Recognizing and managing a deteriorating patient, in any setting, can be a challenging and distressing event for health care providers (HCPs). End of life care is a core component of nursing and medical education, yet historically has received minimal focus. Simulation Based Education (SBE) has been shown to be an effective tool for enhancing HCPs competence and confidence when involved with complex clinical scenarios and advocating patient-centred care [1]. The national drive to increase recognition and provision of timely, individualized end of life care is catalysing the need for multidisciplinary team education [2] [3]. To design, deliver and modify SBE programme to enhance quality of patient care as they deteriorate. SBE will be utilized to achieve this by increasing both confidence and competence of a cohesive multidisciplinary team when involved in the care of deteriorating patients. Three SBE study days are held each year which are booked through an online portal. The sessions are facilitated by HCPs from intensive care, palliative medicine, and the practice development team. A handbook outlining SBE scenarios and learning objectives is distributed in advance, this pre-brief allows learners to prepare and understand the format of the day. The teaching day is structured with three clinical scenarios following a patient through different stages of their illness: initially an acute assessment and escalation, leading to consideration of individual treatment escalation plans and ultimately their end-of-life care. Learning through simulation is multifaceted through evidence-based role play, with observers as learners and collective debriefing through facilitated feedback after every scenario. Online feedback provided by all learners has been collated throughout the four-year course development process. Evaluations revealed three main themes; learners valued SBE in terms of replicating practice, de-briefing discussions consolidated learning and enabled learners the opportunity to understand how it will improve their practice and value was placed on multidisciplinary team learning. SBE is an effective method of enhancing the quality of individualized and coordinated care delivered to a deteriorating patient in any setting by HCPs. As an effective tool it also stands aligned with the national drive to improve recognition of patients at the end of their life with proactive advance care planning discussions and holistic care for the dying and their families. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.
{"title":"A63 The use of simulation based education (SBE) to improve recognition and management of patients in the transition from acute to end of life care","authors":"Jane Brundish, Genevieve Russell","doi":"10.54531/qqyx4473","DOIUrl":"https://doi.org/10.54531/qqyx4473","url":null,"abstract":"Recognizing and managing a deteriorating patient, in any setting, can be a challenging and distressing event for health care providers (HCPs). End of life care is a core component of nursing and medical education, yet historically has received minimal focus. Simulation Based Education (SBE) has been shown to be an effective tool for enhancing HCPs competence and confidence when involved with complex clinical scenarios and advocating patient-centred care [1]. The national drive to increase recognition and provision of timely, individualized end of life care is catalysing the need for multidisciplinary team education [2] [3]. To design, deliver and modify SBE programme to enhance quality of patient care as they deteriorate. SBE will be utilized to achieve this by increasing both confidence and competence of a cohesive multidisciplinary team when involved in the care of deteriorating patients. Three SBE study days are held each year which are booked through an online portal. The sessions are facilitated by HCPs from intensive care, palliative medicine, and the practice development team. A handbook outlining SBE scenarios and learning objectives is distributed in advance, this pre-brief allows learners to prepare and understand the format of the day. The teaching day is structured with three clinical scenarios following a patient through different stages of their illness: initially an acute assessment and escalation, leading to consideration of individual treatment escalation plans and ultimately their end-of-life care. Learning through simulation is multifaceted through evidence-based role play, with observers as learners and collective debriefing through facilitated feedback after every scenario. Online feedback provided by all learners has been collated throughout the four-year course development process. Evaluations revealed three main themes; learners valued SBE in terms of replicating practice, de-briefing discussions consolidated learning and enabled learners the opportunity to understand how it will improve their practice and value was placed on multidisciplinary team learning. SBE is an effective method of enhancing the quality of individualized and coordinated care delivered to a deteriorating patient in any setting by HCPs. As an effective tool it also stands aligned with the national drive to improve recognition of patients at the end of their life with proactive advance care planning discussions and holistic care for the dying and their families. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.","PeriodicalId":93766,"journal":{"name":"International journal of healthcare simulation : advances in theory and practice","volume":"2000 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135813636","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}
Simulation is integral to the recovery of surgical training in the UK after the COVID pandemic. Physical constraints on traditional simulation training can affect access. We sought to understand if cardiac and thoracic simulation training remotely is feasible and effective. It has been demonstrated in other settings and has potential in the surgical setting [1]. We completed simulation training sessions using the Teams and Zoom online platforms with single one on one and group simulation training sessions covering Video-assisted-thoracoscopic-surgery wedge resections and lobectomy as well as coronary anastomosis. We had 15 participants in the thoracic arm and 5 participants over 4 sessions in the cardiac arm. All participants found the remote simulation training useful and improved their confidence in surgical skill. We did not have any technical connection difficulties during sessions but challenges for simulation in this format included standardizing the equipment and setup pre-sessions. Participants found in 89% of cases that feedback on performance was superior to face to face simulation and/or surgical theatre experience. Remote simulation is feasible and effective in cardiothoracic surgery in our pilot study. Further studies are needed to better clarify who this resource should be targeted at included experience of trainees and level of competence. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.
{"title":"A68 Remote Simulation in Cardiothoracic Surgery","authors":"Abdul Badran, Aiman Alzetani","doi":"10.54531/dmmo7757","DOIUrl":"https://doi.org/10.54531/dmmo7757","url":null,"abstract":"Simulation is integral to the recovery of surgical training in the UK after the COVID pandemic. Physical constraints on traditional simulation training can affect access. We sought to understand if cardiac and thoracic simulation training remotely is feasible and effective. It has been demonstrated in other settings and has potential in the surgical setting [1]. We completed simulation training sessions using the Teams and Zoom online platforms with single one on one and group simulation training sessions covering Video-assisted-thoracoscopic-surgery wedge resections and lobectomy as well as coronary anastomosis. We had 15 participants in the thoracic arm and 5 participants over 4 sessions in the cardiac arm. All participants found the remote simulation training useful and improved their confidence in surgical skill. We did not have any technical connection difficulties during sessions but challenges for simulation in this format included standardizing the equipment and setup pre-sessions. Participants found in 89% of cases that feedback on performance was superior to face to face simulation and/or surgical theatre experience. Remote simulation is feasible and effective in cardiothoracic surgery in our pilot study. Further studies are needed to better clarify who this resource should be targeted at included experience of trainees and level of competence. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.","PeriodicalId":93766,"journal":{"name":"International journal of healthcare simulation : advances in theory and practice","volume":"55 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135869283","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}
Amy Huggin, Deepta Churm, Lucy Robinson, Laura Massey, Owain Leng
Simulation as a learning platform is recognized internationally as beneficial in terms of education, training and assessment of doctors [1,2]. This study aimed to introduce and evaluate a novel Palliative Medicine simulation session as a tool for Foundation Year 2 (FY2) doctors to gain competency and confidence in the assessment and management of life-limiting illness. We designed the palliative care (PC) simulation session based on the FY2 curriculum. The three scenarios involved management of opioid toxicity, breaking bad news and shared decision-making with a role-play patient with a gastrointestinal bleed. Session faculty included a mix of healthcare professionals, but always included a PC specialist. We evaluated the session using a pre- and post-session questionnaire collecting data using 5-point Likert scales and free-text comments. We analysed qualitative data using content analysis. Researcher and methodological triangulation increased the credibility of the findings. The three prevalent themes noted from the pre-content analysis were Communication, Prognostication and the Process of complex decision-making. Comments such as ‘Senior colleagues hesitant to have escalation discussions’ and ‘I find it difficult when the patient has a very different idea of how poorly they are’ were examples of quotes given by candidates as pre-session challenges. 95.6% of our candidates felt that the session addressed these challenges, mainly through the debrief process. The main learning points articulated were in relation to prescribing and communication skills. Candidates expressed the importance of ‘picking up communication techniques and phrases’. The debrief was the most highly valued, and frequently mentioned positive element of the content analysis. ‘Open discussions’ was mentioned on numerous occasions, ‘I felt comfortable asking questions’ and ‘Discussion after SIM was very useful’, all support the importance of skilled debrief. FY2 doctors identified communication as their biggest concern when managing Palliative Care patients. Our session addressed this through open and frank debrief discussion. This allowed reflection on previous experience and peer-to-peer learning of key vocabulary when talking to patients with a limited prognosis. Further qualitative evaluation of the impact of this session on clinical practice and how peer learning could be incorporated into day-to-day skills development on the wards would be of value. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.
{"title":"A16 ‘Not being afraid of saying dying’: sharing key vocabulary for palliative care discussions through simulation debrief","authors":"Amy Huggin, Deepta Churm, Lucy Robinson, Laura Massey, Owain Leng","doi":"10.54531/lwvr1443","DOIUrl":"https://doi.org/10.54531/lwvr1443","url":null,"abstract":"Simulation as a learning platform is recognized internationally as beneficial in terms of education, training and assessment of doctors [1,2]. This study aimed to introduce and evaluate a novel Palliative Medicine simulation session as a tool for Foundation Year 2 (FY2) doctors to gain competency and confidence in the assessment and management of life-limiting illness. We designed the palliative care (PC) simulation session based on the FY2 curriculum. The three scenarios involved management of opioid toxicity, breaking bad news and shared decision-making with a role-play patient with a gastrointestinal bleed. Session faculty included a mix of healthcare professionals, but always included a PC specialist. We evaluated the session using a pre- and post-session questionnaire collecting data using 5-point Likert scales and free-text comments. We analysed qualitative data using content analysis. Researcher and methodological triangulation increased the credibility of the findings. The three prevalent themes noted from the pre-content analysis were Communication, Prognostication and the Process of complex decision-making. Comments such as ‘Senior colleagues hesitant to have escalation discussions’ and ‘I find it difficult when the patient has a very different idea of how poorly they are’ were examples of quotes given by candidates as pre-session challenges. 95.6% of our candidates felt that the session addressed these challenges, mainly through the debrief process. The main learning points articulated were in relation to prescribing and communication skills. Candidates expressed the importance of ‘picking up communication techniques and phrases’. The debrief was the most highly valued, and frequently mentioned positive element of the content analysis. ‘Open discussions’ was mentioned on numerous occasions, ‘I felt comfortable asking questions’ and ‘Discussion after SIM was very useful’, all support the importance of skilled debrief. FY2 doctors identified communication as their biggest concern when managing Palliative Care patients. Our session addressed this through open and frank debrief discussion. This allowed reflection on previous experience and peer-to-peer learning of key vocabulary when talking to patients with a limited prognosis. Further qualitative evaluation of the impact of this session on clinical practice and how peer learning could be incorporated into day-to-day skills development on the wards would be of value. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.","PeriodicalId":93766,"journal":{"name":"International journal of healthcare simulation : advances in theory and practice","volume":"1 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135870031","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}
Registered healthcare professionals undertake a wide range of mental health work, sometimes with little preparation and training [1]. Increasingly non-registered staff take on mental health call-handler roles, having conversations with vulnerable individuals over the phone; these staff often lack the training to effectively communicate with callers. The aim of this initiative was to design and deliver a telephone skills training program for non-registered NHS mental health call-handlers, with the hypothesis that such training would improve their communication skills and overall job performance. Studies have shown that receiving training in having supportive mental health conversations over the phone increases staff confidence and changes their attitudes [2] and has the potential to benefit staff retention. A mixed-methods approach was used in the design, incorporating both qualitative and quantitative data collection and based on the needs and feedback of the call-handlers themselves. Evidence shows that involving simulated patients (SPs) can be effective in telephone studies [3]; leading us to train experienced SPs in their roles as members of the community phoning the help line. All was face to face, although conducted over the phone with the SP hidden. Active participants, the SP and the observing participants all became involved in the debrief. The content covered active listening, empathy, signposting and options in handling the challenging situations. Developed over a month, the programme was delivered as part of an overall training for their roles. The evaluation of the session indicated significant self-rated confidence in having calls with members of the public. The scenarios increased in intensity, covering topics ranging from bullying, domestic violence, gambling addiction and intent to take life. Qualitative feedback from the call-handlers showed that they felt more confident and prepared in their roles, and were better equipped to handle challenging situations. The involvement of SPs was also found to be authentic and highly beneficial by the call-handlers. Participants requested frequent practice sessions, face to face or online. Investing in providing targeted training and support for non-registered NHS mental health call-handlers, can have a positive impact on their communication skills, overall job performance and likely staff retention. This can ultimately lead to improved quality of care and patient outcomes in the mental health sector. The involvement of SPs can provide a valuable learning experience, both in role and in the debrief, for call-handlers, and help to prepare them for real-life scenarios. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.
{"title":"A28 Developing and delivering a telephone skills simulation training for non-registered NHS mental health call-handlers","authors":"Anna Thame, Carrie Hamilton","doi":"10.54531/jciu3983","DOIUrl":"https://doi.org/10.54531/jciu3983","url":null,"abstract":"Registered healthcare professionals undertake a wide range of mental health work, sometimes with little preparation and training [1]. Increasingly non-registered staff take on mental health call-handler roles, having conversations with vulnerable individuals over the phone; these staff often lack the training to effectively communicate with callers. The aim of this initiative was to design and deliver a telephone skills training program for non-registered NHS mental health call-handlers, with the hypothesis that such training would improve their communication skills and overall job performance. Studies have shown that receiving training in having supportive mental health conversations over the phone increases staff confidence and changes their attitudes [2] and has the potential to benefit staff retention. A mixed-methods approach was used in the design, incorporating both qualitative and quantitative data collection and based on the needs and feedback of the call-handlers themselves. Evidence shows that involving simulated patients (SPs) can be effective in telephone studies [3]; leading us to train experienced SPs in their roles as members of the community phoning the help line. All was face to face, although conducted over the phone with the SP hidden. Active participants, the SP and the observing participants all became involved in the debrief. The content covered active listening, empathy, signposting and options in handling the challenging situations. Developed over a month, the programme was delivered as part of an overall training for their roles. The evaluation of the session indicated significant self-rated confidence in having calls with members of the public. The scenarios increased in intensity, covering topics ranging from bullying, domestic violence, gambling addiction and intent to take life. Qualitative feedback from the call-handlers showed that they felt more confident and prepared in their roles, and were better equipped to handle challenging situations. The involvement of SPs was also found to be authentic and highly beneficial by the call-handlers. Participants requested frequent practice sessions, face to face or online. Investing in providing targeted training and support for non-registered NHS mental health call-handlers, can have a positive impact on their communication skills, overall job performance and likely staff retention. This can ultimately lead to improved quality of care and patient outcomes in the mental health sector. The involvement of SPs can provide a valuable learning experience, both in role and in the debrief, for call-handlers, and help to prepare them for real-life scenarios. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.","PeriodicalId":93766,"journal":{"name":"International journal of healthcare simulation : advances in theory and practice","volume":"101 18","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135870037","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}
Within health care provision many case history assessments are now performed online [1], with students expected to utilize a variety of virtual platforms in a safe, effective and professional manner. Aim: To approximate a real environment for students to practice virtual skills of case history assessment with service users. Objectives: Student development of: 1. Virtual communication skills (verbal, non-verbal, active listening, respect), 2. Clinical reasoning and interpretation, and 3. Reflective skills facilitated by debrief. Simulation preparation including revision of musculoskeletal assessment and familiarization with virtual ground rules linked to HCPC Guidance on Conduct and Ethics [2]. 42 students participated, split into groups of 14 for each virtual simulation session with a total of 5 service users briefed beforehand. Initial warm-up activities in breakout rooms were used to familiarize students with use of the online platform and to facilitate virtual communication skills. Groups of 4 students planned and undertook a virtual musculoskeletal case history with a service user. The Diamond structure for simulation debrief [3] was facilitated by Faculty staff involving the service users and peers; enabling further development of the students’ clinical reasoning and interpretation. Students reflected on their own performance using a simulation checklist as a resource, closing the loop by creating an action plan prior to their first practice placement. 25 students voluntarily completed an anonymous questionnaire linked to their virtual experiential learning activity. 75% strongly agreed and 21% agreed that the simulation was helpful in their development for placements (see Graph to show student response that virtual musculoskeletal simulation with service users was helpful in their development for placements Thematic analysis of good aspects of the activity identified 4 main themes: Benefits and realism of service user involvement compared to actors or peers Development of virtual communication and assessment skills Richness of involvement of service users in the debrief Usefulness of warm up activities using virtual technology Suggestions for improvement showed 2 main themes around increasing planning time and more opportunities for simulation with service users. Findings demonstrated the simulation aims and objectives were met with students positively reporting that the activity was helpful in their learning ahead of practice placements - enabling development of virtual communication, clinical reasoning/ interpretation and reflection through debrief. Approximation of a real environment for students to practice virtual case history assessment incorporating service users offers a rich educational example that aligns well with practice and sustainability in the current healthcare environment and is highly valued by students. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submittin
{"title":"A104 A virtual musculoskeletal case history simulation with service users for pre-registration physiotherapy students","authors":"Carol McNally, Katy Baines","doi":"10.54531/wzqj2908","DOIUrl":"https://doi.org/10.54531/wzqj2908","url":null,"abstract":"Within health care provision many case history assessments are now performed online [1], with students expected to utilize a variety of virtual platforms in a safe, effective and professional manner. Aim: To approximate a real environment for students to practice virtual skills of case history assessment with service users. Objectives: Student development of: 1. Virtual communication skills (verbal, non-verbal, active listening, respect), 2. Clinical reasoning and interpretation, and 3. Reflective skills facilitated by debrief. Simulation preparation including revision of musculoskeletal assessment and familiarization with virtual ground rules linked to HCPC Guidance on Conduct and Ethics [2]. 42 students participated, split into groups of 14 for each virtual simulation session with a total of 5 service users briefed beforehand. Initial warm-up activities in breakout rooms were used to familiarize students with use of the online platform and to facilitate virtual communication skills. Groups of 4 students planned and undertook a virtual musculoskeletal case history with a service user. The Diamond structure for simulation debrief [3] was facilitated by Faculty staff involving the service users and peers; enabling further development of the students’ clinical reasoning and interpretation. Students reflected on their own performance using a simulation checklist as a resource, closing the loop by creating an action plan prior to their first practice placement. 25 students voluntarily completed an anonymous questionnaire linked to their virtual experiential learning activity. 75% strongly agreed and 21% agreed that the simulation was helpful in their development for placements (see Graph to show student response that virtual musculoskeletal simulation with service users was helpful in their development for placements Thematic analysis of good aspects of the activity identified 4 main themes: Benefits and realism of service user involvement compared to actors or peers Development of virtual communication and assessment skills Richness of involvement of service users in the debrief Usefulness of warm up activities using virtual technology Suggestions for improvement showed 2 main themes around increasing planning time and more opportunities for simulation with service users. Findings demonstrated the simulation aims and objectives were met with students positively reporting that the activity was helpful in their learning ahead of practice placements - enabling development of virtual communication, clinical reasoning/ interpretation and reflection through debrief. Approximation of a real environment for students to practice virtual case history assessment incorporating service users offers a rich educational example that aligns well with practice and sustainability in the current healthcare environment and is highly valued by students. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submittin","PeriodicalId":93766,"journal":{"name":"International journal of healthcare simulation : advances in theory and practice","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135870273","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}
Advance Choice Documents (ACDs) are one of the important upcoming reforms to the Mental Health Act in the UK [1]. The aim of the document is to allow service users greater autonomy when they are well, to make decisions and guide what happens if they become unwell in the future. It is created by a service user and clinician in a shared decision-making process. Maudsley Learning (ML) collaborated with an Institute of Psychiatry, Psychology and Neuroscience research team to provide a co-produced simulation day for service users, carers and clinicians. The aim was for participants to be able to gain a greater understanding of how to co-produce and implement ACDs. ML ran two separate simulation days, alongside, members of the research team including a lawyer and facilitator with lived experience. The initial part of the day included didactic teaching; allowing participants to learn more about ACDs and have a space to ask questions from those with lived experience, clinicians and lawyers. This ensured participants gained a baseline level of knowledge to undertake the scenarios. There were four simulation scenarios written, but only three took place on both days because of limited time. These revolved around one patient; the participants followed the patient through their ACD journey. The patient was played by an actor. All scenarios were designed to involve a clinician, often with the presence of a carer and service user as well. The debrief consisted of a modified Pendleton model with feedback from service user, carers and clinicians to allow feedback and learning from all involved. Participants were asked to complete a pre-course and post-course questionnaire. Paired samples t-tests were conducted to analyse the difference between pre- and post-course questionnaires. Results demonstrated a significant difference in scores for course-specific questions between the pre (M = 3.17, SD = 0.81) and post (M = 4.21, SD = 0.20), t(5) = -5.26, p <.05, 95% CI [-1.55, -0.53], with a large effect size of d = -2.15. 100% of participants would recommend this course. This was the first simulation that ML has run with a mixed group of learners that included not only clinicians, but also service users and carers taking part in the simulation and debrief. The feedback was positive and helped to improve the knowledge around ACD’s. It was also noticeable the positive difference it made having clinicians, service users and carers learning from one another. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.
{"title":"A81 Advance Choice Documents: a Simulation for Service Users, Carers and Clinicians","authors":"Megan Fisher, Anita Bignell, Marcela Schilderman, Claire Henderson, Shubulade Smith, Abigail Babatunde, Selena Galloway, Mariola Ruiz","doi":"10.54531/ksgv4971","DOIUrl":"https://doi.org/10.54531/ksgv4971","url":null,"abstract":"Advance Choice Documents (ACDs) are one of the important upcoming reforms to the Mental Health Act in the UK [1]. The aim of the document is to allow service users greater autonomy when they are well, to make decisions and guide what happens if they become unwell in the future. It is created by a service user and clinician in a shared decision-making process.\u0000 Maudsley Learning (ML) collaborated with an Institute of Psychiatry, Psychology and Neuroscience research team to provide a co-produced simulation day for service users, carers and clinicians. The aim was for participants to be able to gain a greater understanding of how to co-produce and implement ACDs.\u0000 ML ran two separate simulation days, alongside, members of the research team including a lawyer and facilitator with lived experience.\u0000 The initial part of the day included didactic teaching; allowing participants to learn more about ACDs and have a space to ask questions from those with lived experience, clinicians and lawyers. This ensured participants gained a baseline level of knowledge to undertake the scenarios.\u0000 There were four simulation scenarios written, but only three took place on both days because of limited time. These revolved around one patient; the participants followed the patient through their ACD journey. The patient was played by an actor. All scenarios were designed to involve a clinician, often with the presence of a carer and service user as well.\u0000 The debrief consisted of a modified Pendleton model with feedback from service user, carers and clinicians to allow feedback and learning from all involved.\u0000 Participants were asked to complete a pre-course and post-course questionnaire. Paired samples t-tests were conducted to analyse the difference between pre- and post-course questionnaires. Results demonstrated a significant difference in scores for course-specific questions between the pre (M = 3.17, SD = 0.81) and post (M = 4.21, SD = 0.20), t(5) = -5.26, p <.05, 95% CI [-1.55, -0.53], with a large effect size of d = -2.15. 100% of participants would recommend this course.\u0000 This was the first simulation that ML has run with a mixed group of learners that included not only clinicians, but also service users and carers taking part in the simulation and debrief. The feedback was positive and helped to improve the knowledge around ACD’s. It was also noticeable the positive difference it made having clinicians, service users and carers learning from one another.\u0000 Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.","PeriodicalId":93766,"journal":{"name":"International journal of healthcare simulation : advances in theory and practice","volume":"37 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135870725","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}
There is a large backlog in surgery due to covid as well as surgical training [1]. We explored the feasibility of a dry lab simulation environment to teach advanced surgical specialty skills to learners with different levels of experience. Session description: We ran 5 cardiothoracic surgical simulation courses over 2021-2022 with a total of 61 delegates. We covered coronary anastomosis, aortic valve replacement, video-assisted-thoracoscopic-surgery (VATS) lung wedge resection and pulmonary vessel dissection. Each skill station ran for 40 minutes including a 15-minute description and real-time demo. Target audience: Participants included 36 medical students, 14 specialty doctors and 11 foundation doctors. We used synthetic plastinated and resin printed models with modular metal frames to help with retraction and suspension of the area of interest for the cardiac models. For the VATS models a laptop with connected angled endoscopic camera was utilized. The lung models were 3D printed. 88% of all participants were able to complete all procedures successfully under supervision. 96% of all participants increased in confidence with the procedure following simulation compared to before. Interestingly only 44% of specialty trainees described themselves as confident in some procedures prior to simulation. Of the medical student cohort 95% had not had any previous simulation or surgical experience prior. We have demonstrated the feasibility of a dry lab simulation programme for candidates of all experiences in cardiothoracic surgery. Confidence in surgical technique is low during the COVID era. Simulation improved confidence in surgical technique and must be offered more widely to enhance training experiences. No experience is necessary for successful simulation. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.
{"title":"A67 Advanced cardiothoracic Simulation -how to do it and who is it for?","authors":"Abdul Badran, Aiman Alzetani","doi":"10.54531/gfpu7452","DOIUrl":"https://doi.org/10.54531/gfpu7452","url":null,"abstract":"There is a large backlog in surgery due to covid as well as surgical training [1]. We explored the feasibility of a dry lab simulation environment to teach advanced surgical specialty skills to learners with different levels of experience. Session description: We ran 5 cardiothoracic surgical simulation courses over 2021-2022 with a total of 61 delegates. We covered coronary anastomosis, aortic valve replacement, video-assisted-thoracoscopic-surgery (VATS) lung wedge resection and pulmonary vessel dissection. Each skill station ran for 40 minutes including a 15-minute description and real-time demo. Target audience: Participants included 36 medical students, 14 specialty doctors and 11 foundation doctors. We used synthetic plastinated and resin printed models with modular metal frames to help with retraction and suspension of the area of interest for the cardiac models. For the VATS models a laptop with connected angled endoscopic camera was utilized. The lung models were 3D printed. 88% of all participants were able to complete all procedures successfully under supervision. 96% of all participants increased in confidence with the procedure following simulation compared to before. Interestingly only 44% of specialty trainees described themselves as confident in some procedures prior to simulation. Of the medical student cohort 95% had not had any previous simulation or surgical experience prior. We have demonstrated the feasibility of a dry lab simulation programme for candidates of all experiences in cardiothoracic surgery. Confidence in surgical technique is low during the COVID era. Simulation improved confidence in surgical technique and must be offered more widely to enhance training experiences. No experience is necessary for successful simulation. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.","PeriodicalId":93766,"journal":{"name":"International journal of healthcare simulation : advances in theory and practice","volume":"9 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135872190","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}
Whether clinical or non-clinical, patient facing or not, staff working in a healthcare environment will need to initiate or manage challenging conversations in the workplace, with colleagues, patients or relatives/carers. How well and how compassionately these more difficult interactions are handled is critical to whether the conversation is effective, and leaves all parties feel respected and heard, even if the issue itself cannot be resolved. If there is negative escalation of the situation, trust is undermined, leading to further complications, distress and potential error. This can have a significant impact on team working, and ultimately on the patient or their relative’s experience [1]. Evidence was gathered from a large NHS Trust during the two-month long design of the workshop. The aim was to enable participants to learn communication strategies and techniques helping them to effectively manage challenging conversations with kindness and compassion. In 2020, five standalone sessions were delivered online (a result of the geographical size of the Trust rather than a result of the pandemic); there has been a further six online deliveries per year to date, with constant review and revision. Content includes: Active listening, empathy, communication strategies, appreciative enquiry, an exploration of values, and opportunities for reflection. The scenarios cover colleague to colleague interactions (Teams meeting), frustrated relatives (phone call), isolated patient (video consultation) and unsafe colleague (face to face). All are effective in an online environment, and are authentic and relatable. Over 300 NHS staff have participated over three years. Evaluation shows they agree or strongly agree that their skills and knowledge has improved, the scenarios were relevant and authentic, and the mode of participation provided a valuable opportunity to practice new skills in a safe environment. All felt more confident to hold challenging conversations that would be more mutually positive and avoid escalation. Consistently, participants have commented on the positivity of receiving feedback from each other and the involvement of actors was found to be highly beneficial, with feedback from them, from their perspective, uniquely insightful. For the last three years, staff from a large NHS Trust have been able to learn and practice challenging conversations, through online, live simulation, with ‘real’ patients, relatives/carers and colleagues. They have explored why conflict occurs and practised strategies, stopping and restarting, rehearsing and debriefing. Participants have requested further sessions and stated they would highly recommend all colleagues to undertake this training. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.
{"title":"A36 Supporting clinical and non-clinical staff to have challenging conversations with patients, relatives and colleagues: online simulation with live actors","authors":"Anna Thame, Carrie Hamilton","doi":"10.54531/veea2969","DOIUrl":"https://doi.org/10.54531/veea2969","url":null,"abstract":"Whether clinical or non-clinical, patient facing or not, staff working in a healthcare environment will need to initiate or manage challenging conversations in the workplace, with colleagues, patients or relatives/carers. How well and how compassionately these more difficult interactions are handled is critical to whether the conversation is effective, and leaves all parties feel respected and heard, even if the issue itself cannot be resolved. If there is negative escalation of the situation, trust is undermined, leading to further complications, distress and potential error. This can have a significant impact on team working, and ultimately on the patient or their relative’s experience [1]. Evidence was gathered from a large NHS Trust during the two-month long design of the workshop. The aim was to enable participants to learn communication strategies and techniques helping them to effectively manage challenging conversations with kindness and compassion. In 2020, five standalone sessions were delivered online (a result of the geographical size of the Trust rather than a result of the pandemic); there has been a further six online deliveries per year to date, with constant review and revision. Content includes: Active listening, empathy, communication strategies, appreciative enquiry, an exploration of values, and opportunities for reflection. The scenarios cover colleague to colleague interactions (Teams meeting), frustrated relatives (phone call), isolated patient (video consultation) and unsafe colleague (face to face). All are effective in an online environment, and are authentic and relatable. Over 300 NHS staff have participated over three years. Evaluation shows they agree or strongly agree that their skills and knowledge has improved, the scenarios were relevant and authentic, and the mode of participation provided a valuable opportunity to practice new skills in a safe environment. All felt more confident to hold challenging conversations that would be more mutually positive and avoid escalation. Consistently, participants have commented on the positivity of receiving feedback from each other and the involvement of actors was found to be highly beneficial, with feedback from them, from their perspective, uniquely insightful. For the last three years, staff from a large NHS Trust have been able to learn and practice challenging conversations, through online, live simulation, with ‘real’ patients, relatives/carers and colleagues. They have explored why conflict occurs and practised strategies, stopping and restarting, rehearsing and debriefing. Participants have requested further sessions and stated they would highly recommend all colleagues to undertake this training. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.","PeriodicalId":93766,"journal":{"name":"International journal of healthcare simulation : advances in theory and practice","volume":"187 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135872651","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}
Autoethnography is an emerging category of qualitative research that seeks to connect the rigorous analysis of traditional science with the undeniable influence of human experience [1]. Despite remaining under-utilized within surgical and simulation-based education research [2], autoethnography has great potential for sharing systematic, personal reflections with the wider readership, particularly with surgical trainees who rely on experiential learning as a cornerstone of their training. This study examines the use of autoethnography to investigate virtual reality (VR) temporal bone (TB) drilling simulation as a learning tool for Ear, Nose and Throat (ENT) training from the perspective of a surgical novice. The primary researcher undertook 16 three-hour sessions learning to perform a virtual cortical mastoidectomy on the Voxel-Man TempoSurg (VMT) TB simulator from October 2021 to July 2022. Qualitative data including field notes and reflective journal logs were collected using a template. These data were coded using NVivo12 and analysed using inductive thematic analysis. Additional quantitative data on surgical simulation performance derived from the Modified Welling Scale and Modified Stanford Assessment were plotted using Microsoft Excel and statistically analysed using simple linear regression. Six themes were ultimately yielded relating to the learning experience: (1) VMT as a surgical learning tool, (2) internal and external causes of rushing leading to inaccuracy, (3) overcoming VMT technological issues, (4) reflecting on reflection and the importance of feedback, (5) the physical impact of surgery on the operator and (6) overcoming demotivation. The author’s reflections on each theme were subsequently discussed in detail and analysed in the context of the current literature to meet the study objectives. Statistical analysis of the quantitative data demonstrated statistically significant improvements in procedural skills and ability over the 16-session period ( This study demonstrates a novel application of autoethnography showing VR TB simulation to be an effective ENT training tool for learning anatomy and technical skills when used in combination with the regimented reflection and feedback of autoethnography. We found that rushing caused by assessment-driven behaviour and hunger led to errors. These errors led to demotivation and stress, emotions frequently experienced by operating surgeons [3]. Therefore, we have also demonstrated that VR TB simulation can successfully model several human factors commonly found in operating theatres which must be self-identified and prompt seeking senior support to prevent patient harm. This evidence should provide a springboard for future autoethnographic research in the field of surgical and simulation-based literature. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if
{"title":"A6 Virtual reality simulation as a tool for ENT training: an autoethnographic study","authors":"Thomas Binnersley, C. Lucy Dalton","doi":"10.54531/pvza8652","DOIUrl":"https://doi.org/10.54531/pvza8652","url":null,"abstract":"Autoethnography is an emerging category of qualitative research that seeks to connect the rigorous analysis of traditional science with the undeniable influence of human experience [1]. Despite remaining under-utilized within surgical and simulation-based education research [2], autoethnography has great potential for sharing systematic, personal reflections with the wider readership, particularly with surgical trainees who rely on experiential learning as a cornerstone of their training. This study examines the use of autoethnography to investigate virtual reality (VR) temporal bone (TB) drilling simulation as a learning tool for Ear, Nose and Throat (ENT) training from the perspective of a surgical novice. The primary researcher undertook 16 three-hour sessions learning to perform a virtual cortical mastoidectomy on the Voxel-Man TempoSurg (VMT) TB simulator from October 2021 to July 2022. Qualitative data including field notes and reflective journal logs were collected using a template. These data were coded using NVivo12 and analysed using inductive thematic analysis. Additional quantitative data on surgical simulation performance derived from the Modified Welling Scale and Modified Stanford Assessment were plotted using Microsoft Excel and statistically analysed using simple linear regression. Six themes were ultimately yielded relating to the learning experience: (1) VMT as a surgical learning tool, (2) internal and external causes of rushing leading to inaccuracy, (3) overcoming VMT technological issues, (4) reflecting on reflection and the importance of feedback, (5) the physical impact of surgery on the operator and (6) overcoming demotivation. The author’s reflections on each theme were subsequently discussed in detail and analysed in the context of the current literature to meet the study objectives. Statistical analysis of the quantitative data demonstrated statistically significant improvements in procedural skills and ability over the 16-session period ( This study demonstrates a novel application of autoethnography showing VR TB simulation to be an effective ENT training tool for learning anatomy and technical skills when used in combination with the regimented reflection and feedback of autoethnography. We found that rushing caused by assessment-driven behaviour and hunger led to errors. These errors led to demotivation and stress, emotions frequently experienced by operating surgeons [3]. Therefore, we have also demonstrated that VR TB simulation can successfully model several human factors commonly found in operating theatres which must be self-identified and prompt seeking senior support to prevent patient harm. This evidence should provide a springboard for future autoethnographic research in the field of surgical and simulation-based literature. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if","PeriodicalId":93766,"journal":{"name":"International journal of healthcare simulation : advances in theory and practice","volume":"2014 8","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135813282","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}
There is significant variation of foundation programme tracks across the United Kingdom, giving a range of clinical exposure to newly qualified doctors [1]. Common themes in tracks can be identified to include acute/emergency, community, general medicine, surgery and psychiatry components. In the deanery, many Foundation Trainees (FTs) on psychiatry will have up to 3 additional simulation days devoted to psychiatry themes and this is felt to be an especially effective way to supplement education on psychiatry consultation skills [2]. FTs who do not have psychiatry posts will not have the opportunity to attend this training. Typically, mandatory foundation simulation training focuses on human factors related to acute medical and surgical problems [3]. Our education department has developed a pilot programme to support simulation training on key mental health consultations to support well rounded training of FTs. Half day sessions have been delivered to small groups of FTs who do not have psychiatry posts. Faculty has included experienced simulation faculty and psychiatry doctors and the scenarios conducted in a small group format with professional actors playing patients for increased realism of scenarios. The participants rotated between 3 key scenarios covering essential themes of mental state examination, psychiatry team liaison, patient risk assessment and explaining mental health presentations. 2 sessions have been delivered for a total of 18 FTs. FTs showed insight to a number of challenges related to mental health presentations they had experienced outside of psychiatric settings and this formed the outline of the learning objectives for the session. The participants further reflected on discussions in their feedback from the session and portfolio. The sessions were well received, with improvement in confidence in managing these consultations demonstrated in pre and post course survey comparison from the majority of participants. Given the initial success of the session, the team is building a database of local faculty for continuity of the course and looking to secure relevant funding from HEE to provide further sessions for the FTs in the next academic year. This simulation pilot has shown promise to be a useful addition to supplement the education of FTs for mental health consultations applicable in all areas of their clinical practice. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.
{"title":"A107 Mental Health Simulation for Foundation Doctors: Bridging the gap of placement variation","authors":"Lisa Stevens, John Sterling","doi":"10.54531/ixgd1670","DOIUrl":"https://doi.org/10.54531/ixgd1670","url":null,"abstract":"There is significant variation of foundation programme tracks across the United Kingdom, giving a range of clinical exposure to newly qualified doctors [1]. Common themes in tracks can be identified to include acute/emergency, community, general medicine, surgery and psychiatry components. In the deanery, many Foundation Trainees (FTs) on psychiatry will have up to 3 additional simulation days devoted to psychiatry themes and this is felt to be an especially effective way to supplement education on psychiatry consultation skills [2]. FTs who do not have psychiatry posts will not have the opportunity to attend this training. Typically, mandatory foundation simulation training focuses on human factors related to acute medical and surgical problems [3]. Our education department has developed a pilot programme to support simulation training on key mental health consultations to support well rounded training of FTs. Half day sessions have been delivered to small groups of FTs who do not have psychiatry posts. Faculty has included experienced simulation faculty and psychiatry doctors and the scenarios conducted in a small group format with professional actors playing patients for increased realism of scenarios. The participants rotated between 3 key scenarios covering essential themes of mental state examination, psychiatry team liaison, patient risk assessment and explaining mental health presentations. 2 sessions have been delivered for a total of 18 FTs. FTs showed insight to a number of challenges related to mental health presentations they had experienced outside of psychiatric settings and this formed the outline of the learning objectives for the session. The participants further reflected on discussions in their feedback from the session and portfolio. The sessions were well received, with improvement in confidence in managing these consultations demonstrated in pre and post course survey comparison from the majority of participants. Given the initial success of the session, the team is building a database of local faculty for continuity of the course and looking to secure relevant funding from HEE to provide further sessions for the FTs in the next academic year. This simulation pilot has shown promise to be a useful addition to supplement the education of FTs for mental health consultations applicable in all areas of their clinical practice. Authors confirm that all relevant ethical standards for research conduct and dissemination have been met. The submitting author confirms that relevant ethical approval was granted, if applicable.","PeriodicalId":93766,"journal":{"name":"International journal of healthcare simulation : advances in theory and practice","volume":"46 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135869298","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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