Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.115
S. Sait, Peter Springbett, S. Hicks, G. Janakan
Introduction Many surgical healthcare professionals feel inadequately prepared in dealing with acutely unwell surgical patients (1). Simulation can give doctors and nurses the confidence in managing these patients (2). Currently there is no high-fidelity simulation focusing on human factors in the field of surgery. Our aim was to run a full day interprofessional surgical simulation course for healthcare professionals. This is the only surgical interprofessional simulation currently being offered to healthcare professionals. Methods We ran three full day interprofessional surgical simulation courses. Scenarios included managing acutely unwell surgical patients and being called when scrubbed in theatre. Each scenario had a surgical doctor and nurse, and this led to discussion on relevant human factors and clinical learning points. Results Candidates who attended the course found that their confidence increased in managing acutely unwell surgical patients (4.5/10 to 8.2/10), doing an A-E assessment (6.6/10 to 8.4/10) and providing a good handover (6/10 to 8.3/10). Candidates rated the course as 9.6/10. Some of the comments from the course were ‘teaching, excellent feedback in a safe environment’ and ‘much more confident in assessing and managing acutely unwell patients’. All the candidates who attended the course said that they would recommend this course to a colleague and felt it should be made available to all healthcare professionals. Discussion and Conclusion This novel, high fidelity, interprofessional surgical simulation course was both well received and led to improved confidence in the management of acutely unwell surgical patients. The course allowed candidates to work in an interprofessional team. All the candidates would recommend this course to their colleagues. We would therefore recommend that this course be made available to all healthcare professionals working in surgery. References Isherwood, J., Mughal, Z. and Yeung, J., 2013. Can simulation training improve foundation doctors’ assessment and management of acutely unwell surgical patients?. BMJ, 346. Carling, J., 2010. Are graduate doctors adequately prepared to manage acutely unwell patients?. The clinical teacher;7(2): pp.102–105.
{"title":"PG67 Acute surgical emergency patient (ASEP) simulation course","authors":"S. Sait, Peter Springbett, S. Hicks, G. Janakan","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.115","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.115","url":null,"abstract":"Introduction Many surgical healthcare professionals feel inadequately prepared in dealing with acutely unwell surgical patients (1). Simulation can give doctors and nurses the confidence in managing these patients (2). Currently there is no high-fidelity simulation focusing on human factors in the field of surgery. Our aim was to run a full day interprofessional surgical simulation course for healthcare professionals. This is the only surgical interprofessional simulation currently being offered to healthcare professionals. Methods We ran three full day interprofessional surgical simulation courses. Scenarios included managing acutely unwell surgical patients and being called when scrubbed in theatre. Each scenario had a surgical doctor and nurse, and this led to discussion on relevant human factors and clinical learning points. Results Candidates who attended the course found that their confidence increased in managing acutely unwell surgical patients (4.5/10 to 8.2/10), doing an A-E assessment (6.6/10 to 8.4/10) and providing a good handover (6/10 to 8.3/10). Candidates rated the course as 9.6/10. Some of the comments from the course were ‘teaching, excellent feedback in a safe environment’ and ‘much more confident in assessing and managing acutely unwell patients’. All the candidates who attended the course said that they would recommend this course to a colleague and felt it should be made available to all healthcare professionals. Discussion and Conclusion This novel, high fidelity, interprofessional surgical simulation course was both well received and led to improved confidence in the management of acutely unwell surgical patients. The course allowed candidates to work in an interprofessional team. All the candidates would recommend this course to their colleagues. We would therefore recommend that this course be made available to all healthcare professionals working in surgery. References Isherwood, J., Mughal, Z. and Yeung, J., 2013. Can simulation training improve foundation doctors’ assessment and management of acutely unwell surgical patients?. BMJ, 346. Carling, J., 2010. Are graduate doctors adequately prepared to manage acutely unwell patients?. The clinical teacher;7(2): pp.102–105.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"22 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89061059","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.26
A. Blackmore, E. Herrieven, P. Stewart, B. Cherian
Background The first positive COVID-19 tests in the UK were in our Trust. We were fortunate that there was a significant time delay between the first identified cases and the surge in cases that was seen across the UK in early 2020. Our department had been designed for maximal ease of access to equipment but the pandemic required us to change our layout and pathways. Summary of Work Across our adult and paediatric emergency departments we used targeted simulation scenarios to train staff, to help in the design of new pathways and expose latent errors. A series of basic scenarios with a member of staff as a simulated patient were used to train existing and redeployed staff in basic skills such as donning/doffing, entering and exiting a barriered room and passing samples out of the room without cross-contamination. Another series of simulated patient scenarios were used to train clinicians in the clinical management of a COVID-19 patient with an escalating oxygen requirement. We also practiced transfer of a deteriorating patient to Resus. Other simulation scenarios used an intubatable manikin to practice scenarios involving aerosol generating procedures. ED intubation simulations contributed to the design of our Trust’s COVID-19 intubation checklist. We ran simulated cardiac arrest scenarios in adult and paediatric Majors cubicles and in Resus. In situ simulations were used to design our new ‘Cold Majors’ area in what was our Emergency Care Area. We designed scenarios to test transfer pathways from the ambulance bay to the new area and from Cold Majors to X ray and CT. Summary of Results In all, more than 50 scenarios were run over a six week period. Orientation simulations ran most frequently and highlighted any lapses in infection control practices that could be addressed. Deteriorating patient, intubation, cardiac arrest and fitting patient scenarios highlighted latent errors around storage of equipment and preparation of airway trollies. They also directly informed the new layout of our resus cubicles and the ever-evolving departmental COVID-19 policies. In Cold Majors, they helped to plan the flow of patients within the new area and helped to orientate staff within the new environment. Discussion and Conclusions In situ simulation is an effective tool to help an emergency department adapt to the new demands placed on it by the COVID-19 pandemic; from maintaining standards in infection control to designing pathways and even the layout of the department itself.
{"title":"PP7 Using in situ simulation to manage changes to an emergency department’s processes during the COVID-19 pandemic","authors":"A. Blackmore, E. Herrieven, P. Stewart, B. Cherian","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.26","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.26","url":null,"abstract":"Background The first positive COVID-19 tests in the UK were in our Trust. We were fortunate that there was a significant time delay between the first identified cases and the surge in cases that was seen across the UK in early 2020. Our department had been designed for maximal ease of access to equipment but the pandemic required us to change our layout and pathways. Summary of Work Across our adult and paediatric emergency departments we used targeted simulation scenarios to train staff, to help in the design of new pathways and expose latent errors. A series of basic scenarios with a member of staff as a simulated patient were used to train existing and redeployed staff in basic skills such as donning/doffing, entering and exiting a barriered room and passing samples out of the room without cross-contamination. Another series of simulated patient scenarios were used to train clinicians in the clinical management of a COVID-19 patient with an escalating oxygen requirement. We also practiced transfer of a deteriorating patient to Resus. Other simulation scenarios used an intubatable manikin to practice scenarios involving aerosol generating procedures. ED intubation simulations contributed to the design of our Trust’s COVID-19 intubation checklist. We ran simulated cardiac arrest scenarios in adult and paediatric Majors cubicles and in Resus. In situ simulations were used to design our new ‘Cold Majors’ area in what was our Emergency Care Area. We designed scenarios to test transfer pathways from the ambulance bay to the new area and from Cold Majors to X ray and CT. Summary of Results In all, more than 50 scenarios were run over a six week period. Orientation simulations ran most frequently and highlighted any lapses in infection control practices that could be addressed. Deteriorating patient, intubation, cardiac arrest and fitting patient scenarios highlighted latent errors around storage of equipment and preparation of airway trollies. They also directly informed the new layout of our resus cubicles and the ever-evolving departmental COVID-19 policies. In Cold Majors, they helped to plan the flow of patients within the new area and helped to orientate staff within the new environment. Discussion and Conclusions In situ simulation is an effective tool to help an emergency department adapt to the new demands placed on it by the COVID-19 pandemic; from maintaining standards in infection control to designing pathways and even the layout of the department itself.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"18 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84643903","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.145
M. Phipps, Ben Hammond, J. Chilman, Matthew Donaldson, Felix Liu
Background The current COVID-19 pandemic has caused significant challenges within medical education, particularly with regards to the use of volunteer patients for clinical examination teaching sessions given their potential vulnerability and susceptibility to infection. As a result, we have been looking for novel ways to deliver clinical examination skills teaching that does not require contact with patients, but can still help students to develop these essential skills and improve their recognition of ‘abnormal’ as well as ‘normal’ findings. Recently, high fidelity simulation stethoscopes have been developed that can be used with both mannequins and healthy individuals to simulate a wide variety of heart and lung sounds.1 These stethoscopes have the look of their normal counterparts, can be controlled wirelessly by the tutor and only transmit sound when placed onto a mannequin or body, helping to improve the fidelity of the simulation.2 Summary of Work As part of our clinical examination skills teaching for third year undergraduate medical students during the COVID-19 pandemic, we have decided to utilise simulation stethoscopes as part of a simulated patient encounter. Rather than risk exposing potentially vulnerable patients, students will take a standard history over the telephone and we will then use the stethoscopes to simulate carefully linked examination findings on a mannequin or healthy volunteer. We will pilot this approach on 8 September 2020 with 16 undergraduate medical students. Each student will be given two scenarios which will focus on cardio-respiratory examination skills and will involve a mixture of both ‘normal’ and ‘abnormal’ simulated examination findings. Students and tutors will complete pre- and post-session questionnaires to assess the impact of this approach on students’ confidence with regards to cardio-respiratory examination and recognition of ‘normal’ and ‘abnormal’ findings. Summary of Results Results will be available for presentation at the conference, pending the initial session on 8 September 2020. Discussion and Conclusions We hope to establish whether the use of simulation stethoscopes in this way may be a valuable approach to undergraduate medical student clinical examination teaching. Conclusions will be based on both qualitative and quantitative data collected from student and tutor questionnaires after the initial session. Recommendations Depending on the findings, this approach may prove a useful adjunct to undergraduate clinical examination skills teaching, particularly during the COVID-19 pandemic. References Warrington SJ, Beeson MS, Fire FL. Are simulation stethoscopes a useful adjunct for emergency residents’ training on high-fidelity mannequins?West J Emerg Med 2013;14:275–277. iSimulate. AURiS: A Simulation Stethoscope with Advanced Sensor Technology [Internet]. 2020 [cited 2020 Aug 30]. Available from: https://www.isimulate.com/auris
当前的COVID-19大流行给医学教育带来了重大挑战，特别是在使用志愿患者进行临床检查教学方面，因为他们潜在的脆弱性和易受感染。因此，我们一直在寻找新的方法来提供临床检查技能教学，不需要与患者接触，但仍然可以帮助学生发展这些基本技能，提高他们对“异常”和“正常”发现的认识。最近，高保真模拟听诊器已经被开发出来，它既可以用于人体模型，也可以用于健康人来模拟各种各样的心肺声音这些听诊器和普通听诊器一样，可以由教师无线控制，只有放在人体模型或身体上时才传输声音，有助于提高模拟的保真度作为2019冠状病毒病大流行期间医三年级本科生临床检查技能教学的一部分，我们决定利用模拟听诊器作为模拟患者就诊的一部分。为了避免暴露潜在的脆弱病人，学生们将通过电话填写一份标准病史，然后我们将使用听诊器在人体模型或健康志愿者身上模拟仔细关联的检查结果。我们将于2020年9月8日在16名医科本科生中试行这一方法。每个学生将会有两个场景，重点是心肺检查技能，并将包括“正常”和“异常”模拟检查结果的混合物。学生和导师将完成课前和课后的问卷调查，以评估这种方法对学生对心肺检查的信心以及对“正常”和“异常”发现的认识的影响。在2020年9月8日的首次会议之前，将提供结果以供在会议上展示。讨论与结论我们希望通过这种方式来探讨模拟听诊器在医科本科学生临床检验教学中的应用是否有价值。结论将基于在初始阶段后从学生和导师问卷中收集的定性和定量数据。根据研究结果，这种方法可能被证明是对本科临床检查技能教学的有用辅助，特别是在COVID-19大流行期间。参考文献Warrington SJ, Beeson MS, Fire FL.模拟听诊器是急救住院医师高保真假人培训的有用辅助吗?中华医学杂志(英文版);2013;iSimulate。AURiS:采用先进传感器技术的模拟听诊器[Internet]。2020[引用自2020年8月30日]。可从:https://www.isimulate.com/auris获得
{"title":"PG97 ‘But we know it will be normal!’ The role of simulation stethoscopes in undergraduate education","authors":"M. Phipps, Ben Hammond, J. Chilman, Matthew Donaldson, Felix Liu","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.145","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.145","url":null,"abstract":"Background The current COVID-19 pandemic has caused significant challenges within medical education, particularly with regards to the use of volunteer patients for clinical examination teaching sessions given their potential vulnerability and susceptibility to infection. As a result, we have been looking for novel ways to deliver clinical examination skills teaching that does not require contact with patients, but can still help students to develop these essential skills and improve their recognition of ‘abnormal’ as well as ‘normal’ findings. Recently, high fidelity simulation stethoscopes have been developed that can be used with both mannequins and healthy individuals to simulate a wide variety of heart and lung sounds.1 These stethoscopes have the look of their normal counterparts, can be controlled wirelessly by the tutor and only transmit sound when placed onto a mannequin or body, helping to improve the fidelity of the simulation.2 Summary of Work As part of our clinical examination skills teaching for third year undergraduate medical students during the COVID-19 pandemic, we have decided to utilise simulation stethoscopes as part of a simulated patient encounter. Rather than risk exposing potentially vulnerable patients, students will take a standard history over the telephone and we will then use the stethoscopes to simulate carefully linked examination findings on a mannequin or healthy volunteer. We will pilot this approach on 8 September 2020 with 16 undergraduate medical students. Each student will be given two scenarios which will focus on cardio-respiratory examination skills and will involve a mixture of both ‘normal’ and ‘abnormal’ simulated examination findings. Students and tutors will complete pre- and post-session questionnaires to assess the impact of this approach on students’ confidence with regards to cardio-respiratory examination and recognition of ‘normal’ and ‘abnormal’ findings. Summary of Results Results will be available for presentation at the conference, pending the initial session on 8 September 2020. Discussion and Conclusions We hope to establish whether the use of simulation stethoscopes in this way may be a valuable approach to undergraduate medical student clinical examination teaching. Conclusions will be based on both qualitative and quantitative data collected from student and tutor questionnaires after the initial session. Recommendations Depending on the findings, this approach may prove a useful adjunct to undergraduate clinical examination skills teaching, particularly during the COVID-19 pandemic. References Warrington SJ, Beeson MS, Fire FL. Are simulation stethoscopes a useful adjunct for emergency residents’ training on high-fidelity mannequins?West J Emerg Med 2013;14:275–277. iSimulate. AURiS: A Simulation Stethoscope with Advanced Sensor Technology [Internet]. 2020 [cited 2020 Aug 30]. Available from: https://www.isimulate.com/auris","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"41 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87505096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.160
A. Saunders, Marta Ortega Vega, Hannah Ianelli, C. Attoe, S. Cross
Mental health is a growing sector of healthcare, in which patients who suffer untreated experience worse quality of life outcomes and lower life expectancy. In order to achieve the best possible care, training and subsequent evaluation is needed for those who work with patients experiencing mental health difficulties. Research suggests that age has the potential to impact training efficacy, in which older participants are significantly worse at retaining novel training skills compared to their younger counterparts. It has also been suggested that there are differences in preferred learning styles, and thus learning efficacy, between males and females. Thus, this paper sought to investigate these differences within the novel training method of high-fidelity, actor-based mental health simulation training, in order to identify factors that may affect training efficacy and subsequently patient outcomes. 829 participants attended simulation training courses and completed the Human Factors Skills for Healthcare Instrument pre- and post-course. Significant changes in HFSHI scores were found between pre- and post-course data across all participants, suggesting that simulation training can be universally effective as a method of pedagogy. Individuals within the ages of 25–29 reported significantly less mean change in HFSHI scores than those between 35–45. Career stage did not seem to mediate this effect. No differences in HFSHI scores were found across gender. The study concludes that simulation is an innovative training method that is effective across a variety of courses and professions. More research should be conducted to investigate why there may be differences in learning outcomes for different ages in regard to simulation, and to identify any other confounding factors that may influence these results. Reference McManus, S., Bebbington, P., Jenkins, R., & Brugha, T. ( 2016). Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014. A survey carried out for NHS Digital by NatCen Social Research and the Department of Health Sciences, University of Leicester. Reedy, G. B., Lavelle, M., Simpson, T., & Anderson, J. E. ( 2017). Development of the Human Factors Skills for Healthcare Instrument: a valid and reliable tool for assessing interprofessional learning across healthcare practice settings. BMJ Simulation and Technology Enhanced Learning;3(4):135–141.
{"title":"PG112 Exploring the influence of trainee attributes on simulation-based mental health training efficacy","authors":"A. Saunders, Marta Ortega Vega, Hannah Ianelli, C. Attoe, S. Cross","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.160","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.160","url":null,"abstract":"Mental health is a growing sector of healthcare, in which patients who suffer untreated experience worse quality of life outcomes and lower life expectancy. In order to achieve the best possible care, training and subsequent evaluation is needed for those who work with patients experiencing mental health difficulties. Research suggests that age has the potential to impact training efficacy, in which older participants are significantly worse at retaining novel training skills compared to their younger counterparts. It has also been suggested that there are differences in preferred learning styles, and thus learning efficacy, between males and females. Thus, this paper sought to investigate these differences within the novel training method of high-fidelity, actor-based mental health simulation training, in order to identify factors that may affect training efficacy and subsequently patient outcomes. 829 participants attended simulation training courses and completed the Human Factors Skills for Healthcare Instrument pre- and post-course. Significant changes in HFSHI scores were found between pre- and post-course data across all participants, suggesting that simulation training can be universally effective as a method of pedagogy. Individuals within the ages of 25–29 reported significantly less mean change in HFSHI scores than those between 35–45. Career stage did not seem to mediate this effect. No differences in HFSHI scores were found across gender. The study concludes that simulation is an innovative training method that is effective across a variety of courses and professions. More research should be conducted to investigate why there may be differences in learning outcomes for different ages in regard to simulation, and to identify any other confounding factors that may influence these results. Reference McManus, S., Bebbington, P., Jenkins, R., & Brugha, T. ( 2016). Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014. A survey carried out for NHS Digital by NatCen Social Research and the Department of Health Sciences, University of Leicester. Reedy, G. B., Lavelle, M., Simpson, T., & Anderson, J. E. ( 2017). Development of the Human Factors Skills for Healthcare Instrument: a valid and reliable tool for assessing interprofessional learning across healthcare practice settings. BMJ Simulation and Technology Enhanced Learning;3(4):135–141.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"21 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86759378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.164
R. Lloyd, M. Mooncey, L. Parker, K. Robinson, F. Baldeweg, Alex S. Jolly
Introduction Approximately 70% of adverse events in healthcare are thought to be attributable to a failure of non-technical performance, including communication, teamwork and leadership.1 The integration of regular in situ simulation promotes positive team-working relationships. The aviation industry is widely considered to be the gold standard for safety culture. ‘On average, just one commercial flight goes down for every 8.3million take-offs worldwide. In the US alone, there are approximately 400,0000 avoidable medical errors every year, which is the equivalent of two jumbo jet crashes every day’.2 Enhanced inter-specialty relationships and improved human factors training are both imperative for promoting patient safety. Methods/Project Description Twenty in situ simulations were facilitated across the hospital. Sims often involved multiple specialties, fostering a collaborative training spirit. Emergency Medicine, Paediatrics, Acute Medicine and Anaesthetics scenarios were facilitated by departmental simulation leads, with logistics support from the Resuscitation Officers. The technical debrief was led by the clinical facilitator, and the human factors debrief was facilitated by airline pilots in attendance. A write-up with key learning points was then distributed to the departments involved within one week. Summary of Results/Outcomes The write-ups comprised of technical feedback from the medical team and human factors feedback from the pilots. Human factors feedback centred around four key areas: Communication Situational Awareness Workload Management Decision-making A questionnaire survey was used to assess the effects of human factors feedback on both confidence and competence. 94% of participants reported that their understanding of human factors principles improved following simulation. Qualitative evaluation of results was undertaken; comments included: ‘Authentic learning experience which highlighted areas of weakness and also given me confidence to ‘step up’ in a supervised setting’. The feedback was circulated amongst the wider team and shared on the PonderMed blog.3 Discussion, Conclusions, Recommendations Parallels were drawn between healthcare and the aviation industry, to highlight key learning points. There were four key concepts repeatedly emphasised (see table 1 below): Table 1. References Carayon P, Wood KE. Patient safety – the role of human factors and systems engineering. Stud Health Technol Inform 2010;153:23–46. ‘Black Box thinking, 2015. Syed M. PonderMed.co
医疗保健中大约70%的不良事件被认为是由于非技术表现的失败，包括沟通、团队合作和领导定期现场模拟的整合促进了积极的团队工作关系。航空业被广泛认为是安全文化的黄金标准。“全球平均每830万次起飞中，只有一次商业航班坠毁。仅在美国，每年就有大约40万起可避免的医疗事故，相当于每天两架大型喷气式飞机坠毁加强专业间关系和改进人为因素培训对于促进患者安全都是必不可少的。方法/项目描述在整个医院进行了20次现场模拟。Sims通常涉及多个专业，培养协作培训精神。急救医学、儿科、急症医学和麻醉学的情景由部门模拟主管协助，并由复苏主任提供后勤支援。技术汇报由临床协调员主持，人为因素汇报由在场的航空公司飞行员主持。然后在一周内将一份包含重点学习要点的总结分发给相关部门。结果/结果摘要报告包括医疗团队的技术反馈和飞行员的人为因素反馈。人为因素反馈集中在四个关键领域:沟通、态势感知、工作量管理、决策。一项问卷调查用于评估人为因素反馈对信心和能力的影响。94%的参与者报告说，在模拟之后，他们对人为因素原理的理解有所提高。对结果进行了定性评价;评论包括:“真实的学习经历，突出了我的弱点，也让我有信心在有监督的环境中‘进步’。”这些反馈在更广泛的团队中传播，并在PonderMed博客上分享讨论、结论和建议在医疗保健和航空业之间进行了比较，以突出重点学习点。有四个关键概念被反复强调(见下面的表1):参考文献Carayon P, Wood KE。病人安全-人为因素和系统工程的作用。种马卫生技术通报2010;153:23-46。黑匣子思维，2015年。Syed M. pondermed.com
{"title":"PG116 ‘A pilot study’ – multi-departmental in situ simulation with human factors feedback delivered by pilots","authors":"R. Lloyd, M. Mooncey, L. Parker, K. Robinson, F. Baldeweg, Alex S. Jolly","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.164","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.164","url":null,"abstract":"Introduction Approximately 70% of adverse events in healthcare are thought to be attributable to a failure of non-technical performance, including communication, teamwork and leadership.1 The integration of regular in situ simulation promotes positive team-working relationships. The aviation industry is widely considered to be the gold standard for safety culture. ‘On average, just one commercial flight goes down for every 8.3million take-offs worldwide. In the US alone, there are approximately 400,0000 avoidable medical errors every year, which is the equivalent of two jumbo jet crashes every day’.2 Enhanced inter-specialty relationships and improved human factors training are both imperative for promoting patient safety. Methods/Project Description Twenty in situ simulations were facilitated across the hospital. Sims often involved multiple specialties, fostering a collaborative training spirit. Emergency Medicine, Paediatrics, Acute Medicine and Anaesthetics scenarios were facilitated by departmental simulation leads, with logistics support from the Resuscitation Officers. The technical debrief was led by the clinical facilitator, and the human factors debrief was facilitated by airline pilots in attendance. A write-up with key learning points was then distributed to the departments involved within one week. Summary of Results/Outcomes The write-ups comprised of technical feedback from the medical team and human factors feedback from the pilots. Human factors feedback centred around four key areas: Communication Situational Awareness Workload Management Decision-making A questionnaire survey was used to assess the effects of human factors feedback on both confidence and competence. 94% of participants reported that their understanding of human factors principles improved following simulation. Qualitative evaluation of results was undertaken; comments included: ‘Authentic learning experience which highlighted areas of weakness and also given me confidence to ‘step up’ in a supervised setting’. The feedback was circulated amongst the wider team and shared on the PonderMed blog.3 Discussion, Conclusions, Recommendations Parallels were drawn between healthcare and the aviation industry, to highlight key learning points. There were four key concepts repeatedly emphasised (see table 1 below): Table 1. References Carayon P, Wood KE. Patient safety – the role of human factors and systems engineering. Stud Health Technol Inform 2010;153:23–46. ‘Black Box thinking, 2015. Syed M. PonderMed.co","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"27 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83161586","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.163
Maxene Murdoch, A. Adlan, Ifan Patchell, C. Doyle, J. Dunne, C. Diaz-Navarro
Introduction The need to provide ‘clean, non-COVID’ surgical areas during the current pandemic has mandated many changes within our organisation, such as the redeployment of cardiac surgical services (albeit without the transfer of interventional cardiology) to a different hospital within our health board. This move necessitated the upskilling of general anaesthetists to provide anaesthesia for emergency procedures in the cardiac catheterisation suite (cath-lab). This is an unfamiliar remote environment which may challenge anaesthetic teams, as they face limited access to the patient, radiation hazards and lack of familiarity with these procedures. As a result, an immediate training response was required to ensure patient safety. Methods We conducted a survey to assess baseline staff experiences and opinions. Following this we created a workgroup to develop specific anaesthesia guidelines, which were provided to candidates. A simulation course was developed, including scenarios designed to familiarise anaesthetists with common cath-lab emergencies and challenges and their potential solutions. Anaesthetists completed surveys before and after their simulation training. Notably, these courses were conducted during the COVID outbreak, hence adhering to social distance and infection control procedures. Results Our surveys highlighted that anaesthetists found the cath-lab a stressful environment, and all felt that multiprofessional teamwork could be improved. 25 individuals completed the simulation training. We measured self-assessed anxiety to the prospect of dealing with an unexpected emergency in the cath lab, both pre and post training, on a Likert scale (0 to 10). This decreased from an average of 7.55 to 5.63. All candidates commented that they found the course useful and advocated for further in situ training. Remarkably, the course provided a number of unexpected clinical safety outcomes: It facilitated interdisciplinary conversations and further team training was agreed upon; infection control measures for aerosol generating procedures were revisited in collaboration with anaesthetists, and the need for a consistent anaesthetic link was identified. Discussion Our results demonstrated that anaesthetists felt safer and better prepared to manage emergencies or unstable patients in the cardiac catheterisation laboratory. Post course reflection identified a need to expand scenarios to include cardiac arrest within the cath lab. Further training will be carried out wearing FFP3 masks and visors in order to increase fidelity and help prepare the team to communicate in this manner. We look forward to continuing exploring non-technical skill challenges during forthcoming multiprofessional training sessions.
{"title":"PG115 Adapting to redeployment challenges: interventional cardiology simulation training for anaesthetists","authors":"Maxene Murdoch, A. Adlan, Ifan Patchell, C. Doyle, J. Dunne, C. Diaz-Navarro","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.163","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.163","url":null,"abstract":"Introduction The need to provide ‘clean, non-COVID’ surgical areas during the current pandemic has mandated many changes within our organisation, such as the redeployment of cardiac surgical services (albeit without the transfer of interventional cardiology) to a different hospital within our health board. This move necessitated the upskilling of general anaesthetists to provide anaesthesia for emergency procedures in the cardiac catheterisation suite (cath-lab). This is an unfamiliar remote environment which may challenge anaesthetic teams, as they face limited access to the patient, radiation hazards and lack of familiarity with these procedures. As a result, an immediate training response was required to ensure patient safety. Methods We conducted a survey to assess baseline staff experiences and opinions. Following this we created a workgroup to develop specific anaesthesia guidelines, which were provided to candidates. A simulation course was developed, including scenarios designed to familiarise anaesthetists with common cath-lab emergencies and challenges and their potential solutions. Anaesthetists completed surveys before and after their simulation training. Notably, these courses were conducted during the COVID outbreak, hence adhering to social distance and infection control procedures. Results Our surveys highlighted that anaesthetists found the cath-lab a stressful environment, and all felt that multiprofessional teamwork could be improved. 25 individuals completed the simulation training. We measured self-assessed anxiety to the prospect of dealing with an unexpected emergency in the cath lab, both pre and post training, on a Likert scale (0 to 10). This decreased from an average of 7.55 to 5.63. All candidates commented that they found the course useful and advocated for further in situ training. Remarkably, the course provided a number of unexpected clinical safety outcomes: It facilitated interdisciplinary conversations and further team training was agreed upon; infection control measures for aerosol generating procedures were revisited in collaboration with anaesthetists, and the need for a consistent anaesthetic link was identified. Discussion Our results demonstrated that anaesthetists felt safer and better prepared to manage emergencies or unstable patients in the cardiac catheterisation laboratory. Post course reflection identified a need to expand scenarios to include cardiac arrest within the cath lab. Further training will be carried out wearing FFP3 masks and visors in order to increase fidelity and help prepare the team to communicate in this manner. We look forward to continuing exploring non-technical skill challenges during forthcoming multiprofessional training sessions.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"122 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79742193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.18
Laura Harrison, D. Bhojwani, Jeffery Dyer, James Ham
Introduction/Background Young people from areas of social deprivation are faced with inequalities in both educational and career opportunities.1 University Hospital Bristol & Weston NHS Foundation Trust offers a range of outreach simulation activities for secondary and college students faced with these inequalities. The service aims to encourage students to consider an NHS career and provide them with the skills, knowledge and confidence to pursue it. Summary of education programme The Covid-19 pandemic resulted in many students home schooling and significant healthcare pressures halting planned outreach simulation activities. To accommodate these challenges we embraced virtual engagement. This required our team to develop skills as faculty and develop a programme accessible to young people receiving and healthcare workers delivering. The ‘Medicine Clinic’ aimed at 14–18 year olds considering medical careers offered a two-hour virtual session plus access to pre-event recorded material. A live webinar exploring the application process, accessing a contextual offer at Bristol University and a personal journey of applying to medicine. We then conducted a live simulation of a clinically unwell adult via a high definition camera system with live streaming capability. The students communicated via the chat box function to advise us on how we should assess and treat the patient, concluding with a debrief. The final part of the session facilitated students to simulate answering pre sent mock interview questions and ask the faculty for example answers. We have offered the students a junior doctor mentor to support their application to medicine. Outcomes 100% Completion of both a pre and post session questionnaire and all students opted for mentorship. All candidates found the session useful, informative and would recommend to a peer. Discussion and Conclusion The positive feedback from young people was very encouraging in terms of the content delivered however; we found the biggest issue related to technical difficulties. Using a sophisticated camera system offered high quality video definition however, potentially over complicated the session. The streaming capacity was limited which affected the student’s ability at times to take part in the simulation. Offering more than one engagement is proven to be more effective2 which is why we are offering a mentorship program however, we plan to hold another virtual event closer to interview season. Recommendations A follow up session to enable us to offer further support and track the application journeys of students Utilise a webcam and simpler technology. References Social Mobility Commission. State of the Nation 2018-19: Social Mobility in Great Britain. London, United Kingdom: April 2019 Ashwin P, McVitty D. The Meanings of Student Engagement: Implications for Policies and Practices. In: Curaj A, Matei L, Pricopie R, et al., eds. The European Higher Education Area: Between Critical Reflections and Future Po
{"title":"O18 Embracing virtual simulation based education: using virtual simulation to support young people who face social inequalities to pursue careers in medicine","authors":"Laura Harrison, D. Bhojwani, Jeffery Dyer, James Ham","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.18","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.18","url":null,"abstract":"Introduction/Background Young people from areas of social deprivation are faced with inequalities in both educational and career opportunities.1 University Hospital Bristol & Weston NHS Foundation Trust offers a range of outreach simulation activities for secondary and college students faced with these inequalities. The service aims to encourage students to consider an NHS career and provide them with the skills, knowledge and confidence to pursue it. Summary of education programme The Covid-19 pandemic resulted in many students home schooling and significant healthcare pressures halting planned outreach simulation activities. To accommodate these challenges we embraced virtual engagement. This required our team to develop skills as faculty and develop a programme accessible to young people receiving and healthcare workers delivering. The ‘Medicine Clinic’ aimed at 14–18 year olds considering medical careers offered a two-hour virtual session plus access to pre-event recorded material. A live webinar exploring the application process, accessing a contextual offer at Bristol University and a personal journey of applying to medicine. We then conducted a live simulation of a clinically unwell adult via a high definition camera system with live streaming capability. The students communicated via the chat box function to advise us on how we should assess and treat the patient, concluding with a debrief. The final part of the session facilitated students to simulate answering pre sent mock interview questions and ask the faculty for example answers. We have offered the students a junior doctor mentor to support their application to medicine. Outcomes 100% Completion of both a pre and post session questionnaire and all students opted for mentorship. All candidates found the session useful, informative and would recommend to a peer. Discussion and Conclusion The positive feedback from young people was very encouraging in terms of the content delivered however; we found the biggest issue related to technical difficulties. Using a sophisticated camera system offered high quality video definition however, potentially over complicated the session. The streaming capacity was limited which affected the student’s ability at times to take part in the simulation. Offering more than one engagement is proven to be more effective2 which is why we are offering a mentorship program however, we plan to hold another virtual event closer to interview season. Recommendations A follow up session to enable us to offer further support and track the application journeys of students Utilise a webcam and simpler technology. References Social Mobility Commission. State of the Nation 2018-19: Social Mobility in Great Britain. London, United Kingdom: April 2019 Ashwin P, McVitty D. The Meanings of Student Engagement: Implications for Policies and Practices. In: Curaj A, Matei L, Pricopie R, et al., eds. The European Higher Education Area: Between Critical Reflections and Future Po","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"9 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82603293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.63
B. Kerr, R. Hoey, D. Gaunt, Mary Holding
Introduction Knife crime in the United Kingdom remains a leading cause of death (table 1), particularly in the younger population. 259 deaths due to stabbing were recorded year ending March 2019.1 Watford General Hospital is a large district general hospital with approximately 150,000 Emergency Department (ED) attendances per year and an incidence of 1–2 patients per year presenting with life-threatening penetrating chest trauma. It is a low frequency, high stakes emergency with patients sometimes arriving out of hours when the department is covered by middle grade doctors who have little or no experience of resuscitative thoracotomy. Training in resuscitative thoracotomy is strongly recommended for emergency medicine trainees working in centres that do not have cardiothoracic expertise.2 Objective The aim of this novel immersive simulation training was to provide all middle grade ED doctors with; the knowledge the skills hands–on experience in performing a resuscitative clamshell thoracotomy. Method In order to allow 18 middle grades the opportunity to have hands-on practice, 6 back-to-back simulations were required, with trainees working in teams of 3. The simulations were in workshop format, guided by a senior consultant experienced in thoracotomy. TraumaFX Ltd were contacted for advice regarding feasibility of the day and provided costings for the hire of two thoracotomy manikins and a technician who repaired the manikins between simulations. Results A total of 18 ED doctors (ST1-6) attended during the course of the day and completed an evaluation form. Confidence levels for the doctors performing resuscitative thoracotomy after the training ranged from 3 (reasonably confident) to 5 (very confident) with an average score of 4.1 Realism of the manikin scored highly (4.8 average), as did the venue (4.9 average), style of instructors (4.6 average) and pre-learning material (4.5 average). Feedback on the session was extremely positive for both technical and non-technical skills, evidenced by learning points identified on the evaluation form: ‘no CPR, sharps awareness and technique with scalpel’ ‘how to cut the pericardium…’ ‘practical skills, decision making, leadership…’ ‘take the leadership, decisions on time, no CPR, learn skills, communication…’ Conclusions This novel way of delivering clamshell thoracotomy training to a large number of middle-grade ED doctors in a short period of time is educationally sound. It met our objectives and reinforced the importance of clear closed-loop communication, delegation, team-working and leadership. References Office of National Statistics: Homicide in England and Wales 2019. 13thFebruary 2020 The Royal College of Emergency Medicine: Curriculum and Assessment Systems for Training in Emergency Medicine. August 2015
{"title":"PG14 Simulated resuscitative thoracotomy training for emergency department middle grades","authors":"B. Kerr, R. Hoey, D. Gaunt, Mary Holding","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.63","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.63","url":null,"abstract":"Introduction Knife crime in the United Kingdom remains a leading cause of death (table 1), particularly in the younger population. 259 deaths due to stabbing were recorded year ending March 2019.1 Watford General Hospital is a large district general hospital with approximately 150,000 Emergency Department (ED) attendances per year and an incidence of 1–2 patients per year presenting with life-threatening penetrating chest trauma. It is a low frequency, high stakes emergency with patients sometimes arriving out of hours when the department is covered by middle grade doctors who have little or no experience of resuscitative thoracotomy. Training in resuscitative thoracotomy is strongly recommended for emergency medicine trainees working in centres that do not have cardiothoracic expertise.2 Objective The aim of this novel immersive simulation training was to provide all middle grade ED doctors with; the knowledge the skills hands–on experience in performing a resuscitative clamshell thoracotomy. Method In order to allow 18 middle grades the opportunity to have hands-on practice, 6 back-to-back simulations were required, with trainees working in teams of 3. The simulations were in workshop format, guided by a senior consultant experienced in thoracotomy. TraumaFX Ltd were contacted for advice regarding feasibility of the day and provided costings for the hire of two thoracotomy manikins and a technician who repaired the manikins between simulations. Results A total of 18 ED doctors (ST1-6) attended during the course of the day and completed an evaluation form. Confidence levels for the doctors performing resuscitative thoracotomy after the training ranged from 3 (reasonably confident) to 5 (very confident) with an average score of 4.1 Realism of the manikin scored highly (4.8 average), as did the venue (4.9 average), style of instructors (4.6 average) and pre-learning material (4.5 average). Feedback on the session was extremely positive for both technical and non-technical skills, evidenced by learning points identified on the evaluation form: ‘no CPR, sharps awareness and technique with scalpel’ ‘how to cut the pericardium…’ ‘practical skills, decision making, leadership…’ ‘take the leadership, decisions on time, no CPR, learn skills, communication…’ Conclusions This novel way of delivering clamshell thoracotomy training to a large number of middle-grade ED doctors in a short period of time is educationally sound. It met our objectives and reinforced the importance of clear closed-loop communication, delegation, team-working and leadership. References Office of National Statistics: Homicide in England and Wales 2019. 13thFebruary 2020 The Royal College of Emergency Medicine: Curriculum and Assessment Systems for Training in Emergency Medicine. August 2015","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"18 1 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82954440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.49
Neil Tiwari, Laura Troth, A. Barclay, J. Chilvers, Lynn Carpenter, G. Turner
Our challenge was to establish and deliver a novel, rapid, multipronged approach to educating a multi-disciplinary group of health care professionals, in the face of the Covid 19 outbreak. This was tailored to our district general hospital where we implemented a responsive, multimodal programme of education incorporating simulation to disseminate current information approved by national bodies in order to enhance team working. The first multidisciplinary teaching team comprised anaesthetic and critical care staff. Over 48 hours, a 5 week teaching programme was developed sourcing material from a national critical care course1 incorporating lectures, practical workshops and multidisciplinary simulation aimed at all health professionals in the anaesthesia directorate. We addressed key concerns and potential service pitfalls before widening our scope to include in situ simulation in theatres and the obstetric delivery suite. We subsequently adapted our course material for non-anaesthetic health professionals, and conducted simultaneous nurse upskilling sessions to enhance critical care nursing cover. The second teaching unit led by the acute medical team and resuscitation department aimed to rapidly facilitate training in modified Advanced Life Support (ALS) practice. A new Trust policy informed by Public Health England and the World Health Organisation was instituted, before the latest Resuscitation Council Guidance was released.2 3 In situ teaching was instituted on all wards highlighting key changes and the importance of PPE. These ad hoc sessions aimed to rapidly upskill multidisciplinary team members and also offered the chance to practice systematic assessment of sick patients. Rapid feedback and peer review allowed dynamic configuration of teaching, enabling us to address questions and issues arising from the teaching via weekly hospital wide updates, disseminating the latest recommendations and peer reviewed evidence. Almost all 151 attendees to refresher sessions reported a significantly increased knowledge base post session. All 120 multidisciplinary staff attending upskilling prior to redeployment to critical care, reported increased knowledge post attendance. All 191 multidisciplinary candidates attending dedicated teaching days incorporating lectures, simulated PPE and proning practice reported an appropriate level of delivery, with all 52 multidisciplinary simulation candidates reporting 100% satisfaction. All 40 staff attending ALS simulations and sick patient assessment sessions felt training was relevant to their scope of practice, and fulfilled their needs. Staff confidence, education and team working across an organisation can be rapidly enhanced when confronted by a challenge as evidenced by our efforts, and doing so establishes strong foundations for future lear. References The Critical CARE Course®, Troth L, Kocierz L, Burtenshaw A, Hulme J. 2020. Covid-19 Technical Specifications for Personal Protective Equipment and related IP
{"title":"PP30 Pioneering education in a pandemic – a rapid response unit approach","authors":"Neil Tiwari, Laura Troth, A. Barclay, J. Chilvers, Lynn Carpenter, G. Turner","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.49","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.49","url":null,"abstract":"Our challenge was to establish and deliver a novel, rapid, multipronged approach to educating a multi-disciplinary group of health care professionals, in the face of the Covid 19 outbreak. This was tailored to our district general hospital where we implemented a responsive, multimodal programme of education incorporating simulation to disseminate current information approved by national bodies in order to enhance team working. The first multidisciplinary teaching team comprised anaesthetic and critical care staff. Over 48 hours, a 5 week teaching programme was developed sourcing material from a national critical care course1 incorporating lectures, practical workshops and multidisciplinary simulation aimed at all health professionals in the anaesthesia directorate. We addressed key concerns and potential service pitfalls before widening our scope to include in situ simulation in theatres and the obstetric delivery suite. We subsequently adapted our course material for non-anaesthetic health professionals, and conducted simultaneous nurse upskilling sessions to enhance critical care nursing cover. The second teaching unit led by the acute medical team and resuscitation department aimed to rapidly facilitate training in modified Advanced Life Support (ALS) practice. A new Trust policy informed by Public Health England and the World Health Organisation was instituted, before the latest Resuscitation Council Guidance was released.2 3 In situ teaching was instituted on all wards highlighting key changes and the importance of PPE. These ad hoc sessions aimed to rapidly upskill multidisciplinary team members and also offered the chance to practice systematic assessment of sick patients. Rapid feedback and peer review allowed dynamic configuration of teaching, enabling us to address questions and issues arising from the teaching via weekly hospital wide updates, disseminating the latest recommendations and peer reviewed evidence. Almost all 151 attendees to refresher sessions reported a significantly increased knowledge base post session. All 120 multidisciplinary staff attending upskilling prior to redeployment to critical care, reported increased knowledge post attendance. All 191 multidisciplinary candidates attending dedicated teaching days incorporating lectures, simulated PPE and proning practice reported an appropriate level of delivery, with all 52 multidisciplinary simulation candidates reporting 100% satisfaction. All 40 staff attending ALS simulations and sick patient assessment sessions felt training was relevant to their scope of practice, and fulfilled their needs. Staff confidence, education and team working across an organisation can be rapidly enhanced when confronted by a challenge as evidenced by our efforts, and doing so establishes strong foundations for future lear. References The Critical CARE Course®, Troth L, Kocierz L, Burtenshaw A, Hulme J. 2020. Covid-19 Technical Specifications for Personal Protective Equipment and related IP","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"119 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82817675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-01DOI: 10.1136/bmjstel-2020-aspihconf.44
Catherine Holmes, A. Davies, M. Elsheikh
Background The ‘LeedsEDSimulation’ Team run an embedded in-situ interprofessional simulation (IIS) programme in the Emergency Departments(ED). A vital part of the simulation process is the debrief of the team involved. Two frameworks/prompts were created to optimise this process and aid faculty development. Summary 18 months detailed observation of debriefing practices of regular faculty members and a selection of debrief structures were evaluated - Eppich et al’s1 seemed the best aligned. This led to the development of our own bespoke debriefing framework. (Figure 1) A ‘debrief of the debrief’(DotD) session has been introduced after the candidates leave. This enhances faculty development and continued professional development and encourages sharing of experiences. A prompt has been developed from Runnacle et al’s2 framework. (Figure 1) After 9 months use (August 2019– March 2020), feedback was sought via questionnaire from faculty for evaluation as a means of continuous improvement. Results 16 replies were received from faculty. When asked ‘how helpful do you find the debrief framework?’, an average score of 4.3 (out of 5) was given (all 16 had used this tool). General comments suggested that the framework was easy to follow, well-structured and a welcome reminder of how to debrief optimally. However, one comment suggested it was only of use to novice debriefers. When asked ‘how helpful do you find the DotD prompt?’, an average score of 4.1 (out of 5) was given by 9/16 who had used the tool. The majority of comments were positive with many finding this peer feedback helpful but also that giving the feedback aided in their own debriefing development. There was a suggestion that formal training in this prompt may be beneficial and that it may be too complex. Discussion and Conclusion Results from faculty who are using frameworks suggested that the LeedsEDSimulation debrief framework and DotD prompt was welcomed and useful for faculty of ED IIS. It may need to be clarified, particularly for more experienced debriefers, that it is not a rigid structure but a flexible guide. References Eppich W, Cheng A. Promoting excellence and reflective learning in simulation (PEARLS). Simul Healthc J Soc Simul Healthc 2015;10(2):106–15. Runnacles J, Thomas L, Sevdalis N, Kneebone R, Arora S. Development of a tool to improve performance debriefing and learning: The paediatric objective structured assessment of debriefing (OSAD) tool. Postgrad Med J 2014;90(1069):613–21.
“LeedsEDSimulation”团队在急诊科(ED)运行嵌入式现场跨专业模拟(IIS)程序。模拟过程的一个重要部分是对相关团队进行汇报。创建了两个框架/提示来优化这一过程并帮助教师发展。18个月来，对常规教员的汇报实践进行了详细观察，并对一些汇报结构进行了评估——Eppich等人的1似乎是最一致的。这导致了我们自己定制的汇报框架的发展。(图1)在候选人离开后，引入了“汇报的汇报”(DotD)环节。这促进了教师的发展和持续的专业发展，并鼓励分享经验。从Runnacle等人的2框架中开发了一个提示符。(图1)经过9个月的使用(2019年8月至2020年3月)，我们通过调查问卷向教师征求反馈意见，以进行评估，作为持续改进的手段。结果共收到教师回复16份。当被问及“你觉得汇报框架有多大帮助?”，平均得分为4.3分(满分5分)(所有16人都使用过这个工具)。一般意见认为，该框架易于遵循，结构良好，并且是如何以最佳方式进行汇报的一个受欢迎的提醒。然而，有人评论说，它只对新手汇报者有用。当被问及“你觉得DotD提示符有多大帮助?”，使用该工具的人中有9/16人的平均得分为4.1分(满分5分)。大多数评论都是积极的，许多人认为同行的反馈很有帮助，而且给予反馈也有助于他们自己的汇报发展。有人建议，这方面的正式培训可能是有益的，但可能过于复杂。使用框架的教师的结果表明，LeedsEDSimulation汇报框架和DotD提示对ED IIS的教师来说是受欢迎和有用的。可能需要澄清的是，特别是对于更有经验的汇报者来说，这不是一个僵化的结构，而是一个灵活的指南。Eppich W, Cheng A.促进卓越与反思性学习(PEARLS)。仿真医疗[J] .仿真医疗，2015;10(2):106-15。Runnacles J, Thomas L, Sevdalis N, knebone R, Arora S.改进绩效汇报和学习的工具开发:儿科客观结构化汇报评估(OSAD)工具。中华医学杂志，2014;39(6):613 - 621。
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