Pub Date : 2020-11-01DOI: 10.1136/BMJSTEL-2020-ASPIHCONF.6
R. Johnston, C. Sen, Y. Baki
Introduction Effective communication is a fundamental aspect of good medical practice. It has been shown to enhance patient safety and care1 yet poor communication continues to be cited as a leading cause of adverse events, patient dissatisfaction and complaints.2 Communication skills programs have shown improvements in communication beyond that achieved by standard patient encounters3 however amidst the Covid-19 pandemic face-to-face training opportunities are limited. We developed a real-time online workshop to teach undergraduate communication skills in a virtual environment. Methods We designed a multimodal programme utilising Kolb’s experiential learning cycle4 to meet the learning objectives identified on the paediatric undergraduate curriculum (see figure 1). We introduced the session exploring students’ objectives with focus on creating a psychologically safe environment. A pre-recorded simulated ‘breaking bad news’ scenario followed, interspersed with group reflection on the management of non-accidental injuries, approaches to difficult discussions and dealing with conflict. Students then role-played in break-out groups: (i) disclosure of a medication error and (ii) obtaining consent for a lumbar puncture followed by peer-led feedback and group reflection. We surveyed students’ confidence of the learning objectives prior to and after the workshop collecting quantitative and qualitative feedback. We also considered the feasibility of the session including resources required, technical issues and levels of student engagement. Results The session was delivered on Blackboard Collaborate, a virtual classroom tool, by three paediatricians and attended by 26 students. Internet connectivity issues were minimal and using a web-based application (Articulate Rise) ensured video quality was preserved. The video observation and opportunity to practice and interact with peers in small groups were rated highly by students. Breakout groups stimulated active learning with students describing the role play as ‘daunting’ but ‘really useful’. Monitoring student engagement was challenging but high usage of the interactive whiteboard was encouraging. Confidence in all learning outcomes improved following the workshop (pre->post test% of students self-assessed as confident): talking to anxious parents (0->83.3%); explaining common procedures and investigations (13.6->100%); obtaining consent (13.6->91.7%); breaking bad news (22.7->66.6%) and explaining safeguarding concerns (0->58.3%). Discussion and Conclusion Undergraduate paediatric curriculums must address essential competencies in communication. This is particularly challenging in the Covid-19 era with reduced clinical exposure. We found online workshops are feasible, require minimal resources and are well received by students. Utilising online small group personal tutor sessions, we plan to repeat this workshop regularly over the next academic year. References Poore JA, Cullen DL, Schaar GL. Simulation-b
{"title":"O6 Teaching communication skills in the Covid-19 era: an online workshop for medical students","authors":"R. Johnston, C. Sen, Y. Baki","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.6","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.6","url":null,"abstract":"Introduction Effective communication is a fundamental aspect of good medical practice. It has been shown to enhance patient safety and care1 yet poor communication continues to be cited as a leading cause of adverse events, patient dissatisfaction and complaints.2 Communication skills programs have shown improvements in communication beyond that achieved by standard patient encounters3 however amidst the Covid-19 pandemic face-to-face training opportunities are limited. We developed a real-time online workshop to teach undergraduate communication skills in a virtual environment. Methods We designed a multimodal programme utilising Kolb’s experiential learning cycle4 to meet the learning objectives identified on the paediatric undergraduate curriculum (see figure 1). We introduced the session exploring students’ objectives with focus on creating a psychologically safe environment. A pre-recorded simulated ‘breaking bad news’ scenario followed, interspersed with group reflection on the management of non-accidental injuries, approaches to difficult discussions and dealing with conflict. Students then role-played in break-out groups: (i) disclosure of a medication error and (ii) obtaining consent for a lumbar puncture followed by peer-led feedback and group reflection. We surveyed students’ confidence of the learning objectives prior to and after the workshop collecting quantitative and qualitative feedback. We also considered the feasibility of the session including resources required, technical issues and levels of student engagement. Results The session was delivered on Blackboard Collaborate, a virtual classroom tool, by three paediatricians and attended by 26 students. Internet connectivity issues were minimal and using a web-based application (Articulate Rise) ensured video quality was preserved. The video observation and opportunity to practice and interact with peers in small groups were rated highly by students. Breakout groups stimulated active learning with students describing the role play as ‘daunting’ but ‘really useful’. Monitoring student engagement was challenging but high usage of the interactive whiteboard was encouraging. Confidence in all learning outcomes improved following the workshop (pre->post test% of students self-assessed as confident): talking to anxious parents (0->83.3%); explaining common procedures and investigations (13.6->100%); obtaining consent (13.6->91.7%); breaking bad news (22.7->66.6%) and explaining safeguarding concerns (0->58.3%). Discussion and Conclusion Undergraduate paediatric curriculums must address essential competencies in communication. This is particularly challenging in the Covid-19 era with reduced clinical exposure. We found online workshops are feasible, require minimal resources and are well received by students. Utilising online small group personal tutor sessions, we plan to repeat this workshop regularly over the next academic year. References Poore JA, Cullen DL, Schaar GL. Simulation-b","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"64 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81078466","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.151
Melanie Tanner, C. Hamilton, Jack Orledge, S. Andrews, J. Booth
Introduction A repercussion of the NMC standards (2018a) and the NMC code (2018b) is that educators are considering the best teaching style to maximise student understanding and retention. Our second year student nurses learn the skill of basic life support; we wanted to extend this learning, enabling them the opportunity to practice ‘bystander skills’, immersing them in an unexpected ‘crisis’. The aim was for them to practice verbal/nonverbal supportive skills with distressed relatives, manage crowds during a crisis event, deescalate and attend to privacy, recognise the challenges of unfamiliar situations, and build confidence if unethical or unsafe practice is noted. Methods The simulation suite changing-room was converted to a swimming pool changing-room. 25 students in each cohort became bystanders to the (unseen) collapse and resuscitation of a child, in a semi-closed room. Two trained actor-role players, one the grandmother of the child and one a bystander taking photographs, were embedded in the changing-room with the students. Self-selecting student(s) immediately stepped in to support the distraught relative and, as the scenario progressed other student bystanders challenged the indiscreet onlooker. Two concurrent scenarios ran in the same area, with stop-start, freeze-frame and feedback from student participants, actor-role players, the group, and the facilitators. Results This simulation was highly evaluated by students. They stated that they were more confident in their abilities to ‘stay calm’ in providing comfort and in challenging behaviours; the support of peers in ‘pause and seek advice’ was invaluable. The practical application of this simulation, in everyday life, and as value to society, was recognised. Cross faculty academics, health professionals and educators external to the University, observed and became involved as ‘onlooking bystanders’. Over 200 student nurses have taken active roles in this simulation, with a further 50 student paramedics and ODPs – none in their professional roles, all as ‘lay bystanders’. Discussion Our mantra of ‘teamwork makes the dreamwork’ was upheld. Multiple discussions (pre/post simulation) with technicians, actors, a breadth of academics and students supported the venture. The actors were carefully selected, trained for their specific roles and agreed to wear swimsuits. Their involvement in the debrief was vital; a relative’s perspective and a vicarious bystander perspective. De-roling was essential for all as the content of the simulation could be deeply upsetting. References Nursing & Midwifery Council (NMC), (2018a) Standards of proficiency for registered nurses. London: NMC. Available at: https://www.nmc.org.uk/standards/standards-for-nurses/standards-of-proficiency-for-registered-nurses/ Nursing & Midwifery Council (NMC), (2018b) The code: professional standards of practice and behaviour for nurses, midwives and nursing associates. [pdf] Available at: www.nmc.org.uk/globalassets/sitedoc
{"title":"PG103 ‘Managing bystanders’ in an emergency situation: practising through simulation","authors":"Melanie Tanner, C. Hamilton, Jack Orledge, S. Andrews, J. Booth","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.151","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.151","url":null,"abstract":"Introduction A repercussion of the NMC standards (2018a) and the NMC code (2018b) is that educators are considering the best teaching style to maximise student understanding and retention. Our second year student nurses learn the skill of basic life support; we wanted to extend this learning, enabling them the opportunity to practice ‘bystander skills’, immersing them in an unexpected ‘crisis’. The aim was for them to practice verbal/nonverbal supportive skills with distressed relatives, manage crowds during a crisis event, deescalate and attend to privacy, recognise the challenges of unfamiliar situations, and build confidence if unethical or unsafe practice is noted. Methods The simulation suite changing-room was converted to a swimming pool changing-room. 25 students in each cohort became bystanders to the (unseen) collapse and resuscitation of a child, in a semi-closed room. Two trained actor-role players, one the grandmother of the child and one a bystander taking photographs, were embedded in the changing-room with the students. Self-selecting student(s) immediately stepped in to support the distraught relative and, as the scenario progressed other student bystanders challenged the indiscreet onlooker. Two concurrent scenarios ran in the same area, with stop-start, freeze-frame and feedback from student participants, actor-role players, the group, and the facilitators. Results This simulation was highly evaluated by students. They stated that they were more confident in their abilities to ‘stay calm’ in providing comfort and in challenging behaviours; the support of peers in ‘pause and seek advice’ was invaluable. The practical application of this simulation, in everyday life, and as value to society, was recognised. Cross faculty academics, health professionals and educators external to the University, observed and became involved as ‘onlooking bystanders’. Over 200 student nurses have taken active roles in this simulation, with a further 50 student paramedics and ODPs – none in their professional roles, all as ‘lay bystanders’. Discussion Our mantra of ‘teamwork makes the dreamwork’ was upheld. Multiple discussions (pre/post simulation) with technicians, actors, a breadth of academics and students supported the venture. The actors were carefully selected, trained for their specific roles and agreed to wear swimsuits. Their involvement in the debrief was vital; a relative’s perspective and a vicarious bystander perspective. De-roling was essential for all as the content of the simulation could be deeply upsetting. References Nursing & Midwifery Council (NMC), (2018a) Standards of proficiency for registered nurses. London: NMC. Available at: https://www.nmc.org.uk/standards/standards-for-nurses/standards-of-proficiency-for-registered-nurses/ Nursing & Midwifery Council (NMC), (2018b) The code: professional standards of practice and behaviour for nurses, midwives and nursing associates. [pdf] Available at: www.nmc.org.uk/globalassets/sitedoc","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"44 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81113964","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.16
F. Hanlon, E. Suckling, Rosie Fish
Introduction Simulated system tests can be used to address system errors, improve system performance, patient safety and quality of healthcare1,2. The University Hospitals Bristol and Weston Simulation Services (UHBW SS) adapted this simulation model to review the potential system performance of an individual patient pathway to improve patient outcome. Background Patient X is a 2-year old female with complex medical background, tracheostomy and posterior fossa pilocytic astrocytoma requiring 6-week radiotherapy course under general anaesthetic. The primary complicating factor for the patient and radiotherapy journey was brainstem dysfunction resulting in frequent breath holding spells, respiratory arrest and subsequent hypoxic cardiac arrest. Due to the high-risk nature of the patient, UHBW SS paediatric team designed and delivered a patient-specific simulated systems test (PSSST) simulating patient X’s intended radiotherapy pathway to identify and address latent safety threats. Methods We designed and delivered the PSSST using a basic, low-fidelity ‘walk-through’ simulation model, simulating each step of patient X’s radiotherapy journey. Staff involved in the patient’s care and radiotherapy treatment were present, including anaesthetic, general paediatric, HDU and nursing teams, paediatric critical care outreach, radiotherapy and hospital porters. We did not run simulated acute emergencies, instead adapted the use of reflective pauses, addressing anticipated complications at each stage of the journey. Issues identified were further discussed in a modified debrief following the simulation and action plans formulated. Members of the MDT were allocated tasks, with clear instructions and dates of when they were to be completed by prior to the radiotherapy course commencing. Examples of issues identified: Emergency equipment and staff required for transfer Need for personal protective equipment (PPE) in light of COVID–19 pandemic Environment familiarity for the patient to reduce risk of breath holding spells secondary to agitation/anxiety Results The PSSST of patient X’s radiotherapy pathway identified clinical and ethical implications on both the patient and wider hospital triggering further senior discussions prior to proceeding with her treatment. Latent safety threats were identified and addressed in a timely manner. As a result of this PSSST, patient X underwent an uneventful radiotherapy course without complication or adverse impact on the wider hospital. Discussion This exercise has identified how basic, low-fidelity simulated MDT system tests can be adapted to review system performance of an individual patient-specific pathway, improving patient and hospital outcomes. We aim to expand the use of PSSST for assessing and planning individual patient pathways in the future at BRHC. References Vincent C, Moorthy K, Sarker SK, et al. Systems approaches to surgical quality and safety: from concept to measurement. Annals of Surgery2004;239:475e82. Ag
{"title":"O16 PSSST!: Using a patient-specific simulated systems test (PSSST) to review system performance and latent safety risks when assessing and planning an individual patient-specific pathway, improving patient and hospital outcomes","authors":"F. Hanlon, E. Suckling, Rosie Fish","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.16","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.16","url":null,"abstract":"Introduction Simulated system tests can be used to address system errors, improve system performance, patient safety and quality of healthcare1,2. The University Hospitals Bristol and Weston Simulation Services (UHBW SS) adapted this simulation model to review the potential system performance of an individual patient pathway to improve patient outcome. Background Patient X is a 2-year old female with complex medical background, tracheostomy and posterior fossa pilocytic astrocytoma requiring 6-week radiotherapy course under general anaesthetic. The primary complicating factor for the patient and radiotherapy journey was brainstem dysfunction resulting in frequent breath holding spells, respiratory arrest and subsequent hypoxic cardiac arrest. Due to the high-risk nature of the patient, UHBW SS paediatric team designed and delivered a patient-specific simulated systems test (PSSST) simulating patient X’s intended radiotherapy pathway to identify and address latent safety threats. Methods We designed and delivered the PSSST using a basic, low-fidelity ‘walk-through’ simulation model, simulating each step of patient X’s radiotherapy journey. Staff involved in the patient’s care and radiotherapy treatment were present, including anaesthetic, general paediatric, HDU and nursing teams, paediatric critical care outreach, radiotherapy and hospital porters. We did not run simulated acute emergencies, instead adapted the use of reflective pauses, addressing anticipated complications at each stage of the journey. Issues identified were further discussed in a modified debrief following the simulation and action plans formulated. Members of the MDT were allocated tasks, with clear instructions and dates of when they were to be completed by prior to the radiotherapy course commencing. Examples of issues identified: Emergency equipment and staff required for transfer Need for personal protective equipment (PPE) in light of COVID–19 pandemic Environment familiarity for the patient to reduce risk of breath holding spells secondary to agitation/anxiety Results The PSSST of patient X’s radiotherapy pathway identified clinical and ethical implications on both the patient and wider hospital triggering further senior discussions prior to proceeding with her treatment. Latent safety threats were identified and addressed in a timely manner. As a result of this PSSST, patient X underwent an uneventful radiotherapy course without complication or adverse impact on the wider hospital. Discussion This exercise has identified how basic, low-fidelity simulated MDT system tests can be adapted to review system performance of an individual patient-specific pathway, improving patient and hospital outcomes. We aim to expand the use of PSSST for assessing and planning individual patient pathways in the future at BRHC. References Vincent C, Moorthy K, Sarker SK, et al. Systems approaches to surgical quality and safety: from concept to measurement. Annals of Surgery2004;239:475e82. Ag","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":"88249126","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.10
Z. Wellbelove, Diana Kluczna, D. Wright, O. Charlton, G. Barlow, S. Oliver
Introduction COVID19 has significantly impacted undergraduate medical education. At Hull York Medical School, the elective period for fifth-year students was cancelled and a seven-week online distance learning course was developed and initiated, focusing on key learning outcomes. Our aim was to incorporate live simulation to add an interactive element to online fifth-year teaching. Methods We wrote and recorded immersive 360-degree scenarios tailored to learning outcomes for the week. These focused on the assessment, investigation, and management of an unwell patient. The scenarios were delivered as small group teaching sessions through online meeting software weekly for seven weeks. Clinical teaching fellows guided sessions, encouraging participation, the application of knowledge and progression of clinical reasoning. Quantitative and qualitative feedback was collected after every session and pre/post course evaluation was conducted. A Likert scale from 1 to 5 was used to subjectively assess student’s confidence in the assessment and management of acutely unwell patients. Results The number of students participating in the online simulation course ranged from 127 to 149; 84 to 136 completed the surveys each week. 95.8% of students reported virtual simulation as a beneficial form of learning. Of those, 60.4% stated virtual simulations complemented other forms of teaching and 39.6% felt that simulations were more beneficial. Mean confidence rating improved from 3.52 to 4.12 for assessment and 2.89 to 3.68 for management of acutely unwell patients (p-value Discussion and Conclusion Online simulation was a valuable learning resource to final year medical students at the Hull York Medical School during their distance learning block. It improved the student’s confidence in the assessment and management of acutely unwell patients and provided an interactive educational experience that helped prepare them for hospital placements. Delivering simulation in small groups online is a novel teaching method that can be used in line with social distancing measures and can be developed further for both undergraduate and postgraduate education.
{"title":"O10 Simulation from a distance. an online simulation programme for final year medical students","authors":"Z. Wellbelove, Diana Kluczna, D. Wright, O. Charlton, G. Barlow, S. Oliver","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.10","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.10","url":null,"abstract":"Introduction COVID19 has significantly impacted undergraduate medical education. At Hull York Medical School, the elective period for fifth-year students was cancelled and a seven-week online distance learning course was developed and initiated, focusing on key learning outcomes. Our aim was to incorporate live simulation to add an interactive element to online fifth-year teaching. Methods We wrote and recorded immersive 360-degree scenarios tailored to learning outcomes for the week. These focused on the assessment, investigation, and management of an unwell patient. The scenarios were delivered as small group teaching sessions through online meeting software weekly for seven weeks. Clinical teaching fellows guided sessions, encouraging participation, the application of knowledge and progression of clinical reasoning. Quantitative and qualitative feedback was collected after every session and pre/post course evaluation was conducted. A Likert scale from 1 to 5 was used to subjectively assess student’s confidence in the assessment and management of acutely unwell patients. Results The number of students participating in the online simulation course ranged from 127 to 149; 84 to 136 completed the surveys each week. 95.8% of students reported virtual simulation as a beneficial form of learning. Of those, 60.4% stated virtual simulations complemented other forms of teaching and 39.6% felt that simulations were more beneficial. Mean confidence rating improved from 3.52 to 4.12 for assessment and 2.89 to 3.68 for management of acutely unwell patients (p-value Discussion and Conclusion Online simulation was a valuable learning resource to final year medical students at the Hull York Medical School during their distance learning block. It improved the student’s confidence in the assessment and management of acutely unwell patients and provided an interactive educational experience that helped prepare them for hospital placements. Delivering simulation in small groups online is a novel teaching method that can be used in line with social distancing measures and can be developed further for both undergraduate and postgraduate education.","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":"88335624","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.172
D. Bagg, N. Finneran, Anand Pankhania
Background The new Internal Medicine Training (IMT) Stage 1 curriculum mandated skills lab and simulation training for the first time1. Whilst simulation-based education is used widely in many other specialties, it is not a widely used teaching modality for medical trainees2. There is a lack of understanding among some physicians about simulation therefore most Trusts in region were not in a position to offer high quality simulation training to their IMTs. Summary of Work A one day course was created, covering technical and non-technical skills, directly mapped to the IMT curriculum. Themes included anaphylaxis, asthma and handover, hypoglycaemia and mistakes/duty of candour, recognition of deterioration and ceiling of care decisions, as well as breaking bad news. In addition to participating in their current role, trainees also assumed roles of more junior doctors, nurses and healthcare assistants after a pre-brief to ensure they were comfortable stepping outside their usual position. Following this, a scenario bank was created to share with Trusts within the region to ensure local delivery and consistency. Summary of Results Almost all IMTs in region booked places, however the covid-19 pandemic forced the final two courses to be cancelled. The scenarios were based on real patients and in particular, the medication error scenario was co-created with a senior pharmacist to ensure accuracy and realism. The delivery of this scenario was changed after initial feedback indicated it had been a little complex; feedback after the change was very positive. All participants reported that their confidence had improved in the topics covered and would recommend the course to colleagues. The feedback was overwhelmingly positive, even from IMTs who had negative perceptions of simulation prior to attending. Assuming different roles was highlighted as a positive aspect as they were able to gain greater appreciation for their colleagues. Discussion, Conclusions, Recommendations This regional course has allowed IMTs to develop confidence in both technical and non-technical skills, as well as provide standardised, high quality training. Trusts are being supported to deliver the created scenarios locally, which will hopefully ensure sustainable simulation for IMTs going forwards. References Joint Royal Colleges of Physicians Training Board, (2019a) Curriculum for Internal Medicine Stage 1 Training, Available at: https://www.jrcptb.org.uk/sites/default/files/IM_Curriculum_Sept2519.pdf (Accessed 23/08/2020). Joint Royal Colleges of Physicians Training Board and Health Education England, ( 2016) Enhancing UK Core Medical Training through simulation-based education: an evidence-based approach, Available at: https://www.jrcptb.org.uk/sites/default/files/HEE_Report_FINAL.pdf (Accessed 22/08/2020).
{"title":"PG124 Creation of a regional simulation course and scenario bank for internal medicine trainees","authors":"D. Bagg, N. Finneran, Anand Pankhania","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.172","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.172","url":null,"abstract":"Background The new Internal Medicine Training (IMT) Stage 1 curriculum mandated skills lab and simulation training for the first time1. Whilst simulation-based education is used widely in many other specialties, it is not a widely used teaching modality for medical trainees2. There is a lack of understanding among some physicians about simulation therefore most Trusts in region were not in a position to offer high quality simulation training to their IMTs. Summary of Work A one day course was created, covering technical and non-technical skills, directly mapped to the IMT curriculum. Themes included anaphylaxis, asthma and handover, hypoglycaemia and mistakes/duty of candour, recognition of deterioration and ceiling of care decisions, as well as breaking bad news. In addition to participating in their current role, trainees also assumed roles of more junior doctors, nurses and healthcare assistants after a pre-brief to ensure they were comfortable stepping outside their usual position. Following this, a scenario bank was created to share with Trusts within the region to ensure local delivery and consistency. Summary of Results Almost all IMTs in region booked places, however the covid-19 pandemic forced the final two courses to be cancelled. The scenarios were based on real patients and in particular, the medication error scenario was co-created with a senior pharmacist to ensure accuracy and realism. The delivery of this scenario was changed after initial feedback indicated it had been a little complex; feedback after the change was very positive. All participants reported that their confidence had improved in the topics covered and would recommend the course to colleagues. The feedback was overwhelmingly positive, even from IMTs who had negative perceptions of simulation prior to attending. Assuming different roles was highlighted as a positive aspect as they were able to gain greater appreciation for their colleagues. Discussion, Conclusions, Recommendations This regional course has allowed IMTs to develop confidence in both technical and non-technical skills, as well as provide standardised, high quality training. Trusts are being supported to deliver the created scenarios locally, which will hopefully ensure sustainable simulation for IMTs going forwards. References Joint Royal Colleges of Physicians Training Board, (2019a) Curriculum for Internal Medicine Stage 1 Training, Available at: https://www.jrcptb.org.uk/sites/default/files/IM_Curriculum_Sept2519.pdf (Accessed 23/08/2020). Joint Royal Colleges of Physicians Training Board and Health Education England, ( 2016) Enhancing UK Core Medical Training through simulation-based education: an evidence-based approach, Available at: https://www.jrcptb.org.uk/sites/default/files/HEE_Report_FINAL.pdf (Accessed 22/08/2020).","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"5 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88564587","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.91
Gil Smith
Introduction Failings in human factors, is the most common cause of adverse incidents in healthcare. Ineffective hand-off communication is recognised as a critical patient safety problem; an estimated 80% of serious medical errors involve miscommunication between caregivers during the transfer of patients. There is no ‘one thing’ that will address human factor failings- its multi-factorial with multiple interventions. The ‘Gamification for Human Factors’ project deploys the application of gamification approach to human factor learning and skills in health and social care. Gamification in training is the process of applying gaming designs and concepts in order to make learning processes more engaging, entertaining and interactive. The game mechanics, story, and media act as reinforcements to learning goals. The aim of the project is to extend the reach of access of Human Factor training. The Game is accessible by App via mobile phone devices. Method Quality Improvement and Agile design methodologies have been adopted; along with multi-disciplinary team input. Phase 1 of the project - the development of the gamification strategy, requirements specification, characters and stories which form the basis of the design; was carried out in partnership between the Northern Health and Social Care Trust and the University of Ulster. Phase 2 is the conversion of the initial development work into an App suitable for commercial release. Main Themes: Majuri et al. (2018) review of 128 empirical research papers focussed on the application of gamification to assist with education and learning. The most common gamification elements found in these studies was achievement and progression - designed to allow users to track their progress and improve upon their previous performance. Discussion The Gamification for Human Factors App is based around the journey of a patient and his interactions with the health and care system. As ‘gamers’ travel through the different levels of the game, they complete ‘missions’ and follow the patient9s experience. As the patient journey unfolds it exposes ‘gamers’ to learning centred around DuPont’s Dirty Dozen – the 12 most common human factor elements which degrade a person’s ability for them to perform effectively and safely, leading to errors. To progress to each new mission ‘gamers’ must answer a series of questions, testing knowledge and reinforcing their learning of human factors. On completion of missions ‘gamers’ are awarded badges and rewards – increasing motivation to learn. The App also provides links to additional learning resources and useful human factor references. References Joint Commission on Accreditation of Healthcare Organisations, August 2020, Volume 3, Issue 8. Joint Commission Perspectives Majuri, et al., 2018. Gamification of Education and Learning: A Review of Empirical Literature.
{"title":"PG43 Gamification for human factors – using an interactive gaming strategy to build human factor capability in health and social care","authors":"Gil Smith","doi":"10.1136/bmjstel-2020-aspihconf.91","DOIUrl":"https://doi.org/10.1136/bmjstel-2020-aspihconf.91","url":null,"abstract":"Introduction Failings in human factors, is the most common cause of adverse incidents in healthcare. Ineffective hand-off communication is recognised as a critical patient safety problem; an estimated 80% of serious medical errors involve miscommunication between caregivers during the transfer of patients. There is no ‘one thing’ that will address human factor failings- its multi-factorial with multiple interventions. The ‘Gamification for Human Factors’ project deploys the application of gamification approach to human factor learning and skills in health and social care. Gamification in training is the process of applying gaming designs and concepts in order to make learning processes more engaging, entertaining and interactive. The game mechanics, story, and media act as reinforcements to learning goals. The aim of the project is to extend the reach of access of Human Factor training. The Game is accessible by App via mobile phone devices. Method Quality Improvement and Agile design methodologies have been adopted; along with multi-disciplinary team input. Phase 1 of the project - the development of the gamification strategy, requirements specification, characters and stories which form the basis of the design; was carried out in partnership between the Northern Health and Social Care Trust and the University of Ulster. Phase 2 is the conversion of the initial development work into an App suitable for commercial release. Main Themes: Majuri et al. (2018) review of 128 empirical research papers focussed on the application of gamification to assist with education and learning. The most common gamification elements found in these studies was achievement and progression - designed to allow users to track their progress and improve upon their previous performance. Discussion The Gamification for Human Factors App is based around the journey of a patient and his interactions with the health and care system. As ‘gamers’ travel through the different levels of the game, they complete ‘missions’ and follow the patient9s experience. As the patient journey unfolds it exposes ‘gamers’ to learning centred around DuPont’s Dirty Dozen – the 12 most common human factor elements which degrade a person’s ability for them to perform effectively and safely, leading to errors. To progress to each new mission ‘gamers’ must answer a series of questions, testing knowledge and reinforcing their learning of human factors. On completion of missions ‘gamers’ are awarded badges and rewards – increasing motivation to learn. The App also provides links to additional learning resources and useful human factor references. References Joint Commission on Accreditation of Healthcare Organisations, August 2020, Volume 3, Issue 8. Joint Commission Perspectives Majuri, et al., 2018. Gamification of Education and Learning: A Review of Empirical Literature.","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"138 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77447930","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.22
M. Aldridge, B. Gupta, C. Dowse
Background Airway management during emergency obstetric anaesthesia is associated with higher rates of difficulty and failed intubation.1 This occurs in a high-intensity team setting and involves multiple professional groups. Although team training is used successfully for other obstetric scenarios, this does not commonly cover airway emergencies.2 We aimed to introduce regular simulation-based multiprofessional training at University Hospitals Bristol and Weston NHS Foundation Trust specifically designed to encourage team working during airway emergencies in obstetrics. In particular we aimed to identify and reduce the impact of latent safety threats by using in-situ simulation. Summary of Work We identified regular 45-minute sessions to fit with existing staff training to allow attendance by multiple professions when theatre usage was minimal. Obstetricians, midwives, theatre practitioners and anaesthetists were invited to attend, and the sessions were held in the emergency obstetric theatres. The simulated scenario involved both ‘Can’t Intubate Can Oxygenate’ and ‘Can’t Intubate Can’t Oxygenate’ events during an emergency caesarean section, culminating in scalpel cricothyroidotomy on an improvised front-of-neck trainer. The scenario was specifically designed to involve multiple professional groups, with an emphasis on good teamworking and communication which was further developed through post-simulation debriefing. Summary of Results Over 2 pilot sessions there were 10 participants from the multiple professional groups and feedback was positive. In particular non-anaesthetists commented on the benefits of simulating an airway emergency they were otherwise unfamiliar with. Specific areas for discussion included the importance of making team-based decisions in advance regarding failed airway management (i.e. proceed vs. abandon procedure), and the importance of good visibility of the emergency intubation checklist and protocols in the obstetric theatres. This has led to relevant cognitive aids being attached to the video laryngoscopes used in airway emergencies. Discussion and Conclusions Multiprofessional obstetric airway training appears to be well received and beneficial to all participants. In particular our sessions benefited from the in-situ setting and input from multiple professional groups. We have written a training pack designed to allow easy replication of this session, and intend to run this on a regular basis. Materials have been designed to support facilitation by individuals less experienced in simulation-based education, and we hope to empower others from multiple professional groups to deliver this in future. Recommendations Similar training should form an essential component of wider obstetric team training, and could be facilitated by any member of the multiprofessional team with appropriate support and experience. References Cook TM, Woodall N, Frerk C. A national survey of the impact of NAP4 on airway management practice in
背景:急诊产科麻醉期间气道管理与较高的插管困难率和插管失败率相关这发生在高强度的团队环境中，涉及多个专业团体。虽然团队训练成功地用于其他产科情况，但这通常不包括气道紧急情况我们的目标是在布里斯托尔大学医院和韦斯顿NHS基金会信托基金引入定期的基于模拟的多专业培训，专门设计用于鼓励在产科气道紧急情况下的团队合作。特别是，我们旨在通过现场模拟来识别和减少潜在安全威胁的影响。我们确定了定期45分钟的会议，以适应现有的员工培训，以便在剧院使用最少的情况下允许多种专业人员出席。邀请产科医生、助产士、手术室从业人员和麻醉师参加，课程在产科急诊病房举行。模拟的场景包括紧急剖腹产过程中的“无法插管，无法充氧”和“无法插管，无法充氧”事件，最终在临时的前颈部训练器上进行了环甲状软骨切开术。该方案是专门为涉及多个专业小组而设计的，重点是良好的团队合作和沟通，并通过模拟后的汇报进一步发展。在两次试点会议中，来自多个专业团体的10名参与者得到了积极的反馈。特别是非麻醉师评论了模拟气道紧急情况的好处，否则他们不熟悉。讨论的具体领域包括对气道管理失败(即继续或放弃程序)提前作出基于团队的决定的重要性，以及产科手术室急诊插管检查表和规程的良好可视性的重要性。这导致了相关的认知辅助装置被附加到用于气道紧急情况的视频喉镜上。讨论与结论:多专业产科气道培训似乎很受欢迎，对所有参与者都有益。特别是我们的会议受益于现场设置和来自多个专业团体的投入。我们已经编写了一个培训包，旨在方便地复制这个会议，并打算定期运行它。材料的设计是为了支持那些在模拟教育方面经验不足的个人，我们希望将来能够授权来自多个专业团体的其他人来提供这一服务。类似的培训应成为更广泛的产科小组培训的一个重要组成部分，并可由具有适当支持和经验的多专业小组的任何成员提供便利。Cook TM, Woodall N, Frerk C.一项关于NAP4对英国医院气道管理实践影响的全国性调查:缩小麻醉、重症监护和急诊科的安全差距。中华麻醉学杂志，2016;17(2):182-90。刘建军，刘建军，刘建军，编辑。提示课程手册。剑桥大学出版社;2017年10月19日。
{"title":"PP2 Multiprofessional airway training: a crucial component of safe teamworking in obstetrics","authors":"M. Aldridge, B. Gupta, C. Dowse","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.22","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.22","url":null,"abstract":"Background Airway management during emergency obstetric anaesthesia is associated with higher rates of difficulty and failed intubation.1 This occurs in a high-intensity team setting and involves multiple professional groups. Although team training is used successfully for other obstetric scenarios, this does not commonly cover airway emergencies.2 We aimed to introduce regular simulation-based multiprofessional training at University Hospitals Bristol and Weston NHS Foundation Trust specifically designed to encourage team working during airway emergencies in obstetrics. In particular we aimed to identify and reduce the impact of latent safety threats by using in-situ simulation. Summary of Work We identified regular 45-minute sessions to fit with existing staff training to allow attendance by multiple professions when theatre usage was minimal. Obstetricians, midwives, theatre practitioners and anaesthetists were invited to attend, and the sessions were held in the emergency obstetric theatres. The simulated scenario involved both ‘Can’t Intubate Can Oxygenate’ and ‘Can’t Intubate Can’t Oxygenate’ events during an emergency caesarean section, culminating in scalpel cricothyroidotomy on an improvised front-of-neck trainer. The scenario was specifically designed to involve multiple professional groups, with an emphasis on good teamworking and communication which was further developed through post-simulation debriefing. Summary of Results Over 2 pilot sessions there were 10 participants from the multiple professional groups and feedback was positive. In particular non-anaesthetists commented on the benefits of simulating an airway emergency they were otherwise unfamiliar with. Specific areas for discussion included the importance of making team-based decisions in advance regarding failed airway management (i.e. proceed vs. abandon procedure), and the importance of good visibility of the emergency intubation checklist and protocols in the obstetric theatres. This has led to relevant cognitive aids being attached to the video laryngoscopes used in airway emergencies. Discussion and Conclusions Multiprofessional obstetric airway training appears to be well received and beneficial to all participants. In particular our sessions benefited from the in-situ setting and input from multiple professional groups. We have written a training pack designed to allow easy replication of this session, and intend to run this on a regular basis. Materials have been designed to support facilitation by individuals less experienced in simulation-based education, and we hope to empower others from multiple professional groups to deliver this in future. Recommendations Similar training should form an essential component of wider obstetric team training, and could be facilitated by any member of the multiprofessional team with appropriate support and experience. References Cook TM, Woodall N, Frerk C. A national survey of the impact of NAP4 on airway management practice in","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":"87558410","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.34
Daniel Kostić, N. Kaushal, Phil Gurnett, Lauren Philpott, L. Moore
Background The Transgender Equality report found that transgender people encounter significant problems in using NHS services, due to staff attitudes and their lack of knowledge and understanding.1 Equality legislation in the UK prohibits discrimination of individuals based on their gender identity and yet the NHS is not ensuring zero tolerance of transphobic behaviour.1 2 Therefore it is vital that we fill this gap in educating healthcare professionals on responding to the needs of patients who identify as transgender. Summary of Work A survey was sent out to all staff at Darent Valley Hospital (DVH) in June 2020 enquiring about their experiences with the transgender community. The authors of this paper received LGBTQ+ basic awareness training. Following this, we created a transgender simulation scenario in which the transgender woman who hasn’t fully transitioned presents with signs and symptoms of testicular torsion. The scenario was firstly run for Foundation Year 1 doctors in our simulation suite, and then run in our Emergency Department as an in-situ simulation for the Emergency Department staff. Both verbal and written feedback was collected from the simulation sessions. Summary of Results 57 staff responded to the survey, with 41 of them (72%) stating that they had previous experience with treating transgender patients. 79% of the participants said that they had never had any teaching about transgender awareness in a medical context, or had accessed any e-learning modules on the subject. The simulation was well received and comments included ‘the scenario was really useful to highlight the differences in medical problems transgender people may face due to the medications they may be taking’, and ‘it is really important for junior doctors to experience working with transgender people to ensure they are aware of how important it is to make the patient comfortable’. Discussion and Conclusions Our results showed that many of the staff at DVH had experience with transgender patients but most of them had never had any sort of education on how best to care for them and meet their specific needs. The feedback from our simulation scenarios was overwhelmingly positive, and showed that there is clearly an appetite for education on transgender issues and this has been neglected somewhat by the NHS so far. Reference House of Commons Women and Equalities Committee ( 2016). Transgender equality: First report of session 2015-2016, London: The Stationery Office (HC390). Available at www.publications.parliament.uk/pa/cm201516/cmselect/cmwomeq/390/39003.htm#_idTextAnchor216 (Last accessed 13/07/20) UK Government ( 2010). Equality Act. Available at: http://www.legislation.gov.uk/ukpga/2010/15/contents (Last accessed 13/07/20)
{"title":"PP15 Can simulation fill the gap in transgender medical education for healthcare professionals?","authors":"Daniel Kostić, N. Kaushal, Phil Gurnett, Lauren Philpott, L. Moore","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.34","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.34","url":null,"abstract":"Background The Transgender Equality report found that transgender people encounter significant problems in using NHS services, due to staff attitudes and their lack of knowledge and understanding.1 Equality legislation in the UK prohibits discrimination of individuals based on their gender identity and yet the NHS is not ensuring zero tolerance of transphobic behaviour.1 2 Therefore it is vital that we fill this gap in educating healthcare professionals on responding to the needs of patients who identify as transgender. Summary of Work A survey was sent out to all staff at Darent Valley Hospital (DVH) in June 2020 enquiring about their experiences with the transgender community. The authors of this paper received LGBTQ+ basic awareness training. Following this, we created a transgender simulation scenario in which the transgender woman who hasn’t fully transitioned presents with signs and symptoms of testicular torsion. The scenario was firstly run for Foundation Year 1 doctors in our simulation suite, and then run in our Emergency Department as an in-situ simulation for the Emergency Department staff. Both verbal and written feedback was collected from the simulation sessions. Summary of Results 57 staff responded to the survey, with 41 of them (72%) stating that they had previous experience with treating transgender patients. 79% of the participants said that they had never had any teaching about transgender awareness in a medical context, or had accessed any e-learning modules on the subject. The simulation was well received and comments included ‘the scenario was really useful to highlight the differences in medical problems transgender people may face due to the medications they may be taking’, and ‘it is really important for junior doctors to experience working with transgender people to ensure they are aware of how important it is to make the patient comfortable’. Discussion and Conclusions Our results showed that many of the staff at DVH had experience with transgender patients but most of them had never had any sort of education on how best to care for them and meet their specific needs. The feedback from our simulation scenarios was overwhelmingly positive, and showed that there is clearly an appetite for education on transgender issues and this has been neglected somewhat by the NHS so far. Reference House of Commons Women and Equalities Committee ( 2016). Transgender equality: First report of session 2015-2016, London: The Stationery Office (HC390). Available at www.publications.parliament.uk/pa/cm201516/cmselect/cmwomeq/390/39003.htm#_idTextAnchor216 (Last accessed 13/07/20) UK Government ( 2010). Equality Act. Available at: http://www.legislation.gov.uk/ukpga/2010/15/contents (Last accessed 13/07/20)","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"20 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87710039","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.3
E. Wooding, T. Gale, V. Maynard
Introduction/Background Teamwork training for acute healthcare professionals is a recognised priority for risk reduction associated with improved team performance and improved clinical outcomes for patients.1The Team Emergency Assessment Measure (TEAM) is validated as an objective teamwork rating tool for real-life resuscitations, where teamwork is scored across multiple domains using observed behaviours and scored with an overall impression of teamwork performance using a global rating scale.2 The literature suggests a gap for comparing participant self-rating in interprofessional simulation with multiple external rater scores.3 Methods Validity evidence supporting the use of TEAM to assess self- and external rating of teamwork in 15 interdisciplinary paediatric in situ simulations was evaluated. 77 healthcare professionals were recruited across multiple disciplines in 2 hospitals. Using TEAM, participants self-rated their team’s performance in simulation scenarios contemporaneously; two external raters also retrospectively rated all simulations. Interrater reliability, internal consistency of the instrument, intraclass correlation coefficients, effect and generalisability analysis were calculated, and feedback was collated from all raters to explore feasibility. Results Older participant raters gave higher total TEAM scores (P=0.001), as did nurses over doctors (P=0.05). Linear modelling demonstrated that the association between participant rater age and score given was cumulative. Good correlation was noted between the total TEAM score and the Global Score for participant and external raters. The total TEAM score demonstrated superior intraclass correlation coefficient for external raters compared to the global score. There was moderate agreement between external and participant raters which was significant (P Discussion, Conclusions and Recommendations The TEAM tool is a reliable self-rating tool for multiple raters in paediatric interprofessional teams, where it is used by at least 6 external raters or 9 or more self-raters. Nurses and older participants rate team performance more highly. The TEAM tool demonstrated good or very good internal consistency across the majority of items and the TEAM total score was the more reliable measure, rather than the Global Rating Score. It is best suited for formative feedback to support team development. Further research to establish its suitability for self-rating of team performance in the clinical environment, or amongst smaller teams is warranted. References Siassakos D, Bristowe K, Draycott TJ, Angouri J, Hambly H, Winter C, et al. Clinical efficiency in a simulated emergency and relationship to team behaviours: A multisite cross-sectional study. BJOG: An International Journal of Obstetrics and Gynaecology 2011;118(5):pp. 596–607. doi: 10.1111/j.1471-0528.2010.02843.x. Cooper S, Cant R, Connell C, Sims L, Porter JE, Symmons M, et al. Measuring teamwork performance: validity testing of the team emerg
{"title":"O3 Reliability and feasibility of the team emergency assessment measure (TEAM) for self- and external rating of teamwork in paediatric interprofessional simulation","authors":"E. Wooding, T. Gale, V. Maynard","doi":"10.1136/BMJSTEL-2020-ASPIHCONF.3","DOIUrl":"https://doi.org/10.1136/BMJSTEL-2020-ASPIHCONF.3","url":null,"abstract":"Introduction/Background Teamwork training for acute healthcare professionals is a recognised priority for risk reduction associated with improved team performance and improved clinical outcomes for patients.1The Team Emergency Assessment Measure (TEAM) is validated as an objective teamwork rating tool for real-life resuscitations, where teamwork is scored across multiple domains using observed behaviours and scored with an overall impression of teamwork performance using a global rating scale.2 The literature suggests a gap for comparing participant self-rating in interprofessional simulation with multiple external rater scores.3 Methods Validity evidence supporting the use of TEAM to assess self- and external rating of teamwork in 15 interdisciplinary paediatric in situ simulations was evaluated. 77 healthcare professionals were recruited across multiple disciplines in 2 hospitals. Using TEAM, participants self-rated their team’s performance in simulation scenarios contemporaneously; two external raters also retrospectively rated all simulations. Interrater reliability, internal consistency of the instrument, intraclass correlation coefficients, effect and generalisability analysis were calculated, and feedback was collated from all raters to explore feasibility. Results Older participant raters gave higher total TEAM scores (P=0.001), as did nurses over doctors (P=0.05). Linear modelling demonstrated that the association between participant rater age and score given was cumulative. Good correlation was noted between the total TEAM score and the Global Score for participant and external raters. The total TEAM score demonstrated superior intraclass correlation coefficient for external raters compared to the global score. There was moderate agreement between external and participant raters which was significant (P Discussion, Conclusions and Recommendations The TEAM tool is a reliable self-rating tool for multiple raters in paediatric interprofessional teams, where it is used by at least 6 external raters or 9 or more self-raters. Nurses and older participants rate team performance more highly. The TEAM tool demonstrated good or very good internal consistency across the majority of items and the TEAM total score was the more reliable measure, rather than the Global Rating Score. It is best suited for formative feedback to support team development. Further research to establish its suitability for self-rating of team performance in the clinical environment, or amongst smaller teams is warranted. References Siassakos D, Bristowe K, Draycott TJ, Angouri J, Hambly H, Winter C, et al. Clinical efficiency in a simulated emergency and relationship to team behaviours: A multisite cross-sectional study. BJOG: An International Journal of Obstetrics and Gynaecology 2011;118(5):pp. 596–607. doi: 10.1111/j.1471-0528.2010.02843.x. Cooper S, Cant R, Connell C, Sims L, Porter JE, Symmons M, et al. Measuring teamwork performance: validity testing of the team emerg","PeriodicalId":44757,"journal":{"name":"BMJ Simulation & Technology Enhanced Learning","volume":"62 1","pages":""},"PeriodicalIF":1.1,"publicationDate":"2020-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91152372","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.25
Ciaran Walsh, Tobias Chanin, D. Wise, Timothy Parr, Hannah Davis, S. Mercer
Background The recognition and management of acutely unwell patients is a major cause of anxiety for newly qualified medical professionals.1 Nurses and Junior Doctors are often first responders to deteriorating patients and as such it is critically important, they are equipped with the appropriate skills and knowledge to assess, treat, and escalate patients in a safe and structured manner. Previously work within our institution2 has indicated improved confidence to manage deteriorating patients, amongst doctors, through high fidelity simulation training. We describe a one day fully immersive high-fidelity simulation course designed to practice the management of the deteriorating patient. Summary of Work Candidates undertook six scenarios, themed around NHS England never events and local trust serious untoward incidents (SUI’s), in the context of the deteriorating patient. These were based in a high-fidelity simulation centre reproduced as a monitored bay on an Acute Medical Unit, with non-participating delegates spectating each scenario via live stream. A video assisted debrief followed each scenario led by a human factors’ expert. Candidates completed a pre and post course questionnaire. An unpaired (two-tail) t-test was used to analyse quantitative measurements from participant confidence scores and free text responses were assessed using thematic analysis. Summary of results Our course was undertaken by 98 candidates (51 nurses and 31 doctors) and 86 (87.8%) completed a post-course questionnaire. There were statistically significant differences in confidence scores before and after the course in leadership, assessment of acutely unwell patients, management and situational awareness. Thematic analysis indicated course strengths including: utilising a multidisciplinary delegate approach, realism & variety of scenarios undertaken & reinforcement of knowledge and safe clinical practice through the debriefing process, with subject matter experts. Discussion and Conclusions; Recommendations Theming scenarios around never events and SUI’s promotes education & learning from historical error. Our one day fully immersive high-fidelity simulation course demonstrated a perceived improvement in confidence in assessing acutely unwell patients and in assuming a leadership role within the clinical team as well as handover of care. The course demonstrated perceived improvements in key non-technical skills such as situational awareness, management and teamworking skills of particular importance for first responders to deteriorating patients in a ward setting. This adaptive course recommends and actively encourages learning from historical error, by theming scenarios around never events and SUI’s, in order to reduce risk of future recurrence to promote increased patient safety. References Monrouxe LV, Bullock A, Gormley G, Kaufhold K, Kelly N, Roberts CE, et al. New graduate doctors’ preparedness for practice: a multistakeholder, multicentre narrative study. BMJ
背景对急性不适患者的识别和处理是新入职医务人员焦虑的主要原因护士和初级医生通常是病情恶化患者的第一反应者，因此，他们具备适当的技能和知识，以安全和有组织的方式评估、治疗和升级患者，这一点至关重要。我们机构之前的工作表明，通过高保真模拟培训，医生对管理病情恶化的病人的信心有所提高。我们描述了一个为期一天的完全沉浸式高保真模拟课程，旨在实践对恶化患者的管理。候选人承担了六个场景，主题围绕NHS英格兰从未事件和当地信任的严重不幸事件(SUI)，在恶化的病人的背景下。这些模拟是在一个高保真模拟中心进行的，作为一个急症医疗单位的监测舱进行复制，未参加的代表通过直播观看每个场景。在人为因素专家的带领下，每个场景都有视频辅助汇报。考生完成了课前和课后问卷调查。非配对(双尾)t检验用于分析参与者信心得分的定量测量，并使用主题分析评估自由文本回复。98名学员(51名护士，31名医生)参加了本课程，86名学员(87.8%)完成了课程后问卷调查。课程前后在领导力、急性不适患者评估、管理和情境感知方面的信心得分差异有统计学意义。专题分析表明课程的优势包括:利用多学科代表方法，现实主义和各种场景，通过与主题专家的汇报过程加强知识和安全的临床实践。讨论与结论;围绕从未发生过的事件和SUI的主题场景促进了教育和从历史错误中学习。我们为期一天的完全沉浸式高保真模拟课程展示了在评估急性不适患者和在临床团队中担任领导角色以及护理交接方面的信心的明显改善。该课程展示了关键非技术技能的明显改善，如态势感知、管理和团队合作技能，这些技能对病房环境中病情恶化的患者的急救人员尤其重要。本适应性课程建议并积极鼓励从历史错误中学习，通过围绕从未发生的事件和SUI的主题场景，以减少未来复发的风险，从而提高患者的安全性。参考文献Monrouxe LV, Bullock A, Gormley G, Kaufhold K, Kelly N, Roberts CE，等。新毕业医生的实践准备:一个多利益相关者、多中心的叙事研究。2018年BMJ公开赛;8: e023146。Taylor J, Mercer SJ。完全沉浸式模拟提高了初级医疗和护理人员处理气管切开术紧急情况的信心。欧洲麻醉学杂志2016;33 (eS54): 486。
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