Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.130
A. Sunderland
Background March 2020 saw the United Kingdom (UK) in chaos as the Covid-19 pandemic led to mass lockdown. Education provision changed dramatically over night with universities rapidly adapting to online teaching. While some universities put postgraduate clinical courses on hold to enable staff to focus on practice, others changed their delivery and assessment methods in order to support student progression and implementation of new skills in practice. This project focuses on evaluating the move to online OSCEs for a post graduate clinical assessment module delivered at a regional university. Summary of Work A case study approach was taken using mixed methodology. A purposive sample of OSCE examiners participated in semi-structured interviews. 56% of examiners (n=5) took part. Transcripts were analysed using template analysis and NVivo software. OSCE check lists were uploaded to CAE Learning Space to ensure parity from two retrospective cohorts. Students from cohort one participated in face to face OSCEs and cohort two participated in online OSCEs. Both cohorts sat the same stations. Descriptive statistics, using both Learning Space and SPSS, were utilised as a method of triangulation focusing on both scores achieved and pass rates comparing similar sized cohorts of learners undertaking face to face (n=171) and online (n=228) OSCEs. Summary of Results Mann-Whitney U tests demonstrated a statistical difference in the range of marks between cohorts but no statistical difference in the pass rates, which were comparable to other organisations. Remote OSCEs appear to be acceptable by faculty as an appropriate method of summative assessment although careful planning needs to be undertaken with regards to student and faculty preparation1 2 including: Faculty examiner training Guidelines for the use of proxy/standardised patients need to be established and incorporate ethical considerations Policy for setting up and communicating Zoom meetings to students, including read receipts and confirmation of attendance A method of inter–examiner communication during OSCEs e.g. WhatsApp Stations need to be fit for purpose and consider multiprofessional practice and service user needs Inter–rater reliability needs to be actively assessed during the OSCE and issues addressed where required Conclusions and Recommendations Further research is required in order to incorporate student views of online OSCEs before they can be considered as an acceptable method of summative assessment. However, initial evaluation is favourable, particularly in relation to OSCEs focusing on communication skills, history taking etc. References Harden RM. Revisiting ‘Assessment of clinical competence using an objective structured clinical examination (OSCE)’. Medical Education. 2016;50(4):376–379. doi:10.1111/medu.12801 Major S, Sawan L, Vognsen J, & Jabre M. COVID-19 pandemic prompts the development of a Web-OSCE using Zoom teleconferencing to resume medical students’ clinical skills trainin
{"title":"PG82 Are remote objective structured clinical examinations (OSCEs) an appropriate method of summative assessment?","authors":"A. Sunderland","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.130","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.130","url":null,"abstract":"Background March 2020 saw the United Kingdom (UK) in chaos as the Covid-19 pandemic led to mass lockdown. Education provision changed dramatically over night with universities rapidly adapting to online teaching. While some universities put postgraduate clinical courses on hold to enable staff to focus on practice, others changed their delivery and assessment methods in order to support student progression and implementation of new skills in practice. This project focuses on evaluating the move to online OSCEs for a post graduate clinical assessment module delivered at a regional university. Summary of Work A case study approach was taken using mixed methodology. A purposive sample of OSCE examiners participated in semi-structured interviews. 56% of examiners (n=5) took part. Transcripts were analysed using template analysis and NVivo software. OSCE check lists were uploaded to CAE Learning Space to ensure parity from two retrospective cohorts. Students from cohort one participated in face to face OSCEs and cohort two participated in online OSCEs. Both cohorts sat the same stations. Descriptive statistics, using both Learning Space and SPSS, were utilised as a method of triangulation focusing on both scores achieved and pass rates comparing similar sized cohorts of learners undertaking face to face (n=171) and online (n=228) OSCEs. Summary of Results Mann-Whitney U tests demonstrated a statistical difference in the range of marks between cohorts but no statistical difference in the pass rates, which were comparable to other organisations. Remote OSCEs appear to be acceptable by faculty as an appropriate method of summative assessment although careful planning needs to be undertaken with regards to student and faculty preparation1 2 including: Faculty examiner training Guidelines for the use of proxy/standardised patients need to be established and incorporate ethical considerations Policy for setting up and communicating Zoom meetings to students, including read receipts and confirmation of attendance A method of inter–examiner communication during OSCEs e.g. WhatsApp Stations need to be fit for purpose and consider multiprofessional practice and service user needs Inter–rater reliability needs to be actively assessed during the OSCE and issues addressed where required Conclusions and Recommendations Further research is required in order to incorporate student views of online OSCEs before they can be considered as an acceptable method of summative assessment. However, initial evaluation is favourable, particularly in relation to OSCEs focusing on communication skills, history taking etc. References Harden RM. Revisiting ‘Assessment of clinical competence using an objective structured clinical examination (OSCE)’. Medical Education. 2016;50(4):376–379. doi:10.1111/medu.12801 Major S, Sawan L, Vognsen J, & Jabre M. COVID-19 pandemic prompts the development of a Web-OSCE using Zoom teleconferencing to resume medical students’ clinical skills trainin","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"130 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74551286","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.2
T. Guest, Payal Ghatnekar, N. Peres
Introduction Gamified Virtual Reality (VR) is a part of simulation education tools used in healthcare education to teach technical skills such as laparoscopy, arthroscopy, ophthalmology etc. However, gamified VR does not appear to be part of non-technical skills education such as effective team communication. Through a series of novel workshops called ‘VR Team Talk’, a VR game ‘Keep Talking and Nobody Explodes’ has been used to train multidisciplinary, varied seniority and work experience healthcare teams in effective communication. Our primary aim is to present workshop attendees’ opinions and perceptions on gamified VR as a learning technology that for teaching effective communication and the implications for healthcare quality, value, and safety. The secondary aim is to present the feasibility of setting up gamified workshops as part of healthcare simulation education. Methods VR Team Talk workshops were delivered over 3 months in Torbay hospital’s ICU staff room, attended by teams of up to 5 staff members each (figure 1). Sessions were facilitated by a clinician who explained the game and workshop purpose. Upon completion of the game, the facilitator debriefed the workshop attendees, exploring the importance of effective team communication during the game and similarities with healthcare work settings. Feedback was collected from the workshop attendees to get an insight into whether VR Team Talk is an effective education tool. The total workshop turnout was 50, feedback was received from 45 participants. Results Following qualitative feedback (table 1) of workshop attendees’ opinions and perceptions, we conclude that gamified VR may be an effective immersive learning tool and become part of the simulation education programme. The workshops were widely perceived to be an effective modality for educating healthcare teams on the importance of team communication. In addition to the feedback, we were able to develop guidance around the feasibility of setting up similar gamified VR workshops within healthcare education settings. Discussion and Conclusion Effective team communication is critical within healthcare teams. Lack of training in this area may lead to errors that have serious implications on patient safety and outcomes (Sevdalis, 2013; Khan et al., 2017). VR gaming workshops are easy to set up and facilitate. VR provides safe environments for practice, which when paired with debriefing can have implications on long term knowledge retention (Rosenkrantz et al., 2019). As this is a new and upcoming area of study, we will be conducting longitudinal research to study implications on staff team behaviours. References Khan R, et al. Simulation-based training of non-technical skills in colonoscopy: protocol for a randomized controlled trial. JMIR Research Protocols 2017;6(8):p. e153. doi: 10.2196/resprot.7690. Rosenkrantz O, et al. Priming healthcare students on the importance of non-technical skills in healthcare: How to setup a medical escape r
游戏化虚拟现实(VR)是医疗保健教育中模拟教育工具的一部分，用于教授腹腔镜、关节镜、眼科等技术技能。然而，游戏化的VR似乎并不是非技术技能教育的一部分，比如有效的团队沟通。通过一系列名为“VR团队对话”的新颖工作坊，VR游戏“保持对话，没有人爆炸”已被用于培训多学科，不同资历和工作经验的医疗团队有效沟通。我们的主要目的是介绍研讨会参与者对游戏化VR作为一种学习技术的看法和看法，这种技术可以教授有效的沟通以及对医疗质量、价值和安全的影响。第二个目标是提出建立游戏化讲习班作为医疗保健模拟教育的一部分的可行性。方法在Torbay医院的ICU员工室进行为期3个月的VR团队谈话研讨会，每个小组最多有5名工作人员参加(图1)。会议由临床医生指导，解释游戏和研讨会目的。游戏结束后，主持人向与会者介绍了游戏过程中有效团队沟通的重要性，以及与医疗保健工作环境的相似之处。我们收集了研讨会参与者的反馈，以深入了解VR Team Talk是否是一种有效的教育工具。工作坊参加者共50人，共收到45名参加者的意见。根据研讨会参与者的意见和看法的定性反馈(表1)，我们得出结论，游戏化VR可能是一种有效的沉浸式学习工具，并成为模拟教育计划的一部分。人们普遍认为，讲习班是教育医疗团队了解团队沟通重要性的有效方式。除了反馈之外，我们还能够围绕在医疗保健教育环境中建立类似游戏化VR研讨会的可行性制定指导方针。在医疗团队中，有效的团队沟通是至关重要的。缺乏这方面的培训可能导致对患者安全和结果产生严重影响的错误(Sevdalis, 2013;Khan et al.， 2017)。VR游戏工作坊很容易建立和促进。虚拟现实为实践提供了安全的环境，当与汇报相结合时，可能会对长期的知识保留产生影响(Rosenkrantz等人，2019)。由于这是一个新的和即将到来的研究领域，我们将进行纵向研究，以研究对员工团队行为的影响。参考文献Khan R，等。结肠镜检查非技术技能模拟训练:随机对照试验方案。JMIR研究协议2017;6(8):p。e153。doi: 10.2196 / resprot.7690。Rosenkrantz O等人。引导医疗保健学生了解非技术技能在医疗保健中的重要性:如何设置医疗逃生室游戏体验。医学教师(2019):pp。1 - 8。doi: 10.1080 / 0142159 x.2019.1636953。非技术技能和医疗机构团队合作的未来。健康基金会(2013年)。
{"title":"O2 Team skills development using a gamified virtual reality ‘VR Team Talk’ workshop","authors":"T. Guest, Payal Ghatnekar, N. Peres","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.2","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.2","url":null,"abstract":"Introduction Gamified Virtual Reality (VR) is a part of simulation education tools used in healthcare education to teach technical skills such as laparoscopy, arthroscopy, ophthalmology etc. However, gamified VR does not appear to be part of non-technical skills education such as effective team communication. Through a series of novel workshops called ‘VR Team Talk’, a VR game ‘Keep Talking and Nobody Explodes’ has been used to train multidisciplinary, varied seniority and work experience healthcare teams in effective communication. Our primary aim is to present workshop attendees’ opinions and perceptions on gamified VR as a learning technology that for teaching effective communication and the implications for healthcare quality, value, and safety. The secondary aim is to present the feasibility of setting up gamified workshops as part of healthcare simulation education. Methods VR Team Talk workshops were delivered over 3 months in Torbay hospital’s ICU staff room, attended by teams of up to 5 staff members each (figure 1). Sessions were facilitated by a clinician who explained the game and workshop purpose. Upon completion of the game, the facilitator debriefed the workshop attendees, exploring the importance of effective team communication during the game and similarities with healthcare work settings. Feedback was collected from the workshop attendees to get an insight into whether VR Team Talk is an effective education tool. The total workshop turnout was 50, feedback was received from 45 participants. Results Following qualitative feedback (table 1) of workshop attendees’ opinions and perceptions, we conclude that gamified VR may be an effective immersive learning tool and become part of the simulation education programme. The workshops were widely perceived to be an effective modality for educating healthcare teams on the importance of team communication. In addition to the feedback, we were able to develop guidance around the feasibility of setting up similar gamified VR workshops within healthcare education settings. Discussion and Conclusion Effective team communication is critical within healthcare teams. Lack of training in this area may lead to errors that have serious implications on patient safety and outcomes (Sevdalis, 2013; Khan et al., 2017). VR gaming workshops are easy to set up and facilitate. VR provides safe environments for practice, which when paired with debriefing can have implications on long term knowledge retention (Rosenkrantz et al., 2019). As this is a new and upcoming area of study, we will be conducting longitudinal research to study implications on staff team behaviours. References Khan R, et al. Simulation-based training of non-technical skills in colonoscopy: protocol for a randomized controlled trial. JMIR Research Protocols 2017;6(8):p. e153. doi: 10.2196/resprot.7690. Rosenkrantz O, et al. Priming healthcare students on the importance of non-technical skills in healthcare: How to setup a medical escape r","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"83 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74563972","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.127
S. Khin-htun, Faisal Faruqi, C. Khine, Tan Ling
Introduction Patients seek medical assessment with a problem and not a diagnosis so the starting point to the diagnosis process is ‘ A patient with A symptom’ and everything should follow from that. Therefore, we intend to give hints and tips for medical students how to approach to a patient with a symptom and design the series of concept maps presentations. The aims of designing these resources are: For the clinical teachers To apply in their teachings To analyse patient’s symptom in clinical areas and develop clinical expertise To recognise the resources to guide students’ learning For the clinical students To apply the basic medical sciences into a clinical context To make conceptual links between topics covered in different modules To identify the complexity of issues that may be associated with an individual patient. To develop Clinical reasoning To differentiate common clinical symptoms To develop own concept maps To use as revision tools Project Description Concept maps, unlike textbooks and lectures which teach in a disease-to-symptom format, foster a symptom-to-disease approach, as shown in figure 1. This way of learning enables information to be memorised and organised in a way which is far more realistic and useful for retrieval in a clinical setting (Cooper and Frain, 2016). We intend to create fifty short online presentations and they are in the process of designing it. Summary Concept maps are ways of ‘road mapping’ differentials of a disease based on defining criteria, which help narrow down differentials, and discriminatory criteria, which help isolate a diagnosis. The combination of visual learning and the amalgamation of several illness scripts makes concept maps a very good learning tool for building intellectual engagement and developing clinical reasoning. Conclusions The intended learning outcomes for newly qualify doctors here is not to ‘recall a number of facts’ but to ‘mobilise and apply those facts or knowledge in a relevant context to solve new problems’. So, the learning activities should aid discussion or encourage ways of comparing and contrasting given resources. Instead of teaching the pathophysiology of ‘Myocardial Infarct (MI)’, the concept map is designed how to approach ‘the patient with chest pain’ and encourage students to mobilise, interpret and efficiently manage knowledge in a clinical context with the purpose of solving clinical problems. By this way that knowledge of pathophysiology of MI is integrated into more complex knowledge schemas. Reference Cooper N and Frain J. ( 2016) Teaching CR, ABC of CR: An overview. Hoboken, NJ: John Wiley and Sons.
{"title":"PG79 Creating ‘ concept maps online symptoms to diagnosis teaching’","authors":"S. Khin-htun, Faisal Faruqi, C. Khine, Tan Ling","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.127","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.127","url":null,"abstract":"Introduction Patients seek medical assessment with a problem and not a diagnosis so the starting point to the diagnosis process is ‘ A patient with A symptom’ and everything should follow from that. Therefore, we intend to give hints and tips for medical students how to approach to a patient with a symptom and design the series of concept maps presentations. The aims of designing these resources are: For the clinical teachers To apply in their teachings To analyse patient’s symptom in clinical areas and develop clinical expertise To recognise the resources to guide students’ learning For the clinical students To apply the basic medical sciences into a clinical context To make conceptual links between topics covered in different modules To identify the complexity of issues that may be associated with an individual patient. To develop Clinical reasoning To differentiate common clinical symptoms To develop own concept maps To use as revision tools Project Description Concept maps, unlike textbooks and lectures which teach in a disease-to-symptom format, foster a symptom-to-disease approach, as shown in figure 1. This way of learning enables information to be memorised and organised in a way which is far more realistic and useful for retrieval in a clinical setting (Cooper and Frain, 2016). We intend to create fifty short online presentations and they are in the process of designing it. Summary Concept maps are ways of ‘road mapping’ differentials of a disease based on defining criteria, which help narrow down differentials, and discriminatory criteria, which help isolate a diagnosis. The combination of visual learning and the amalgamation of several illness scripts makes concept maps a very good learning tool for building intellectual engagement and developing clinical reasoning. Conclusions The intended learning outcomes for newly qualify doctors here is not to ‘recall a number of facts’ but to ‘mobilise and apply those facts or knowledge in a relevant context to solve new problems’. So, the learning activities should aid discussion or encourage ways of comparing and contrasting given resources. Instead of teaching the pathophysiology of ‘Myocardial Infarct (MI)’, the concept map is designed how to approach ‘the patient with chest pain’ and encourage students to mobilise, interpret and efficiently manage knowledge in a clinical context with the purpose of solving clinical problems. By this way that knowledge of pathophysiology of MI is integrated into more complex knowledge schemas. Reference Cooper N and Frain J. ( 2016) Teaching CR, ABC of CR: An overview. Hoboken, NJ: John Wiley and Sons.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"69 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77219360","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.171
Tracey Harrison, E. Flockton
Background The outbreak of COVID -19 has had catastrophic impact on healthcare throughout the world and as a result has altered the delivery of many clinical procedures. Covid -19 is thought to spread from person to person through close contact and droplets, aerosol transmission can also occur. During CPR there is the risk of exposure to bodily fluids and for procedures including chest compressions, intubation or ventilation to generate infectious aerosol. As a result, the Resuscitation Council UK recommends that for all aerosol generating procedures, personal protective equipment must be worn by all members of the resuscitation team before entering the area and CPR commencing. Summary of Work As a result of this considerable change to practice it was acknowledged there was a need for staff to have the opportunity to practice these changes. We offered an insitu simulation programme to all the wards and departments throughout BTHFT focussing on ED, Renal, AMU and Care of the Elderly wards and departments. We ran a simple deteriorating patient scenario leading to a shockable cardiac arrest. Summary of Results Despite numerous communications issued relating to the changes to practice staff appeared unfamiliar with the new procedure. Many were uncomfortable with the new practice but all involved expressed their appreciation for the opportunity to take part in a session and improve their knowledge. The sessions allowed staff to ask questions about the new procedure and ensured that they were familiar with the updates. To date we have run a total 19 sessions, with further planned. Approximately 100 staff members from the multi-disciplinary team accessed the sessions with 4–5 staff attending each session. Qualitative feedback from staff included comments such as ‘time taken to don PPE’, ‘reminders on the use of the defib’ and ‘excellent to be able to practice this in the clinical area’. Feedback was collated via feedback forms following the individual sessions. Conclusions and Recommendations Despite written communications being sent to all staff within the organisation it became obvious that many staff did not access these or were aware of the changes to the resuscitation procedure. By delivering a training session in the clinical area allowed staff the opportunity to take part in a ‘hands on’ simulated safe learning environment. It is our recommendation that when a significant change to clinical practice is made this is reinforced with an insitu simulation programme.
{"title":"PG123 Insitu simulation: changes to resuscitation practice – living in a covid-19 world","authors":"Tracey Harrison, E. Flockton","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.171","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.171","url":null,"abstract":"Background The outbreak of COVID -19 has had catastrophic impact on healthcare throughout the world and as a result has altered the delivery of many clinical procedures. Covid -19 is thought to spread from person to person through close contact and droplets, aerosol transmission can also occur. During CPR there is the risk of exposure to bodily fluids and for procedures including chest compressions, intubation or ventilation to generate infectious aerosol. As a result, the Resuscitation Council UK recommends that for all aerosol generating procedures, personal protective equipment must be worn by all members of the resuscitation team before entering the area and CPR commencing. Summary of Work As a result of this considerable change to practice it was acknowledged there was a need for staff to have the opportunity to practice these changes. We offered an insitu simulation programme to all the wards and departments throughout BTHFT focussing on ED, Renal, AMU and Care of the Elderly wards and departments. We ran a simple deteriorating patient scenario leading to a shockable cardiac arrest. Summary of Results Despite numerous communications issued relating to the changes to practice staff appeared unfamiliar with the new procedure. Many were uncomfortable with the new practice but all involved expressed their appreciation for the opportunity to take part in a session and improve their knowledge. The sessions allowed staff to ask questions about the new procedure and ensured that they were familiar with the updates. To date we have run a total 19 sessions, with further planned. Approximately 100 staff members from the multi-disciplinary team accessed the sessions with 4–5 staff attending each session. Qualitative feedback from staff included comments such as ‘time taken to don PPE’, ‘reminders on the use of the defib’ and ‘excellent to be able to practice this in the clinical area’. Feedback was collated via feedback forms following the individual sessions. Conclusions and Recommendations Despite written communications being sent to all staff within the organisation it became obvious that many staff did not access these or were aware of the changes to the resuscitation procedure. By delivering a training session in the clinical area allowed staff the opportunity to take part in a ‘hands on’ simulated safe learning environment. It is our recommendation that when a significant change to clinical practice is made this is reinforced with an insitu simulation programme.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"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":"76371387","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.155
T. Collins, C. Laws-Chapman, Louise Houslip
Introduction NHS Nightingale London provided a critical care environment for creating capacity within the healthcare system. An education faculty designed & delivered a curriculum with the aim of equipping the workforce with the skills to work within NHS Nightingale at the Excel. NHS Nightingale presented unique challenges, including unfamiliar working practices, equipment & team membership variables, whilst working in a large and noisy environment, originally built as an exhibition centre 1. Simulation is an education modality that is employed to produce a safe experience to help prepare learners for a future real event 2. A 12 bed high-fidelity simulation facility was set up in The O2 Arena to replicate clinical reality for what will be anticipated within NHS Nightingale. Providing mass scale simulation in an arena provided many complexities which were confounded by the emergent situation of having to rapidly increase ICU provision due to COVID-19 pandemic. Methods A simulation ward was built on the arena floor, aiming to provide clinical simulation for staff working at NHS Nightingale. We had 5 days to design and implement a simulation curriculum with limited kit availability. The large and acoustically challenging arena with no privacy, as well as social distancing, made it difficult to communicate and facilitate debriefs. Due to NHS surge plans already being activated, there was limited adult critical care educators, which created variability with the faculties expertise in simulation and critical care. There was variance in the learners which included both experienced & non-experienced critical care staff, through too volunteers with no health care background. Results In total 2732 learners went through the education curriculum which involved a large component of simulation education. The curriculum was positively evaluated by learners. Discussion The faculty adopted a co-facilitation, adaptive approach to support simulation and debriefing. Daily pre-briefing and debriefing allowed iterative adaptation of the programme and supported faculty development. Social distancing was maintained by limiting participants per scenario, providing short simulation sessions and distancing during debrief. The plus/delta debrief model was used as this provides a swift debrief whilst also allowing novice and experts to debrief to successful outcomes 3. Scenarios with differentiated learning outcomes were matched to the streamed groups depending on their expertise and where applicable benchmarked to national competencies 4. Conclusion A large and skilled faculty, creative and adaptive to varying learner needs using a rapid improvement framework ensured that large scale simulation could be implemented within an arena. Reference Collins T, Laws-Chapman C & Houslip L ( 2020) Reflection on NHS Nightingale London. Resuscitation Today. 7:10–12. https://www.resustoday.com/view-latest-issue/ Gaba D ( 2004) The future vision of simulation in health care. Qual Saf Heal
{"title":"PG107 Mass simulation: delivering mass scale simulation at the 02 Arena","authors":"T. Collins, C. Laws-Chapman, Louise Houslip","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.155","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.155","url":null,"abstract":"Introduction NHS Nightingale London provided a critical care environment for creating capacity within the healthcare system. An education faculty designed & delivered a curriculum with the aim of equipping the workforce with the skills to work within NHS Nightingale at the Excel. NHS Nightingale presented unique challenges, including unfamiliar working practices, equipment & team membership variables, whilst working in a large and noisy environment, originally built as an exhibition centre 1. Simulation is an education modality that is employed to produce a safe experience to help prepare learners for a future real event 2. A 12 bed high-fidelity simulation facility was set up in The O2 Arena to replicate clinical reality for what will be anticipated within NHS Nightingale. Providing mass scale simulation in an arena provided many complexities which were confounded by the emergent situation of having to rapidly increase ICU provision due to COVID-19 pandemic. Methods A simulation ward was built on the arena floor, aiming to provide clinical simulation for staff working at NHS Nightingale. We had 5 days to design and implement a simulation curriculum with limited kit availability. The large and acoustically challenging arena with no privacy, as well as social distancing, made it difficult to communicate and facilitate debriefs. Due to NHS surge plans already being activated, there was limited adult critical care educators, which created variability with the faculties expertise in simulation and critical care. There was variance in the learners which included both experienced & non-experienced critical care staff, through too volunteers with no health care background. Results In total 2732 learners went through the education curriculum which involved a large component of simulation education. The curriculum was positively evaluated by learners. Discussion The faculty adopted a co-facilitation, adaptive approach to support simulation and debriefing. Daily pre-briefing and debriefing allowed iterative adaptation of the programme and supported faculty development. Social distancing was maintained by limiting participants per scenario, providing short simulation sessions and distancing during debrief. The plus/delta debrief model was used as this provides a swift debrief whilst also allowing novice and experts to debrief to successful outcomes 3. Scenarios with differentiated learning outcomes were matched to the streamed groups depending on their expertise and where applicable benchmarked to national competencies 4. Conclusion A large and skilled faculty, creative and adaptive to varying learner needs using a rapid improvement framework ensured that large scale simulation could be implemented within an arena. Reference Collins T, Laws-Chapman C & Houslip L ( 2020) Reflection on NHS Nightingale London. Resuscitation Today. 7:10–12. https://www.resustoday.com/view-latest-issue/ Gaba D ( 2004) The future vision of simulation in health care. Qual Saf Heal","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"14 8","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72460117","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.83
F. Cull, Gunjeet Dua
Introduction In situ simulation in the operating theatre has potential in highlighting latent environmental threats, trialling new procedures and human factors training1. During the peak of the COVID-19 pandemic, elective operating was cancelled, and teams formed to manage emergencies. Following the initial peak, emergency intubations reduced before elective operating could resume. Staff were therefore on-site in case of emergencies, but regularly available for training. We piloted a series of short in situ theatre simulation sessions for the multidisciplinary team. Methods The one hour sessions each comprised an introduction, case briefing, 15-minute simulation scenario and 25-minute debrief. Scenarios were medium fidelity, with some higher-fidelity practical elements maintained e.g. IV access, intubation, manual handling. Scenarios included common anaesthetic and surgical emergencies e.g. major haemorrhage, anaphylaxis. The Plus/Delta debrief model2 was used. Pre- and post-course questionnaires were undertaken, using the validated Human Factors Skills for Healthcare Instrument (HuFSHI)3 evaluation system and a question on the perceived usefulness of the session. Data was paired and compared for service evaluation. Results 9 sessions were undertaken in 3 weeks. 93 attendances were captured, of which paired data was obtained for approximately two thirds. All participants who responded to the question ‘did you think that today’s activity was a good use of time?’ answered affirmatively. In ‘monitoring the big picture during a complex situation’, scores increased by 1.42 (t(64)=7.78, p Discussion and Conclusion These sessions aimed to reduce ‘downtime’ at a time when formal training had ceased out of necessity. Uptake of these sessions was high, and recruiting learners subjectively easier than pre-pandemic in situ training, in part due to team presence without planned activities. The abbreviated, one-hour format provided a time-efficient delivery method. The informal approach and storage of simulation equipment within a designated training theatre meant that the session was easily adapted/rearranged in case of emergencies. Elements of these sessions (short duration, informal approach) might be utilised in improving uptake and efficiency of future theatre training. Attention should be paid to addressing, rather than just identifying, gaps in knowledge or latent threats in this short time. Failing this, steps should include follow-up sessions or distribution of further learning materials. References Owei L, Neylan CJ, Rao R, et al. In Situ Operating Room-Based Simulation: A Review. Journal of Surgical Education 2017;74(4):579–588. Fanning R and Gaba D. The Role of Debriefing in Simulation-Based Learning. Simulation in Healthcare. 2007;2(2):115–125. Reedy G, Lavelle M, Simpson T, et al. Development of the Human Factors Skills for Healthcare Instrument: a valid and reliable tool for assessing interprofessional learning across healthcare practice setting
{"title":"PG35 Maximising opportunities for in situ operating theatre simulation with short, accessible sessions – lessons learnt during a pandemic","authors":"F. Cull, Gunjeet Dua","doi":"10.1136/bmjstel-2020-aspihconf.83","DOIUrl":"https://doi.org/10.1136/bmjstel-2020-aspihconf.83","url":null,"abstract":"Introduction In situ simulation in the operating theatre has potential in highlighting latent environmental threats, trialling new procedures and human factors training1. During the peak of the COVID-19 pandemic, elective operating was cancelled, and teams formed to manage emergencies. Following the initial peak, emergency intubations reduced before elective operating could resume. Staff were therefore on-site in case of emergencies, but regularly available for training. We piloted a series of short in situ theatre simulation sessions for the multidisciplinary team. Methods The one hour sessions each comprised an introduction, case briefing, 15-minute simulation scenario and 25-minute debrief. Scenarios were medium fidelity, with some higher-fidelity practical elements maintained e.g. IV access, intubation, manual handling. Scenarios included common anaesthetic and surgical emergencies e.g. major haemorrhage, anaphylaxis. The Plus/Delta debrief model2 was used. Pre- and post-course questionnaires were undertaken, using the validated Human Factors Skills for Healthcare Instrument (HuFSHI)3 evaluation system and a question on the perceived usefulness of the session. Data was paired and compared for service evaluation. Results 9 sessions were undertaken in 3 weeks. 93 attendances were captured, of which paired data was obtained for approximately two thirds. All participants who responded to the question ‘did you think that today’s activity was a good use of time?’ answered affirmatively. In ‘monitoring the big picture during a complex situation’, scores increased by 1.42 (t(64)=7.78, p Discussion and Conclusion These sessions aimed to reduce ‘downtime’ at a time when formal training had ceased out of necessity. Uptake of these sessions was high, and recruiting learners subjectively easier than pre-pandemic in situ training, in part due to team presence without planned activities. The abbreviated, one-hour format provided a time-efficient delivery method. The informal approach and storage of simulation equipment within a designated training theatre meant that the session was easily adapted/rearranged in case of emergencies. Elements of these sessions (short duration, informal approach) might be utilised in improving uptake and efficiency of future theatre training. Attention should be paid to addressing, rather than just identifying, gaps in knowledge or latent threats in this short time. Failing this, steps should include follow-up sessions or distribution of further learning materials. References Owei L, Neylan CJ, Rao R, et al. In Situ Operating Room-Based Simulation: A Review. Journal of Surgical Education 2017;74(4):579–588. Fanning R and Gaba D. The Role of Debriefing in Simulation-Based Learning. Simulation in Healthcare. 2007;2(2):115–125. Reedy G, Lavelle M, Simpson T, et al. Development of the Human Factors Skills for Healthcare Instrument: a valid and reliable tool for assessing interprofessional learning across healthcare practice setting","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"24 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75939482","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.68
N. Finneran, Claire Levi
Introduction Early in the coronavirus epidemic prior to lockdown, the resus council released its guidance on resuscitation in patients who were considered high risk for covid. We tested the guidance with a multiprofessional in situ sim on AMU. Design Teams from AMU, theatres and anaesthetics and the trust lead for resuscitation attended AMU for a prebrief. Our simulation team admitted SimMan into a side room on the AMU as a possible covid patient but as per guidance at that time was not being nursed with level 3 PPE. The anaesthetic team were to be on ITU where they would normally be based if covering the crash bleep. The nurse in charge of the patient was the first responder who noticed a change in their patient and called a junior doctor. By the time the junior doctor arrived the patient was in cardiac arrest and a crash call put out. The time taken to respond, to establish a secure airway and to initiate first shock were noted. There was then a multiprofessional debrief involving all of the teams. The simulation was repeated a week later to see if findings were consistent. Results Time taken to establish a secure airway was on average 15 minutes with time to first shock being administered of 7 minutes. The requirement for full PPE added a significant delay and complication to the process. The anaesthetists found difficulty in ensuring cross contamination did not occur when using airway adjuncts. Discussion We felt the delay in establishing an airway and instigating the first shock was unacceptable. This was despite the team being primed and ready to respond to the crash when it happened. We therefore changed local guidance ahead of national guidance being altered that the first attender could deliver a shock even if not in PPE. The need for early discussion around DNACPR was established and because of this simulation awareness of this issue was spread before national guidance was circulated. Changes were made to the crash trolley including transparent bags for the anaesthetists to keep used equipment clean and to hand. The juniors involved summarised their learning (appendix) and circulated this to the junior staff. It is not often that we are able to demonstrate such a clear change in practice as being directly applicable to a simulation. This undoubtedly had a clear benefit for our patients.
{"title":"PG19 Resuscitation in covid patients- an in-situ simulation that resulted in immediate change of practice","authors":"N. Finneran, Claire Levi","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.68","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.68","url":null,"abstract":"Introduction Early in the coronavirus epidemic prior to lockdown, the resus council released its guidance on resuscitation in patients who were considered high risk for covid. We tested the guidance with a multiprofessional in situ sim on AMU. Design Teams from AMU, theatres and anaesthetics and the trust lead for resuscitation attended AMU for a prebrief. Our simulation team admitted SimMan into a side room on the AMU as a possible covid patient but as per guidance at that time was not being nursed with level 3 PPE. The anaesthetic team were to be on ITU where they would normally be based if covering the crash bleep. The nurse in charge of the patient was the first responder who noticed a change in their patient and called a junior doctor. By the time the junior doctor arrived the patient was in cardiac arrest and a crash call put out. The time taken to respond, to establish a secure airway and to initiate first shock were noted. There was then a multiprofessional debrief involving all of the teams. The simulation was repeated a week later to see if findings were consistent. Results Time taken to establish a secure airway was on average 15 minutes with time to first shock being administered of 7 minutes. The requirement for full PPE added a significant delay and complication to the process. The anaesthetists found difficulty in ensuring cross contamination did not occur when using airway adjuncts. Discussion We felt the delay in establishing an airway and instigating the first shock was unacceptable. This was despite the team being primed and ready to respond to the crash when it happened. We therefore changed local guidance ahead of national guidance being altered that the first attender could deliver a shock even if not in PPE. The need for early discussion around DNACPR was established and because of this simulation awareness of this issue was spread before national guidance was circulated. Changes were made to the crash trolley including transparent bags for the anaesthetists to keep used equipment clean and to hand. The juniors involved summarised their learning (appendix) and circulated this to the junior staff. It is not often that we are able to demonstrate such a clear change in practice as being directly applicable to a simulation. This undoubtedly had a clear benefit for our patients.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"35 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77553687","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.50
Sarah Williamson, F. Caliandro
Background We describe a QI project designed to improve junior doctors’ skills in performing central venous catheter (CVC) insertion in a tertiary cardiac centre. Feedback from local Core Medical Trainees suggested that junior doctors in the local deanery sought further training in core procedural skills, especially in CVC insertion. Trainees reported low confidence in this procedure and felt formal training would improve their ability to provide better patient care, particularly in emergency settings. Therefore, using quality improvement methodology, we set up a local course on CVC insertion to address this skill gap. Project description The four-step PDSA model was utilised to improve trainee’s practical skills in CVC insertion. Plan: A CVC insertion course was planned for junior doctors. Do: Five half-day courses were run over two years between 2018–2019 at our local Simulation, Training and Resource (STaR) Centre in Harefield Hospital. Study: Feedback from candidates was gathered after each course, and pre- and post-course tests were utilised to assess learning. Act: From this feedback, changes were made to the course and other training pathways introduced. This cycle was repeated several times. Outcome Forty four candidates attended five courses run at the STaR Centre at Harefield Hospital over a period of two years from 2018–2019. Feedback from the courses was unanimously positive and comparison of pre- and post-course test scores demonstrated both candidate learning and increased confidence in performing the procedure in clinical settings. Feedback from the CVC training days also suggested that trainees desired further training with real patients in a supportive environment. Therefore, as part of a second PDSA cycle a local training pathway was set up to enable trainees to attend a theatre day where they conducted supervised insertion of CVCs into patients undergoing cardiac surgery. Discussion This QI project demonstrates the benefit of developing sustainable training programmes locally in response to educational need, in a learner-lead way by allowing junior doctors to identify training gaps which they feel impact on patient care. This local CVC insertion course gave rise to a training programme of CVC insertion in theatres led by consultant anaesthetists within Harefield Hospital. Positive impact on patient care has been inferred from trainee feedback suggesting they were significantly more confident in safely performing the procedure in clinical settings after this training.
{"title":"PG1 Quality improvement project: implementation of a central venous catheter insertion course to improve trainees procedural skills and patient care","authors":"Sarah Williamson, F. Caliandro","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.50","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.50","url":null,"abstract":"Background We describe a QI project designed to improve junior doctors’ skills in performing central venous catheter (CVC) insertion in a tertiary cardiac centre. Feedback from local Core Medical Trainees suggested that junior doctors in the local deanery sought further training in core procedural skills, especially in CVC insertion. Trainees reported low confidence in this procedure and felt formal training would improve their ability to provide better patient care, particularly in emergency settings. Therefore, using quality improvement methodology, we set up a local course on CVC insertion to address this skill gap. Project description The four-step PDSA model was utilised to improve trainee’s practical skills in CVC insertion. Plan: A CVC insertion course was planned for junior doctors. Do: Five half-day courses were run over two years between 2018–2019 at our local Simulation, Training and Resource (STaR) Centre in Harefield Hospital. Study: Feedback from candidates was gathered after each course, and pre- and post-course tests were utilised to assess learning. Act: From this feedback, changes were made to the course and other training pathways introduced. This cycle was repeated several times. Outcome Forty four candidates attended five courses run at the STaR Centre at Harefield Hospital over a period of two years from 2018–2019. Feedback from the courses was unanimously positive and comparison of pre- and post-course test scores demonstrated both candidate learning and increased confidence in performing the procedure in clinical settings. Feedback from the CVC training days also suggested that trainees desired further training with real patients in a supportive environment. Therefore, as part of a second PDSA cycle a local training pathway was set up to enable trainees to attend a theatre day where they conducted supervised insertion of CVCs into patients undergoing cardiac surgery. Discussion This QI project demonstrates the benefit of developing sustainable training programmes locally in response to educational need, in a learner-lead way by allowing junior doctors to identify training gaps which they feel impact on patient care. This local CVC insertion course gave rise to a training programme of CVC insertion in theatres led by consultant anaesthetists within Harefield Hospital. Positive impact on patient care has been inferred from trainee feedback suggesting they were significantly more confident in safely performing the procedure in clinical settings after this training.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"2021 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82463482","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}
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