International Journal of Healthcare Simulation - subjects-1640339194646-a83dabf3-e140-4089-848b-3d4a2bb354bf https://www.ijohs.com Default RSS Feed en-us Adi Health + Wellness <![CDATA[121 The Rapid Infuser Challenge: Applying Gamification to Improve Performance]]> https://www.ijohs.com/article/doi/10.54531/TXRK1878 Background: Major haemorrhage causes systemic shock with resultant coagulopathy. The Belmont Rapid Infuser© (BRI) is one example of a rapid infuser device to deliver intravenous fluids and blood products to patients as part of emergency resuscitation. We are a simulation team based in a busy trauma unit and anecdotally our staff did not feel confident in using our BRI.

Aims:

We aimed to quantify how confident our nursing staff were in using the BRI, before and after delivering a simulated patient scenario asking them to transfuse blood products using the BRI. We also aimed to quantify whether a simulated scenario could reduce the time taken to use the BRI. We aimed to create an enjoyable environment and use aspects of gamification2 within the training.

Method:

A self-evaluation questionnaire was circulated to establish pre-scenario confidence. Candidates observed a demonstration of the set-up and use of the BRI. Candidates were read a scenario brief and asked to use the BRI to infuse 500 ml of simulated blood product at 200 ml/minute. Once they had completed the scenario, their time was recorded, they were asked to again self-evaluate their confidence and were invited to attend again at a later date to ‘compete’ against their previous time.

Results:

Pre-scenario data confirmed what was suspected; there was a wide variation in confidence in using the BRI across the sample. Early data suggest that the simulation was able to significantly increase staff confidence in safely using the BRI and repeated attempts led to a significant reduction in time to safely transfuse.

Implications for practice:

Positive participant feedback included recommendations for further hands-on deliberate practice. We hope the training can be expanded to also include members of the medical team. Further research is needed to explore the use of gamification to support simulation-based medical education within urgent care. ]]>
<![CDATA[128 Efficacy of a Virtual Mock Trial for Inter-Professional Learning]]> https://www.ijohs.com/article/doi/10.54531/YQWE8954 Background: A medical negligence trial can be stressful for all involved and may be the first time in a courtroom for many health professionals. To provide students with the opportunity to learn from, with and about each other, the Mock Trial was established as an annual collaborative learning event between a local law school and our university-affiliated Office for IPE (Inter-professional Education). In 2021, Mock Trial was conducted virtually to continue high-quality IPE throughout the COVID-19 pandemic.

Aims:

The aims of the study were to establish the efficacy of translation of a large-scale inter-professional malpractice Mock Trial simulation to the virtual platform and to determine whether this will be a useful modality once social distancing restrictions ease.

Method:

The virtual simulation was structured using the brief-simulation-debrief model. Students participated as jury members via Zoom. A simulated courtroom held 11 participants of the trial (one judge, four law students [two defence, two prosecutions], five witnesses and one administrator) and was broadcast in real time to students. The learners first heard the case (opening statements, Plaintiff’s case, Defendant’s case, closing statements and jury instructions) before moving to IP jury break-out rooms with facilitator supervision to deliberate a verdict. Verdicts were delivered in the main room, followed by a debriefing. All students completed a pre-/post-questionnaire, including the Interprofessional Collaborative Competency Attainment Survey (ICCAS) and evaluation of simulation methodology, Mock Trial structure/content and overall impression. To assess efficacy, we compared student evaluations from 2018 and 2019 (in-person events) to those from 2021 (virtual).

Results:

A total of 179 learners participated in three in-person Mock Trials; 143 attended the virtual offering. The virtual event included learners from 19 professions from 4 institutions and 12 facilitators. Evaluations assessed IPEC competencies. For the virtual Mock Trial, learners (96%) strongly agreed/agreed that ‘this activity demonstrated the value of IP collaborative practice to prevent malpractice lawsuits’ and 97% felt that this was a valuable educational activity. Representative qualitative data include: ‘as a law student it was interesting to see what laypeople take away from evidence…’, ‘watching the process provided insight into the litigation process’, ‘the most valuable experience is hearing other people’s perspective’.

Implications for practice:

Large-scale virtual simulation events such as a Mock Trial are feasible and provide a valuable inter-professional learning experience. Student feedback demonstrates that gaining insight from different perspectives is a meaningful part of the experience. Incorporation of large-scale simulation events post-pandemic can increase accessibility to foster IP learning on a wider scale. ]]>
<![CDATA[160 Applying Human Factors Practices and Simulation to Develop Systems and Processes for a Pandemic Vaccine Service]]> https://www.ijohs.com/article/doi/10.54531/EMTI6707 Background:The COVID-19 vaccine hubs required rapid implantation. While organizations had plans as part of the emergency resilience response to the community, there were particular challenges for setting up and running vaccine hubs for COVID-19 that Human Factors and Ergonomic practices could help to identify and address prior to opening as a vaccine hub.

Aims:

The aim of the study was to assist with understanding the abilities of vaccinators and design of processes for the vaccine service at Dartford and Gravesham NHS Trust.

Method:

Simulation, observation, semi-structured interviews and Hierarchical Task Analysis (HTA) were used to understand the complexity of the vaccinator role and potential challenges for the implementation of the vaccine service. This was then used in identifying an area that could meet the capacity requirements identified and to help design the process and flow through the vaccine hub.

Results:

The work undertaken was used to identify and design the processes required to deliver the vaccine service. This in turn helped to identify the space required and, due to changes in practice following potential reactions to the Pfizer BioNTech vaccine [1], develop the process within the identified footprint. The process developed went into operation in late December and ran largely as designed throughout its operating life delivering first and second dose vaccines to trust staff and the wider keyworker community while community sites were identified and developed for mass vaccine hubs.

Implications for practice:

Using simulation and HFE processes as part of a collaborative process with staff trained with these skills can help to design safer, more effective processes in healthcare. ]]>
<![CDATA[51 Preparing Ward Staff for Covid-19: Can Remote Simulation Replace Face-to-Face Learning?]]> https://www.ijohs.com/article/doi/10.54531/MLHJ3772 Background:Human factors are essential to patient and staff safety, particularly during the COVID-19 pandemic with redeployment of staff to different roles in unfamiliar environments [1]. With concerns that the second pandemic wave would engender greater pressures on general medical wards, the simulation team at a London teaching hospital set out to create a multi-disciplinary educational programme for ward staff caring for COVID-19 patients. The course, planned for face-to-face delivery, was rapidly converted to online simulation at the height of the pandemic.

Aim:

The aim of the study was to ascertain the efficacy of converting face-to-face simulation and debriefing into online asynchronous video-based scenarios and debriefing, to enhance understanding of human factors skills.

Method:

In October 2020, a half-day simulation course commenced. Due to suspension of face-to-face teaching in December 2020 with COVID-19 cases rising, this was converted into a half-day online format through filming faculty participating in the existing scenarios. These films were shown to participants, followed by asynchronous online debriefing via Microsoft Teams. Both formats had e-learning as a pre-requisite. Data were collected using pre- and post-session questionnaires containing the Human Factors Skills for Healthcare Instrument (HuFSHI) [2]. Learners who attended both formats were excluded from quantitative analysis.

Results:

Post-training, staff demonstrated improvement in self-efficacy of human factors skills for healthcare. There was no statistical significance between mean improvements for both formats; the greatest improvement was split equally (Table 1). 100% found the face-to-face (N = 24) useful, versus 98% online (N = 54). Communication was the skill most learnt (face-to-face 58%, online 65%), with teamwork (face-to-face 50%, online 48%), escalation (face-to-face 42%, online 57%) and self-care (face-to-face 38%, online 19%) also frequently mentioned. Aspect’s learners’ thought were good included the discussion-based element (face-to-face 50%, online 37%), interactivity (face-to-face 13%, online 31%), multi-disciplinary team involvement (face-to-face 13%, online 20%) and videos for the online format (19%). 21% wanted the face-to-face longer, 15% wanted the online shorter. 9% would rather the online was face-to-face.

Implications for practice:

Online asynchronous debriefing produced similar outcomes to face-to-face for teaching human factors. We posit that this was because the videos were not ‘best practice’ – thus stimulating learning conversations, which accessed learners’ frames and past experiences. Challenges for faculty included: pace and volume of sessions, managing psychological safety, emotive discussions, screen fatigue, and technical aspects. A 6-month follow-up survey is planned and will be included in the presentation. Further work is required to understand why the results were similar. ]]>
<![CDATA[141 Simulation: a Tool to Optimize the Activation of Novel Hospital and Critical Care Pathway]]> https://www.ijohs.com/article/doi/10.54531/AOJR5259 Background:As part of the national COVID-19 response, an NHS Nightingale Hospital was established for our region. An initial cohort of patients was admitted with resource allocation, demanding that limitation of care be clearly defined, including avoidance of invasive ventilation. Within weeks, an increasing bed capacity need drove preparation to admit patients who might require escalation to mechanical ventilation. This shift in admission criteria demanded significant change to the hospital’s service provision, including the ability to stabilize and transfer critically ill patients from this satellite location to an acute partner trust [1].

Aim:

The aim of this study was to perform a rapid, prospective analysis of the critical care patient pathway and surrounding environment at a novel Nightingale Hospital using high-fidelity simulation.

Method:

Following a need assessment and discussion with stakeholders, in situ simulation was undertaken using a Hal® (Gaumard) manikin with a multi-disciplinary team. The immersive scenario, requiring intubation of a deteriorating COVID-19 patient, was undertaken in real time, debriefed and then repeated to assess interventional safety improvements. A demonstration video narrative was produced as a learning aid for dissemination to all supporting staff who may be involved with this clinical scenario, potentially at short notice.

Results:

The internal environment and infrastructure were adequate to perform the task. A significant number of latent threats were identified and actioned during the simulation (Table 1). Qualitative feedback demonstrated that simulation was a useful and effective experience to increase confidence in performing this high-risk procedure in a remote location. Feedback on the video was positive and it was approved for dissemination to staff who may be involved in managing these patients.
Table 1:
Latent threats found at the Exeter Nightingale hospital during simulated intubation of a critically unwell COVID-19 patient
Domain Latent threat Action
Safety Intubation checklist Adopted and amended by members of the visiting teams. A video was created for demonstration purposes.
Equipment Unfamiliar ventilators Breathing circuits incompatible Arterial lines Central lines Sterile packs Pressure bags Ultrasound probe covers Sterile gloves Theatre hats Tapered high-volume low-pressure endotracheal tubes, with integrated above cuff suction port Size 3 face masks Yanker suckers CPAP masks compatible with the ‘Jenny’ ventilator A training video for use on the ventilator was made with information sought from the company representative. Boxes were unpacked and checked. Any additional equipment requested by the team was documented and ordered. Nightingale clinical lead informed of the extra requirements.
Drugs Lack of critical care drugs Intensivist involved with the investing team liaised with the Nightingale pharmacist to order any additional drugs.
General Equipment unchecked and boxed identified. The team unpacked and checked equipment and set it up for clinical use.
Staffing Requirements for operation department practitioners, anaesthetists on near standby Transfer to the main hospital site Transfer simulation planned with the ambulance service to test the multi-disciplinary components. The clinical lead was informed of the findings.
Resource planning Ability to manage patients prone at the remote site Staffing requirements were reported back to Nightingale lead consultant

Implications for practice:

In situ simulation with a high-fidelity manikin proved to be a useful and reproducible tool in developing and testing the systems involved in managing critical care patients at a novel hospital. In accurately simulating a real-time clinical scenario, the care pathway is experienced and contextualized within the team. It offers an opportunity to expose deficits in the system without causing harm (Kaba and Barnes, 2019). Evidence gathered can be easily and rapidly reported to operational leaders allowing timely decision-making, change implementation and mitigation of preventable risk. This makes simulation a cost- and resource-effective quality improvement method. In addition to patient safety process testing, in situ simulation offers a valuable individual and collective training opportunity, providing realistic orientation for clinicians and staff. In recording the simulation, educational tools have been created, extending their reach to both clinical and non-clinical staff. ]]>
<![CDATA[57 Using <i>in situ</i> Simulation to Respond to Critical Incidents in Emergency Medicine]]> https://www.ijohs.com/article/doi/10.54531/XAZQ2961 Background: In situ simulation (ISS) has been shown to be an effective tool in delivering education to the inter-professional team in the Emergency Department (ED) [1]. ISS has also been utilized to drive quality improvement [2]. Using our local ISS programme, we provided a response to critical incidents involving patients within the ED. This has allowed identification and improvement of individual, team and system failures and has led to enhanced learning and departmental improvements to reduce risks of further incidents.

Aims:

The aim of the study was o describe how simulation has improved learning and development from critical incidents.

Method:

A simulated case is built around specific clinical incidents. Four were identified having occurred within the timeframe: missed abdominal aortic aneurysm, ischaemic limb, digoxin toxicity and ruptured ectopic pregnancy. The aim is to use ISS as a tool to educate colleagues about these presentations and as a way of checking that there are no system issues in managing such cases. Our ISS process involves either an ‘actor’ or a low-fidelity manikin with an ‘app’ providing a monitor. All equipment is sought and used in real time to attempt to simulate as close to real life as possible. The scenario utilizes junior doctors, nurses, healthcare assistants, trainee nurse associates and students. A senior team member is included if required. The participants are both briefed and debriefed, and learning points are disseminated via email placed on the ‘MYED’ Facebook group as well as the ‘MYEDSim’ ‘padlet’ page.

Results:

The ISS was run between October 2020 and May 2021. A total of 23 participants answered the nine questions on the post-ISS feedback form from the four incidents. Results are summarized in Figure 1. The participants were asked to record learning points from the sessions and suggestions for improvement. Key themes appear to be communication, team working and location of equipment in the department.
Figure 1:

Implications for practice:

By running simulations of critical incidents, we have identified deficiencies in areas within individual’s knowledge, factors shaping inter-professional team working and system failings from the wider trust which contribute to these events. This has led to wide dissemination of learning and knowledge sharing on various departmental social media/communication platforms and has allowed development and modification of clinical guidance and pathways within Mid-Yorkshire NHS Trust to reduce risks of further incidents occurring. ]]>
<![CDATA[149 Updates to the Healthcare Simulation Design Standard of Best Practice]]> https://www.ijohs.com/article/doi/10.54531/RVDZ2686 Background:Offering high-quality and purposeful simulation-based educational (SBE) activities to learners requires careful planning [1]. To improve SBE practice across all healthcare professions and for learners at all levels of experience, the International Nursing Association for Clinical Simulation and Learning (INACSL) has outlined a set of standards recently rebranded as the Healthcare Simulation Standard of Best Practice Practice™ (HSSOBPTM) that were initially published in 2013 and recently revised in 2021. Involving individuals with a range of relevant expertise, revisions to these standards have occurred every few years, including expanding the topics covered as developments in this domain have occurred and the use of simulation has expanded.

Aim:

The aim of this abstract was to present the changes made to the Simulation Design Standard in comparison to its previously published version [2].

Method:

From 2019 to 2021, a group of simulation educators and researchers representing multiple specialities, simulation societies and geographic areas (the authors of this abstract) met regularly via a videoconferencing platform to review and revise the Simulation Design Standard based on their review of the latest literature and their individual experiences. The team identified several aspects that would benefit from being updated to make this key standard more explicit and applicable to all types of simulation modalities. Drafts of the standard were reviewed on multiple occasions by peer reviewers and the society’s leadership until the latest version was approved for publication.

Results:

An updated version of the Simulation Design HSSOBPTM will soon be published by INACSL in the journal Clinical Simulation in Nursing. It includes the same number of criteria, 11, most of which have retained the same title whereas a few others have been slightly redefined (Table 1). The new Simulation Design Standard provides clear information and guidance to the simulationists. The updated criteria can still be matched to those from the previous edition (see colour coding in Table 1) but are now more detailed and inclusive to be applicable to various simulation modalities and healthcare professions. Advances in virtual simulation experiences, new research and knowledge regarding pre-briefing, greater integration of simulation experiences throughout the curriculum both as a clinical replacement and in the classroom, as well as integration of multipatient and inter-professional teamwork experiences create excellent opportunities for learning if designed well using the HSSOBPTM.
Table 1:
Criteria of the 2016 and 2021 HSSOBPTM for simulation design
INACLS simulation design standard 2016 2021
Criterion 1 Perform a need assessment to provide the foundational evidence of the need for a well-designed simulation-based experience Simulation experiences should be designed in consultation with content experts as well as simulationists who are knowledgeable and competent in best practices in simulation education, pedagogy and practice
Criterion 2 Construct measurable objectives Perform a need assessment to provide the foundational evidence of the need for a well-designed simulation-based experience
Criterion 3 Structure the format of a simulation based on the purpose, theory and modality for the simulation-based experience Construct measurable objectives that build upon the learner’s foundational knowledge
Criterion 4 Design a scenario or case to provide the context for the simulation-based experience Build the simulation-based experience to align the modality with the objectives
Criterion 5 Use various types of fidelity to create the required perception of realism Design a scenario, case or activity to provide the context for the simulation-based experience
Criterion 6 Maintain a facilitative approach that is participant-centred and driven by the objectives, participant’s knowledge or level of experience, and the expected outcomes Use various types of fidelity to create the required perception of realism
Criterion 7 Begin simulation-based experiences with a pre-briefing Plan a learner-centred facilitative approach driven by the objectives, learners’ knowledge and level of experience, and the expected outcomes
Criterion 8 Follow simulation-based experiences with a debriefing and/or feedback session Create a pre-briefing plan that includes preparation materials and briefing to guide participant success in the simulation-based experience
Criterion 9 Include an evaluation of the participant(s), facilitator(s), the simulation-based experience, the facility and the support team Create a debriefing or feedback session and/or a guided reflection exercise to follow the simulation-based experience
Criterion 10 Provide preparation materials and resources to promote participants’ ability to meet identified objectives and achieve expected outcomes of the simulation-based experience Develop a plan for evaluation of the learner and of the simulation-based experience
Criterion 11 Pilot test simulation-based experiences before full implementation Pilot test simulation-based experiences before full implementation

Implications for practice:

It is expected that the revised Simulation Design Standard of Best Practice will be welcomed by healthcare educators and simulation technology developers. It has been designed as a guide to help educators in all the key aspects of designing SBE activities, irrespective of the modality employed. It should ultimately benefit all learners but also promote the continuing professional development of the healthcare educator with an interest in SBE. It includes an updated list of useful references readers can consult to find additional information. ]]>
<![CDATA[133 Establishing An Inter-Professional <i>in situ</i> Simulation (ISS) Programme in District General Hospital Emergency Departments (EDS)]]> https://www.ijohs.com/article/doi/10.54531/ARYJ8432 Background:In situ simulation (ISS) is an effective educational tool that improves patient safety outcomes [1]. It has been trialled previously in this trust but not regularly and many staff members had never participated. Anticipated challenges included freeing staff from clinical duties, scepticism about simulation training and technical issues.

Aim:

The aim of the study was to establish a regular programme of inter-professional ISS delivered by a dedicated team in the emergency department (ED).

Method:

An ED simulation team was created, including consultants, a senior registrar and two newly appointed simulation junior clinical fellows. Sessions run monthly in both EDs in the trust, taking place in the ‘green’ resus area, in the morning when clinical demand is usually lowest. Participants include doctors and nursing staff of all grades, with cross-speciality involvement. Increasing participation required was influenced by senior management and clinical staff agreeing this was a necessary and valuable tool. Faculty include the ED simulation team and a simulation technician. Scenarios are developed by the team with specific intended learning outcomes, e.g. ALS in COVID-19, assessment of the acutely unwell pregnant patient. Intended learning outcomes are influenced by new guidelines, specific emergency cases or skills and suggestions by staff. The patient has been trialled as an actor and/or SimMan3G, depending on the scenario. Clinical equipment is mostly donated and expired. A structured debrief is led by a senior simulation team member. Key learning from each session is summarized in a ‘Sim News’ poster which is tweeted, disseminated via email to all staff and published on the departmental ‘EMBeds’ website. Participants fill in an anonymous feedback form online and receive a certificate of participation.

Results:

Fifty-nine participants from December 2020 to April 2021 gave feedback (see Table 1). Comments included ‘…helped me learn my anaphylaxis protocol’, ‘Teamwork and communication are vital’.
Table 1:
Feedback form results
This simulation session… Average score (10 – strongly agree, 1 – strongly disagree)
…improved my clinical knowledge 9.63
…made me more familiar with my working environment 9.58
…taught me about current guidelines 9.68
…helped me improve my team working 9.84
…helped me improve my leadership skills 9.21
…helped me improve my communication skills 9.53
I enjoyed this simulation session 9.74
I would feel more confident managing a similar situation in the future 9.58
Simulation is a valuable tool in my training 9.74

Implications for practice:

The in situ programme has successfully educated staff; led to changes in guidelines published on ‘EMBeds’; and identified and corrected problems relating to the clinical environment. Staff have found it an enjoyable and valuable experience. The next steps are to increase the frequency of sessions, expand faculty to include a paid senior staff member and include further clinical teams such as blood bank, trauma team and other specialities. ]]>
<![CDATA[188 Community Simulation Program Designed to Improve Recognition of The Deteriorating Patient and Escalation of Care Pathways]]> https://www.ijohs.com/article/doi/10.54531/MOCR4645 Background: This abstract looks at how we implemented physical health simulations within community hospitals in late 2020 and more recently physical health simulation in mental health units.

Aims:

The objectives of these simulations were to improve the recognition of deteriorating patients and the appropriate escalation and/or transfer of care as well as ‘identifying latent errors through simulation’ [1].

Method:

We have run simulations in the community since October 2020 and in the mental health units in February 2021. These sessions have covered four main themes: Sepsis Hypoglycaemia Anaphylaxis Opioid overdose These sessions were taken from pre-existing incidents such as the hypoglycaemic relative and anaphylaxis. We also added opioid overdose as this topic is relevant to both mental health units and community hospitals. We delivered a package of four simulations across 1 month at each unit. This allowed for a different simulation each week, regular learning outcomes and wider opportunity of contact with the staff working within these areas. These sessions were always well attended with staff even committing to learning on days off. This level of commitment shows a real desire to improve not only their own knowledge but also patient safety. We engaged over 50 staff on 9 separate sites (five community hospitals, four mental health wards). Staff have been very engaging and have really got behind these simulation sessions as well as the ward managers. By engaging both mental and physical health, it has helped to provide a wider audience of staff and helped to gain a parity of esteem across the trust in the provision of safety training and simulation. We have also identified a number of latent errors such as non-standardized provision of anaphylaxis adrenalin across the trust, staff unfamiliar with resuscitation equipment bags and equipment location within and identifying the lack of Glucagon within a Hypo box.

Results:

The data collected from these sessions have shown a growth in confidence in identifying deteriorating patients and how to correctly implement and use escalation tools such as the sepsis pathway, electronic observations (E-Obs), anaphylaxis algorithms and the SBAR communication tool.

Implications for practice:

These simulations have really allowed us to bridge the gap between the acute and community site, allowing for a greater parity of esteem for all patients. Further steps in this program will be delivering mental health simulations to all mental health units and community hospitals to further bridge the learning between physical health and mental health. ]]>
<![CDATA[137 Simulated Surgical Assessment Unit – A Quality Improvement Project to Increase Medical Student Confidence In Assessment and Management of Acute Surgical Conditions Through High-Fidelity Simulation]]> https://www.ijohs.com/article/doi/10.54531/GIGT5713 Background:The COVID-19 pandemic resulted in limited opportunities for medical students to assess patients in the Surgical Assessment Unit (SAU) at an acute teaching hospital. Inadequate exposure to acute surgical conditions affected student-reported confidence and preparedness for Objective Structured Clinical Examination (OSCE). We hypothesized that simulation-based teaching during the pandemic could supplement disrupted learning [1] and improve patient safety [2].

Aim:

The aim of the study was to address the quality dimension of patient safety. This Quality Improvement Project (QIP) was designed to increase student confidence by 50% in the assessment and management of acute surgical conditions, and preparedness for OSCE.

Method:

The educational intervention ‘Simulated SAU’, consisting of scenarios based on common acute surgical presentations, was co-designed with project champion, placement lead, teaching fellows and medical education department, utilizing transformational leadership. Model for improvement approach was utilized with Plan-Do-Study-Act (PDSA) cycles. During the first PDSA cycle, intervention was delivered over 3-hour sessions in March 2021 to 12 third-year medical students, through the use of simulated patients. The second cycle encompassed integration of learning points including amended scenario and debrief timings, and improved questionnaires, delivered in April 2021 to a further 11 third-year medical students. Students completed paired 14-item pre- and post-intervention paper questionnaires consisting of 5-point Likert scale questions on confidence and preparedness. The Wilcoxon signed-rank test was used for statistical analysis, with a p-value of <0.05 considered statistically significant.

Results:

During the first cycle, student-reported median confidence in assessment increased by 50% (p = 0.01), and in management by 66.7% (p = 0.02). Students felt 50% more prepared for OSCE assessment (p = 0.02). During second cycle, median confidence in assessment increased by 100% (p = 0.003), in management by 100% (p = 0.004), and students felt 50% more prepared for OSCE assessment (p = 0.015). 100% of students felt simulated SAU is useful and future sessions would further enhance surgical learning.

Implications for practice:

The QIP achieved its aim to increase student confidence with statistically significant differences, through a high-fidelity simulation intervention. Through QI methodology and leadership for improvement, this QIP has successfully bridged the educational gap resulting from the pandemic, with emphasis on delivering safe patient care. Next steps encompass integration of learning points over the following PDSA cycle, engagement of new staff and resource sharing for future implementation and sustainability. Simulated SAU intervention is low-cost, requires minimal staff and is simple to deliver, hence has the potential to become integrated within medical education across numerous educational settings and enhance patient safety. ]]>
<![CDATA[174 Increased Self-Efficacy in General Practice and Higher Psychiatric Trainees Following Simulation-Based EDUCATION TO SUPPORT INTER-PROFESSIONAL CO-CONSULTING IN PRIMARY CARE]]> https://www.ijohs.com/article/doi/10.54531/ZCLO4480 Background: Learning Together is a training model providing general practice (GP) and higher psychiatric trainees with peer learning opportunities across London in partnership with Health Education England. The initiative encompasses inter-speciality training days and joint clinics delivered by trainee pairs aiming to bridge the gap between mental healthcare in primary and secondary care. On the basis of this model, a full-day online simulation-based education (SBE) course for these groups was designed and delivered with a specific focus on inter-professional education and issues related to co-consulting [1].

Aims:

The aim of this study was to use SBE to enable sharing of knowledge, skills and approaches to clinical practice to improve inter-professional collaboration in the context of co-consulting in primary care.

Method:

A full-day online SBE course for GP (ST2/3) and higher psychiatric trainees (ST4 and above) was delivered to 64 participants over six deliveries. It included five live scenarios using professional actors depicting mental health presentations to reflect the overall learning objectives. Scenarios were followed by a structured psychologically informed debrief chaired by trained facilitators with support from an external senior GP. A mixed-methods evaluation was used. Participants completed the Human Factors Skills for Healthcare Instrument (HuFSHI) pre- and post-course, rating their level of self-efficacy in managing issues, such as ‘constructively managing others’ negative emotions at work’ and ‘working effectively with a new team in clinical situations’ (Cronbach’s alpha = 0.96) [2]. Participants rated aspects of course quality on a 5-item scale and provided additional course feedback via open-ended questions.

Results:

Responses from 51 participants were analysed (response rate = 79%). Median HuFSHI scores increased from 70 to 86 for the overall group (Z = 5.881, p < 0.001). Sub-group analysis between both trainee groups (i.e. GP and higher psychiatric trainees) showed no significant HuFSHI score differences. High scores were reported for scenario quality (90% of participants) and provision of a safe and constructive learning environment (91.7% of participants). Ninety per cent of respondents would recommend the course to colleagues. Emerging themes from the qualitative data were positive reflections on the importance of patient-centred care and appreciation of the value of inter-professional collaboration and joint clinics.

Implications for practice:

Findings demonstrated improvements in participants’ self-efficacy as measured by HuFSHI. Qualitative data suggest a deeper understanding and appreciation of patient-centred care and inter-professional collaboration. Considering the need for early intervention, prevention and delivery of mental healthcare in primary care, this early evidence supports the potential role of SBE in developing integrated care. ]]>
<![CDATA[120 Cervical Spine Injury Immobilization and Management: Addressing the Gap in Knowledge and Improving Systems through Multi-Disciplinary <i>in situ</i> Simulation in a Busy Emergency Department]]> https://www.ijohs.com/article/doi/10.54531/TYCP3840 Background:Cervical spine (C-spine) injuries are a significant cause of morbidity and mortality, particularly in the elderly population [1]. The Canadian C-spine Rule is sensitive in determining which patients require immobilization and radiological investigation [2]. Junior clinicians entering Emergency Medicine (EM) may not have had previous career exposure to trauma and may be uncomfortable approaching such injuries or using similar assessment tools. In situ simulation offers an opportunity to build confidence and learn from human interactions, typically only encountered during ‘real-life’ exposure.

Aims:

The aims of the study were to identify clinician knowledge gaps when starting EM, create a simulation-based teaching program to address these weaknesses and to improve multi-disciplinary systems relating to C-spine injury immobilization and management.

Methods:

A sample of 20 clinicians finishing their EM rotation in April 2021 at Queen Alexandra Hospital, Portsmouth, completed a survey listing conditions/procedures they would have appreciated simulation scenarios on as part of induction. A 30-minute C-spine simulation station was designed focussing on knowledge gaps identified, incorporating Canadian C-spine rules, immobilization, radiological investigation and treatment. Sessions were delivered in situ to groups of 5–10, including doctors, trainee acute care practitioners, nurses, healthcare assistants and physician associate students. Feedback was collected gauging enjoyment, confidence levels before and after the session as well as the likelihood of application of the topics covered soon. Data were collected from candidates at the end of their rotation to assess the lessons learnt.

Results:

About 70% of surveyed candidates included ‘C-spine’ within conditions/procedures they desired simulation teaching on. Candidate feedback suggested high levels of enjoyment with 100% of candidates scoring 7 or 8/8. The mean confidence of candidates before and after the session increased by 30.6% (52%–82.6%). 100% of candidates felt that the session was useful in improving day-to-day practice and 67.7% of candidates envisaged implementing teachings within the next week (96.8% within the next 3 months).

Implications for practice:

In a busy department, it is important to prioritize education and address workforce knowledge gaps. Trauma and C-spine injury appear to be an area of under-confidence in junior clinicians starting in EM. Short in situ simulation sessions were an effective and flexible way of improving confidence and multi-disciplinary systems, avoiding disruption during busy periods. We believe that repeating similar teaching programmes at the start of a new clinician intake can aid in identifying gaps in knowledge and effectively addressing these early and improved systems operation throughout the rotation. ]]>
<![CDATA[41 Introduction of Emergency Department <i>in situ</i> Simulation]]> https://www.ijohs.com/article/doi/10.54531/AEUM3397 Background:In situ simulation (ISS) is an effective way to deliver inter-professional education in the Emergency Department (ED) [1]. Since October 2020, we have been running regular inter-professional ISS in both EDs in Mid-Yorkshire NHS Trust. We used personal experience, systems and processes from other EDs in West Yorkshire [2] and the literature to assist with initiating this.

Aim:

The aim of this study was to describe the process to set up an ED ISS programme and share our challenges and successes.

Method:

We run a variety of cases including paediatric and adult on a broad topic range (anything that can be seen in the ED), e.g. medical, surgical, trauma, psychiatric and maternity emergencies. We prepare the case beforehand and ensure that we have the appropriate staff and equipment. A vital aspect to ISS is ensuring the ED is safe. Embedding the attitude that this is ‘just another patient’ has been key. We use a low-fidelity manikin and a simulated monitor app. All participants are briefed, everything is in real-time to closely simulate real life. After the simulation, a debrief takes place. Feedback is sought from all and a certificate is provided. From 14 October 2020 to 5 May 2021, we have run 39 ISS with 138 inter-professional ED participants.

Results:

Figure 1 demonstrates feedback given by these participants (largely positive).
Participant feedback
Figure 1:
Participant feedback

Implication for practice:

Although challenges exist, it is achievable and effective to run an ISS programme in a busy ED. While this was set up with the education of staff as the primary objective, it has become clear that ISS is also important in identifying system problems, testing new pathways and providing an educational response to incidents in the department. Aspects of our programme that have worked for us include: Picking a regular day weekly (early morning best for ED). Having an inter-professional debriefing team helps to engage all professions. Ensuring senior departmental support. Build slowly to more complex simulations. Challenges we have found are: Changing culture/attitudes – most support simulation once they have taken part/seen it happen regularly – persevere with it! The ED is busy – we cannot change this but can be flexible. Too many observers put the learners off and reduce learning. We have reduced observer numbers and have a sim ‘uniform’. Some participants have difficulty engaging with the manikin/low-grade technology – a good briefing can help. ]]>
<![CDATA[111 Using Video Teleconferencing for an Effective Remote Simulation Course in Transfer Medicine]]> https://www.ijohs.com/article/doi/10.54531/CIYV5037 Background:Critically ill patients require transfer within and between hospitals – a necessity amplified by ITU capacity pressures during the COVID-19 pandemic. This rising demand highlighted the need for dedicated transfer teams. Alongside establishing and expanding a cross-sector transfer team, we necessarily needed to meet growing training requirements. Transfer medicine is a core competency for intensivists, anaesthetists, ITU nurses and pre-hospital staff, with simulation recommended in the respective curricula. However, COVID-related restrictions alongside demands on staff’s time, limited opportunities for face-to-face training. We overcame these challenges by developing an online simulation-based course. Teleconferencing has previously been received favourably and rated highly for educational benefit [1]. Our innovative programme uses e-learning and interactive video teleconferencing to combine the requirements of distanced learning with the benefits of simulation.

Aim:

The aim of the study was to test the efficacy of and response to remote simulation-based training in transfer medicine.

Method:

Before attending the online simulation, multi-disciplinary participants completed 3 hours of interactive e-learning hosted online via the platform Rise. This incorporated case-based discussions, practical assignments and filmed presentations. Simulation utilized Zoom teleconferencing to immerse participants in clinical transfers. We used high-fidelity, pre-recorded scenarios made with a mannequin simulator and high-definition video. The participants observed the simulated transfer of critically ill patients (Figure 1). Scenarios paused at set intervals facilitating debriefing utilizing electronic whiteboards and interactional tools available in Zoom to elicit learning. The course was delivered twice. Each cohort completed a pre- and post-course test to assess learning of the intended learning objectives.
Example screenshot of online simulated scenario with participants observing
Figure 1:
Example screenshot of online simulated scenario with participants observing

Results:

A total of 21 multi-disciplinary participants completed training: 43% doctors and 57% nurses. 100% of respondents (18) rated the course 5/5 on the Likert scale when asked ‘how much did you enjoy the course’ and 100% would recommend the course to colleagues. All rated the course extremely relevant to their practice. Average assessment scores pre- versus post-course improved by approximately 20% (74.3% to 94.4%) (Figure 2).
Results of pre- and post-course knowledge assessments
Figure 2:
Results of pre- and post-course knowledge assessments

Implications for practice:

We developed an effective and well-received remote simulation transfer course to deliver training to a wide-reaching audience. Participants were enthusiastic about the innovative and interactive approach, finding the online course enjoyable and relevant to their clinical practice. Results suggest the course effectively increased learning. The flexible nature of online remote provision allows for delivery at scale, to meet a rising demand. Further evaluation will establish the extent at which this training translates to performance, such as a reduction in adverse events in transfer practice. ]]>
<![CDATA[26 Mixed Realities Chest Drain Workshop: Integrating Hands-On and VR Learning]]> https://www.ijohs.com/article/doi/10.54531/DJOB5086 Background: During the pandemic, several wards in our surgical wing became re-purposed for COVID patients. This resulted in patients who would usually be nursed in those wards being placed elsewhere. There were also many nurses and medical staff being redeployed to wards in unfamiliar specialities which required caring for patients outside their usual clinical areas. This resulted in some patients with chest drains being nursed outside the usual areas, and incidents being reported regarding their management.

Aims:

The hour-long workshop was designed to simulate the management and understanding of the terminology around chest drains. The hands-on aspect was achieved by modifying a manikin to be able to demonstrate these actions and troubleshoot when things go wrong. What is meant by a swinging chest drain? How much bubbling is expected? Followed by the procedure of inserting a large-bore chest drain using immersive virtual reality

Methods:

Ward nursing staff, operating theatre staff and junior doctors were invited to attend the workshop. Six sessions each with five participants ran over the course of a month. The first part of the workshop was a hands-on session with a modified defunct manikin. We had the locally available kit for people to be able to interact with and understand the mechanics of chest drains Introducing people to the Royal Marsden manual of clinical nursing procedures [1] as a reference to be used in parallel with our trust protocols. Hands-on session covered the observations taken for safe management of a chest drain, demonstrating what a swinging and bubbling drain look like. Recognizing when and how to clamp a chest drain was simulated, with a short scenario requiring the attendees to troubleshoot a drain that had stopped swinging and the patient condition deteriorated. How the consumables are changed in the chest drain and its ultimate removal was also covered in the hands-on session as this had been a particular area of concern expressed prior to the workshop. The manikin (Frank) was limited in the ability to insert the chest drain in a realistic manner, so this component of the education was augmented by a virtual reality (VR) option. Pottle [2] asserts that VR allows participants to learn from experience as they would do in real life. VR is the use of software to create an immersive simulated environment, to experience VR, participants put on head-mounted display which places them inside an experience, where they can engage with the environment and virtual characters in a way that feels real. VR has a unique power, more than any other simulation technology, to make users believe they are in a different environment. The application used is available on the Oculus go format and is produced by the Royal College of Surgeons in Ireland, it takes the participants through the accident that results in the patient requiring the insertion of a chest drain. They are then faced with decisions regarding his care throughout the experience, following through decisions that may lead to a fatal result for the virtual patient. The VR simulation was in real time, with events unfolding at a realistic pace and included the various airway emergencies unfolding before you after the drain insertion

Results:

Questionnaires were completed before and after the workshop for attendees to evaluate their confidence to independently manage a chest drain. Every attendee reported an increase in confidence because of the session (Table 1).
Table 1:
How confident are you to……. Pre-session, % Post-session, %
Monitor vital signs 95 100
Assess chest drain function 60 90
Recognize/monitor swinging drain 60 90
Patient mobilizing with drain 55 90
Recognizing when/why/if to clamp 25 80
Clamp a chest drain 50 80
Wound management post-removal 35 75
Change chest drain bottle 25 65
Remove chest drain 25 55

Implications for practice:

As a result of this session, the ward areas created a ‘chest drain box’ which had everything needed to manage and replace a chest drain included as locating where kit was kept was identified as an issue. This box will be at the side of the patient being managed with the chest drain and will be checked for completeness regularly. This workshop would be useful to repeat because 50% of junior doctors have now rotated placements and many of the ward staff have been re-deployed to other areas. ]]>
<![CDATA[42 Updates to the International Nursing Association for Clinical Simulation and Learning Simulation Debriefing Standard of Best Practice]]> https://www.ijohs.com/article/doi/10.54531/KMRA2674 Background:Debriefing is a key component of all simulation-based educational (SBE) activities and is an activity for which a multitude of approaches and models have been developed and implemented (Oriot & Alinier, 2016). To improve SBE practice in general, the International Nursing Association for Clinical Simulation and Learning (INACSL) has outlined a set of Simulation Standards of Best Practice first published in 2013. Revisions to these standards have occurred every few years, including expanding the topics covered as developments in this domain have occurred and the use of simulation has expanded.

Aim:

The aim of this study was to present the changes in the Simulation Debriefing Standard in comparison to those last published (INACSL Standards Committee, 2016).

Method:

From 2019 to 2021, a group of simulation educators and researchers, the authors of this abstract, representing multiple specialities, simulation societies and geographic areas began meeting to review and revise the Simulation Debriefing Standard based on the latest literature. This group identified several items that would benefit from being updated, including expanding the terminology of this Standard to encompass Feedback, Debriefing and Guided reflection as distinct but integral components of this key phase of simulation-based experiences.

Results:

An updated version of the Simulation Debriefing Standard of Best Practice will soon be published by INACSL in Clinical Simulation in Nursing. Some of the updates include expansion to understand and allow electronic systems to be recognized as components of the debriefing process and emphasizing the need for practice and review of the skill of facilitators in the techniques of debriefing. The new Simulation Debriefing Standard provides clear information and guidance to the simulationists. It includes four as opposed to the five criteria in the 2016 version (INACSL Standards Committee, 2016). The updated criteria can still be matched to those from the previous edition (see colour coding in Table 1) but are now more detailed and inclusive to be applicable to various simulation modalities.
Table 1:
Criteria of the 2016 and 2021 INACSL debriefing standards of best practice
INACLS simulation debriefing standard 2016 2021
Criterion 1 The debrief is facilitated by a person(s) competent in the process of debriefing. The debriefing process is planned and incorporated into the simulation-based experience in an appropriate manner to guide the learner(s) in achieving the desired learning outcomes.
Criterion 2 The debrief is conducted in an environment that is conducive to learning and supports confidentiality, trust, open communication, self-analysis, feedback and reflection. The debriefing process is constructed, designed and/or facilitated by a person(s) or technology-enhanced system capable and/or competent in providing appropriate feedback, debriefing and/or guided reflection.
Criterion 3 The debrief is facilitated by a person(s) who can devote enough concentrated attention during the simulation to effectively debrief the simulation-based experience. The debriefing process is conducted in a manner that promotes self, team and/or systems analysis. This process should encourage reflection, exploration of knowledge and resolution of performance/system gaps while maintaining psychological safety and confidentiality.
Criterion 4 The debrief is based on a theoretical framework for debriefing that is structured purposefully. The debriefing process is planned and structured purposefully based on theoretical frameworks and/or evidenced-based concepts.
Criterion 5 The debrief is congruent with the objectives and outcomes of the simulation-based experience.

Implications for practice:

It is expected that the revised Simulation Debriefing Standard of Best Practice will be welcomed by the simulation community, which includes the healthcare educators and simulation technology developers, but also the learners. It has been designed as a guide to help educators in all the key aspects of debriefing, providing feedback and facilitating guided reflection conversations that will ultimately benefit learners. It includes an updated list of useful references readers can consult to find additional information. ]]>
<![CDATA[6 Assessment of The Creation of a New Course]]> https://www.ijohs.com/article/doi/10.54531/EQFR8807 Background: Although commonly used in the clinical environment, insertion of peripherally inserted central catheters (PICC) is not routinely taught to clinical staff. As the procedure requires knowledge in relevant anatomy, sonography skills, and understanding of complications management, it requires dedicated time for teaching. In 2018 no PICC line insertion courses were found in London County.

Aims:

The Harefield educational team has therefore created a PICC line insertion course delivered by a multi-disciplinary faculty. This course aimed to increase understanding and confidence of PICC insertion.

Method:

Using Miller’s pyramid of clinical competence, the course was structured to provide learners with the knowledge and understanding of the procedure through interactive lectures and demonstrations, before progressing to hands-on practise in the workshops using high-fidelity models to increase dexterity and confidence [1]. Five editions of the course were delivered over 16 months with a total of 65 participants. Pre- and post-course questionnaires were conducted to assess the course’s effectiveness in achieving its purposes.

Results:

The results have shown the achievement of all the course objectives such as increased understanding of indications, relevant anatomy, equipment uses, complications and their management relating to the procedure. With increased confidence in the theoretical and practical aspects of PICC insertions, we hope the course attendees will have better performances in practicing the procedure, thus reaching the highest level of clinical competence on Miller’s pyramid.

Implications for practice:

As soon as face-to-face teaching will be allowed again, the PICC insertion course will be resumed as proven well-received and effective. ]]>
<![CDATA[81 Debriefing the Debriefer; Developing an Inter-Professional Faculty for Emergency Medicine Simulation]]> https://www.ijohs.com/article/doi/10.54531/ABCI4973 Background:Previous research has described the importance of debriefing in Simulation-Based Medical Education; it is considered the most critical part of the teaching experience [1]. It is a skill requiring practice and poorly structured debriefs can harm candidates [1]. There are few formal debriefing courses available to aspiring faculty members; they are often oversubscribed.

Aim:

The aim of this work was to develop an inter-professional faculty with a variety of backgrounds to assist on an inter-professional nursing-medical simulation course in Emergency Medicine. A further aim was to develop a novel formal debrief for the debriefer to help improve confidence in this skill.

Method:

A variety of professionals were invited to attend the course as faculty. Following their debrief of the scenario, the debriefer was invited to discuss their opinion on how they managed the debrief, from room set up to structure used. Troubleshooting advice was offered and an action plan was put in place for next steps of development. Faculty members were asked to complete a formal feedback form at the end of the session.

Results:

Inter-professional faculty members included Emergency Medicine consultants, trainees and clinical fellows, simulation technicians, emergency medicine nursing staff and resuscitation officers. 75% of faculty members had attended <5 simulation courses as faculty prior to this session. 81% of faculty members scored 4 and 5/5 for feeling confident at debriefing as a result of the session. 100% scored 4 and 5/5 for feeling supported during their debrief. 100% felt that the session had improved their debriefing skills. 87.5% felt appropriately challenged as a faculty member. 100% were willing to attend the course again in the future. Free-text comments included the best part of the day was ‘Personally observing and practicing debrief, brief and debrief of my debrief’, ‘Supportive atmosphere for faculty’ and ‘Debrief learning points’.

Implications for practice:

Overall, faculty members from varying clinical and simulation backgrounds were supported throughout the day and as a result were more confident in their debriefing abilities following the session. Future work aims to continue this incremental learning to allow all faculty members to feel confident and able to ‘debrief the debriefer’. This will ensure the quality of the debrief for learners, maximizing the impact of simulation-based medical education. ]]>
<![CDATA[13 Medical Emergency <i>in situ</i> Simulation Training for Dental Hygiene Therapists]]> https://www.ijohs.com/article/doi/10.54531/GFOH7831 Background: In situ simulation, in the clinical environment, can help detect any issues with the systems, policies and practices within an organization that may not work. Many system errors go unnoticed until there is a real incident. Conducting simulation in situ is an innovative way of picking up these embedded problems [1]. Experiential learning theory suggests that, to truly understand a concept, you must experience it first-hand by doing it. Deliberate practice [2] recognizes that to gain expertise you must keep practicing a skill. Practicing tasks in a simulation environment helps to build performance levels and thus improves patient care and safety.

Aims:

This simulation exercise is designed to develop the skillset of foundation dental therapists in respect of Medical Emergency recognition and management in their own working environment. The parameters for assessment included teamwork, knowledge, communication, effectiveness of actions and situational awareness.

Methods:

Research methods for this project included a learning needs analysis, surveying and interviewing previous cohorts of hygiene therapists. The conclusions of which highlighted the need for further training in managing medical emergencies. The learning needs identified from stakeholders relating to this course have been used to develop the learning outcomes using Blooms’ taxonomy [3]. The faculty delivered a medical emergency in situ simulation training session for Dental Foundation Therapists across the Midlands and East region. The therapist and dental nurse were given information on the ‘patient’ before the interactive mannikin was positioned. Facilitators used an adjacent room from which to control the mannikin, including its vital signs and voice. A 360-degree camera along with iPads were used to monitor and record the session for safety and debrief purposes. The therapist worked with their dental nurse to react and respond to the emergency unfolding before them. They then watched back their performance, reflected and provided feedback.

Results:

Using GIBBs model of reflection, the 2021 delegates recognized personal learning needs including improvement in leadership and management skills, delivery of chest compressions and teamwork. Changes to practice were also recognized, for example, placing their emergency drugs in a more appropriate location. Using video, a ‘Hot Debrief’ method of evaluation was carried out whilst the experience was fresh. This proved to be powerful and enhanced personal reflection to support future learning and development. Later, an evaluation method in the form of a survey took place. Results of which showed that 50% of delegates had never partaken in simulation-based education before and 100% gave an excellent rating on the benefits to team and individual. One participant stated ‘this was such a good, real-life experience! I hope this can either be introduced into undergraduate training or as part of the practice annual BLS CPD!!’.

Implications for practice:

A successful session needed prior communications with the practice staff to free up a surgery for use, inform present patients of the activity and understand where the emergency equipment was during the session for patient safety. The benefits of conducting in situ simulation were staggering, the delegates reviewed their current practices and made changes as appropriate. ]]>
<![CDATA[7 Covid-19 Vaccination Clinic Experience: Using Simulation to Create and Test Systems]]> https://www.ijohs.com/article/doi/10.54531/YKMW2498 Background:In November 2020, the first COVID-19 vaccine for the UK had been approved. We were subsequently tasked with the rapid development of vaccination clinics. Two COVID-19 vaccination clinics in suitable spaces within the University Hospitals Bristol and Weston NHS Ft were planned, across two different hospital sites (25 miles apart), to be operational within 7 days. Changes to both pharmaceutical and national guidelines were altering by the hour.

Aims:

The key driver for this fast-paced change was to ensure vaccines were delivered as soon as available to Bristol-based health and social care staff.

Methods:

A process map outlining the vaccination journey established in the local public vaccination site was the starting point to understand how to efficiently, effectively and safely deliver vaccines. Hospital sites for both clinics were identified, and work began immediately to vacate those rooms and establish both the infrastructure and personnel to run the large-scale clinics. Simulation Lead Educator involvement during the first days of planning was essential and at each stage of the process mapping. Simulation Round 1: full-scale simulated vaccine clinic in the newly designed rooms on one site standardized patients (actors) briefed as receiving the simulated vaccine key staff in roles – administrators, pharmacy, vaccinators debrief focussed on latent threats, agreeing immediate changes to be tested in the next round patient experience feedback from the standardized patients Simulation round 2: immediate re-run of the simulated clinic solutions identified in Round 1 were applied and tested rapid improvements to the process mapping, ergonomics, clarity of roles and timings for clinic appointments were able to be made Simulation round 3: Round 3 took place on the second site a few days later lessons learnt from the first two stages being shared and translated within the new site essential safety and efficiency issues were explored and lessons learnt applied to the clinic

Results:

The three rounds of simulation systems testing identified a number of latent threats and process mapping alterations which were implemented immediately, with solutions being tested on the spot. The vaccination clinics opened, administering over 500 vaccines per day across a 4-month period. The team involved continued to adapt processes and environment to suit the constantly changing guidelines and ensure safe practice.

Implications for practice:

Simulation is an adaptive and responsive tool in systems testing, process mapping and implementing solutions within a high-pressured and time-restricted environment. ]]>
<![CDATA[103 Unpicking the Mechanisms Used in Simulation-Based Education that Support Undergraduate Students’ Development of their Collaborative Practice Skills]]> https://www.ijohs.com/article/doi/10.54531/WJNI1192 Background:Annually, approximately 80 undergraduate physiotherapy and occupational therapy students participate in simulation-based learning, as part of a second-year module. The experience provides opportunities for students to achieve core module outcomes, such as developing communication skills, inter-professional practice and clinical reasoning. The simulation is supported by a small team of academic faculty and a professional actor, all trained in simulation and debriefing. The students are required to assess an older person at home as part of an emergency response team. They work in groups of up to eight students, are pre-briefed and given a profession-specific written brief of their role in the scenario. A two-pronged approach to debriefing is used; the origami approach, utilizes pauses to capture teachable moments [1], and the advocacy-inquiry approach, used to reflect on the experience [2]. The simulation itself is not assessed; the students write a reflective assignment through the simulation lens, discussing the concepts of effective collaborative practice.

Aim:

The aim of the study was to identify the mechanisms used in simulation-based education that support development of collaborative practice skills of undergraduate students.

Method:

The simulation-based learning scenario was iteratively developed, delivered and evaluated over 3 years. Staff reflection and content analysis of 3 years of feedback from anonymous evaluation questionnaires, and a sample of student assignments, were used to identify aspects of simulation delivery that supported students’ development of collaborative practice.

Results:

Although students consistently report anxiety about participating in the simulation, they also identify it as one of the most intense but helpful learning experiences of their on-campus degree programme. The use of trained, experienced actors, indistinguishable from service users maximizes student engagement. Effective pre-briefing reduces student anxiety and provides an opportunity to add complexity via the written brief. The student roles as observers and/or participants (in a familiar role) improve students’ experience and support students with diverse needs. Assigning clear staff roles improves delivery and cost-effectiveness. Combining the two approaches to debriefing students was necessary to allow reflection-in-action and -on-action. Thorough debriefing is essential, challenging and requires planning and practice.

Implications for practice:

Simulation is an effective pre-qualifying education tool. Adequate pre-briefing, effective debriefing styles, and clear assignment of staff roles aid in effective delivery. Simulation scenarios need to be carefully constructed and delivered to ensure that all students remain within their optimal learning zone and to support students with diverse needs. ]]>
<![CDATA[109 Perceptions of Virtual Simulations by Inter-Professional Simulation Facilitators]]> https://www.ijohs.com/article/doi/10.54531/SQSY6763 Background: The COVID-19 pandemic has necessitated pedagogical change with many events virtual or hybrid in nature. Simulation events are particularly affected due to their hands-on quality. In addition, requirement for virtual facilitators may be increased compared with in-person counterparts. Virtual simulation education must be as high quality as in-person efforts and facilitator training is key. Some principles of virtual facilitation differ from in-person, for example, in relation to debriefing [1]. Effective education should be tailored to address these differences.

Aims:

The aim of the study was to deliver virtual facilitator education addressing the format, objectives, expectations and strategies for virtual IP simulations.

Method:

The traditional in-person Facilitator Training and Inter-professional Education (IPE) Event Training Design course our university-affiliated program delivers was adapted based on a local needs assessment to the virtual Facilitating Virtual Simulations Crash Course. This was delivered as required as small-group Zoom-based teaching, outlining educational theory, practice and principles of virtual simulation facilitation.

Results:

Sixteen virtual inter-professional simulations have been delivered for students in 19 professions within our Office of IPE since September 2020 with 33 inter-professional facilitators from 4 institutions. To determine the efficacy of our novel virtual facilitation, training facilitators were surveyed. The majority had facilitated one to five simulations (in-person 58%, virtual 70%). In addition to the Office of IPE training, 30% of facilitators had received external education on in-person simulation facilitation compared with 6% for virtual facilitation. The majority of facilitators strongly agreed/agreed that they were as effective a facilitator in virtual simulations (80%), as confident facilitating virtually (70%), as psychologically safe in virtual debriefings (75%), and that virtual simulations will continue in their practice after the pandemic (100%). Most (95%) facilitators strongly agreed/agreed that students were as engaged with virtual simulations as with in-person and 80% felt virtual simulations were a good learning experience for students. The majority (88%) of facilitators strongly agreed/agreed that the virtual crash course provided the knowledge and practice to help them effectively facilitate virtually, and 75% strongly agreed/agreed that the crash course made them appreciate and foster IP relationships in their daily work. These results are comparable to evaluation of in-person training delivered before the pandemic.

Implications for practice:

Virtual simulation events require specific facilitation strategies, and virtual education is useful to improve the knowledge and confidence of facilitators. Facilitators value the virtual simulation experience for themselves and their students, and they believe that this will be an important pedagogy post-pandemic. ]]>
<![CDATA[122 Adapting Foundation Programme Simulation in Response to a Pandemic: Has it Diminished Learning?]]> https://www.ijohs.com/article/doi/10.54531/SCFI7451 Background:A human factor-based simulation course is run for foundation doctors and nurses annually at a London teaching hospital. Simulation helps to improve technical and non-technical skills in a supportive environment [1]. The course was adapted in response to the COVID-19 pandemic. We analysed feedback from participants to understand whether the educational value of the course was maintained and to identify potential areas of improvement.

Aim:

The aim of the study was to evaluate the impact of the course adaptations on the participants’ learning experience, delivery of learning objectives and quality of teaching.

Method:

The course comprises simulated scenarios with facilitated debrief sessions. Post-COVID-19 changes comprised: moving to a half-day format, reducing the number of scenarios from five to three, reducing the number of participants per session, running multiple courses on 1 day and reducing debriefing time. Feedback was gathered pre- and post-course using SurveyMonkey. The questionnaires utilized free-text answers and Likert scales based on the Human Factors Skills for Healthcare Instrument [2]. Two cohorts, before and after the changes were introduced, were analysed. There were 175 participants in cohort 1 (3 October 2019–11 March 2020) and 105 in cohort 2 (1 October 2020–12 April 2021).

Results:

Despite changes made, participants reported an improvement in clinical skills (Table 1) and human factors (Table 2). 67.6% of cohort 2 reported that personal protective equipment (PPE) had no impact on simulation; however, 7.6% felt masks hindered communication. Common themes reported in feedback are shown in Table 2. Both cohorts reported the course as useful (38% in cohort 1 and 36% in cohort 2). 7% of cohort 1 felt that the debrief needed shortening, compared with 4% in cohort 2 where shorter debrief models were used, conversely 6% of cohort 1 suggested more scenarios were needed compared with 8% in cohort 2 (Table 3).
Table 1:
Percentage of participants who reported feeling confident in clinical skills
% of participants who felt confident in the following scenarios
Pre-course 19–20 Post-course 19–20 Difference Pre-course 20–21 Post-course 20–21 Difference
Managing acutely deteriorating patients 64.32 94.1 29.78 65.39 92.93 27.54
Assessing patients using ABCDE 93.1 100 6.9 92.32 97.98 5.66
Escalating patient care 93.03 98.84 5.81 92.23 96.96 4.73
Using SBAR to handover information to colleagues 79.89 98.84 18.95 86.54 97.98 11.44
Accessing and using clinical guidance and policies 80.46 90.14 9.68 85.58 96.97 11.39
Table 2:
Percentage of participants who reported that they could adequately do the following Human Factors Skills for Healthcare Instrument skills
% of participants who felt they could do the following
Pre-course 19–20 Post-course 19–20 Difference Pre-course 20–21 Post-course 20–21 Difference
Constructively managing others’ negative emotions at work 50.68 79.78 29.1 53.4 83.83 30.43
Requesting help from colleagues in other professions 86.13 97.11 10.98 80.59 96.96 16.37
Communicating effectively with a colleague with whom you disagree 63.01 85.55 22.54 53.39 87.87 34.48
Prioritizing when many things are happening at once 69.37 87.28 17.91 62.14 85.85 23.71
Speaking up as part of a team to convey what you think is going on 69.36 90.17 20.81 67 90.9 23.9
Involving colleagues in your decision-making process 86.13 94.79 8.66 80.58 98.98 18.4
Dealing with uncertainty in your decision-making process 65.31 87.28 21.97 58.25 88.89 30.64
Asking other team members for the information I need during a busy ward environment 80.92 95.95 15.03 77.67 96.96 19.29
Recognizing when you should take on a leadership role 67.05 90.76 23.71 66.98 88.88 21.9
Monitoring the ‘big picture’ during a complex clinical situation 56.65 89.02 32.37 56.31 85.85 29.54
Anticipating what will happen next in clinical situations 60.11 89.02 28.91 51.46 86.87 35.41
Working effectively with a new team in clinical situations 75.73 92.48 16.75 67.97 89.9 21.93
Table 3:
Common themes arising from participants’ feedback
19–20 20–21
% of participants % of participants
Good/useful course 38 36
Improved confidence/knowledge 11 16
Useful inclusion of human factors 5 7
Good range of scenarios 9 12
Useful debrief/reflection 21 44
Supportive/non-judgmental environment 9 10.40
Supportive facilitators 18.90 9.50
More focus needed on clinical skills 5 4
Shorter debrief needed 7 4
More scenarios needed 6 8

Implications for practice:

This course demonstrates that simulation can be delivered safely throughout a pandemic while maintaining education value. Participants continued to find simulation useful; the use of PPE did not affect debriefing and learning processes. Changes did arise as a result of the changes: increased workload on staff (multiple sessions), timing issues, repetition in scenarios delivered and ward pressures on participants. Moving forwards, some adaptations such as the use of PPE will remain, but the course will return to a full day. To further evaluate the impact of the changes made. We are currently obtaining feedback from faculty. ]]>
<![CDATA[194 Implementing a Simulation Training Programme for Physician Associates]]> https://www.ijohs.com/article/doi/10.54531/FNZQ6629 Background:The physician associate (PAs) profession is a relatively new profession to the NHS. As such, there is no official national or regionally agreed further training to support PAs transitioning from PA school into clinical practice once they have graduated. Simulation training has proved to be an effective tool for developing clinical and non-clinical skills in other groups of clinicians [1,2]. We have adapted an already implemented simulation programme for junior doctors to make it suitable for the PA profession with the aim of improving the confidence and skills of PAs working in primary and secondary care. We have evaluated the perceived beneficence of our initial work and have so far observed a perceived positive impact.

Aim:

We aimed to describe the development and implementation of a novel PA-specific simulation training programme and present the evaluation of our initial work.

Method:

We designed and implemented a bespoke simulation training programme based on existing training for junior doctors. This model has three separate simulation sessions, spaced over 2 years, each session has three different clinical scenarios. Seventeen PAs have undergone the first two sessions. The first session contained three scenarios that highlighted important local protocols such as the major haemorrhage protocol and the sepsis [6]. The second session contained three clinical scenarios which followed the same patient’s journey: diagnosis of myocardial infarction, cardiac arrest scenario and breaking bad news. We then collected feedback from candidates’ written feedback and Likert-scale questions.

Results:

At this point in time, we have feedback from 16 candidates from session 1 and 11 from session 2. The results are overwhelmingly positive showing improved confidence, better team-working skills and a perceived perception of improved patient safety following the simulation training, as shown in graphs 1 and 2. The majority of candidates partaking in the session found the simulation training beneficial to their practise. The main negative feedback given was the lack of ‘senior support’ (i.e. from a senior doctor) in the scenarios that were unrealistic to actual practice.

Implication for practice:

The introduction of a novel PA simulation training programme has demonstrated improvements in clinical and non-clinical skills. This supports our aim of improving post-graduate PA training. Work continues to further develop our PA simulation programme and further evaluate its effectiveness with the aim of making this as a regional simulation programme that PAs can undertake when joining the healthcare workforce. ]]>
<![CDATA[53 Remote and Back Again: An Educator’s Tale of Simulation]]> https://www.ijohs.com/article/doi/10.54531/BOXZ8545 Background: Between November 2020 and May 2021, 61 simulation sessions were run either face-to-face or remotely for foundation-level doctors and pre-registration pharmacists. A total of 346 participants attended. Thirty-three sessions were face-to-face (185 participants) and 28 were remotely via Microsoft Teams (161 participants). The content was the same for both modalities.

Aims:

The aim of the study was to discern whether there was a difference in learning points and confidence scores between face-to-face and remote participants.

Methods:

Participants were asked to rate their confidence (see Table 1) before and after the course. They were asked to provide their main learning points and what they gained from the course. Confidence scores were compared and assessed for change. Responses were compared between face-to-face and remote.
Table 1:
Confidence score change on Likert scale 1–5.
Q. no. How confident do you feel… Change
F2F REM
1 …that your clinical knowledge is appropriate for your role +0.67 +0.89
2 … to manage a patient who is peri-arrest +1.03 +1.27
3 …to manage a patient with a NEWS2 >7 and/or is deteriorating +0.93 +1.23
4 …that you possess the skills required to communicate information to the rest of the MPT +0.81 +0.83
5 … that you possess sufficient strategies to raise concerns when necessary +0.51 +0.64

Results:

All participants reported increased confidence. Table 1 shows that the changes were comparable, with the changes in the remote participants all being marginally higher than in face-to-face. The distribution of learning points for remote and face-to-face participants was identical. For both modalities, the top two points were communication and escalation. The dominant theme in remote was escalation and communication in face-to-face. Remote participants were positive about the course, in their free-text responses, ‘most innovative use of technology I have seen during COVID’ and ‘My hands are sweating, I can’t believe how real that felt’ a common theme in the comments was that they would rather do the course face-to-face.

Implications for practice:

While not preferred, remote simulation appears to deliver equivalent learning and is a suitable alternative when face-to-face is impossible. The main difference seen was in communication skills, which is concurrent with Cheng et al. [1] related to the difficulties of communication in a virtual debriefing. ]]>
<![CDATA[52 Virtual Shine (Simulation to Help in Neonatal Emergencies): Adapting Simulation Through the COVID-19 Pandemic]]> https://www.ijohs.com/article/doi/10.54531/LPSB7944 Background: It is well established that simulation can help individuals and teams improve their clinical skills and confidence in managing medical emergencies [1]. In our region, a full-day simulation course on common neonatal emergencies was established in 2018 for paediatric trainees. It consists of four scenarios and two workshops. It is designed for eight candidates who are split into two groups so that each has an opportunity to ‘lead’ a simulation. The Diamond Model is used for debriefing. The course has been running 3–4 times per year and receives consistently excellent feedback. During the COVID-19 pandemic, the course was suspended.

Aims:

The aim of the study was to adapt the SHINE course for virtual delivery.

Method:

We replaced live simulations for pre-recorded scenarios. We filmed these on the labour ward and our simulation room with members of our Neonatal Unit, instructing ‘candidates’ to act in specific ways which would bring out learning objectives. The videos were edited to optimize quality. We delivered the course via Zoom, playing the videos followed by a live debrief. The workshops remained the same. We increased participants to 12, split them into two break-out rooms. We ran the course twice during the peak of the pandemic. We evaluated self-rated confidence pre-attending and post-attending the course.

Results:

We ran the course with four members of faculty instead of eight required face-to-face. We encountered minor technical difficulties which were easily resolved. Twenty-four paediatric trainees of various grades attended. Candidates rated their confidence managing scenarios from 1 (very low) to 5 (very high). The average score before the course was 2.8 and improved to 3.9 after the course. 81% (22) candidates agreed/strongly agreed that the workshops were well structured and educational, 96% (23) agreed/strongly agreed that they had enough opportunities to interact and 81% (22) agreed/strongly agreed that the virtual environment worked well. All candidates agreed/strongly agreed that the video debrief sessions were well structured and educational and that the virtual learning environment was safe and supportive. All trainees would recommend the course to colleagues.

Implications for practice:

SHINE is a well-established sought-after course. We were able to continue this training virtually during the COVID-19 pandemic Whist we recognize that there is no replacement for hands-on experiential learning, we have demonstrated that virtual simulation is possible, effective, highly valued by trainees and has the advantage of being less resources intense and accessible to more candidates. We propose that virtual simulation training should be offered where face-to-face teaching is not possible. ]]>
<![CDATA[67 Even Better than the Real Thing? Comparing In-Person and Online Delivery of Simulation-Based Training for Early-Stage Psychiatric Doctors]]> https://www.ijohs.com/article/doi/10.54531/TDNO4582 Background:COVID-19 required many simulation faculties to provide online alternatives to in-person training. Over this period, our organization pivoted fully to online delivery of mental health simulation-based education (SBE), defined as delivery entirely via a videoconferencing platform to participants remote from one another and the simulation team. SBE can help early-stage psychiatric doctors to bridge educational and clinical practice by providing exposure to a variety of presentations and a safe space to hone communication and de-escalation techniques while encouraging reflective practice [1,2]. There is, however, limited research comparing the efficacy of in-person and online mental health SBE.

Aim:

We assessed for any significant differences across several course evaluation measures in a comparison between groups attending in-person and online versions of a simulation course for early-stage psychiatric doctors.

Method:

An existing full-day course was adapted for online delivery over a half-day period. It focuses on developing confidence and skills in psychiatric history-taking, mental state examination, risk assessment and formulation, meeting the relevant learning outcomes set by the Royal College of Psychiatrists. It encourages participants to explore consultation dynamics with a key emphasis on communication and human factors skills. Participants for in-person (n = 228) and online deliveries (n = 90) comprised of early-stage psychiatric doctors (core psychiatric trainee, or GP trainee level) based in mental health trusts in South London. Pre- and post-course quantitative data (assessing learners’ confidence, situational awareness, and course satisfaction) using the Human Factors Skills for Healthcare Instrument (HuFSHI) and Course-specific Questions (CSQ) measures were collected and compared across the two delivery formats, that is, in-person and online. Data previously collected from participants attending in-person deliveries were used in the comparison.

Results:

Paired-samples t-tests were conducted to determine whether there were any changes in HuFSHI and CSQ scores pre- and post-course. Results indicated that there were significant improvements in HuFSHI scores as well as CSQ scores for both digital delivery and in-person delivery. Large and very large effect sizes were also observed for HuFSHI and CSQ scores, respectively, in both delivery formats. Our data suggest that participants benefited more from in-person delivery across CSQ measures and from digital delivery across HuFSHI measures.

Implications for practice:

Our understanding of the educational differences between in-person and online mental health SBE is at an early stage. Our data suggest that online mental health SBE potentially represents an effective alternative to in-person delivery. Further research is required to better understand these differences. ]]>
<![CDATA[92 Improving Knowledge and Human Factors Skills During a Pandemic: A Multimodal Covid-19 Educational Project]]> https://www.ijohs.com/article/doi/10.54531/HPSH4431 Background:Following a rise in COVID-19 cases and hospitalizations in autumn 2020, the resultant pressures on general medical wards galvanized the simulation education team at a London teaching hospital to create a multi-disciplinary educational programme aimed at ward staff caring for the surge in COVID-19 patients. This was especially important in the context of rapidly evolving clinical guidance and recognition of the importance of human factors in re-deployment of staff, thus a multimodal educational project was initiated to develop ward staff knowledge and human factors skills.

Aim:

The aim of the study was to ascertain the effectiveness of the multimodal COVID-19 educational project in improving ward staff knowledge and human factors skills.

Method:

In October 2020, the team began creating the project – comprising e-learning to improve staff knowledge, in situ simulation training and an in-centre human factor course, all based around the care of patients with COVID-19. With rising COVID-19 cases and subsequent suspension of face-to-face teaching, an online format for the human factors training was created incorporating scenarios from the in situ simulation. Data were collected via SurveyMonkey with pre- and post-surveys for each facet – six key learning outcomes for e-learning and the Human Factors Skills for Healthcare Instrument (HuFSHI) for the other elements – with free-text boxes for qualitative feedback.

Results:

e-Learning surveys were completed by 108 learners with a significant difference (p < 0.01) in self-reported pre- and post-survey scores across the six domains. Learners demonstrated mean improvements across all areas of the HuFSHI for the in situ (N = 9), human factors course (N = 15) and online format (N=46). Results were comparable between face-to-face and online formats. Learners found all formats useful (e-learning 99%, in situ 100%, human factors 100%, online 98%).

Implications for practice:

In a limited time frame, the simulation education team implemented a multimodal educational project that improved both ward staff knowledge and human factors skills amidst the second wave of the COVID-19 pandemic. Moreover, following restriction of face-to-face delivery, the project was successfully converted into a purely online format. This ability to be flexible and adapt accordingly is one that needs to be widely adopted going forwards, especially during these unpredictable times. Further challenges included staff release for training, time pressures, managing emotive discussions using the online modality and COVID-19 safety measures. A 6-month follow-up survey is planned to evaluate the benefit to staff’s clinical work and will be included at the presentation. ]]>
<![CDATA[175 Embracing a System-Based Approach to Simulation – The Experience of a Paediatric Hospital During a Global Pandemic]]> https://www.ijohs.com/article/doi/10.54531/JAVB6206 Background:The GOSH Clinical Simulation Centre (CSC) delivers an established paediatric in situ simulation programme at Great Ormond Street Hospital. Prioritizing advancement of the patient safety agenda, we work closely with our quality and safety teams to embed key safety themes within our trust-wide in situ curriculum. A fundamental objective of in situ simulation is to identify and remove risks or ‘latent safety threats’ in the clinical environment, which could cause unintended harm to patients or staff [1]. Fitting with the safety II approach advocated in the National Patient Safety Strategy [2]; another emerging application of in situ simulation is its use to evaluate clinical systems and processes [3].

Aim:

The aim of the study was to expand the applications of our pan-trust in situ programme to adopt a prospective approach to simulation delivery via ‘Systems Safety’ exercises.

Method:

Over the course of 18 months, simulation exercises were designed to focus on rehearsal and refinement of processes and systems, towards uncovering latent safety threats or gaps in practice. A reporting tool was developed; to capture risks and identify mitigating actions. In addition to this, an established reporting structure enabled faculty to share findings and escalate risks to the local patient safety team. The COVID-19 pandemic presented healthcare workers with many new or unfamiliar working practices. This context further shifted our focus towards systems safety simulations (SSS) with the aim of enabling teams to focus on rehearsing and preparing for new ways of working.

Results:

Ten different exercises were delivered with clinical teams across the trust: successfully informing the development of five new clinical guidelines relating to COVID-19-specific practices. In one exercise alone, 11 latent safety threats (LSTs) were captured and managed with the appropriate teams (Figure 1). A system-based approach to simulation has since been used to inform equipment location and fire evacuation processes in two new clinical environments (Figures 2 and 3).
Themes from LSTs captured during COVID-19 CT transfer simulation
Figure 1:
Themes from LSTs captured during COVID-19 CT transfer simulation
SSS fire evacuation exercise in the IMRI suite
Figure 2:
SSS fire evacuation exercise in the IMRI suite
SSS fire evacuation exercise in the new sight and sound building
Figure 3:
SSS fire evacuation exercise in the new sight and sound building

Implications for practice:

These exercises demonstrate the potential applications of simulation to support process and system improvement. Beyond the pandemic, we aim to continue to deliver SSS exercises to help make clinical systems and spaces safer for patients and teams. Following in the footsteps of successful simulation teams in the USA, we aim to advance this work to deliver SSS at the preconstruction level in future to inform the design of new clinical spaces. ]]>
<![CDATA[9 Enhanced Recovery After Surgery: Multi-Disciplinary Healthcare Simulation Training for Perioperative Teams]]> https://www.ijohs.com/article/doi/10.54531/XJEC2113 Background: Enhanced recovery after surgery (ERAS) is an evidence-based approach in perioperative care allowing patients to recover more quickly after surgery. The ultimate aim of this programme is to optimize organ function pre-operatively and reduce the stress response from major surgery to aid in early recovery [1]. The multimodal pathways utilize a wide range of staff from the multi-disciplinary healthcare team. Although medical staff such as senior anaesthetists and surgeons may be confident in implementing ERAS protocols and troubleshooting post-operative problems, this may not be the case for more junior medical, theatre and nursing staff. This is of particular relevance in smaller surgical units across the UK.

Aims:

We aimed to provide structured and interactive simulation (SIM) training for staff involved in the management of colorectal surgery patients on the ERAS programme. Staff included operating department practitioners (ODPs), surgical staff nurses and anaesthetics senior house officers (SHOs). This was based at a small district general hospital (DGH) in the West Midlands.

Method:

Staff were given hypothetical post-operative scenarios of commonly encountered surgical problems on the ward. These included hypotensive patients and the management of regional analgesic techniques such as epidurals. Sessions were commenced with a brief and targeted outline of relevant physiology, followed by a series of SIM moulages. A longer period of time was made available at the end of each SIM for debrief.

Results:

Staff were more confident after SIM sessions in managing the acutely ill ERAS surgical patient. The multi-disciplinary nature of the scenarios was highly commended. Feedback from staff was encouraging, in particular, about how ‘real’ the scenarios felt. There was also increased awareness about the rationale behind the principles of the ERAS programme and healthcare staff felt it would change their practice. Feedback was measured through a series of pre- and post-SIM questionnaires.

Implications for practice:

Through a series of SIM sessions and theatre shadowing, we aim to create an ERAS team and ERAS unit at the hospital. SIM will play a major role in addressing the learning objectives of junior medical staff, ODPs and nurses. The long-term goal is to safely manage these patients on a dedicated unit. We aim to create a safe environment where invasive monitoring can be used, and treatments such as vasopressors prescribed under the supervision of anaesthetists. This will ultimately improve patient care and help fulfil the core objectives of the ERAS approach. ]]>
<![CDATA[102 Haunted House: The Dangers and Ghosts of The Lived Environment]]> https://www.ijohs.com/article/doi/10.54531/KOGI8266 Background: Accurate assessment of potential hazards and challenges within a home environment is essential to ensure the safety of our patients both post-discharge from hospital and within the community. Inter-professional education in this area allows students to learn from, with and about each other to provide more effective patient care. COVID-19 challenged the Arkansas Interprofessional Education Consortium (ARIPEC) to develop meaningful inter-professional activities while minimizing COVID-19 risk [1].

Aims:

The aim of the study was to create and deliver a novel virtual home assessment simulation for inter-professional learners to improve the performance of home assessments state-wide.

Method:

Faculty from three universities created rooms within a simulated home assessment environment illustrating patient characteristics, hazards, habits and interpersonal considerations. Each university created and video recorded one simulated room (kitchen, bedroom and living room) which were combined in one video to represent a home. Students received pre-course material including education on the INHOMES tool and learning objectives before the virtual learning event. The brief included education on the importance of home assessment and the INHOMEs tool. The simulated home video was played to all students who subsequently were split into break-out rooms with facilitators. In inter-professional groups, students created action plans for immediate needs and for when weight-bearing status allowed increased mobility and identified professionals required to meet needs. Following this debriefs occurred in break-out rooms and then as a large group to summarize and identify take-aways. All students completed a pre-/post-questionnaire including the Interprofessional Collaborative Competency Attainment Survey (ICCAS) and evaluation of simulation methodology, home assessment and overall impression. Mean scores for 5-point Likert scores are reported.

Results:

In total, 400 students participated in the 2021 event, including medical, pharmacy, physician assistant, dental hygiene, communication science disorders, physical and occupational therapy, addiction studies, respiratory care, radiography, public health, sonography and nursing. All ICCAS metrics increased pre- to post-evaluation. See Table 1.
Table 1:
Student evaluation data from the simulated home environment assessment activity
Quality assessed Mean Likert score (1 – strongly disagree, 5 – strongly agree)
Improve confidence 4.32
Improve communication skills 4.34
Improve reasoning skills 4.41
Improve decision-making skills 4.41
Helpful for professional development 4.46
More comfortable in completing home assessment to identify safety hazards and concerns 4.48
More comfortable to identify team members to meet the immediate and long-term needs of a patient with pain and limited mobility 4.48
The activity demonstrated the value of providing team-based home assessment education 4.54
Overall was a valuable educational activity 4.48
Simulation video portrayed the simulated environment well 4.5
Simulation video gave constructive indicators to identify patient characteristics and behaviours 4.53
Simulation provided an effective mechanism to learn home assessment using the INHOMES tool 4.52

Implications for practice:

Our results demonstrate that a video-recorded simulated home environment event is successful in supporting the development of an inter-professional action plan for a home assessment using the INHOMES assessment tool. The collaborative creation of this event was essential due to the COVID-19 pandemic, but the efficacy for learning demonstrates the utility of this approach in the post-pandemic area. Virtual simulations increase accessibility for inter-professional learners to learn from, with and about each other for the benefit of our patients. ]]>
<![CDATA[114 Latent Environmental Errors Revealed: Using <i>in situ</i> Simulation to Check the Safety of Returning Theatres to Operating After Being Repurposed as a Ventilator Inpatient Unit]]> https://www.ijohs.com/article/doi/10.54531/AEFU7500 Background:During the second wave of the coronavirus pandemic, Day Surgery had been stopped for 6 months at Aintree University Hospital to respond to an influx of COVID patients. Day Surgery theatre staff had been redeployed to other areas of the hospital, including A&E and Intensive Care. The Day Surgery recovery had been repurposed as a ventilatory inpatient unit for coronavirus patients. We felt that this potentially jeopardized the confidence and competence of returning elective care staff. We hypothesized that the theatres themselves had become unsafe to accept patients for elective procedures having been used for a different purpose for such a long time. We used in situ simulation to re-skill the staff and test the safety of the clinical area [1].

Aim:

We aimed to improve the confidence and capability of theatre staff returning to work in elective theatres and to perform a systems test of the Day Surgery Unit to identify and rectify any latent errors.

Methods:

The refresher day was split into morning and afternoon sessions. The morning session comprised of two simulation sessions: cardiac arrest in recovery and a difficult airway in theatre. The afternoon comprised of sessions focussing on five anaesthetic emergencies: malignant hyperthermia, local anaesthetic toxicity, massive haemorrhage, anaphylaxis and sepsis. These sessions included locating and studying standard operating procedure (SOP) folders and locating vital equipment in the treatment of these emergencies. Participants then evaluated their confidence in managing emergencies before and after the refresher day using pre- and post-questionnaires. We also encouraged participants to raise concerns and make suggestions in a free-text section.

Results:

Forty participants took part in the refresher day. Pre- and post-questionnaires indicated that participants had much-improved confidence in dealing with anaesthetic emergencies post-session. We identified several latent errors within the unit including missing and out-of-date SOP folders, missing anaphylaxis bag, no fibrescope available for the difficult airway, no key available for the malignant hyperthermia cupboard and a poorly stocked and unsealed difficult airway trolley.

Implication for practice:

The results show that participants felt more confident to restart work in the Day Surgery Unit, hopefully improving their performance in critical incidents. By running in situ emergency simulations, we identified several latent errors in the elective care centre which allowed us to rectify these in preparation for its re-opening, improving the safety of our unit. Participants expressed a desire to engage in more simulation sessions. Latent environmental errors revealed: using in situ simulation to check the safety of returning theatres to operating after being repurposed as a ventilator inpatient unit. ]]>
<![CDATA[72 Medical Student Attitudes Towards Point-of-Care Ultrasound in Undergraduate Medical Education]]> https://www.ijohs.com/article/doi/10.54531/RYJX3157 Background: Point-of-care ultrasound (PoCUS) is a bedside imaging modality that provides the operator with instant clinical patient information. PoCUS is a low-cost, radiation-free, portable diagnostic tool that is utilized in many specialities [1]. To the best of our knowledge, no Irish medical schools have a formalized ultrasound curriculum in place for undergraduate students. Hands-on ultrasound teaching has the potential to enhance medical students’ basic understanding of human anatomy and confidence in diagnostic ability [2].

Aims:

The aim of the study was to assess undergraduate medical students’ attitudes towards PoCUS through the implementation of a rudimentary proctored PoCUS workshop.

Methodology:

Third-year medical students at the Royal College of Surgeons in Ireland participated in a 1-hour PoCUS workshop as part of their fundamental clinical skills training. Medical students attended the in-person workshop repeated over 8 weeks. Students were exposed to three ultrasound stations. The first was a CAE Vimedix ultrasound simulator utilizing augmented reality colourization and 3D modelling. The second station was learning and performing an extended FAST scan with a focus on bright mode image acquisition and free fluid recognition. The third station was the practical placement of peripheral/central IV-line insertion helping students to identify vasculature while also manipulating the ultrasound transducer as a procedural adjunct. Students were asked to complete a post-workshop survey to investigate their attitudes towards ultrasound teaching in undergraduate medical education. The survey consisted of 10 questions to assess attendee’s prior ultrasound knowledge, to provide constructive feedback regarding the workshop and how ultrasound can be incorporated into future undergraduate medical education.

Results:

A total of 121 students completed the post-workshop survey. Of those who completed the survey, 94.2% of students had never used an ultrasound machine before and 100% had never performed PoCUS previously. Collectively, participants strongly agreed 100% that PoCUS should be incorporated into the undergraduate medical student curriculum at RCSI. In particular, 89.3% and 45.5% of students indicated that POTUS should be included in the third- and fourth-year medicine curriculum, respectively. 85.1% of students indicated that PoCUS education would be most valuable to supplement clinical placement followed by anatomy (62.8%), pathology (59.9%) and physiology (23.1%). 86.8% of the students were interested in learning more about PoCUS through an online format.

Implications for practice:

PoCUS appears to be an additional valuable learning resource for undergraduate medical students. Of the students surveyed, it is apparent that there is strong support in favour of early ultrasound integration into the future medical school curriculum. ]]>
<![CDATA[167 Evaluating the Effectiveness of a Redesigned Simulation Programme for Final-Year Medical Students During their Assistantship Placement]]> https://www.ijohs.com/article/doi/10.54531/BUIS2757 Background:The transition to a foundation doctor is often a daunting process for medical students and, to prepare for this, students attend an assistantship placement in the final months of medical school. The transition to foundation year 1 (TTF1) programme is an 8-week placement where students shadow a junior doctor, taking on a vocational role, and attend various teaching activities including high-fidelity simulation. Evidence suggests that medical students transitioning to clinical practice feel unprepared for working on-call, managing acutely unwell patients and task prioritization, and are often unprepared for scenarios requiring expert communication techniques [1]. As such, we redesigned a simulation programme for TTF1 students using novel scenarios designed to focus on these key areas that students often struggle with.

Aim:

We aimed to evaluate the effectiveness of a redesigned simulation programme for TTF1 students, focussing on student satisfaction, confidence and attitudes across key domains.

Methods:

Fifty-three TTF1 students attended a 1-day high-fidelity simulation training day, separated into cohorts of 10 students. Students completed a pre-course (n = 53) and post-course online evaluation form (n = 49) using Likert scales (0–5) and qualitative data. Students participated in at least one clinical scenario, while observers viewed the scenarios in a separate room. Scenarios were created to reflect likely clinical on-call tasks such as falls assessment, recognizing and managing the acutely unwell patient, bleep prioritization, and de-escalation of an agitated patient-actor. Debrief was undertaken using the Diamond Debrief model.

Results:

In terms of confidence, there was an improvement across all core domains, namely diagnosing and managing acute medical emergencies (2.8 vs. 3.8), performing cardiopulmonary resuscitation (3.0 vs. 3.6) and working effectively with colleagues in the interests of the patient (3.3 vs. 4.2). 96% of students found that simulation was a valuable learning experience, allowing them to integrate theory with practice. 94% of students felt that the simulation allowed them to analyse their behaviours and actions and 88% found that scenarios resembled real-world situations. Attitudes towards simulation were positive, with 92% of students agreeing that simulation is a good way of learning technical and non-technical skills. Qualitative themes focussed on the real-world applicability of the scenarios, increased confidence in task prioritization, closed-loop communication and early escalation.

Implications for practice:

We have demonstrated the benefit of integrating simulation training within the assistantship period and the value of creating novel scenarios directly related to future practice as a junior doctor. ]]>
<![CDATA[203 Ultrasound Identification of the Cricothyroid Membrane for Emergency Front of Neck Access]]> https://www.ijohs.com/article/doi/10.54531/LPAW8776 Background:The difficult airway society states that emergency front of neck access skills should be recapped every 6 months amongst those practitioners expected to perform the skill. Furthermore, the national audit states that, of the 25 emergency cricothyroidotomy cases, 9 failed. These were largely due to incorrect identification of the midline and tube misplacement. There is a convincing argument for training practitioners in ultrasound identification of the cricothyroid membrane, mitigating the risks of incorrect midline identification and blood vessel damage [1].

Aim:

Our aim was two-fold: introduce and embed the skill of ultrasound identification of the cricothyroid membrane for use in emergency front of neck access and encourage regular recap of these skills through a training package of blended learning, consisting of videos, ‘tea trolley’ style theatre training and a more formal simulation-based course that focuses on the ultrasound and front of neck access skill and human factors as we know this is a key factor in the success or failure of this scenario.

Methods:

A pilot course was rolled out amongst anaesthetic trainees to assess relative comfort with performing emergency front of neck access. The course consisted of a short lecture on the background and anatomy, teaching of the ultrasound skill using live subjects, practising of ultrasound-guided front of neck access on animal necks and finally a simulation with debrief surrounding implementation of the skill itself and human factors. This course is now being rolled out regionally and aims to teach all trainees in the region. We encourage trainees to generate their own informal logbook of ultrasound cases, whereby they consent patients to undergo a short ultrasound scan in the anaesthetic room prior to intubation, have their neck marked and then are rescanned after intubation to confirm correct identification. This should be done with ‘normal’ airways, not just those expected to be difficult, as this practice embeds the skill. Our ‘tea trolley’ style teaching is yet to be commenced but will involve ad hoc teaching within the theatre suite including the multi-disciplinary team who would be involved in such an event – the anaesthetist, operating department practitioner and theatre team. Finally, we are generating a video bank, which can be accessed in users’ own time to recap and review the process and troubleshooting of ultrasound identification of the cricothyroid membrane and ensuing cricothyroidotomy.

Results:

An improvement was reported in trainees’ comfort levels to perform ultrasound-guided cricothyroidotomy and all trainees felt that this was a worthwhile skill to embed into their practice. These improvements were tested via a pre- and post-course questionnaire. The same we hope will be true for the tea trolley training and we aim to address the human factors involved during these sessions too.

Implications in practice:

The aspiration is that ultimately ultrasound identification of the cricothyroid membrane for emergency front of neck access will at the very least become a skill that all trainees are formally taught and encouraged to practice and at the most will become the new standard for plan D airway access in the difficult airway society guidelines. ]]>
<![CDATA[56 ‘Abducted Baby’ Simulation: Testing the System to Optimize Patient Safety on a Neonatal Intensive Care Unit]]> https://www.ijohs.com/article/doi/10.54531/IHQQ5470 Background:Infant abductions are rare distressing events. The Care Quality Commission recently highlighted inadequate protective measures in other trusts as a cause of major concern [1]. In April 2020, the security system in our Neonatal Intensive Care Unit (NICU) was updated, with a new baby tag system. A tag is placed onto each baby in NICU, and if this tag is within close proximity of an exit door, an alarm sounds and the door locks.

Aim:

The aim of the study was to test our existing patient safety system in a real-life situation looking at human factors and equipment functionality.

Method:

An activated baby tag was placed on a mannequin which was then put into a pram. A member of staff in disguise (the ‘abductor’) pushed the pram out of the neonatal unit by ‘tailgating’ another member of staff so that the doors would not automatically lock, replicating a potential real-life scenario that exploited a known risk. The aim was to see whether the mannequin could leave the hospital. The ‘abductor’ was eventually stopped from leaving. A detailed timeline of events was recorded and analysed. Safety was ensured and participants were individually debriefed as emotions were high.

Results:

Our simulation highlighted points of excellence including a quick and calm response, the use of the panic button and appropriate persistent challenge of the ‘abductor’ without aggression. Important human factors were highlighted. There is no security staff in the hospital. The ward clerks called the porters directly, rather than dialling 2222 and saying ‘lockdown’, which triggers a lock of all doors out of the hospital. There were several system failures. The baby tag system did not alert the front of house. The panic button was broken, and a set of doors out of the hospital did not lock.

Implications for practice:

Simulation is an effective tool to identify system failures and patient safety risks. This scenario highlighted deficiencies in our system and a lack of established procedures and training. A detailed action plan has been put in place. The panic alarm, door locking mechanism and system linking the baby alarm system to the front of house are being addressed. The option of an automatic lockdown on activation of the baby tag alarm system is being explored. Finally, a standard operating procedure is being written and learning disseminated in the department. We are planning to run this simulation in other areas of the hospital to optimize patient safety. ]]>
<![CDATA[17 Improving Resus Handover for Critically Unwell and Injured Patients]]> https://www.ijohs.com/article/doi/10.54531/HHMT2433 Background: During a single patient journey from admission to hospital discharge, multiple clinical handovers may occur between health professionals from different specialist inpatient teams and between staff at shift changes. Each handover carries a degree of risk for the patient. It is well recognized that poor communication during handovers has resulted in a significant proportion of preventable deaths [1]. The World Health Organisation (WHO) has therefore included clinical handover in the 2020 Global Patient Safety Action Plan as one of the key areas of patient care that requires robust processes and policy to ensure and improve patient safety [2]. Although handover involves risk, it is a vital part of patient care. It is often the primary source of information for health professionals taking over patient care. However, handover in resus could often feel stressful and chaotic with multiple distractions and variability in the information conveyed. It was also apparent that staff from both ED and SAS were not satisfied with the handover process. During debrief sessions, handover was often mentioned as an area of practice that required change.

Aims:

The aim of our quality improvement (QI) project was to improve the handover process between Scottish Ambulance Service (SAS) staff and Emergency Department (ED) staff for critically unwell and injured patients arriving into resus. In addition, we aimed to improve communication and staff satisfaction with the handover process.

Methods:

By utilizing QI tools such as the model for improvement, process mapping and driver diagrams, change ideas were identified and trialled using inter-professional simulation as part of PDSA (Plan, Do, Study, Act) cycles. This project involved engagement with ED and SAS staff members via online surveys, simulation sessions and staff education.

Results:

We increased staff satisfaction with the handover process from 24% to 88% and no adverse events relating to our changes were reported.

Implication for practice:

From the information gathered during PDSA cycles, a new standard operating procedure (SOP) for handover in resus was created. ]]>
<![CDATA[50 Continuing Essential Education During the COVID-19 Pandemic: Virtual Neonatal Skills Training]]> https://www.ijohs.com/article/doi/10.54531/TQEF4397 Background: Practical procedures are integral to neonatal care. All first-year paediatric specialist trainees (ST1s) are expected to develop essential skills from their first neonatal placement. However, many trainees join the speciality with minimal prior exposure. With recent changes in junior doctors’ contracts, reduced working hours and evolving clinical practices, trainees may not get enough clinical exposure to acquire required skills. Simulation is recognized as essential to bridge this training gap [1]. A practical skills course developed in 2018 has been running with consistently good feedback. However, during the COVID-19 pandemic, it was suspended.

Aims:

The aim of the study was to adapt neonatal skills training to virtual delivery.

Methods:

In September 2020, we trialled a half-day virtual training course for new trainees on core topics. The first part included ‘Human Factors’ followed by ‘Stabilization of the premature infant’ using a pre-recorded simulation followed by a live debrief. The second part covered ‘intubation and difficult airway’ followed by ‘vascular access’. We used interactive lectures and pre-recorded demonstrations. A full-day course was then organized for new trainees in March 2021. We included additional sessions on ‘Newborn Infant Physical Examination’ (NIPE), ‘chest drain insertion’ and ‘journal club’, including sign posting to the Critical Appraisal Skills Programme (CASP). Interaction was encouraged to facilitate peer bonding. A Paediatric Trainee Committee representative also joined to outline the support available for trainees. We followed a similar structure to the first course but added live simulation demonstrations of equipment and techniques.

Results:

Seventeen trainees attended the full-day course. A number of candidates rating the sessions as extremely useful were 16 for ‘Stabilization of the premature infant’ and ‘intubation and difficult airway’, 14 for ‘Human Factors’ and ‘NIPE’, 12 for ‘vascular access’ and ‘chest drain insertion’ and 11 for Journal club. Trainees commented positively on the videos, equipment demonstration, level of interactivity and overall usefulness of the course. Nine trainees commented on desire for additional face-to-face training.

Implications for practice:

After balancing the safety and learning needs of trainees, we adapted an established face-to-face skills day for virtual delivery during the COVID-19 pandemic. Whilst we recognize that virtual training is not a substitute for doing, we were able to maintain essential education during highly pressured times. Feedback demonstrates that our virtual teaching programme was well received and useful. It also emphasizes the value of actual practice and the urgency to restore hands-on training as soon as possible. ]]>
<![CDATA[196 Plugged in Sim-Vr 360 Simulation with Headsets: How Does it Work?]]> https://www.ijohs.com/article/doi/10.54531/CEKH9900 Background:Simulation is a technique employed to produce an experience without going through a real event [1], with different methods used to do this within a medical simulation. Virtual reality (VR) is the simulation of the world through a computer or device. VR has been used for procedural training and within medical education for a number of years [2].

Aim:

We had used 360 videos for remote simulation and debrief for over 3 years but as face-to-face sessions started to reoccur, we wondered whether we could use these videos to engage learners using VR headsets for short immersive sessions with a targeted debrief.

Methods:

We used unscripted 360-degree scenarios of Paediatric emergency simulations, loaded onto Occulus-Go VR headsets. Between November 2020 and May 2020, we ran sessions for the paediatric and obstetric teams in North Devon district hospital, where groups of up to five learners watched a scenario, followed by a debrief led by a facilitator. We explored its acceptability, immersion and whether the debrief enriched the session through collecting feedback.

Results:

We engaged 50 participants over 14 sessions. The majority of sessions occurred on night shifts. Twenty-nine staff including doctors, midwives, healthcare assistants and nurses gave feedback. All participants enjoyed the experience and wanted to do it again: 90% felt immersed and 97% enjoyed the debrief. A small minority found the experience strange and one had to stop watching because of motion sickness.

Implications for practice:

Virtual sim with headsets is time-efficient, requires no bedspace and was engaging enough to be requested during out of hours shifts. Feedback proved it to be immersive, safe and enjoyable. It is cost-effective (not needing large numbers of staff or expensive manikins) and the experience reproducible. It was accessible for those who had previously been scared of simulation as they did not feel ‘judged’ and therefore may be a valuable adjunct to engaging those who have not in the past. Debrief was vital and allowed active discussion of learners’ own experiences as well as an exploration of the medicine prompted by being immersed in the scenario. Virtual simulation using headsets and 360 videos gives learners an experience without going through the real event and we feel that it is a valuable tool for engaging teams in simulation education. Through this project have established standards that could help others engage in projects such as this. ]]>
<![CDATA[91 Can ‘Pop-Up’ Style Simulation Teaching Improve The Care That Our Children and Young People’s Emergency Department Team Provide for Children Presenting with Fever?]]> https://www.ijohs.com/article/doi/10.54531/OIFM1105 Background: We wanted to use simulation teaching to improve our multi-disciplinary team’s (MDT) management of children who presented to our Children and Young People’s ED (CYPED) with fever.

Aims:

The aims of the study were: first, to use simulation teaching to train the MDT in our CYPED, to improve the care delivered to children presenting with fever, measured as an improvement in our compliance with the Royal College of Emergency Medicine’s (RCEM) standards [1]. Secondly, to carry out the simulation teaching in a ‘pop-up’ style that can be delivered to staff within their clinical shifts on the shopfloor, without disturbing their work or the functioning of the CYPED.

Method:

For cycle one of our audits, we looked at a sample of 136 children who presented to our CYPED with fever; 61 patients met the inclusion criteria and were included. To improve compliance to the RCEM standards [1], we designed a 10-min, low-fidelity, simulation-based teaching session, requiring minimal resources. When staffing and acuity in the department allowed, we carried out ‘pop-up’ teaching in a spare CYPED cubicle. We ran four sessions, each lasting 1 to 3 h. Within these sessions, we ran the simulation 20 times, to 40 members of the MDT. To aid flexibility, we started each teaching session as and when staff attended. Following the teaching, staff self-rated their knowledge and ability to adhere to the RCEM standards on a 10-point Likert scale. To complete our PDSA cycle [2], we repeated the audit. We looked at a sample of 192 children, 87 met the inclusion criteria and were included.

Results:

Staff’s self-rated knowledge of the RCEM standards [1] improved from 4.4 to 9.3 and their self-rated adherence to the standards improved from 5.4 to 9.3, on a 10-point Likert scale. This was reflected in improved compliance to the RCEM standards 1–6 [1] in the second audit cycle. The compliance with RCEM standards (1) from cycle 1 to cycle 2 was as follows: standard 1; 71% to 79%, standard 2; 59% to 78%, standard 3; 38% to 92%, standard 4; 74% to 66% and standard 5; 100% both cycles. Standard 6 is that the CYPED should provide training in sepsis recognition, which was achieved through our simulation sessions.

Implications for practice:

‘Pop-up’ style simulation teaching can be used to improve the care that we offer our patients, as reflected by an improvement in staff’s confidence and in the department’s compliance with RCEM standards [1]. We endeavour to continue to use pop-up style simulation sessions within clinical shifts to continue to learn and strengthen as an MDT. In turn, we hope that this will improve the care that we offer our patients. ]]>
<![CDATA[176 Does High-Quality Learning Need High-Fidelity Simulation? Experience from Obstetric Theatres Preparing for the First Wave of COVID-19]]> https://www.ijohs.com/article/doi/10.54531/UYUL7558 Background: In early 2020, medical teams globally faced the challenge of preparing for an unprecedented clinical situation. As well as the predicated scale and severity of the COVID-19 pandemic clinical teams were generally inexperienced in dealing with an infectious agent of this nature. Simulation, particularly high-fidelity, plays an important role in preparing for novel, high-stakes situations. However, at this time, all clinical departments were simultaneously occupied with such preparation. This placed unprecedented demand on resource-dependant, high-fidelity simulation. Here we share our use of multiple simulation modalities, ranging from low- to high-fidelity, to prepare our multi-disciplinary obstetric theatre team for the arrival of the COVID-19 pandemic.

Aims:

The aim of the study was to prepare the local team to manage COVID obstetric patients within the theatre environment, particularly in the context of obstetric emergencies. This preparation must take the form of both institutional learning (the creation of a standardized protocol specifically adapted for obstetric theatres) and individual learning (familiarity by individual team members with guidelines and their roles within them).

Method:

Multiple modalities of simulation were utilized (Table 1), ranging from ‘talk-through’ – table-top discussion utilizing paper prompts, such as a map of the theatre complex (Figure 1) – to high-fidelity in situ simulation. Whilst only a single high-fidelity simulation was performed, the other modalities were employed numerous times.
Table 1:
Figure 1:

Results:

This programme of multiple interlinked simulation modalities allowed the creation of a coherent, comprehensive and practical protocol for the management of COVID patients in obstetric theatres in advance of encountering such patients in reality. This protocol was found to be satisfactory to a group of local subject matter experts prior to the arrival of the pandemic. As management of COVID obstetric patients became more familiar, this protocol was reviewed. It was found that no significant alterations were required, indicating that, despite utilizing only a single, high-fidelity simulation session, the original programme of development had pre-empted many of the practical issues that would otherwise only have been discovered later through real-world practice. Individual learning is more challenging to define, but feedback suggested both a greater familiarity with guidelines by individual learners and was able to identify targets for more specific training (e.g. donning/doffing, definitions of aerosol-generating procedures).

Implications for practice:

High-fidelity is often viewed as the highest form of simulation for effective learning. However, its undertaking has a high resource cost. Our experience demonstrated that low-fidelity, less resource-demanding modalities provide significant benefits to both individual and institutional learning. ]]>
<![CDATA[151 Comparing Online and Face-to-Face Simulation for Medical Students During their Healthcare of Later Life Placement]]> https://www.ijohs.com/article/doi/10.54531/QJZN1847 Background:As part of their Healthcare of Later Life placement medical students take part in a simulation-based learning (SBL) programme delivered by the Nottinghamshire Healthcare Simulation Centre. Since face-to-face teaching was not possible during the COVID-19 pandemic the programme was instead delivered online.

Aim:

The aim of the study was to compare the feasibility and acceptability of delivering an SBL programme for medical students virtually versus face to face.

Method:

The existing SBL programme was delivered online while largely keeping the same content and format as for prior, face to face, cohorts. Feedback questionnaires from 136 face-to-face participants (F2F) from the 2019–2020 cohort and 131 virtual participants (V) from the 2020–2021 cohort were compared.

Results:

Overall, the virtual course was still acceptable to most participants with 99% agreeing or strongly agreeing that the learning objectives were met and 98% indicating they would recommend it to a colleague. However, there was a decrease in Likert scale ratings across all domains in the V group. This was most apparent when examining the ‘strongly agree’ responses: the venue/remote format was suitable for the session 34% decrease, the course length was appropriate 30% decrease, the pace of the course was appropriate 20% decrease, the trainers were well-prepared 15% decrease, the presenters were engaging 10% decrease, the simulation was helpful and relevant 10% decrease, the content of the course was organized and easy to follow 5% decrease, the learning objectives were met 4% decrease. There was a small increase in responses in the strongly disagree and disagree categories.

Implication for practice:

Providing the SBL programme using an online format was feasible while also being acceptable to most participants. However, participants did not rate this experience as highly as face-to-face teaching. An interesting finding is that participants rated the pace and length of the online course as less agreeable, despite the content and scheduling is the same as for the face-to-face group. Analysis of qualitative responses indicated that participants in the V group found it difficult to sustain concentration for the duration of the virtual session. This may relate to a newly emerging phenomenon dubbed ‘Zoom Fatigue’ (Lee, December 2020) which is related to the greater cognitive load required when participating in social interactions in a virtual environment. Based on these findings, face-to-face teaching should resume when practicable. The virtual delivery may be improved if the course length was reduced. ]]>
<![CDATA[39 Using Simulation to Improve Surgical Departmental Induction for Junior Doctors]]> https://www.ijohs.com/article/doi/10.54531/TFWV9068 Background:Departmental induction is essential for trainee well-being and patient safety, particularly for doctors in the early stages of their careers. Studies have shown that junior doctors often feel underprepared and without sufficient knowledge for safe and efficient practice in surgical rotations [1]. Simulation has been suggested as a tool to improve preparedness. Simulation training in acute surgical presentations, surgical ward rounds, for theatre teams and for practical surgical skills is well established. However, much of junior doctors’ work involves assessing patients who have deteriorated following admission [2], including post-operatively. There is little in the literature exploring the use of simulation in preparing junior doctors to manage ward-based surgical emergencies.

Aim:

This pilot project aimed to create an immersive simulation-based course for junior doctors, focussing on the technical and non-technical skills required to deal with common post-operative and post-procedural emergencies, to improve the departmental induction process.

Methods:

Junior doctors completed a questionnaire to identify their learning needs. On the basis of this, six high-fidelity immersive simulation scenarios were designed: post-operative bleeding, post-ERCP pancreatitis, post-NG tube insertion aspiration pneumonia, anastomotic leak, post-operative wound dehiscence and post-operative cardiac arrest. The scenarios were constructively aligned to both technical and non-technical learning objectives. Scenario participation was followed by a facilitated debrief. Participants completed a pre- and post-course questionnaire exploring their experience on surgical wards, confidence managing surgical ward emergencies and evaluation of the course.

Results:

Two pilot sessions have been facilitated, involving seven junior doctors. Highlighted challenges of surgical ward work include the need for independent decision-making, obtaining senior support and ensuring review of post-operative patients. Pre-course, confidence was particularly low in identifying and managing post-operative emergencies, identifying patients who need to return to theatre and making escalation decisions for surgical patients. Confidence was higher in escalating to surgical seniors and recognizing own limitations. Post-course, confidence had improved in all technical and non-technical skill domains. Participants found the scenarios and subsequent debriefs relevant and educationally valuable. The main suggestion for improvement was to include the course earlier in the rotation. Data collection is ongoing.

Implications for practice:

Our results show that junior doctors find specific simulation-based training in surgical ward and post-operative emergencies extremely valuable, with improved confidence in technical and non-technical skills. We hope to embed this training as part of the departmental induction within our health board and suggest that simulation training for junior doctors on post-procedural emergencies would be of widespread benefit. ]]>
<![CDATA[79 Importance of Delivering a Face-to-Face Course During a Pandemic]]> https://www.ijohs.com/article/doi/10.54531/IEBA5855 Background:During the COVID-19 pandemic, most face-to-face courses were cancelled in line with government and trust guidelines reducing the risk of virus transmission and, if possible, delivered virtually. Given that this is not feasible for all courses, cancellation would have resulted in suspension of essential training for healthcare staff subsequently impacting on career progression.

Aim:

We aimed to deliver Internal Medical training skills and simulations course, face-to-face with measures taken to minimize virus transmission as well as maintain good-quality teaching.

Method:

COVID-19 measures: Fewer delegates per course to accommodate social distancing – infection control guided Temperature check on registration Wearing appropriate Personal Protective Equipment (PPE) whilst inside the teaching centre Email instructing to notify if exhibiting symptoms of COVID-19, and advise not to attend Maintain social distancing during course Increase ventilation of rooms Cleaning of equipment after each use and encouraged regular use of hand sanitizer Use of register for track and trace purposes

Data collection:

Feedback forms of courses that were run pre-pandemic (2019/20) and during pandemic (2020/21) were collated and compared.

Results:

Four editions of the course were run over a period of 3 months and a total of 19 participants in 2019/2020. Four editions of the course were run over a period of 7 months with a total of 17 participants in 2020–2021. Feedback response was on a Likert scale ranging from ‘strongly agree’ to ‘strongly disagree’. For ease of comparison, Figure 1 shows ‘strongly agree’ and ‘agree’ responses only. The pre- and post-SARS-COVID-19 results from the feedback are similar across the board.

Implications for practice:

The results from the feedback forms are very similar for both courses run pre- and post-SARS-COVID-19. Free-text feedback and feedback on the day from the delegates were positive. The results suggest that the changes made to the course during the pandemic to allow for social distancing and to ensure that the courses were run COVID secure have not affected the quality of the teaching and the learning opportunities for delegates. Furthermore, written feedback showed that most candidates appreciated the opportunity to practice new skills and gain confidence and work fatigue did not dampen their motivation to learn. This highlights the importance of continuing to run face-to-face courses during the pandemic. ]]>
<![CDATA[201 Genital Examination Education and Instruction: Lowering Anxiety and Raising Competence]]> https://www.ijohs.com/article/doi/10.54531/GIOT1631 Background: Gynaecologic Teaching Associate (GTA) and Male Urogenital Teaching Associate (MUTA) methodology have been utilized for decades in effective breast, pelvic and urogenital examination clinical skill instruction. This methodology is recognized as the gold standard of instruction when educating learners on the sensitive, invasive clinical skills techniques associated with a genital examination. While research shows it is the most effective way to learn these procedures, outside of the USA and Canada, there are few GTA/MUTA programmes at medical learning institutions.

Aims:

This methodology aims to provide hands-on, standardized instruction in an anxiety-free environment where learners safely practice the clinical skills techniques of breast, pelvic and urogenital examinations and have the unique experience of learning these techniques from the patient’s perspective.

Method:

The GTA/MUTA is both instructor and live simulated patient, using their own bodies as teaching tools, guiding learners through examination techniques and providing instant feedback. With this unique opportunity for skills acquisition, learners receive step-by-step instruction on an actual person in a quality-controlled environment. In addition to correct palpation techniques, this patient-centred form of instruction addresses the emotional reaction patients may have to these examinations. GTA/MUTA instruction also includes patient education and communication and relaxation techniques. The GTA/MUTA patient empowerment methodology is designed to provide an anxiety-free atmosphere for the learner so that the sensitive nature of the genital examination and the embarrassment often accompanying the examination do not become an obstacle to acquiring safe, effective clinical technique.

Results:

Decades of research prove that this method lowers learner anxiety and provides exceptional outcomes for learners in a multiplicity of learning criteria, including higher overall scores; superior communication skills; better ability to identify pathology; ‘better interpersonal skills than physician trained with lasting effects that can be demonstrated after clinical exposure’ [1]; ability to conduct safe, genital examination techniques on patients after exposure to a GTA/MUTA instructor [2].

Implications for practice:

The methodology has far-reaching implications. The specialized skills of these individuals mean that the teaching method can be brought outside of the well-patient experience; sexual assault providers can practice the trauma examination on live simulated patients; remediation can be provided to practitioners who must relearn techniques to maintain licensure; learners are more empathetic to their patients and more inclined to include their patients in the examination process thus improving patient care. This methodology can be utilized in any setting where invasive examination procedures, patient education and communication must be mastered. ]]>
<![CDATA[32 Using a Simulation Environment to Assess the Usability of a Novel Medical Device During the Covid-19 Pandemic]]> https://www.ijohs.com/article/doi/10.54531/VQTW1346 Background:It was a recognized challenge of lack of ventilators needed to face COVID-19 worldwide. Although ventilators are sparse, self-inflating manual resuscitators are widely available in-hospital services, providing a rapid response to respiratory depression. Based on this, a device (PNEUMA) [1] was designed to be a temporary solution for emergency use, allowing positive pressure ventilation through a standard self-inflating manual resuscitator, without the need for healthcare personal manually operating the resuscitator. In the first stage, the device underwent functionality and performance testing, using a calibrated lung tester. In the second stage, the usability of the device was assessed, using a clinical simulation environment, an effective method to test usability [2].

Aim:

This work describes the use of a simulation environment to test the usability of a novel device to automate self-inflating manual resuscitators.

Method:

The usability study was divided into two parts: (1) participants followed a protocol with instructions for assembling and using the system in a non-clinical context (Figure 1, left panel) and (2) participants used the system in an immersive simulation environment with a clinical case scenario (Figure 1, right panel). Participants received information on how to assemble/use the system through a 4-page user manual. To monitor participants’ interaction with the system, both parts were video-recorded and questionnaires on key aspects of usability were filled out.
Usability testing. Left panel – assembly of the system (part I); right panel – use of the system in an immersive clinical simulation environment (part II).
Figure 1:
Usability testing. Left panel – assembly of the system (part I); right panel – use of the system in an immersive clinical simulation environment (part II).

Results:

A convenience sample (two MDs and six RNs) from an intensive care unit of a tertiary Portuguese hospital participated in the test. Usability testing showed that the system was easy and timely assembled, with low complexity of use (e.g. not requiring external help). The clinical scenario tested the transition between spontaneous and mechanical ventilation, and ventilatory parameters’ control, using PNEUMA. All participants reported that the controllable parameters (I:E, RR, Vol, PIP, Plat, and PEEP) were relevant and easy to change. Participants suggested the inclusion of patient parameters such as the tidal volume and lung compliance. Participants also suggested improvements, such as the inclusion of pressure alarms and a more user-friendly interface. All participants reported that they would be willing to use the device for emergency use.

Implications for practice:

The reported study resulted in recommendations and ameliorations of the device, before its use in real settings, in the context of the COVID-19 pandemic. The use of simulation environments for device/systems’ testing provides a timely and standardized approach, enabling a safer clinical practice. ]]>
<![CDATA[59 Rapid Training During A Pandemic: An Evaluation of a Covid-19 Video E-Learning Package]]> https://www.ijohs.com/article/doi/10.54531/OLFZ4146 Background:As COVID-19 hospital admissions rose in 2020, there was a requirement to prepare wards and staff to care for COVID-19 patients, especially given the rapidly emerging and frequently evolving guidance, and high levels of re-deployment (GMC, 2020). In one London Trust, this need for educational material geared towards ward staff resulted in a multi-disciplinary simulation education team being commissioned to produce an e-learning resource. We measured the effectiveness of the resource for ward staff as well as any improvement in learners’ COVID-19 knowledge.

Aim:

The aim of the study was to quantify the effectiveness of an e-learning package in improving learners’ COVID-19 knowledge.

Method:

In November 2020, an e-learning package was created, comprising a video series documenting the journey of a patient with COVID-19 covering admission to discharge (filmed from the patient perspective). This was integrated with content highlighting key aspects of COVID-19 care, ending with a mandatory assessment with an 80% pass mark. The e-learning was disseminated to hospital staff (doctors, nurses and allied healthcare professionals) with data collection via SurveyMonkey® from November 2020 for 3 months. Pre- and post-surveys were included to investigate the average improvement of learners and the impact of the resource on learner self-efficacy through self-rating on six learning outcomes. Free-text options in the post-survey allowed qualitative feedback, aiding continual resource development.

Results:

In total, 108 learners, about half of whom were doctors, completed both surveys, with a significant difference (p < 0.01) between the pre- and post-learning results and an overall improvement in learners’ knowledge after completion of the e-learning (Table 1). The greatest improvement was in ‘Discharge requirements’ (94%) and 100% of learners passed the assessment. The majority found the resource useful, and none reported finding the resource difficult to use. Most positive feedback referred to the format, resources, content and audio-visual aspects.
Table 1:
Average pre- and post-learning scores of learners’ self-reported knowledge and percentage improvement
Key learning outcome Pre-learning mean (out of 10) Post-learning mean (out of 10) p-value Percent improved
Recognize symptoms 7.2 9.0 <0.01 73
Understand TEPs* 6.7 8.8 <0.01 73
Treatment options 5.8 8.7 <0.01 89
Features of deterioration 6.3 8.7 <0.01 83
Escalation protocol 5.0 8.6 <0.01 93
Discharge requirements 4.6 8.2 <0.01 94
*Treatment escalation plans.

Implications for practice:

E-learning can rapidly disseminate learning, at a time when most feel the pandemic has had a mixed or negative impact on learning opportunities (Dean E, 2020; GMC, 2020). The e-learning is continually updated with new evidence, with plans to expand access across London. An iterative process was undertaken with updates in response to learner feedback due to the speed at which the resource needed to be developed, for example, turning resources into PDFs for home access. The e-learning remains live given rising COVID-19 cases. Further work is required to investigate the effectiveness of this resource across London and how beneficial it has been for clinical work. ]]>
<![CDATA[33 Infant Abduction: Live Simulation Drills Explore The Risk in The Maternity Unit]]> https://www.ijohs.com/article/doi/10.54531/UNLG4542 Background: Child abduction is poorly defined in the UK. Legislation varies, defining offences of child abduction, kidnapping and child stealing/plagium. Rabun [1] reports that 45% of infant abductions occur from healthcare facilities and the remainder occur from homes (40%) and other places (15%). The rise in child abduction in recent years may be related to easier access to hospital units, previously open only to fathers during strict visiting hours [2]. Modern, family-centred units allow many visitors, posing further concerns around abduction.

Aims:

Proactive planning, security and staff training are required to reduce this risk, and a live simulation was utilized to test these elements, identify risks and provide solutions.

Method:

A staff member, unknown to the maternity team, was admitted to the ward and gave birth (simulated to a baby girl). Ward staff were informed that there was a restraining order on her partner who was not permitted to visit. An educator from the Clinical Simulation team was tasked with gaining access to the maternity unit, abduct the baby and make their way to a hospital exit and to the car. With the support of Clinical and Governance Midwives, an unannounced live drill was conducted to analyse: Security of the unit Staff adherence to local policy – proactive planning Conflict management and challenge

Results:

Observation analysis identified: Access to the maternal unit was gained through tailgating with no challenge from staff. Access to the mother’s room, despite being in close proximity to the midwives’ station, went unchallenged. Staff did not engage or challenge abductor despite a team member identifying concern. Activation of local policy was slowed due to handover time. Lack of awareness of who has called who. Communications between staff members occurred through non-secure social media applications. Security cameras ineffective due to relay of images to a different location Escape from the unit made easy by unlocked corridors. Certain staff groups unsure of their role.

Implications for practice:

The identification of latent risks in resources and staffing alongside having confidence with protocols and decision-making has illustrated potential serious risks to both mother and baby. This clinical simulation has allowed us to address and provide recommendations to resolve these by highlighting urgent reassessments of security, proactive planning and staff development to ensure the reality of abduction is minimized. ]]>
<![CDATA[124 The Use of Simulation in Improving Stroke Recognition, Assessment and Management]]> https://www.ijohs.com/article/doi/10.54531/MXMP8920 Background: Stroke remains the second leading cause of death worldwide and an important diagnosis requiring early recognition and action for optimal clinical outcomes which are time dependent [1]. With heterogeneity in healthcare systems according to trust and resources, it is key that healthcare workers are aware of the local pathways for time-critical conditions such as stroke. Delayed recognition and management of an inpatient stroke prompted the development of an acute neurology simulation course at a London district general hospital aimed at junior doctors.

Aims:

The aim of the course was to inform about the local stroke pathways, ensure juniors are comfortable with recognition of stroke and to develop the non-technical skills required in stroke management, thus enabling skill acquisition in a safe environment.

Method:

An innovative course was created using SimMan 3G with a focus on ensuring high fidelity to overcome the limitations associated with the practical aspect of stroke assessment in a mannequin. Five scenarios were created to last 15 minutes: three of which involved acute stroke diagnosis and two about stroke ‘mimics’. These scenarios included the involvement of a junior doctor, an acting nurse and acting members of the multi-disciplinary team as required. The debrief following each scenario would cover the technical aspects of management and self and group reflections. To add to the fidelity when assessing a mannequin for neurological conditions, we ensured that slurred speech could be mimicked, weakness in the limbs was showcased and facial asymmetry represented with innovative techniques using the mannequin.

Results:

Two sessions have been delivered involving nine junior doctors and this has been implemented as a regular course for junior doctors and nurses. All attendees felt more confident with stroke recognition, awareness of stroke mimics and of the local pathways when managing patients with acute stroke.

Implications for practice:

The positive feedback received and the outcome that all attendees felt more confident following the course suggest that stroke recognition and management can be learnt using simulation with a focus on the human factors required to optimize patient care. We hope to continue delivering this course to junior doctors rotating through the hospital and hope to open it up to the wider multi-disciplinary team including nursing staff, healthcare assistants and therapists with a focus on recognition and escalation. Dissemination of learning on local pathways and management using simulation is effective and can impact patient care. ]]>
<![CDATA[16 Exploring the Benefits of Teaching Ultrasound-Guided Vascular Access to Paediatricians]]> https://www.ijohs.com/article/doi/10.54531/FRSW1996 Background: Paediatric vascular access can be notoriously difficult due to small vessels and patient cooperation. Studies have shown ultrasound (US) guided technique to be a more successful method in experienced hands, especially in children with difficult access [1]. US-guided vascular access is well established within adult medicine; however, at present there is no standardized practice in paediatrics with many clinicians not gaining any US experience, unless undertaking acute sub- specialist placements [2]. In some cases, children are transferred to tertiary centres where there is more US expertise [2]. To enable the best patient care within their local setting, US skills should be routinely taught to all paediatricians.

Aims:

To date, there have been no studies exploring the experience and significance of US-guided vascular access training amongst district general hospital (DGH)-based UK paediatricians. We aimed to evaluate this within our DGH.

Methods:

Small-group US vascular access simulation sessions were led by our accredited and experienced paediatric advanced nurse practitioner (ANP). Participants learned to map veins and practiced US cannulation technique on the gelatinous ‘phantom’ model. A questionnaire asked attendees to evaluate confidence levels before and after sessions, and open-space for qualitative comments.

Results:

Thirty-eight paediatricians attended sessions; of whom, 75% had never conducted US vascular access and 96% did not feel confident. Following sessions, 100% of participants felt significantly more confident and would attempt this on real patients (Figure 1). Qualitative comments showed that they valued sessions: ‘good opportunity to practice vein mapping and cannulation on gel model’. All participants felt that this should be taught routinely within paediatric training. Five participants used this new skill in real patients, following the sessions.
Confidence level pre- and post-sessions, n = 38
Figure 1:
Confidence level pre- and post-sessions, n = 38

Implications for practice:

This study demonstrates the effectiveness and usefulness of delivering US-guided vascular access training to DGH paediatricians. It enabled improved self-reported confidence, which translated into improved patient care in real-life scenarios. Following its success, we intend on running this as an ongoing session. For clinicians wanting to utilize their skill on real patients, this will be supervised by our ANP. We recommend that all UK paediatricians train in US vascular access to enable optimal care for paediatric patients in all hospital settings. However, further research in a larger cohort of participants is required. We also recognize the variability in available expertise and equipment in all units to undertake the training. The importance and role of US-guided paediatric vascular access are still lacking in recognition and demands wider acceptance. ]]>
<![CDATA[129 Using Simulation to Identify System Issues in the Emergency Department]]> https://www.ijohs.com/article/doi/10.54531/BBYA1836 Background:In situ simulation (ISS) has previously been shown to be an effective tool for identifying system issues in healthcare [1]. Since the commencement of weekly inter-professional ISS in the Emergency Department (ED) at Mid-Yorkshire NHS Trust in October 2020, we have run 50 ISS sessions involving 225 participants and identified several system issues. These have subsequently been addressed through debriefing, feeding learning points back to the wider department and working with the management team to resolve practical issues.

Aim:

The aim of the present study was to describe how ISS has been used to identify and address system issues in an ED setting.

Method:

Each week a simulated case is selected to address specific clinical presentations and to bring out a range of clinical and non-clinical learning points. The scenarios are run in the ED using a low-fidelity mannequin and a monitor ‘app’. The scenario is run in real time, participants are required to locate and identify real kit; medications are required to be collected and additional help/senior advice is to be sought in the way that the participants would do in normal practice. After each scenario, there is a debrief, facilitated by the ISS team, in which the participants discuss and identify learning points as well as errors and systemic issues drawing both on the scenario and wider clinical experience. These points are collated and written up in the ‘MYSIM’ (an infographic sharing learning points) and distributed through a range of channels to all ED staff. Where practical solutions are required, the team feeds these back to the relevant senior nursing staff or management team to address these issues.

Results:

Table 1 demonstrates the system issues that we have identified and addressed so far through ISS.
Table 1:
System issues identified and addressed so far through ISS
Theme Issue Solution
Medication Idaricizumab unavailable in ED Pharmacy restocked ED
Equipment Lack of infusion pumps ED pumps electronically tagged and returned to department
Environment Lack of familiarity with Resus Simulation familiarizes with environment and participants encouraged to take time to familiarize with the environment following the session
Culture Reluctance to push the emergency buzzer Encouraged in debriefing over several sessions’ behaviour change noted in subsequent sessions

Implications for practice:

By running ISS, we have identified and addressed a number of system issues, which, through shared learning, has seen changes within the ED and ISS continues to be a valuable tool for improving patient safety. ]]>
<![CDATA[10 Introducing a Virtual Ward Round in Times of COVID-19]]> https://www.ijohs.com/article/doi/10.54531/PWAC7112 Background: Many medical students feel unprepared for starting as FY1 doctors, and often report low confidence in taking responsibility for patients and working independently, and lack self-assurance in common FY1 skills, including assessing unwell patients and initiating management, task prioritization, referrals, documentation, ordering imaging and on-call shifts. These skills are developed during clinical placements; however, access to these opportunities during placements has diminished due to COVID-19 and concerns around patient safety. Simulation‐based teaching allows students to take responsibility and work within complex clinical environments without posing a risk to patients [1]. Previous studies have shown that simulated ward rounds improve students’ clinical skills [2]. This study aimed to evaluate whether a new simulated mock ward round with tasks would improve final-year students’ general preparedness for FY1 and confidence across common FY1 tasks.

Aims:

The aim of the study was to evaluate whether simulated mock ward rounds increase final-year medical students’ overall confidence and feeling of preparedness for starting as FY1 doctors.

Method:

In total, 20 final-year medical students took part in the programme in two whole-day sessions. This was comprised of a simulated ward round of 10 patients. Students acted as FY1 doctors on the ward and carried out jobs, reviewed patients who deteriorated and had a number of tasks such as updating families, ordering radiology, initiating management and discharge summaries. Students’ confidence and preparedness was measured using pre- and post-course questionnaires. The questionnaires consisted of a 10‐point Likert scale for students to rate their confidence in key skills and overall preparedness for FY1 (1 = not at all confident, 10 = completely confident). These scores were matched and analysed using the Wilcoxon signed‐rank test. Additionally, there was blank spaces for feedback on the course which were analysed thematically.

Results:

Pre- and post-course questionnaires demonstrated that students felt significantly more prepared for FY1 after the course (p < 0.001). There was also a significant improvement in nine other domains deemed important for FY1 that students had reported low confidence in (see Figure 1). Qualitative data revealed that students appreciated the programme. They stated its superiority to other educational methods such as shadowing or didactic teaching sessions.
Students mean confidence score in overall preparedness and key skills before and after the programme. P < 0.001 for all domains.
Figure 1:
Students mean confidence score in overall preparedness and key skills before and after the programme. P < 0.001 for all domains.

Implications for practice:

Simulated mock ward rounds can be used as an adjunct to clinical placements to increase medical students’ confidence about starting work, and to teach them valuable skills regularly utilized by FY1 doctors. ]]>
<![CDATA[47 Improving Technical and Human Factors Skills on the Older Person Unit: An <i>in situ</i> Frailty Simulation Programme]]> https://www.ijohs.com/article/doi/10.54531/HMZN4367 Background:Awareness of symptoms associated with frailty is uneven across acute hospital staff [1]. Frail patients are more likely to suffer adverse outcomes; managing frailty requires an inter-professional, multi-disciplinary approach – for which simulation has been identified as beneficial in delivering education [2]. Given this, in addition to multiple incidents on wards highlighting a deficiency in both technical and human factors skills, an in situ frailty simulation project was undertaken at a London teaching hospital.

Aim:

The aim of the study was to evaluate the efficacy of in situ frailty simulation in improving both technical and human factors skills for ward staff.

Method:

In situ simulation was selected to increase accessibility for staff and promote ward team learning. Sessions started in October 2020 on one ward, before moving across other wards. These 1-hour sessions have been delivered weekly with a hiatus due to the second wave of the COVID-19 pandemic. A bank of frailty-based scenarios has been created, ranging from acutely unwell patients to communication with families. Participants have been from across the multi-disciplinary team. Data were collected using pre- and post-session questionnaires – containing the Human Factors Skills for Healthcare Instrument (HuFSHI) and frailty-based knowledge questions with Likert scales. Learning has been disseminated through the department via newsletters.

Results:

Thirteen sessions have been delivered with 59 participants (23 nurses, 20 doctors, 9 physiotherapists, 6 nursing assistants, 1 occupational therapist). Forty-nine surveys were completed – 100% of participants found the sessions useful. Post-training, staff demonstrated improvement of self-efficacy in 11/12 HuFSHI questions and all frailty questions (Table 1). The most common learning themes were communication (51%), teamwork (43%) and escalation (24%), as well as management of frail patients (35%). Working with the team (47%), the scenarios (18%) and debriefing (12%) were aspects learners most liked about the sessions.

Implications for practice:

An in situ frailty simulation programme has been successfully implemented, leading to improved learner self-efficacy in both technical and human factors skills when managing frail patients. This has been well received amongst staff. In particular, the sessions have promoted interaction and teamwork within the multi-disciplinary team, which was liked by participants. The in situ delivery has allowed learning to occur without the need for staff release, widening access. Latent threats – such as missing airway equipment – have been identified during sessions and addressed. Moving forwards, funding has been secured for a departmental manikin alongside expanding our multi-disciplinary faculty. ]]>
<![CDATA[55 Introduction of a Cardiac Arrest Proforma Through <i>in situ</i> Simulation Training]]> https://www.ijohs.com/article/doi/10.54531/CTWH8920 Background: The use of in situ simulation (ISS) within the Emergency Department (ED) has been widely accepted and has shown to be a valuable teaching tool [1]. At Mid-Yorkshire NHS Trust, we have been running weekly ISS since October 2020. Within the ED, systems and protocols are frequently audited, guidelines often change, and it can be challenging to disseminate this information. After identifying a clinical need for a cardiac arrest proforma, we considered how best to introduce it. We decided to utilize our weekly ISS to provide a valuable learning opportunity.

Aims:

The aim of the study was to evaluate the effectiveness of using ISS as a learning opportunity to disseminate and trial the introduction of a new cardiac arrest proforma.

Method:

We ran the scenario on two separate occasions involving 11 participants. The simulation involved a low-fidelity manikin and a simulated monitor app. Real equipment is used and the simulation is run in real-time – learners were encouraged to manage the patient as they would in real life. Learners include doctors, nurses, healthcare assistants and student nurses/doctors. Learners are briefed prior to the simulation; in this particular case, the learners were informed that we would be utilizing a cardiac arrest proforma and encouraged to use this. The learners are then debriefed using a promoting excellence and reflective learning (PEARLs) framework and discussion amongst themselves is central to the debrief framework [2]. The purpose of this simulation was multi-faceted; firstly, to discuss the team’s management of cardiac arrest and learning around this and, secondly, to discuss the use of the proforma to improve teamwork and patient care. Learners were asked to complete a feedback form.

Results:

Feedback obtained from this simulation concluded that it was a valuable learning opportunity. Figure 1 shows the results of learner responses (n = 11). The scale included was 5 (strongly agree) to 1 (strongly disagree) – an average of responses is included within the graph.

Implications for practice:

Using ISS to trial our proforma allowed us to implement it within the ED. Collating feedback allowed us to make amendments to our proforma based on multi-disciplinary opinions. As well as recognizing that ISS can be used to achieve this purpose, it also provided a valuable learning opportunity. ISS can be used in future to introduce new guidelines, distribute vital information and provide learning. ]]>
<![CDATA[75 No Time To Train? The Use of Simulation to Develop a Pathway and Deliver Training for Emergency Surgery in Maternity During the COVID-19 Pandemic]]> https://www.ijohs.com/article/doi/10.54531/VTLS2590 Background: The COVID-19 pandemic presented healthcare workers with a challenge to provide safe clinical care while protecting staff and coping with an evolving situation. The use of simulation to devise and test emergency pathways is well recognized in the literature [1]. However, this pandemic presented the world with a very tight timeline to deliver, let alone test potential pathways. This was further complicated in maternity units where workload remained the same during the preparatory phase.

Aim:

Recognizing the need to develop a safe pathway, with a limited evidence base, we sought to test the hypothesis that a combination of table-top and in situ simulation could be used to devise a protocol and train teams in a tertiary maternity unit during the first phase of the pandemic.

Methods:

This programme involved three phases: pathway development, safety testing and team training. The initial phase was a simulated table-top scenario of a parturient requiring a Category 1 Caesarean delivery under general anaesthetic. This pathway was then used to create a structured simulation scenario to test its suitability. The debrief sessions for each explored three themes: (1) pathway feasibility; (2) timing and (3) feedback.

Results:

The table-top simulation took place on 11 March. Team-specific outcomes highlighted the logistics of early senior escalation and the rationalization of staff and equipment in theatre. We also recognized deficits in the amount and correct use of personal protective equipment (PPE). Staffing levels and limitations in communication were also key findings. The subsequent in situ simulation took place 2 days later. The baby was delivered within the 30-min guideline (28 min) and overall, the pathway was safe to use. It was then modified and used to train teams over the subsequent weeks, reaching 151 staff. Feedback from candidates was powerful: ‘I feel safer coming to work’.

Implications for practice:

The initial phases of the COVID-19 pandemic provided a fertile ground for team consolidation and planning that promoted collaboration in one of the most multi-professional areas of any hospital: the maternity unit. Involvement of all teams meant that deficits in training could be identified early, and changes could be adapted rapidly. The simulations also demonstrated to staff that it was possible to safely deliver a baby within the timeframe. Recognizing that this was not an isolated problem, we shared our resources publicly helping teams in the USA, Laos, Australia and UK to develop their own protocols. Importantly, it improved our response to the second wave. ]]>
<![CDATA[43 Learning from COVID-19 and Supporting Staff Using Human Factors and Simulation]]> https://www.ijohs.com/article/doi/10.54531/IRGN8060 Background: The full impact of working in the COVID-19 pandemic surge on NHS staff is yet to be understood. Simulations were run to explore the staff experience following the second COVID surge. From these, it was clear that the staff had powerful stories to tell. A series of further simulation sessions were then delivered, designed to allow staff to explore their experiences and assist with organizational learning within the trust debrief strategy.

Aims:

Firstly, to use simulation to recreate working with uncertainty and unfamiliar staff as a platform within the debrief to explore their experiences of working during the pandemic surges. Secondly, to employ a human factors framework, SEIPS model [1], within a simulation debrief to build a system picture of work-as-done [2] by staff throughout the organization. This was then used to feed back to leadership to influence care processes and staff and patient well-being for potential future surges.

Method:

Simulation sessions, open to all staff, were advertised throughout the organization. In total, 8 sessions were delivered for 38 staff. Multi-disciplinary attendance was encouraged, and a wide range of staff groups participated. During the session, staff were given a brief presentation on human factors, a simulation pre-brief and a pre- and post-simulation questionnaire. A simple patient deterioration scenario unrelated to COVID-19 was used to maintain psychological safety. A system-focussed debrief using the PEARLS model took place after the scenario. Insights shared by candidates were captured by a facilitator and anonymously grouped into the six SEIPS themes.

Results:

Pre- and post-questionnaires show a general theme of improved confidence post-simulation. Findings were reviewed and the impact on care processes and staff, patient and organizational outcomes were summarized. Information captured within the SEIPS framework showed recurring themes that were condensed into four main categories: psychological trauma and burnout, communication, re-deployment and training, and infection control and PPE.

Implications for practice:

It was clear from facilitating sessions that staff were concerned about patient experience but were also suffering their own trauma from working through the surge. Feedback from participants was positive, emphasizing their sense of validation in sharing their experiences and of feeling part of the hospital community. Staff also had experiences to share about what had helped them and where things could be improved. These insights were synthesized into practical recommendations for managing future pandemic surges that were fed back to the wider organization. ]]>
<![CDATA[78 Simulation Integrating Deliberate Practice Method for Developing Assesors of Competence]]> https://www.ijohs.com/article/doi/10.54531/UVOG6797 Background: In response to COVID-19, our organization expanded the critical care beds capacity; however, the number of critical care nurses was insufficient to meet expansion demands. Therefore, non-critical care nurses were deployed to COVID-19 critical care units. The deployed nurses lacked experience and training in critical care. To ensure patient safety, the nurses were assigned to assessors who evaluated their fitness to practice after receiving upskilling training through simulation-based education (SBE). However, due to the massive expansion and rapid deployment process, there was a shortage of competency assessors, highlighting an urgent need to use SBE to develop more assessors. We developed additional competency assessors through simulation embedding deliberate practice and rigorous assessment. Deliberate practice in simulation is described as progressive learning, which includes repetitive performance and rigorous assessment [1].

Aims:

The aim of the study was to explore the effectiveness of simulation embedding deliberate practice in developing nurse competency assessors.

Method:

Eleven assessor candidates were asked to perform competency assessments under simulated conditions. During the simulation, simulated participant (SP) roles were assigned as a bedside nurse and patient relative; the patient was a high-fidelity patient simulator. The assessor candidates were asked to perform a competency assessment of the bedside nurse who should perform the required critical care skills on the patient in the presence of the patient’s relative. The candidates used a valid observation rubric to complete the assessment. Using deliberate practice strategies, after each competency assessment, a debriefing session was conducted in which the SPs provided constructive feedback on the assessor’s performance. The assessor repeated the competency assessment under the same simulation conditions and attended debriefing sessions until they mastered the competency assessment process. Post simulation evaluation collected data to evaluate the candidates’ perception of the training.

Results:

Eleven nurses completed the simulation developmental programme and were assessed as competent to become assessors. The questionnaire findings revealed that all nurses perceived themselves as competent assessors; however, 90% reported the need for frequent exposure to the competency assessment process over time, in the clinical setting, to enhance their competence and confidence levels.

Implications for practice:

The hybrid simulation modality of SP and patient simulator embedding deliberate practice method was deemed to be an effective fast track method to develop competency assessors. However, practice of competency assessment in real clinical settings is essential to confirm competence. ]]>
<![CDATA[77 Fast Track Simulation-Based Education for COVID-19 Deployment]]> https://www.ijohs.com/article/doi/10.54531/XTPQ6984 Background: COVID-19 created pressure on healthcare institutions to quickly prepare for maximum capacities. To meet the critical care capacity challenges, non-critical care nurses and overseas short-term temporary contracted nurses needed to be urgently deployed to the critical care units. That quick deployment and recruitment process raised concern about competence and patient safety; therefore, the deployed nurses were upskilled using fast track simulation-based education (SBE). SBE is an effective method to manage quick, focussed upskilling training, helping to improve patient care and safety [1].

Aim:

The aim of the study was to explore the effectiveness of the COVID-19 SBE upskilling program on perceived satisfaction, confidence and competence of deployed nurses.

Method:

Upskilling of 1200 non-critical care nurses was conducted using SBE between 14 March and 1 June 2021 during the country’s second wave of COVID-19. Training consisted of completing a mandatory 2-hour online critical care introductory module that included information on COVID-19 (the disease, pathophysiology), the critical care environment, critical care scope of service and infection control strategies. The online module was followed by 4 hours of in-person SBE using a demonstration and return demonstration approach. Considering the urgency of the situation and time constraints, skills were selected and prioritized according to patient safety and included care of the patient receiving mechanical ventilation, invasive line monitoring and care, recognition of deterioration, proning, and assessment of patient response to interventions. Post SBE, a survey was administered to collect data on the perceived satisfaction, confidence and competence of the nurses being deployed.

Results:

The majority of the nurses reported confidence in their new skills (97%), while 96% perceived themselves as competent after successful completion of SBEs. The nurses were highly satisfied with the training effectiveness (92%), and 99% believed that they were able to successfully achieve the learning objectives. Specifics about perceived competence and confidence per survey item will be reported in the presentation. The SBE upskilling programme was evaluated as an effective way to learn how to manage critically ill patients.

Implications for practice:

Nurses perceived themselves as confident and competent after participating in SBE. However, competence confirmation will be evaluated either in further SBE or through actual competency assessment in the clinical setting by trained competency validators. Nurses could perceive themselves as confident and competent but still perform incorrectly. Fast track SBEs should not be used to confirm full competence due to the inability to provide repetition of skills practice. ]]>
<![CDATA[71 Step by Step: A Three-Step Approach to Faculty Development]]> https://www.ijohs.com/article/doi/10.54531/YVZM5555 Background: The Clinical Skills and Simulation Centre (CSSC) at Edge Hill University (EHU) was opened in September 2019 to enhance and standardize simulation-based education across all programmes in the Faculty of Health, Social Care and Medicine. Before the CSSC opened, academic staff had not received any formal guidance in using simulation-based education. With the impact of the pandemic, a three-step blended simulation faculty development approach was created to assist and support faculty in their understanding and in the delivery of simulation [1,2].

Aim:

The aim of the study was to enhance, encourage and standardize the use of simulation-based education through the delivery of a three-step faculty development programme.

Method:

The following are the three-step approach to faculty development: Step 1:The introduction of simulation sessions is specifically designed and focussed on the newly appointed academic faculty and is embedded in the staff induction programme. Step 2:Writing simulation scenarios, drop-in sessions are run once a month and are available to all academics from the faculty. They focus on designing and writing simulation scenarios. Step 3:Shadowing and feedback. At this stage, faculty are offered support during their simulation session. The experienced simulation facilitator leads the first part of the event with the faculty member running the second part supported by the facilitator observing and providing feedback after the session. The evaluative methods included two approaches, quantitative incorporating Likert questionnaires, for evaluations, and qualitative focus groups, for faculty. Approximately 1700 student and faculty evaluations were obtained, and seven faculty members participated in the focus groups. These were obtained and conducted between June 2020 and August 2021.

Results:

Evaluations are obtained from students and from faculty who are involved in the sessions. In addition, ethical approval has been obtained to carry out focus groups to identify the challenges and benefits that faculty have found in delivering simulation. Feedback from the evaluations and the focus groups were very positive. Examples include: The simulation team have been extremely supportive and always are. It makes my role so much easier and I appreciate all their hard work. We had 450 students over a fortnight, everyone worked so hard and were very supportive, especially to staff who had not facilitated simulation for some time. Data from June 2020 to August 2021 The session: Was beneficial for my learning, 87.74% Archived the learning outcomes, 91.37% Did the session meet your expectations? 87.32%

Implications for practice:

We will continue to offer a blended approach and, from August 2021, a 1-day simulation facilitation programme will be offered to potential adjunct clinical faculty. ]]>
<![CDATA[190 Virtual Work Experience in Medicine: Widening Participation]]> https://www.ijohs.com/article/doi/10.54531/HQOE6610 Background: The national lockdowns due to COVID-19 have caused significant disruption to schools and colleges. As well as interruption to their studies, pupils work-experience placements have been cancelled, particularly those based in healthcare. Despite this, the BMA continues to recommend all aspiring doctors undertake placements within healthcare to aid their application to medical school and give them an insight into being a doctor [1]. Additionally, for students from low-income families or those with no ties to healthcare, voluntary placements are often the only opportunity to learn about the various roles of doctors.

Aims:

Creating a ‘virtual work experience’ using simulated video demonstrations in order for students to gain an understanding of what working as a doctor encompasses. This course was offered free of charge to help encourage students, particularly from low-income households.

Method:

Invitation letters were sent to all public and private schools in Merseyside. Contact details and school information were obtained through the Office for Standards in Education, Children’s Services and Skills (OFSTED) Government website. Students were asked to fill out a pre- and post-course questionnaire.

Results:

Seventy-five schools and colleges were invited. A total of 326 students registered for the course and 220 participated in the virtual conference. All participants were from 18 schools and colleges. Students, where at least one parent had attended university, felt more confident in applying to medical school and securing a place, this was significantly higher when a parent was in the medical profession. Students from private or schools rated as above average by OFSTED felt that they were more likely to apply to medicine than those in schools who were rated average or below-average. Overall, students felt that they had an improved understanding of the different roles of doctors following the course and the simulated scenarios were most useful in encouraging them to apply to medicine.

Implication for practice:

Up to 20% of secondary schools provide 80% of all applicants to medicine, with half of the schools in the UK not providing any applicants to medicine at all. The selection alliance 2019 report on widening participation in UK medical schools suggested that there continues to be a discrepancy in underprivileged students applying to study medicine with barriers including limitations to securing work-experience placements [2]. Virtual work experience and the use of simulation may be useful in providing work experience and encouraging those from low-income households to apply to medicine. ]]>
<![CDATA[110 Using Simulation to Assess Systems and Processes in a New Paediatric Unit]]> https://www.ijohs.com/article/doi/10.54531/RSRY1468 Background: In situ simulation is an emerging tool used to test systems, improve patient safety outcomes and prepare staff working in new clinical environments [1,2]. Our department opened a new Paediatric Assessment Unit (PAU) in April 2021, which sees an average of 470 patients each month.

Aim:

The aim of the study was to use simulated learning events (SLEs) to assess the effect of a new environment on performance, interpersonal skills and system-based practice. As part of the wider paediatric improvement plan, the simulation programme has been used to enhance teamwork and implement a change to maximize patient safety.

Method:

Five multi-disciplinary SLEs based on paediatric and neonatal emergencies were held over a month following the opening of the new PAU. The simulations were low fidelity and in situ, using static models and facilitator feedback, and were held in the new PAU. Observations were displayed on tablets using the REALITi simulation app by iSimulate. A ‘description, analysis, application’ diamond debrief was held following each SLE, and feedback was collected via an online questionnaire. Latent strengths and safety errors were identified and shared with the wider working group to implement a change. Safety errors were then re-assessed at subsequent SLEs to demonstrate resolution.

Results:

Ten latent errors were identified pertaining to the availability of equipment and medications; all were rectified within 2 weeks. Operational errors were also identified, including unfamiliarity with the new PAU location within the wider emergency team, leading to delayed attendance to the simulation. The time taken to attend the PAU by the anaesthetic team decreased by 69% once the emergency bleep message was amended with location instructions. We observed that, with each SLE, there were successive improvements in teamwork and operational behaviours. The teams were able to familiarize themselves with each other and the new working environment, consequently leading to reduced times on acquiring equipment for the emergency. There were a total of 20 participants from paediatric, anaesthetic and nursing backgrounds. Feedback was received from 55% of participants, of which all agreed or strongly agreed that the SLEs and debriefs contributed to their learning and helped develop their team-working and leadership skills.

Implications for practice:

SLE is an effective tool for systems testing in a new clinical environment and helps to identify potential critical and non-critical safety risks. We will continue to develop our simulation programme to assess a variety of clinical environments and share learning from the latent strengths and errors with the multi-disciplinary team, to improve clinical processes, team working and patient safety outcomes. ]]>