterwards, because people need it’
The necessity of a clear recipient [INT15] In cardiac arrest. ‘And you must think about speaking directly to people, to make sure they hear and understand what you say - and you hear what they want to say’
Structured communication See also: algorithms – SBAR
[INT9] I have used SBAR a lot and I have implemented it, so I don’t really think about it anymore’
Teamwork Understanding the role of other team members [INT4]’…Easier to cooperate with the nurses in the acute situations afterwards’
‘I remember to ask: how far are you?’
  [INT6] ‘Due to this training I can see that sometimes other professions contribute with valuable input, so you have to think aloud and remain focused’
  [INT2] ‘You are more aware of the information your colleagues need in these situations. It really is teamwork and it is especially in these situations you get tested and become most aware of whether it works’
Leadership Take the role as a leader [INT11]’… After the course I wanted to be team leader in a cardiac arrest situation and I would not have liked that before’
Situational awareness Plan and prepare [INT19] Transfer of trauma patients to the CAT scan:’…and then suddenly a bell rang and I said, okay, I need the emergency kit, − I need to consider what potentially might happen, which medication I would potentially need, and then the whole process was better.’
’… And I would actually not have done this prior to this course’
Decision making Being able to make decisions [INT18] ‘In real life I would, in some of the situations in the simulation room, have asked someone, call my attending physician or someone else and I think it is an advantage that you feel confident in making some decisions - that changes your mind set compared to beforehand’
  1. INT Interview number, ABCDE Airway, Breathing, Circulation, Disability, Exposure, ACCEPT Assessment, Control, Communication, Evaluation, Preparation/Packaging and Transport, SBAR Situation, Background, Analysis, Recommendation, CAT Computer Assisted Tomography