Tabletop Simulation Lifts New Doctors’ On-Call Confidence, Study Finds

The anxiety of the first hospital on-call shift is one of the most widely shared experiences in modern medicine. A new junior doctor, freshly armed with a provisional registration and a prescription pad, hears the pager bleep and must decide, within seconds, whether a patient’s deterioration is routine or catastrophic. A study published in BMC Medical Education suggests that a carefully designed tabletop simulation can substantially ease that transition, raising new doctors’ self-reported confidence on a ten-point scale from 3.9 before training to 6.4 afterwards, and lifting satisfaction with the entire induction process from 3.83 to 6.08. The programme, devised by clinicians at University Hospitals Sussex NHS Foundation Trust and Brighton and Sussex Medical School, is called “Not the Bleep!” and represents an unusually pragmatic answer to a stubborn training problem: how to rehearse the chaos of on-call work for large numbers of new doctors without overwhelming the wards themselves.

The research team, led by Sebastian Priest and colleagues, began from a familiar observation in medical education literature. Doctors entering their Foundation Year One posts, the first full year of practice after medical school in the United Kingdom, frequently report feeling under-prepared for the realities of being on call. Undergraduate curricula tend to emphasise structured ward rounds, supervised procedures and theoretical knowledge, whereas on-call work is defined by interruption, competing priorities, incomplete information and decisions made at speed with limited support. This gap between expectation and reality contributes to what educators call transition shock, a period of stress, fatigue and self-doubt that can affect not only the wellbeing of new doctors but also the safety of the patients they treat. Simulation has long been recognised as one of the most powerful tools for closing that gap, allowing trainees to make and correct mistakes in an environment where no patient is at risk.

The most established format for this kind of training is the in-situ bleep simulation. In these exercises, junior doctors carry dedicated pager devices while working through realistic on-call scenarios embedded within the actual clinical environment. Facilitators send bleeps, dispatch simulated nurses and relatives, and observe how candidates triage, prioritise and escalate. The technique has earned a strong reputation because it reproduces the sensory and cognitive texture of a real shift: the corridors, the phones, the competing demands on attention. Yet the same features that make it effective make it difficult to scale. Each scenario demands considerable facilitator input, often with several staff members required to run a single participant or small group through a session. Hospitals also report resistance from clinical teams who worry about disruption to live patient care, and the logistical complexity of staging multiple simultaneous simulations across a working hospital quickly becomes prohibitive. For an entire Foundation Year One cohort undergoing induction, these constraints are serious.

“Not the Bleep!” was designed specifically to address that scalability problem while preserving what makes on-call simulation valuable. The development process began in September 2023 with a formal learning needs assessment and a stakeholder consultation. Rather than inventing scenarios in an education department office, the team consulted the people who actually carry the bleep: junior doctors who had recently completed their own first on-call periods, along with senior clinical staff who supervise them. The tasks, dilemmas and frustrations that emerged from that consultation were then translated directly into the simulation’s scenario material. This design choice proved central to the programme’s later success, because facilitators evaluating the sessions specifically singled out the realism of the tasks, which participants recognised as drawn from the authentic texture of their future working lives rather than from textbook abstractions.

The resulting tabletop simulation was delivered at the annual Foundation Year One trust induction at University Hospitals Sussex, meaning that an entire incoming cohort of new doctors could be trained in a single coordinated event. In a tabletop format, participants work through on-call scenarios seated around tables rather than moving through hospital corridors, with facilitators delivering requests, clinical problems and competing demands in real time, and structured debriefing built into the flow of the exercise. Because the activity is station-based and table-based, multiple groups of candidates can be run simultaneously, dramatically increasing throughput compared with in-situ modalities. The approach also reduces the ratio of facilitators to participants, a critical consideration for NHS trusts facing severe workforce and financial pressures. Where a traditional bleep simulation might require a facilitator or more per small number of participants, the tabletop format allows a far larger cohort to be trained with the same staff, and crucially does so away from live clinical areas, eliminating the disruption that often generates resistance from ward teams.

The evaluation combined several complementary data streams. Eighty-six individuals took part in the tabletop simulation, and 61 candidates completed evaluative feedback. The primary outcome was a self-reported confidence score, collected on a scale out of ten both before and after the intervention. The improvement from 3.9 to 6.4 represents a substantial gain of two and a half points, achieved within the compressed timeframe of an induction programme. Alongside this, the team measured satisfaction with the induction process as a whole, both before and after the simulation was embedded within it, and recorded an increase from 3.83 to 6.08. The second finding carries practical significance for workforce planning, because induction quality is known to influence how welcomed and prepared new doctors feel, and by extension how quickly they settle into safe, effective practice and how likely they are to remain within the organisation.

Qualitative feedback added texture to the numbers. In facilitator debriefs conducted after the sessions, educators praised the strength of near-peer debriefing, in which more senior trainees, close in experience and status to the participants, guide post-scenario reflection. Near-peer teaching is well recognised in medical education because junior doctors often disclose uncertainty and ask questions more freely of someone only a year or two ahead of them than of a consultant, and the Sussex team found this dynamic particularly powerful in their format. The debriefing occurred in real time, immediately after each scenario, when the emotional and cognitive imprint of the decision-making was still fresh. Facilitators also highlighted the realism of the simulation’s tasks, a direct product of the earlier stakeholder consultation, noting that participants engaged readily with material that mirrored the bleeps, referrals and escalations they would genuinely face on their first night shifts.

The study navigated the ethical and practical requirements of educational research carefully. The Clinical Research Facility at the Royal Sussex County Hospital and the Research Standard Operating Procedures of University Hospitals Sussex determined that formal ethics approval was unnecessary, and the study was assigned project number 1931. All participant data were anonymised at the point of collection, informed consent was obtained from every participant, participants were told in advance how their data would be collected and analysed, and participation operated on an opt-in basis through voluntary completion of the data collection tool. The authors declared no competing interests, and publication costs were funded by My Charity University Hospitals Sussex, Registered Charity No. 1050864, with the customary caveat that the views expressed are those of the authors and not necessarily those of the funder. The article was received in May 2025, accepted in September 2026 and published open access on 22 September 2026, making the full methodology and supplementary materials freely available to other institutions.

The authors are explicit that the tabletop format should be understood as an alternative or adjunct to, rather than a replacement for, in-situ pager-based simulation. Each modality has distinct strengths: in-situ simulations offer unmatched environmental fidelity, while tabletop delivery offers throughput, low facilitator burden and freedom from clinical disruption, combined with immediate near-peer debriefing. The most important next step, the team argues, is direct comparative research between the two methodologies to establish whether the confidence gains observed here match or differ from those of in-situ training, and which format better transfers learning to actual on-call performance. They also identify expansion into interprofessional education as a promising frontier, running scenarios with nurses, pharmacists and other members of the multidisciplinary team alongside junior doctors, reflecting the genuinely collaborative nature of out-of-hours hospital care. For NHS trusts confronting large incoming cohorts, limited simulation staff and wards that cannot absorb repeated disruption, the message is strikingly simple: a conference room, a stack of realistic scenarios and a debrief from someone who has been there may be enough to make the first bleep feel less like a threat and more like a well-rehearsed beginning.

Subject of Research: Evaluation of a tabletop on-call simulation for training new Foundation Year One doctors

Article Title: “Not the bleep!”; a novel tabletop approach to on-call simulation

Article References: “Not the bleep!”; a novel tabletop approach to on-call simulation. (n.d.). https://doi.org/10.1186/s12909-026-10456-8

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10456-8

Keywords: tabletop simulation, on-call simulation, medical education, Foundation Year One, new doctors, bleep simulation, near-peer debriefing, induction, confidence, transition to practice, NHS training, scalability