International Journal of Healthcare Simulation - subjects-1640347261197-2619b1d5-6285-43e2-b98d-f94143640e6d https://www.ijohs.com Default RSS Feed en-us Adi Health + Wellness <![CDATA[64 360 Simulation: Assessing Baby Robin]]> https://www.ijohs.com/article/doi/10.54531/MKXW2760 Background:Within a rural county, student placement locations are geographically scattered. Student feedback revealed that only students in one placement were able to benefit from the high-fidelity simulation suite resources situated at the lead hospital. Research shows students value co-created and personalized resources. Working with our practice partners we identified a cost-effective, accessible and inclusive solution, using 360 videos. Clinical simulation has been found to be effective [1] for teaching nursing skills. One limitation is the number of participants who can be involved at one time and in one place. A pilot study [2], with nursing students (n = 217), using low-cost virtual reality headsets, demonstrated that learning via immersive approaches aided understanding of the complex concepts, provided immediate feedback about clinical decisions, and could be completed multiple times. It provided additional opportunities for safe practice and complimented their ward and clinical skills experiences. Simulation technicians and lecturing staff recognized these benefits but identified time and cost constraints as challenges. Building on this research, we designed and evaluated a small-scale pilot to improve processes.

Aim:

To use 360 videos accessed via low-cost VR headsets to scale the clinical simulation experience for paediatric nursing students.

Method/design:

Working with our local hospital and our second-year paediatric nursing students, we used agile design methods and co-creation to develop two ABCDE assessment clinical simulations (sepsis and acute respiratory illness), using a 360 camera. These videos were accessed using low-cost virtual reality headsets, Oculus Quest™, mobile devices and Microsoft HoloLens™. Qualitative evaluation sought views of students, nursing staff/academics and simulation technicians through focus groups (n = 10). Thematic analysis revealed emergent themes of flexibility of access, repetition of learning opportunity and strengthening or the practice-theory link. Challenges included user familiarity with the technology and time investment. The main impact of this project was wider and longer-lasting learning compared with traditional methods.

Implementation outline:

Bite size learning chunks embedded strategically into our new nursing curriculum, for 300 student nurses studying at level 5. Harnessing the full potential of the clinical simulated experience permits students and staff to learn at a time and place of their own choosing. The ABCDE assessment will be expertly demonstrated through 360 videos, which will better prepare students for in-person simulations, saving face-to-face time explaining how to carry out the simulation. Learning from this project will feedforward to a faculty-wide multi-disciplinary clinical simulation event, informing guidelines. ]]>
<![CDATA[29 Reducing Risk: Simulation-Based Clinical Systems Testing to Determine New Hospital Readiness for Anaesthesia Services]]> https://www.ijohs.com/article/doi/10.54531/PXGQ8394 Background: The newly built Women’s Wellness and Research Center (WWRC) replaced the pre-existing Women’s Hospital (WH) as the only provider of tertiary maternity care for the residents of Qatar. The pre-existing WH was smaller, with a 12-bay emergency department, 3 operating theatres, 12 delivery rooms and 220 beds, in shared rooms. The new WWRC facility is significantly bigger, with a 28-bay emergency department, 7 operating theatres over two floors, 26 delivery rooms and 240 private inpatient rooms catering for around 18,000 deliveries per year. New systems, designed over only a few months, would need to promote that same level of high-quality patient care but in a newer, larger and unfamiliar facility.

Aims:

The aim of the study was to identify and mitigate clinical systems risks, relevant to anaesthesia services, by running in situ simulations.

Method:

The ‘WWRC Anesthesia Activation Team’ was established to conduct in situ simulations, testing clinical systems. We hypothesized that, despite meticulous planning, numerous process gaps would be discovered, and that improvements derived from testing sessions would reduce risk [1]. Well-planned scripted ‘everyday’ scenarios were prepared. Relevant multi-disciplinary groups of participants were involved, and the scenarios were kept flexible. After the simulation, facilitated debriefing highlighted problem areas and suggested improvements.

Implementation outline:

Approximately 110 hours of simulation were conducted in sites relevant to anaesthesia. Many of the participants had never experienced simulation before but nearly everybody complimented its usefulness and debriefing was unanimously constructive. Testing identified 143 discrete latent safety threats (LST) and were categorized under Facility, Workflow, Personnel, Process, Equipment and Technology (Table 1). Fifty-four LSTs were due to systems that were incomplete at the time of testing but would be completed by the time services commenced. The remaining 89 were significant LSTs which could have resulted in significant clinical incidents. After mitigation of LSTs, the areas were simulation tested again to confirm threat elimination. WWRC was opened only after all areas of concern were addressed. A year after moving, a review of all the changes recommended from the simulation-based systems testing was conducted. It showed that there were no anaesthesia-related clinical incidents in those areas.
Table 1:
Categories Number 
of LST (89) Examples
Facility 9 Theatre recovery was too congested to deal with any emergencies involving mother or baby – layout was changed, and equipment rearranged to create more space for essential staff and equipment
Workflow 11 Patient pathway, in and out of theatre was not compliant with infection control recommendations – pathway was changed, sterile and non-sterile areas were clearly marked to meet strict recommendations
Personnel 5 Number of anaesthetists on-call was insufficient to cover multiple sites within the hospital – the on-call anaesthetist numbers were increased and working pattern made more efficient
Processes 26 Blood bank was located far from theatres resulting in significant delays in procuring blood – blood processing and procurement process were modified to reduce delays
Equipment 34 Multiple items identified as either faulty/incompatible/missing were removed or replaced by new ones
Technology 4 Paging system was inefficient and emergency calls were missed –existing system scrapped, and new system installed to ensure reliable communication.
Our experience confirms that simulation can identify Latent Safety Threats (LST) prior to a major move to a new facility [2]; 
the team identified problems that had not been identified by existing committees. Scenario-based clinical systems testing allowed for pre-emptive process optimization and risk mitigation thereby improving patient safety, quality and staff preparedness. ]]>
<![CDATA[22 Game On! Meeting the Mission of Gamification to Teach Human Factor Skills]]> https://www.ijohs.com/article/doi/10.54531/CTNI2461 Background: Failings in human factors are a significant contributory factor in accidents/incidents in aviation, energy and healthcare. There is no ‘one thing’ that will address human factor failings- it requires multiple interventions; including developing human factor awareness and skills to influence behavioural change. Local research in the Northern Health & Social Care Trust [1] substantiates this. Six months after accessing face-to-face human factor training 70% of attendees confirmed they had made changes to their practice. Through the acquisition of human factor skills staff can ‘get up stream’ of adverse incidents and poorly designed systems, which can reduce patient harm and increase the quality of care.

Aims:

This project deployed the application of Gamification to human factor learning in healthcare. Feedback from face-to-face Human Factor training is positive, but it is challenging in an organization of 13,500 staff to meet the capacity for this training. More recently, response to COVID-19 has challenged us all to think about how we make training more accessible outside of traditional methods.

Method/design:

The Gaming Strategy is centred around Dupont’s Dirty Dozen (Figure 1) – the 12 most common human factor elements which degrade a person’s ability for them to perform effectively and safely, which can lead to errors.
Dupont’s dirty dozen
Figure 1:
Dupont’s dirty dozen
Through a series of missions ‘gamers’ follow a patient (Joe) as he journeys through the healthcare system, and experiences a series of human factor errors. The five missions below, each incorporate Dupont’s Dirty Dozen: communication and team working lack of knowledge and assertiveness situational awareness complacency and norms pressure and lack of resources Each mission introduces characters and is scenario-driven, depending upon gamers’ responses they will either be successful in their mission (in which case they can proceed to the next step), or unsuccessful and have to restart the mission. At the end of each mission ‘gamers’ must complete a quiz, after which they are rewarded with access to the next mission. The gaming App includes additional learning resources, opportunity for reflection and generation of a completion certificate to support professional development. Psychological and behavioural experiences of gamers’ is captured by the App via quizzes at the start and completion of the Game. The project deployed Quality Improvement and Agile development methodologies. All scenarios and characters were developed by the NHSCT project team, with software development commissioned externally.

Implementation outline:

The Game is accessible via mobile phone from the App Store. Project testing completed in June 2021, with the launch of the Game in NHSCT thereafter. The App has potential for scale-up across NI and the UK. ]]>
<![CDATA[62 The Abcde of Converting Full Patient Simulation to a Virtual Non-Technical Skills Seminar]]> https://www.ijohs.com/article/doi/10.54531/FXPI7957 Background:Due to the pandemic, our undergraduate programme of Interprofessional (IPE) Full Patient Simulation (FPS) 2020–2021 was converted to a virtual human factors seminar using student case scenario footage and a Non-Technical ABCDE Approach Observational Tool (Seale et al. 2020). The IPE FPS programme involves students (n = 960) from medicine, physiotherapy, nursing (adult, child fields) and midwifery with three strands of scenarios covering acute adult, paediatric and obstetric scenarios. To provide meaningful learning without the use of face-to-face simulation, the principles of active learning and directed observation in simulation were applied to create a live online seminar. Using recorded footage of inter-professional discipline students participating in scenarios and the observational tool provided the resources for students to learn about the non-technical skills (NTS) in clinical practice.

Aim:

The aim of the study was to meet IPE graduate outcomes and to explore the significance of human factors in clinical practice.

Method/design:

Prior to the online seminar, students were allocated into their scenario groups to prepare notes on the non-technical skills, with directive guidance from an observational tool using an ABCDE approach. Within the seminar, students worked collaboratively in small inter-professional groups to discuss their observations and prepare a presentation, guided by the debrief diamond structure of description, analysis and application [1]. Facilitators debriefed after each presentation on the NTS observed [2] to explore why they occurred, and reflect how this impacted on the assessment and management of the patient and what students could apply to their own practice.

Implementation:

Evaluation of findings demonstrated achievement of the key ‘take aways’ associated with live simulation and attainment of learning outcomes (Figure 1). The ABCDE observational tool demonstrated good usability and enabled effective analysis. Students asked that it should be adapted to include the patient in the descriptors and faculty observed students were more critical in their analysis of their peers compared with face-to-face debriefs. The long-term aim is to incorporate virtual seminars into the IPE programme to complement the learning in the face-to-face FPS. Innovations in the FPS programme will include using the scenario footage and the observational tool for pre-simulation briefing material, and the tool for directed observation during live scenarios and additional structure to debriefs. The scenario and debrief footage and the observational tool will also be used for facilitator training.
Figure 1:
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<![CDATA[20 Special Delivery: Skills@Home]]> https://www.ijohs.com/article/doi/10.54531/QDPG2486 Background: Due to the sudden shift in online learning at the start of the pandemic, an innovative idea was identified to encourage a student-centred approach for continuing the development of their essential skills whilst learning from home. Taking inspiration from other healthcare programmes, we developed, and risk assessed ‘Skills@Home’ packages to embed a mastery learning approach towards dexterous skills. These comprehensive packages included access to virtual resources and e-learning as well as practical and safety equipment. Implementation of these packages allowed students to maximize their exposure, experience and understanding of a range of skills that could be accessed at a time and pace to suit their needs. The pilot ‘Skills@Home’ package focussed upon the development of suturing, which is a traditional and essential midwifery skill.

Aims:

A collaborative approach between the midwifery team and the clinical simulation and skills education team ensured a robust approach to the risk assessment, procurement and delivery of packages to students’ home addresses. A pre-requisite for receiving a pack was the completion and return of a detailed student agreement form which outlined safety considerations and their responsibilities. The package was piloted with a cohort of 29 third-year student midwives, as a priority group, to facilitate and increase confidence and application in the clinical area and to ensure enough opportunities for progression on the programme.

Method/design:

Students completed an online evaluation form after receiving their packs, which showed overwhelming support for this approach. Students identified that having the opportunity to learn in this manner at home not only enhanced their confidence and skills technique but also helped them to relate theory to practice. Additionally, students identified that they would like to see the ‘Skills@Home’ approach sustained and enhanced once on-campus learning has resumed.

Implementation outline:

This has inspired the clinical simulation and skills education team to identify other Skills@Home packages that can be used within healthcare learning. Ensuring that thorough risk assessments are completed along with the packages being created and delivered to the students in the most cost-effective way. Following the pilot study, ethics approval is currently being sought to explore, using focus groups, the midwifery students’ experiences and view of using the Skills@Home initiative. ]]>
<![CDATA[142 The College of Anaesthesiologists of Ireland Return to Work Programme: An Innovative Approach to Support Trainees’ Well-Being and Patient Safety on Return to Work]]> https://www.ijohs.com/article/doi/10.54531/QCYF5806 Background:Within the 6-year Specialist Anaesthesiology Training (SAT) programme overseen by the College of Anaesthesiologists of Ireland (CAI), there is now an option for trainees to take up to 12-month unaccredited professional or personal leave after years 2 and 4. There is also a cohort of trainees taking academic leave, maternity leave or other leave. There is growing recognition in the CAI and among other Training Bodies that returning to work following a period of absence can be daunting. It requires a comprehensive support package to help with the readjustment to the clinical and training environment, and rebuild confidence [1]. The CAI Committee of Anaesthesiology Trainees (CAT) has also made this recommendation after running a voluntary survey among its members.

Aims:

A CAI steering group was convened to design a Return to Programme (RTP) support package, with the following objectives: To develop a strategy for managing a return to anaesthesia following a period of absence To provide a blended content learning package aiming to ease SAT back into the clinical environment To rebuild confidence with/among the peers in a safe simulation environment To improve trainees’ well-being and patient safety by refamiliarization with anaesthesia guidelines and emergency algorithms

Method/design:

It has been agreed that the RTP syllabus must reflect all eight domains of the Irish Medical Council (IMC) domains of Good Professional Practice, as in the following: Patient Safety and Quality of Patient Care; Relating to Patients; Communication and Interpersonal Skills; Collaboration and Teamwork; Management (including Self-Management); Scholarship; Professionalism, and Clinical Skills [2]. This is to be achieved by providing a blended content support package consisting of online refresher lectures in core clinical areas (e.g. perioperative care, paediatric and obstetric anaesthesia, and intensive care medicine), lectures focussed on trainees’ well-being and human resources matters, and face-to-face simulation sessions.

Implementation:

The lectures have been recorded and embedded in the CAI e-learning platform. A list of simulation scenarios reflecting the most common anaesthesiology emergencies has been selected and tailored towards the needs of the destination training sites and experience level. A first course will take place prior to trainees recommencing their clinical role in July 2021. On successful evaluation, it is aimed to conduct the RTP every 6 months going forward. ]]>
<![CDATA[125 Introducing An <i>in situ</i> Simulation Programme in an Intensive Care Unit]]> https://www.ijohs.com/article/doi/10.54531/WHPG6255 Background: This North London hospital has a 14-bed Intensive Care Unit (ICU). As a small District General ICU, staff exposure to emergency scenarios can be infrequent. Lack of practice can lead to a reduction in staff confidence and knowledge when these scenarios are encountered, especially during the COVID pandemic. The ICU had not previously undertaken in situ multi-disciplinary team (MDT) simulation sessions on the unit.

Aims:

The aim of the study was to introduce a novel programme of MDT simulation sessions in the ICU and provide feedback with the aim of increasing both staff confidence in managing emergency scenarios and staff understanding of the impact of human factors.

Method/design:

A team of ICU Simulation Champions created emergency scenarios that could occur in the ICU. Pre-simulation and post-simulation questionnaires were produced to capture staff opinion on topics including benefits and barriers to simulation training and confidence in managing ICU emergencies. Members of the ICU MDT would be selected to participate in simulation scenarios. Afterwards, debrief sessions would be facilitated by Simulation Champions and Airline Pilots with a particular focus on competence in managing the emergency and human factors elements, such as communication and leadership. Participants would then be surveyed with the post-simulation questionnaire.

Implementation outline:

Nine simulation sessions were conducted between October 2020 and June 2021. The sessions occurred within the ICU during the working day in a designated bay with the availability of all standard ICU resources and involved multiple MDT members to aid fidelity. Feedback by Simulation Champions mainly focussed on knowledge related to the ICU emergency, whilst the Airline Pilots provided expert feedback on human factors training. Fifty-five staff members completed the pre-simulation questionnaire and 37 simulation participants completed the post-simulation questionnaire. Prior to simulation participation, 28.3% of respondents agreed they felt confident managing emergency scenarios on ICU – this figure increased to 54.1% following simulation participation. 94.4% of simulation participants agreed that their knowledge of human factors had improved following the simulation and 100% of participants wanted further simulation teaching. Figure 1 shows a thematic analysis of the responses from 31 participants who were questioned about perceived benefits from simulation teaching. Following the success of the programme, the Hospital Trust will continue to support and develop inter-speciality and inter-professional training, and have funded the appointment of an ICU Simulation Fellow to continue to lead and enhance future in situ simulation teaching on the ICU.
Figure 1:
]]>
<![CDATA[98 ‘AOSim’: A Decision-Making Simulation Course for Acute Oncology Nurses]]> https://www.ijohs.com/article/doi/10.54531/EKXJ8408 Background:Simulation-based education (SBE) as a learning tool is becoming more prevalent, as is the recognition of the importance of non-technical skills. With this insight comes a desire to improve clinical practice using these techniques. ‘AOSim’ has arisen from an intrinsic desire to achieve this from within an Acute Oncology Service (AOS). Wishes to improve confidence, decision-making and teamwork have guided the design and implementation of a novel simulation course in this field.

Aim:

The purpose of the course has been guided by the candidates. The hope is to be able to provide a safe learning environment to explore decision-making, improve confidence in clinical practice and strengthen teamwork.

Design:

The course design was informed by direct stakeholder analysis. Pre-course surveys aided in planning the course and scenario design. The course would run over half a day and comprise three scenarios, each followed by a debrief. The candidates invited were nurses working in the local AOS and the AOS coordinator. Each scenario was designed with a particular focus in mind; ‘Respectful Challenging’, ‘Clinical Prioritisation’ and ‘Treatment Escalation’. The clinical context of the scenarios was based on oncology to provide a familiar environment for the candidates. This would also enable the focus to be paid to the non-technical skills related to the aims of the course. The scenarios were to be run in a high-fidelity setting using a mixture of role players, mannikins and plants. Faculty roles had been assigned prior to the course date.

Implementation outline:

A course overview was sent to the candidates including the planned date for running the course to allow the candidates to plan for handover of their clinical duties; this allowed protected time for the course to run. ‘AOSim’ was run in a simulation suite in the high-fidelity setting with an experienced faculty. The candidates were introduced to the simulated environment and the importance of psychological safety was explained. The three scenarios ran as planned to include subsequent informative debriefs. Immediate and post-course feedback were positive, particularly with increased confidence levels and team-working ability. This has led to aspirations to run the course again for a different candidate group in the future. ]]>
<![CDATA[88 Streaming High-Fidelity ECMO Simulation from a Moving Ambulance]]> https://www.ijohs.com/article/doi/10.54531/CKMB2199 Background:The Trust needed to offer extra-corporeal membrane oxygenation (ECMO) [1] patient transport training in the form of high-fidelity multi-disciplinary simulation utilizing a moving ambulance. ECMO circuits and monitoring would be controlled using Chalice’s Parallel Simulator [2]. The simulation would be broadcast to the simulation centre for observation and debrief. We developed a simulation and AV streaming solution for this.

Aim:

The aim of the study was to deliver high-fidelity ECMO simulation in a moving vehicle while simultaneously allowing candidates and faculty to watch the scenarios take place remotely.

Method/design:

A custom video-over-IP system was used to run three camera feeds and a patient monitor output. A laptop captured this in a quad-view format and streamed it to a dedicated video streamer. This was then networked locally via a router with a secondary laptop which displayed the stream. The router was connected to a mobile 4G modem, allowing the secondary laptop to share this video stream via Microsoft Teams (MS Teams). In addition, a USB audio interface and microphones ensured intelligibility while the vehicle was in motion.

Implementation:

Teaching groups were made up of 3–4 candidates from the ECMO team and 3–4 candidates from patient transport. Scenarios outlined a paediatric patient, currently on ECMO, being transferred to a specialist hospital in the region via ambulance. One or two candidates from each service would take part in the scenario and the remaining candidates would view the simulation in the centre debrief room. A technician in front of the ambulance controlled the simulator and monitored the streams. The lead ECMO specialist nurse spoke to the technician from the simulation centre via a mobile phone link. The role of a consultant was played by a member of the transport faculty on the ambulance. This allowed the faculty to oversee and prompt when necessary. Using MS Teams meant the stream could be shared with the debrief room at the centre, the control room, and with other interested parties outside of the centre. This created a unique learning experience where all candidates could see each scenario and play an active role in debrief when the ambulance returned to the centre. Successful delivery of this course will improve patient safety during potentially complex ECMO transfers. We hope to invite more remote participants via MS Teams to view the simulations and take part in the debrief, increasing learning opportunities for ECMO and transfer staff. ]]>
<![CDATA[113 Making Virtual a Reality During a Pandemic: Improving Learning Opportunities in Medical Education through Virtual Reality Simulation]]> https://www.ijohs.com/article/doi/10.54531/TGCJ1767 Background:William Osler was the first to be credited with taking medical students out of the lecture theatre and to the bedside [1]. However, the COVID-19 pandemic has not just taken medical students out of lectures but also away from the bedside. Virtual reality simulation (VRS) can provide students with a computer-generated environment where users interact with virtual surroundings and patients in any location [2]. To mitigate the gap in clinical experiences we created an education package using VRS for medical students during the initial phases of the pandemic.

Aim:

Could VRS provide a meaningful learning opportunity during the first wave? Could we elicit the strengths and weaknesses of virtual simulation in medical learning?

Method/design:

We used the Oxford Medical Simulation (oxfordmedicalsimulation.com) VRS platform where the learner manages an acutely unwell patient with specified learning objectives (opting for the 2-D to make it accessible to students at home). Scenarios were grouped, accompanied by didactic learning resources and released on a weekly schedule. Data were collected with consent on the number of scenarios accessed, performance score and student feedback.

Implementation outline:

The VRS course ran for 5 weeks (access extended to 11 weeks). In total, 224 students expressed an interest in accessing the VRS platform. Of the 224 students, 64 accessed the scenarios (50% first-year students). The students accessed 821 scenarios. The average score on all first attempts of scenarios was 75%; second attempts 78% and third attempts 90% (Figure 1). Qualitative feedback: ‘I like…the ‘real’ feel of talking to the patient, informing next of kin….it surprised me how real my patient feels’. ‘They are incredibly useful. … I much prefer doing them on a computer screen than in 3D. It does make for a different way of revising’.
Figure 1:
The high initial response rate suggested student interest and engagement. The low (21%) conversion rate to accessing the VRS platform may be explained by initial technical issues and the voluntary nature of the project. The quantitative data show the importance of repetition in improving learning. Participation over time may improve with incorporation into the medical school curriculum. Lower usage among the final-year medical students may be explained by volunteering and early commencement of clinical duties. This innovation reveals some strengths of VRS: basic equipment; learner-directed; improved performance and student interest. Overall, the VRS platform allowed the delivery of a rapid response to fill a gap in clinical education. The next phase of this project will be to provide live tutor-supported debrief. ]]>
<![CDATA[90 COVID-19 Simulation Programme: Rapid Tests of Change]]> https://www.ijohs.com/article/doi/10.54531/VZPO5063 Background:The ‘first wave’ of COVID-19 created many challenges. Our hospital was fortunate to have slightly longer than many others to prepare. One of our Emergency Department (ED) challenges was that, as part of a redesigned process, patients with respiratory failure (presumed COVID-19) were to be assessed in a very different clinical area (single rooms instead of ‘open plan’ resuscitation room), managed by a much larger team of clinicians, using Level 3 (airborne) PPE and a modified approach to Rapid Sequence Intubation (RSI) induction of anaesthesia. Rapid cycle simulation and debrief has subsequently been described as part of a system-based learning approach during the COVID-19 pandemic [1].

Aim:

The aim of this programme was to rapidly familiarize a large team with the new clinical environment and RSI process, using the learning conversation after each simulation to make an immediate change, as required, to the clinical area and/or process.

Method/design:

Each simulation was an identical clinical scenario, i.e. a patient with respiratory distress for whom the need for COVID-19 modified RSI had been identified. The simulation was delivered in the rooms that were subsequently to be used for direct clinical care of confirmed or suspected COVID-19 patients.

Implementation:

A process testing approach was taken. During the simulation brief, the process was talked through in detail (all expected actions and sequence), the team then performed the simulation, followed by a learning conversation that was very focussed on the challenges in delivering this process. Using mobile cameras and large screen TV, all simulations were live streamed to an immediately adjacent area, such that a large number of other clinicians could observe the brief, the simulated clinical scenario and participate in the learning conversation. Agreed changes in equipment, ergonomics and process were immediately incorporated into the next simulation. Once this area was required for direct patient care, an identical room was set up in an adjacent (non-COVID-19 clinical area) to allow daily simulated training to continue. On one occasion, where there was advance notice of the arrival of a patient requiring RSI, the team who were to be involved in the RSI ‘drilled’ this scenario (‘just in time’ simulation) whilst awaiting the arrival of the patient. It was observed that participants who had previously been less comfortable with simulation were happier with this process testing approach (knowing what is expected and with no surprises). ]]>
<![CDATA[143 The Use of an Audio-Visual Streaming Solution to Deliver Portable COVID Compliant <i>in situ</i> Simulation Training]]> https://www.ijohs.com/article/doi/10.54531/OTTO2012 Background:Safe training in the current clinical workplace requires careful participant proximity management. Delivering simulation in a confined clinical environment can impact scenario fidelity and affect psychological safety [1]. A portable audio-visual (AV) streaming system enables audiences to observe and contribute to debriefing without compromising simulation fidelity.

Aim:

The aim of the study was to assess the practical efficacy of a portable AV streaming solution to enable real-time in situ simulation, including to a dispersed audience.

Methods/design:

The Scotia Medical Observation and Training System (smots™) offers a portable AV solution with flexibility, through the addition of cameras and microphones as required, to create bespoke simulation viewing. Smots™ was incorporated into the in situ simulation educational programme within an acute trust at least weekly over a 10-month period. It was concurrently deployed at our partner Nightingale facility to run simulation as part of an induction programme for new staff. Feedback from delivery users and scenario participants was collated and analysed.

Implementation outline:

Smots™ was an effective platform to meet our aims. Delivery users reported smots™ to be reliable in streaming the AV footage to a target audience in a remote debriefing room. The system was compact, easily transportable and had a low burden of training to achieve user competence. Participant feedback was positive, in that the system provided good AV clarity and narration, thereby enabling a successful training evolution. Smots™ offers a reliable capability to stream simulation scenarios to an alternative viewing area with the ability to be relocated as needed. Local wireless broadcasting range is finite and may limit users’ ability to stream information to discrete departments within a larger trust. Mitigation is possible using a secondary streaming platform or integrating it into a secure internal Wi-Fi or ethernet network. Assistance from trust information technology departments is recommended and this capability is something our team will consider as a future option. Expanding connectivity is an effect multiplier, offering distanced, streamed training across trusts and regions, as well as the inclusion of participants working from home. The portable nature of this smots™ solution offers flexibility for rapid deployment to areas of novel clinical capability and community partnerships. This system has proved exceptionally useful during a prolonged period of social distancing, enabling ongoing high-efficacy in situ simulation training to a larger target audience within a robust, safe educational environment. ]]>
<![CDATA[36 Assessing the Acutely Deteriorating Patient: Adaption from Face-to-Face to Remote Simulation, in Response to the Restrictions of COVID-19]]> https://www.ijohs.com/article/doi/10.54531/SPNE6363 Background:COVID-19 has undeniably impacted on learning for medical students, and one of their main concerns was the need for more course material when universities had to abruptly halt medical student placements due to social distancing restrictions. Our team had planned to have face-to-face simulation teaching with second-year medical students, focussing on the essential topic of A-E assessment and management of an acutely deteriorating patient. However, at short notice, we had to adapt this to an entirely online curriculum as a result of COVID-19 measures.

Aim:

The overall aim of the novel session was for students to virtually assess the simulated patient, manage any issues they found and use their examination and investigation findings to formulate a diagnosis and management plan. The presentation of the patient focussed on core conditions such as sepsis and hypoglycaemia.

Design:

We developed an innovative 2-hour online teaching session designed to be delivered to a group of eight second-year medical students, facilitated in an online capacity over Microsoft Teams. The session ran as follows: using a flipped-classroom approach, the students had been given reading material about the A-E assessment to read prior to the teaching, so we started by discussing this and clarifying key points. Then the facilitator explained how the session would run and briefed the students about the scenario in the style of an SBAR (Situation, Background, Assessment, Recommendation) handover. Following this, students took turns to direct the simulated doctor through the A-E assessment of a low-fidelity simulation mannikin, instructing the doctor of any examinations, interventions or investigations they would like. The facilitator guided the students through the scenario, providing necessary examination findings and investigations for students to interpret and act on. Equipment such as oxygen devices, airway adjuncts and blood bottles were demonstrated to the students throughout.

Implementation outline:

This session was an integral part of our second-year students’ 5-week virtual clinical placement. It was very well received; 95% (n = 21) of students strongly agreed or agreed that the session helped their learning. 90.5% strongly agreed or agreed that they enjoyed the use of technology-enhanced learning. Aspects specifically highlighted in the feedback were interactivity and being able to visualize the assessment of an acutely unwell patient. With online teaching likely to remain an important part of medical education, we have found that remote simulation is a suitable and effective way to introduce the assessment of a deteriorating patient. ]]>
<![CDATA[119 From Ad hoc Teaching Sessions to Full-Day Themed Teaching Days: An Undergraduate Education Team’s Response to the COVID-19 Pandemic]]> https://www.ijohs.com/article/doi/10.54531/QSZG9870 Background:The COVID-19 pandemic has had a significant impact on the education of medical students. Many final-year students felt overwhelmed by the pandemic and less confident in the clinical setting having missed a significant proportion of their fourth-year studies. In addition, with increased numbers of critically unwell patients, restructure of services and redeployment of staff, it was inevitable that teaching on clinical placement would be compromised.

Aim:

The aim of the study was to develop an innovative near-peer educational programme with integrated simulation to support the learning needs of students and alleviate pressure from clinical specialities.

Methods:

The team developed a programme whereby students attended a full day of protected small-group teaching each week, equating to a total of 72 taught hours per student over an 8-week placement. Each day centred around a common theme, for example, ‘the breathless patient’, working through patient-centred case discussion, diagnostic workshops and simulation (Figure 1). The sessions integrated knowledge with realistic simulation scenarios, practical skills, communication skills, diagnostic interpretation and human factors in a safe environment. To complement the teaching, the team introduced mentors, allowing us to provide support and individual constructive feedback to aid professional development from student to safe, competent and confident doctor.
Integrated design of the themed teaching days delivered to final-year students.
Figure 1:
Integrated design of the themed teaching days delivered to final-year students.

Implementation outline:

This innovative teaching programme was implemented over the 2020–2021 academic year and was well received by students as evidenced in the following feedback: ‘It was really helpful and interesting to have each teaching day themed on a presenting complaint’. ‘Protected time so (we) do not miss out if clinicians are busy’ ‘The best teaching I have had during medical school (…) I loved how interactive, clinically focussed and relevant to F1/F2 each teaching day was’. ‘Consistently received feedback which I have been able to act upon to improve my clinical practice’ ‘The improvement in my confidence, understanding & knowledge has been unbelievable’. ‘Simulation session was really useful and enjoyable (…) watching and feeding back is a really helpful way to recognize different clinical presentations and critically analyse ABCDE assessment & communication skills’ ‘These teaching sessions are great and unlike anything normally provided on placement’. The teaching programme has proved to be of such success that the team continue to develop them to integrate further aspects of clinical practice and inter-professional simulation. Furthermore, the team hope to develop themed teaching days for other student year groups to complement their clinical placements. ]]>
<![CDATA[35 The Creation of A ‘Choose Your Own Adventure Style’ VR Training Package for Post Anaesthetic Care Unit (PACU) Staff]]> https://www.ijohs.com/article/doi/10.54531/AVFL7970 Background: Lack of training materials for Post Anaesthetic Care Unit (PACU) staff leads to the creation of a ‘choose your own adventure’ style VR training package, working collaboratively with the TEL team and incorporating quality improvement methodology prior to rollout. The development of this training package was initiated following the introduction of a theatre-specific induction programme, during which it was discovered that the learning opportunities for PACU staff were limited, particularly during the COVID-19 response.

Aims:

Therefore, the aim of creating this learning package was to make available more interactive learning opportunities for PACU staff, giving them the chance to develop their knowledge and skills in a safe environment, without the pressure of a live patient.

Method/design:

Planning was completed in collaboration with a Theatre Practice Educator and Simulation and Human Factors Fellow. This was initiated with the use of a modified decision tree as shown in figure one. Following completion of this, the Technology-Enhanced Learning (TEL) Lead and clinical expert advice were sought to assist in the creation of high-quality content. Communication was then sent out seeking actors and location/dates for filming were planned. Appropriate consent was gained from all participants involved. Filming had to be planned around theatre utilization; therefore, it was necessary for this to take place on audit sessions dedicated to training of theatre staff. After the completion of filming, further collaboration with the TEL Lead was required to create the learning package. On completion of the package, it was shared with experienced members of PACU staff to test the quality and validity of the learning experience. At this point, a quality improvement approach was adopted with the use of PDSA (Plan-Do-Study-Act) cycles. Adopting this approach allowed adjustments to be made to the package before it was utilized on a larger scale.

Implementation outline:

The learning package was implemented rapidly after completion. It was immediately included in the Theatre Induction Programme for every PACU member of staff and was also then available to be utilized on audit training sessions for existing PACU staff. This learning package was a creative approach, exploiting technology not yet harnessed within our speciality. Patient post-Anterior Repair brought into PACU with an LMA (Laryngeal Mask Airway) in situ, spontaneous respirations are present.

Patient regains consciousness:

LMA expelled: Laryngospasm – recognize – 02, Waters Circuit/PEEP Vomit – positioning – suction – anti-emetics PV PAIN – check wound – analgesia (ineffective) Get help Laryngospasm has broken with PEEP Auscultation and order chest x-ray Multimodal analgesia – add patient PV pack band ]]>
<![CDATA[30 Shifting an In-Person Simulation Facilitation Training Program for New Nurse Educators to a Virtual Context]]> https://www.ijohs.com/article/doi/10.54531/XNUG8598 Background:Best practices indicate simulation sessions should be facilitated by a trained instructor to maintain a safe environment for learners. We developed and implemented a successful simulation facilitation training curriculum for nurse educators at our organization in 2018 [1], but as the COVID-19 pandemic was declared worldwide in March 2020 the program was put on hold. This pandemic has led to many innovations in health professions’ education, including nursing, to meet the ongoing need for prelicensure training to onboarding programmes at healthcare organizations. The nursing education department at our organization went through this same experience, based on what we have learned during the pandemic it is now time to revisit our simulation facilitation training program for new nurse educators.

Aim:

The aim of the study was to revise our current simulation facilitation curriculum ‘Introduction to Simulation’ with greater emphasis on delivery of the program through virtual processes.

Method/design:

Pulling from the educational methodology of the flipped classroom that has many advantages for the practicing professional such as improved learning performance, increased motivation and flexible learning [2] and our experiences with other nursing education programmes that required adaptation to a virtual context at our organization we will revise the current program. The program will change from a 1/3 virtual, 2/3 in-person model to a 2/3 virtual and 1/3 in-person model. We will redesign the current virtual content to be more engaging while shifting the in-class lecture to a webinar format delivered via our online meeting platform while still incorporating active learning strategies to meet the simulation facilitation learning needs of our new nurse educators. Following the ‘Introduction to Simulation’ webinar, the new nurse educators will attend an in-person session to practice facilitating simulation scenarios and debriefing and will be meta-debriefed by the workshop instructors to provide real-time constructive feedback.

Implementation outline:

This curriculum has yet to be implemented. We anticipate implementation in September 2021 with a cohort of 5 to 6 new nurse educators. The revised curriculum is anticipated to incorporate 2 hours of independent learning, 4 hours of an interactive webinar and 4 hours of simulation facilitation practice that will allow for the application of knowledge learned and feedback from simulation facilitation experts. After the workshop, we will seek feedback from workshop participants asking if this methodology met their learnings needs. We will use the outcomes of this first cohort to evaluate if this educational strategy is viable for ongoing program delivery. ]]>
<![CDATA[99 A Fresh Model in the Vehicles for Learning: Redesigning an Established, Traditional Airway Course to be Delivered in a Multi-Site Hybrid Format in the COVID-19 Era]]> https://www.ijohs.com/article/doi/10.54531/GDRA5954 Background:The Royal College of Anaesthetists (RCOA) stipulates that anaesthetists should be able to use advanced/novel airway management techniques. The RCOA-accredited annual Challenging Airway Course in Northern Ireland is a staple of the calendar, providing an opportunity for all those involved in airway management to gain, refresh and replenish skills. Having already been cancelled in 2020 due to the pandemic, there was a strong appetite, particularly within the trainee body, that it should be staged in some form this year.

Aim:

The aim of the study was to deliver a high-quality course that outlined the theory behind airway management, without loss of the hands-on aspects of equipment/techniques, to a large candidate group in a COVID-19 safe environment.

Method/design:

Alteration of the face-to-face course to run in a hybrid multi-site format with both online components and practical workstations.

Implementation outline:

The course was delivered simultaneously in real time across the multiple deanery teaching hospitals. There was a central hub from which the course lead could synchronize timings/broadcast recorded material. As part of contingency plans for any unanticipated technical difficulties, lectures were pre-recorded and played for candidates on the day. These were punctuated with four practical workstations that mandated two delegates per station. Additionally, some content was recorded for viewing online as pre-course material and new simulation videos of a failed intubation drill and the subsequent debrief were also created. For some unable to attend site locations, a fully virtual experience was also an option. These modifications allowed us to: maximize attendance without breaching social distancing guidelines; retain the hands-on aspect of using equipment/techniques and also maintain an excellent faculty to candidate ratio to allow ample time for practising/asking questions. The pre-course material also empowered the candidates to feel better prepared for the day. Post-course anonymous feedback was completed by the vast majority of delegates and was overwhelmingly positive. Pre-course material, facilities, content, lectures, simulations and workshops were rated highly. The use of airway exchange catheters was mentioned as the introduction of a new skill for many delegates. Apart from one candidate, no one had attended any RCOA-accredited airway events in the preceding year but 100% of the candidates would recommend this course to their peers. Amidst challenging times, we successfully restyled an established and respected course. The novel hybrid multi-site format allowed a larger number of candidates to network face-to-face and gain knowledge/practical skills within a COVID-safe environment. Until such times as ‘normality’ and perhaps beyond, this may be a new formula for learning. ]]>
<![CDATA[38 Using Simulation to Improve and Test a Novel Enhanced Care Drug Trolley]]> https://www.ijohs.com/article/doi/10.54531/DKOT5640 Background:The Royal College of Physicians Acute Medicine Taskforce [1] recommended the establishment of Enhanced Care areas as distinct from Critical We designed a novel purpose orientated Enhanced Care Drug trolley for our Trust’s Acute Medical Unit (AMU), where we have designated Enhanced Care beds. The Enhanced Care Drug trolley was designed to improve the time-critical management of patients experiencing hypoglycaemia, status epilepticus, hyperkalaemia, diabetic ketoacidosis (DKA) and anaphylaxis. Human factors relating to equipment can impact clinical performance in different clinical settings and minimizing this proportionally improves clinical safety.

Aim:

The aim of the study was to optimize the management of life-threatening medical conditions, requiring enhanced care, whilst minimizing the time taken for commencement of drug interventions and staff using a novel Enhanced Care drug trolley.

Method/design:

A drawer on a sealable procedure trolley was designated for each emergency and the following items were included: Treatment algorithm Prescription charts Monitoring charts (where applicable) Medications and their diluents Sundries (needles, flushes, sanicloths etc.) Blood forms, bottles and blood gas kits (where applicable) Cannulation kits Airways (where applicable) Oxygen mask (where applicable) A Standard Operating Procedure (SOP) was produced detailing the responsibilities of the ward manager, pharmacy team and nursing staff. Weekly and daily checklists were produced, along with a ‘seal broken’ table. The process, procedures and innovation were discussed and approved by the Drugs and Therapeutics group.

Implementation outline:

Each emergency scenario was tested in situ on the AMU using the simulation doll and trainer (see Table 1 for results). To test each drawer a corresponding scenario was created and each intervention timed. The scenario was run twice, firstly without the trolley and then again with the trolley using two sets of nursing staff. The time was recorded from when the ward team responded to the patient to when the last step of emergency drug treatment was administered.
Table 1:
Results from testing the enhanced care drug trolley
Emergency Time taken (without trolley) (min) Time taken (with trolley) (min) Total time saving (min)
Anaphylaxis 16:00 07:20 08:40
Hypoglycaemia (severe) 07:40 03:45 03:55
Diabetic Ketoacidosis (DKA) 26:02 08:05 17:57
Hyperkalaemia 31:10 13:06 18:04
Status Epilepticus 18:56 13:08 05:48
Simulation testing led to modifications of the contents of the trolley after feedback from the users. To embed practice, education of the nursing staff and clinicians was commenced to ensure familiarity and confidence to use the trolley, and to ensure governance adhered to. ]]>
<![CDATA[116 Developing a Framework for the Integration of Skills and Simulation: The 5-Stage Approach]]> https://www.ijohs.com/article/doi/10.54531/KYBT8535 Background:In recent years, there have been many publications providing guidance on simulation-based education and frameworks for development of faculty and delivery of simulation. However, there is not a framework for the integration and delivery of skills and simulation within a pre-registration curriculum. In 2017, Woda [1] referred to a need for a ‘sequenced’ integration of simulation into programmes with increasing complexity, knowledge, and exposure to simulation. Furguson [2] also found that there was a gap in how a simulation strategy becomes effectively implemented and embedded within an existing curriculum.

Aim:

The aim of the study was to create a framework that integrates clinical skills and simulation increasing in complexity that can be used for any pre-registration healthcare curriculum. Ability to effectively implement and embed within an existing or new curriculum.

Method/design:

We developed a framework using a five-stage approach to scaffold learning. Bringing simulation into the curriculum from the very start with the early introduction of consolidation and simulation allowing for a gradual cognitive load. Our approach builds on technical and non-technical skills alongside an understanding and exposure to simulation, by their final-year students will be debriefing their own teams in simulation and understand the use of simulation debriefing tools. This integration of skills and simulation and move away from ‘task training’ skills teaching aims to create both competence and confidence in students enhancing practice placements and ultimately improving the safety of patients. The approach consists of five stages: (1) online learning; (2) facilitated practical (task training); (3) simulation consolidation (facilitated simulation); (4) simulation days (remote facilitation); (5) clinical practice.

Implementation outline:

The framework is being applied to the 2-year Master's programmes and nursing associate programmes as well as the standard 3-year pre-registration nursing, midwifery, operating department practitioner and paramedic programmes. Skills both technical and non-technical are introduced in years 1 and 2. In year 3, the focus is on knowledge review with a higher expectation of understanding and assimilation into the simulated environments expected. Over the 3 years, facilitation will lessen until students are leading on the simulation delivery and debrief by the end of their course. The same principle is applied to the 2-year programmes. This framework has been applied to all our healthcare courses by mapping the required skills curriculum and using the framework to build the content and set the delivery. The framework has now been adopted by another university. ]]>
<![CDATA[63 Virtual Community Outreach Simulation Programme]]> https://www.ijohs.com/article/doi/10.54531/LBRR5359 Background:The community outreach programme paused during the global pandemic as schools were closed and we were unable to go into schools and colleges to use simulation-based training to educate and inspire young adults to consider a career in the National Health Service. Now that schools and colleges are open it is still difficult to go into schools and colleges due to COVID-19 restrictions. We needed a way to continue to reach out to these schools and colleges using simulation to educate and inspire young adults.

Aim:

The aim was to continue the outreach programme but virtually, via live streams and some pre-recorded simulations. Aiming to help to increase awareness of the different careers, routes into the National Health Service and skills required to work in healthcare. ‘A virtual learning environment is intended not simply to reproduce a classroom environment -’on-line’, but to use the technology to provide a new way of learning’, Britain and Liber [1]. By continuing to provide the outreach simulation project I hope to be able to engage with a larger number of learners at a single time.

Method/design:

Streaming live simulations sessions with tutor groups from schools and colleges via platforms such as Microsoft Teams and Zoom using a variety of simulation scenarios. These simulations will be mainly focussing on human factors with some teaching on specific subjects depending on the need of the learners. Example: Virtual work experience for young adults interested in medicine. We plan to mock up our simulation centre to replicate an accident and emergency department and have three admissions of different severity. We will be streaming this to two schools simultaneously and they will have the chance to help prioritize the three patients and explain their choice. The simulations will display good teamwork, good communications skills and leadership. One of the simulations will not include these skills and display poor communication, this will be intentionally included in a simulation for the learners to identify.

Implementation outline:

Feedback forms will be given to all learners to complete asking them if the session has inspired them to consider a career in the National Health Service, feedback will then be used to adjust the way we deliver the virtual side of the outreach programme and perfect the programme so we can continue to educate and inspire young adults. ]]>
<![CDATA[189 A Simulation With No Participants Only Co-Faculty: Using Simulation for Systems Integration On the Large Scale]]> https://www.ijohs.com/article/doi/10.54531/JBXJ4450 Background: The large-scale relocation of a paediatric hospital is a significant undertaking. New environments change the system, and ways of working must adapt to maintain quality healthcare. There are risks to patients and staff well-being, with high anxiety around change. There is evidence for the efficacy of simulation as a tool for safe training and rehearsal of staff and teams [1] but less so on such a large scale. Simulation for many is still perceived as a test of performance and a threat. We connected with the international simulation community to design a hospital-wide programme of Patient Environment Simulations for Systems Integration (PESSI). This paper outlines challenges in establishing buy-in from stakeholders and departments, developing a framework for implementation and our reflections on delivery of large-scale simulation activities to assist a hospital move.

Aims:

How can simulation-based methodology be used to support clinical departments on a large scale to adapt/integrate/prepare in moving to a brand-new hospital?

Method/design:

Collaboration with authors of PEARLS for system integration use [1], using it as the main framework for delivery and structure of PESSI. Stages of delivery were: pre-phase work, system testing day, debrief/reflection and evaluation. Immediate feedback of enjoyment and learning was collated from all participants. Three-month post-move feedback is planned to review ongoing impact/behaviour change plus analysis of safety incidents.

Implementation outline:

Pre-phase work involved meeting stakeholders and establishing aims of testing. Ward managers were key departmental links, meeting with members of PESSI to plan scenarios. System testing days involved familiarizing themselves with the environment, followed by ‘day in the life’ simulations with a representation of the whole team. All participants were called ‘co-faculty’ and knew exactly what would happen. Debrief involved facilitated conversations with the whole team describing reactions, and deeper analysis of the key events, with concerted efforts by facilitators to give a balanced approach of positives and challenges. A short report was given back to the department detailing the findings teams would need solutions to. Solutions from simulation were implemented prior to the move, increasing staff confidence, with many feeling PESSI played a major role in feeling prepared for the new site. The PESSI framework is being utilized in adult services and we hope to publish our methodology to share with the wider simulation community. ]]>
<![CDATA[117 Murder on the Laboratory Floor]]> https://www.ijohs.com/article/doi/10.54531/DOJT8974 Background:As leaders are now being encouraged to work across different organizations and in more complex ways, a Systems Leadership programme was developed. The programme required a final module to consolidate the learning which was simulation based. The candidates attending the ‘murder on the lab floor’ module were a mixture of clinical and non-clinical senior leaders from public and third sector organizations.

Aim:

The aim of the study was to design a half-day course utilizing the simulation structure of pre-brief, scenarios and debrief which enable the candidates to reflect on their own learning in the areas of leadership, communication decision-making and collaborative skills.

Method/design:

We formed a working group to design the scenarios, which were a series of games, build prototypes, run pilots to assess suitability, identify modifications and ensure consistency. Games were linked to leadership traits to aid reflection through debriefing. Games were designed to be played face to face, or remotely, thus promoting inclusivity for shielding staff. A short pre-brief or introduction was filmed.

Implementation outline:

In our first cohort, all candidates attended the 3-hour session in person. The pre-brief film was played to the candidates setting the scene of an industrial scientist collapsed on a laboratory floor. It outlined the aim to collect as many golden syringes as possible by completing seven 5-minute activities. The candidates were given 5 minutes to nominate which candidate would complete which of the seven games set out in the laboratory. The games were categorized as mental, physical, mystery and skill. The nominated candidate entered the laboratory fitted with a radio headset. Audio and video were fed to the debrief room and to remote candidates via Teams. Once the candidate entered the laboratory the timer was activated. Candidates in both rooms were expected to work together to solve the puzzle and demonstrate team dynamics, communication and strategic thinking. On completion of all games, the candidates participated in a structured debrief led by two of the faculty. This reflective process highlighted the intended learning points and also brought about a discussion examining the effects of COVID-19 on the individuals and their teams. Qualitative feedback was collected. Candidates stated that It was the best session of the programme The method suited my style of learning I would like my team to go through the process as I found it so valuable. As this fitted social distancing guidelines it is a great alternative to an online programme The activities joined the dots between leadership theory and how we work in practice ]]>
<![CDATA[138 Student Perspectives of a Novel Remote Simulation Course]]> https://www.ijohs.com/article/doi/10.54531/EXZU1969 Background: This study was designed in response to the pandemic. This was to increase the accessibility of Simulation Training whilst under lockdown restrictions and limited departmental capacity due to social distancing.

Aims:

The aim of the study was to assess final-year medical students’ perspectives on a new method of delivering a simulation course remotely.

Method/design:

The technique utilized in the intervention group was a guided experience via ‘Avatars’ – Faculty members who were physically present in the simulation room. Course participants joined via a live video stream and directed the ‘Avatar’ in real time. The scenarios were driven by a script that directed focus to the learning objectives. The debrief followed a ‘pause and perfect’ approach to enhance participation. During these pauses, the students, with guidance from a facilitator, reflected on developments so far and then gave their ‘Avatar’ instructions for the next stage of the scenario. The study took the form of a pragmatic cross-over trial, splitting the cohort into two groups. Group 1 received a face-to-face medicine simulation course and a remote surgery simulation course. Of this group, approximately half had the remote course first and the face-to-face second, the other half in the reverse order. Group 2 had a similar format, however with a face-to-face surgery simulation course and a remote medicine simulation course. The intention was to minimize the influence of pre-course perceptions based on what has already been experienced (i.e. a group might have a different perspective on a face-to-face course if they have had a remote course first and vice versa). Feedback was collected and compared for each.

Implementation outline:

A total of 44 final-year medical students took part in the trial. 40 feedback responses were collected for the face-to-face sessions and 37 for the remote. Overall, the face-to-face simulation sessions were received more positively with 100% of participants scoring face-to-face sessions overall as ‘Excellent’ or ‘Very Good’ compared with 70.2% for the remote simulation. Participants were asked to score out of 10 how much these sessions would change their future practice; the mean score for the face-to-face was 9.29 compared with 8.5 for the remote. Remote simulation produced lower student satisfaction scores compared with face-to-face teaching. Further research is needed to determine the differential impact on knowledge and skills transfer. If there is limited impact, remote simulation could be a viable and valuable alternative to face-to-face simulation, not only during a pandemic but also in diverse environments. ]]>
<![CDATA[105 A Simulation-Based Departmental Induction Using Virtual Reality 360]]> https://www.ijohs.com/article/doi/10.54531/EJJW6579 Background: One of the challenges faced during the COVID-19 pandemic was the need for quick departmental inductions to allow rotating and redeployed junior doctors to familiarize themselves with rapidly changing departmental environments. We were unable to continue traditional inductions due to various challenges including lack of senior staff to provide the induction due to increased workload; lack of administrative staff to support inductions due to sickness and self-isolation; and lack of physical space under the constraints of social distancing. Thus, an alternative was needed incorporating all aspects of a traditional induction. Video Reality 360 (VR360) technology and video simulation have been on the rise during the last few years in medicine [1] and presented an opportunity to produce safe, efficient and flexible inductions for our junior doctors [1].

Aims:

The aim of the study was to produce a simulation-based departmental induction programme that would be equally effective to the traditional model.

Method/design:

We started with identifying the components of a departmental induction and then held a multi-disciplinary team meeting to encourage the addition of topics felt to be important and often overlooked. Stakeholders were involved in a needs analysis on the induction material; previous and current departmental junior doctors, the lead pharmacist, medical registrars, emergency physicians, acute physicians, the clinical lead, the medical director and the director of medical education were all contacted with specific questions on content and junior doctors’ needs. Components of the recent General Medical Council surveys were taken into account to allow for a more junior doctor-centred induction. Subsequently, scenarios were designed with input from the directors of simulation and approved by the acute medical unit (AMU) lead. With the help of our colleagues at Hull Institute of Learning & Simulation (HILS) the scenarios were filmed, edited, and filed to produce an educational tool.

Implementation outline:

The end-product of our VR360 induction has been checked by the educational lead of AMU against specific variables and standards and was characterized as ‘much more flexible and a potentially more effective educational tool for junior doctors’ medical induction’. Initial feedback from junior doctors has been very positive; however, further feedback comparing traditional and VR360 induction is needed. Work is ongoing to produce an interactive VR360 induction video with the hope that this could replace face-to-face departmental induction within our hospital. ]]>
<![CDATA[100 ACUTE MEDICINE MEETS ‘KNIGHTMARE’: ‘CHOOSE YOUR OWN ADVENTURE’ FORMAT FOR REGISTRAR COURSE DELIVERY]]> https://www.ijohs.com/article/doi/10.54531/FSQS3328 Background: Ongoing social distancing restrictions have greatly limited opportunities for registrars to attend regional acute medicine teaching. Basing the project on previous work within the trust running simulation via Microsoft Teams (using a one-to-one method of delivery) this project set about opening this up to a much larger group using a ‘choose your own adventure’ (‘CYOA’) format depicted in the children’s television show ‘Knightmare’.

Aims:

The aim of the study was to deliver a simulation-based training course for a large number of participants simultaneously using an online platform.

Method/design:

Scenarios were as follows: Patient with an exacerbation of COPD Patient with a life-threatening overdose Patient presenting with undifferentiated unconsciousness The clinical room featured an audio-visual set-up for debrief with three cameras and patient observations from Laerdal Learning Application (LLEAP) combined with an audio mix shared via video-stream to VLC media player; then from the host laptop via Teams. Teams used audio mixer input from room via USB. This included phone audio allowing calls to relatives, other specialists, etc. to be heard. Teams accessed from the following locations: Host (control room) Faculty (control room) Faculty (clinical room) Faculty (debrief room) Participants (remote) × 14 Teams host laptop was pre-loaded with all scenario information which allowed ECGs, CTs, Toxicology reports to be shared as requested throughout the scenarios. The multi-screen set-up allowed for monitoring of chat from a control room and clinical space meaning all users could access key information shared on screen. Faculty had radio communication to control room for prompts and questions. Scenarios would be led by a member of faculty playing the role of a clinician in the scenario. The scenario would progress with input from the participants via that Teams chat. At key points, the scenario would pause and a question would be put to the group and an option would be voted on to continue. After each scenario, using Teams break-out rooms for debrief allowed the large group of participants to have a more focussed debrief session led by one of the medical faculty.

Implementation outline:

Using the structure of ‘CYOA’ encouraged users to take part in key interventions, whilst chat function within teams allowed for continuous dialogue. Participant feedback stated that the discussion format and expertise within the group was very useful in their training and would have a positive impact on working practice. Faculty found virtual simulation more demanding to facilitate than face-to-face simulation, but feasible to run the session annually. ]]>
<![CDATA[5 Core Care Skills Simulation Training for Undergraduate Medical Students]]> https://www.ijohs.com/article/doi/10.54531/HWTI6960 Background:Throughout the coronavirus pandemic, healthcare professionals have needed to rapidly adapt to changing demands. For some, this has involved adapting a ‘task-sharing’ approach which means that professionals undertake tasks that are not usually considered part of their job role, for example, Junior doctors giving medications and many were ‘redeployed’ completely to areas of greater need. In the same vein, the role of the medical student was expanded and explored and some medical students were given the opportunity to undertake paid work as healthcare support workers (HCSWs). It can be argued that the education and training of medical students are heavily focussed on a medical model of healthcare and often lacks depth insight into the caring aspects of patient care.

Aim:

The aim of the study was to create an interactive practical care skills simulation training aimed at medical students.

Method/design:

We designed a practical simulation training programme based around the ‘fundamentals of care’ as defined by the nursing and midwifery council [1]. It was delivered over a half day (3 hours) and involved explanation, discussion and practice of basic care skills that would be needed, including clinical observations, nutrition and hydration, bowel and bladder care, personal care (including some basic moving and handling) and last offices. This was based around a patient care scenario, with students required to interact with the manikin and each other as they would in practice, allowing them to practice interpersonal skills as well as the practical aspects of care.

Implementation outline:

Early versions of this course were used as part of a comprehensive induction programme that included testimony from HCSWs working within the site hospital, who were able to share real-life experiences and offer peer support. This helped influence the development of this course to shape it into an innovative multi-disciplinary training. The training course was developed reactively to meet the developing need of students to prepare for redeployment by April of 2020 and since then has grown and developed into the half-day simulation training that is outlined above. It has now been incorporated into the in-hospital clinical skills curriculum for third-year medical students passing through the trust on the understanding that, this course has helped medical students to better understand the role of other professionals and will enable closer multi-disciplinary working in future. Anecdotally, it is obvious from interacting with students that there is a need to incorporate training in basic care into the medical curriculum to prepare students for task-sharing in the future as well as to better understand the caring professions and improve multi-disciplinary working. However, there is not enough post-course data to establish a true effect from this course at present. We continue to run this training course as part of the year 3 undergraduate clinical skills programme and aim to collect more survey data to evaluate and adapt it. ]]>
<![CDATA[156 Practice Made Perfect: The Evolution of an LVAD Algorithm Through Clinical Simulation]]> https://www.ijohs.com/article/doi/10.54531/KIST8196 Background: In total, 70% of patients implanted with a left ventricular assist device (LVAD) will experience a life-threatening emergency within the first year of implantation [1,2]. 
Complexities surrounding deterioration and resuscitation in these patients are clinically vast and intimidating to the staff who encounter them. This may present significant challenges for staff caring for this complex patient group and often leaves them feeling anxious and insufficiently prepared when presented with LVAD deterioration. A literature review revealed a lack of clear guidance for the management of in-hospital LVAD emergencies. As a result, an organization-wide project was launched to design the first ever, non-brand-specific, LVAD emergency algorithm. A multi-disciplinary clinical simulation programme was fundamental to the evolution of the tool and the clinical decision-making, competence and confidence of the staff group.

Aim:

Develop and introduce an emergency algorithm that provides a standardized approach to LVAD patient emergencies. Increase staff confidence, competence and clinical decision-making. Use simulation to facilitate and enable staff to solve complex problems using standardized assessment and management while ensuring transparency and equitable treatment in situations of rapid clinical deterioration.

Method/design:

The LVAD Simulation and Algorithm project commenced through the trial of an out-of-hospital algorithm developed by Bowles that was adapted for in-hospital use. Direct feedback from staff attending low-fidelity ward-based simulations was used to consistently develop and adjust the algorithm from a three-page flowchart to a single page (Figure 1). The invaluable feedback and constant observation of the algorithm through simulation has allowed for the evolution of a clear, concise tool that provides staff of all skill sets with a defined course of action during an LVAD emergency.
Practice made perfect
Figure 1:
Practice made perfect

Implementation outline:

Simulation has proved to be essential in developing this innovative, unique, patient safety tool that has increased staff confidence and competence throughout the organization while providing a safe place for clarifying questions. The single-page algorithm continues to be practised via simulation weekly with an ever-increasing multi-disciplinary presence. Staff report increased confidence not only in dealing with LVAD emergencies but also in their ILS and ALS skills, all of which increase safety, quality care for patients. This one of a kind algorithm is now finalized and awaiting organizational review, following which a complete evaluation of its effectiveness will be conducted. ]]>
<![CDATA[171 Safe Patient Transfer: Getting Everyone in on the Acct]]> https://www.ijohs.com/article/doi/10.54531/YLRL2252 Background:Optimal patient care frequently requires the safe inter-hospital transfer of critically ill patients for time-sensitive treatments, often outside of normal working hours. Safe transfer requires a multi-disciplinary approach including doctors (typically anaesthesiologists), nurses and paramedics. In a 2018 survey of anaesthesiology trainees in Ireland, 81% agreed that specific training in this area was ‘deficient’ or ‘absent’ [1].

Aim

Recognizing the lack of formal training, we identified the need for training in the transport of critically ill patients including familiarization with the ambulance environment and common critical transfer scenarios [2]. Supported by national health and education bodies, we assembled a multi-disciplinary team of clinical experts and simulation educators to develop, implement and evaluate an Adult Critical Care Transport programme (ACCT) for key healthcare professionals involved in transferring critically ill patients. Our aims were: (1) to support a shared approach across multi-disciplinary teams; (2) to provide clinical training promoting safe, efficient transfer of patients; (3) to address gaps in training of anaesthesiologists involved in transporting critically ill patients; (4) to design a course acknowledging the challenges of COVID-19, and difficulties with releasing clinical staff and faculty from work for face-to-face training.

Method/design:

The ACCT methodology consists of (1) comprehensive Video-Assisted Learning (VAL) material for pre-course completion; (2) on-site face-to-face simulation; (3) an ACCT Train the Trainer (ACCT-TTT) for trainers to subsequently deliver the programme.

Implementation outline:

The VAL material includes lectures (e.g. transport physiology), clinical skills demonstrations (e.g. transport and ambulance equipment) and simulation (e.g. safe packaging for transfer). There is an accompanying multiple-choice questionnaire (MCQ) to ensure full engagement and testing of core knowledge prior to the on-site component. On-site, small multispecialty delegate groups comprising of doctors, nurses and paramedics rotate through three simulations, allowing for enhanced experiential learning. Two take place in high-fidelity simulation laboratories, and one occurs in a fully operational ambulance. Delegates assume their real work roles and deal with common transport scenarios and adverse incidents. Debriefing focuses on reinforcing prescribed learning objectives. A post-course MCQ is used to validate learning, with feedback forms used for course evaluation. We plan to pilot the course and subsequently conduct ACCT-TTT courses. We aim to implement and expand ACCT nationwide, making it a mandatory component of anaesthesiology training. ]]>
<![CDATA[82 Surgeons Don’t Just Operate: Improving Junior Surgical Practitioners’ Non-Technical Skills Outside of the Operating Theatre Using High-Fidelity Simulation]]> https://www.ijohs.com/article/doi/10.54531/KEYW7406 Background:The non-technical skills of surgeons play a significant role in patient confidence, experience and safety [1]. Courses, such as NOTSS, have been successful in advancing senior surgeons’ abilities in situational awareness, decision-making, communication and teamwork, and leadership. These courses focus on non-technical skills intraoperatively [1]; however, the work of a surgeon is far from limited to the operating theatre. Often, critical events take place in A&E or the ward environment involving junior surgical practitioners potentially unsupervised. Still, there remains no required human factors training at the junior stage or surrounding surgical care outside of the operating theatre at any stage of practice. We are establishing a course for junior surgical practitioners encompassing two areas where non-technical skills are frequently tested outside of the theatre environment; DNACPR and consent.

Aims:

The aim of the study was to improve non-technical skills and confidence of junior surgical practitioners regarding DNACPR conversations and obtaining operative consent.

Method:

We have developed a speciality-specific course to address the educational deficit surrounding non-technical skills outside of the operating theatre, focussing on DNACPR and consent, for junior surgical practitioners. It was piloted at Aintree University Hospital with their Orthopaedic Department. We combined lectures and workshops delivered by subject matter specialists with simulated scenarios. The simulated scenarios were debriefed by human factors specialists using the gold standard validated NOTSS tool [2]. Anonymized candidate data were collected using electronic forms.

Implementation outline:

The pilot course in June was a resounding success; candidate confidence scores increased significantly across both skills and knowledge surrounding capacity, consent and DNACPR. All attending candidates have recommended the course to their peers and suggested integration into the Foundation training curriculum. However, identifying and implementing courses appropriate for all foundation doctors with such a specialized course would be challenging. Most foundation doctors have at least one placement in a surgical specialty. Therefore, it is more realistic to adjust the course to become less specialized, encompassing all the surgical specialities, to target all foundation doctors initially instead of juniors in each speciality. Following the capture of foundation doctors, the second phase of implementation will return to speciality-specific courses to address the learning needs of non-medical practitioners, such as Physician Associates and Advanced Nurse Practitioners, working in surgical departments. ]]>
<![CDATA[106 How the COVID-19 Pandemic has Changed Departmental Teaching in a Tertiary Hospital]]> https://www.ijohs.com/article/doi/10.54531/NZXQ5081 Background:Pressure from the COVID-19 pandemic on healthcare has had a detrimental effect on the delivery of teaching to junior doctors. During a time when teaching is needed more than ever the constraints of a pandemic have made this challenging. Parallel to this patient safety remains a cause for concern in healthcare systems worldwide [1]. Incident reporting is recognized as a key tool for improving patient safety and learning from such incidents is a fundamental part of improving patient care and safety [1]. The need to address recurring significant incidents (SIs) on the Acute Medical Unit (AMU) at Hull Royal Infirmary (HRI) was identified. With the pandemic placing pressure on departments to rethink teaching an opportunity to develop a simulation-based induction video integrating lessons learnt from SIs presented itself. Incorporating technologies like Video Reality 360 (VR360) into traditional teaching methods have shown to produce a more effective teaching tool in the medical education field [2].

Aim:

The aim of the study was to create an educational programme for the acute medical unit to allow flexibility of learning whilst incorporating key lessons from significant incidents.

Method/design:

Our initial approach was to gain an understanding of the problem by consulting the multi-disciplinary team. We spoke with a range of healthcare professionals working on the acute medical unit to identify concerns relating to SIs: in particular, the governance lead was key in this. Following this, we consulted junior doctors using questionnaires to explore the challenges they faced working on AMU. The design of the scenarios is based around two SIs per scenario for a total of five scenarios and all scenarios were based around the management of common conditions seen on AMU. We opted for an interactive ward round style teaching with a particular focus on key skills such as prescribing and taking bloods. With the help of our colleagues at Hull Institute of Learning & Simulation (HILS) the scenarios were filmed in 1 day and later edited to produce a short video.

Implementation outline:

We have designed and created a VR360 teaching programme that combines with departmental induction allowing junior doctors to access learning from anywhere in the world and immerse themselves on AMU. Feedback has been positive so far and we hope to expand this simulation-based learning to allow to include additional topics. ]]>
<![CDATA[115 On-Call Bleep Simulation for Final-Year Medical Students]]> https://www.ijohs.com/article/doi/10.54531/MHKQ6744 Background: A common concern amongst final-year medical students is the on-call shifts as a Foundation Year 1 (FY1) doctor. With a large focus on knowledge, clinical and communication skills, and practical procedures, there is little in the medical curriculum to cover the non-technical skills required whilst on-call such as prioritization. A novel teaching programme was devised to help develop students’ confidence and preparedness for these shifts. This in situ simulation allowed the students to fully immerse into the role of an FY1 whilst experiencing the stressors of being on-call in a safe, risk-free environment.

Aims:

The aim of this course was to prepare final-year medical students for their on-call duties as FY1 doctors. This includes developing confidence with the technical aspects of on-calls such as managing the acutely unwell patient, as well as the non-technical skills expected from bleep-related tasks such as responding, prioritization and escalation.

Method/design:

A total of five sessions were delivered from September to December 2020 for final-year medical students. Twelve simulated on-call ‘activities’ were designed mirroring real tasks commonly encountered as an FY1 on-call. These activities were spread across the hospital involving the medical wards as part of the in situ training. The training utilized bleeps, simulated patient notes, simulated handover, mannikins for part-task procedures and actors. The students were briefed on how to respond to bleeps and the expectations of the training. Debriefs were carried out following the training facilitating reflections and relevant teaching on the various encountered activities. Students who took part in the training completed a pre- and post- course survey with a Likert-scale questionnaire to evaluate their confidence in the skills required of being on-call.

Implementation outline:

A total of 17 students completed the on-call bleep simulation. Only a third of the candidates had used a bleep prior to the session. Pre-course, 66.6% of candidates responded feeling not confident about being on-call as an FY1. Encouragingly, following the simulation, 100% felt more confident about being on-call. During the open feedback sessions, students valued the use of hospital wards, practicing procedures under time pressure, and performing handovers. This on-call bleep simulation was very well received and improved students’ confidence and preparedness for being on-call as an FY1 from August 2021. Students commented on how invaluable this training was. This on-call bleep simulation will continue to be implemented as part of the final-year teaching provided at the trust. ]]>
<![CDATA[155 Piloting a Tabletop Simulation to Prepare Nurses for Ward Coordination]]> https://www.ijohs.com/article/doi/10.54531/TOQK1602 Background: We know staff attrition is a core challenge for the NHS with many nurses leaving the profession in the first 2 years post-qualification [1]. Health Education England has recently published themes from a national student survey showing that feeling overwhelmed, concerns about mental health and doubting clinical ability are key reasons for students to consider leaving. This echoes findings from local conversations with newly qualified staff, which highlight workload management skills, particularly leading teams in clinical areas (‘coordinating’), as a key source of anxiety. Simulation is used in emergency planning and military settings to prepare staff for managing teams but has rarely been used in healthcare. Yet the national framework for simulation-based education [2] supports simulation for workforce design and processes. Working from this insight we piloted a tabletop exercise to introduce and build coordination skills for nursing staff.

Aims:

The aim of the study was to improve retention and resilience of the nursing workforce by increasing confidence in their ability at clinical coordination.

Method/design:

This table-top simulation pilot used a convenience sample of six staff nurses new to the role of clinical coordinator. We drew on clinical governance findings and input from experienced nurse-coordinators to simulate coordinating a shift on a surgical emergency unit. The shift was run in compressed time over 32 minutes followed by a 1.5 hour debrief. During the shift we used ‘injects’ intentionally designed to stimulate learning in: Problem solving Decision-making Clinical processes Supporting colleagues/workforce resilience Situational awareness The pilot was evaluated through peer observation and focus group. Peer observation provided an objective analysis of session content. A neutral party facilitated the focus group, which gathered data on how the training session had been received by participants and evaluated whether learning outcomes were met by content.

Implementation outline:

Participants were assigned to work in pairs. Briefing was provided for session content and timeline. We used a simulated handover of patients for verisimilitude. The 12-hour shift was compressed into 4-minute segments with a ‘countdown’ timer ticking off each segment as the simulated shift progressed. This added time pressure and demonstrated how decision-making skills can be influenced by external forces. The participants had access to the hospital intranet and documented their actions/decisions on a template. Facilitated discussion took place after the tabletop simulation followed by a lunch break and then the focus group. ]]>
<![CDATA[25 Unmuting Regional Paediatric Simulation Training Throughout the COVID-19 Pandemic]]> https://www.ijohs.com/article/doi/10.54531/GFTQ7250 Background: The National Health Service endured significant strains during the COVID-19 pandemic to the point where all face-to-face training had to be paused. Our team delivers simulation-based training face to face and offers support for those returning to work, stepping up to senior roles and addressing important aspects of general paediatric care such as acute mental health crises and end of life care.

Aims:

The aim of the study was to deliver our courses virtually without compromising the quality of content.

Method/design:

Initially, we reviewed all scenarios to appraise whether they could be delivered online. Scenarios that involved acute clinical decisions were recorded with the faculty acting as the candidates. This also allowed scripting to ensure that key discussion points could be raised within the debrief. Scenarios mainly involving communication skills with standardized patient role player were retained, and briefs were adapted so that the candidates were aware that the scenarios began when the actor appeared on screen.

Implementation outline:

Participants were recruited using newsletters and subsequently directed to a website to collate email addresses where invites to the virtual meeting space and pre-course material were sent. The scenarios were combined with contracting rules and links to interactive polls to form a presentation that could be shared on the screen throughout the day. Links to post-course feedback surveys were also included to evaluate participant satisfaction of the course design. From October 2020 to May 2021, we delivered eight virtual teaching sessions to a total of 67 multi-professional candidates ranging from nursing staff, police officers and doctors. Candidates were asked whether the course addressed their learning objectives or whether the course had increased their knowledge and 53 (79%) candidates ‘strongly agreed’ with these statements. Including those who ‘agreed’ with these statements, 66 out of 67 (98%) of the candidates perceived this course addressed their learning outcomes or improved their knowledge. The results from the evaluation of these courses indicate that the adaptation of our face-to-face courses have not impaired the quality of the content and have been beneficial to the targeted audience. Despite the challenges that online teaching can pose, we have overcome these by ensuring that we contract behaviour to ensure psychological safety, included interactive aspects such as live word clouds and polls and used a modality of learning such as the use of role players and modified scenarios to guide debriefs and learning. ]]>
<![CDATA[118 Simulation for Novice Anaesthetists: Addressing Training Gaps Created by a Global Pandemic]]> https://www.ijohs.com/article/doi/10.54531/MVNW1487 Background:It is well documented that the COVID-19 pandemic is having a huge impact on doctors in training. Much of novice anaesthetists’ training is delivered during high turnover, elective theatre lists of low-risk patients [1]. List cancellations and staff redeployment have significantly reduced these opportunities [2]. In our department, amendments to standard operating procedures within theatres have created further training barriers. Supervisors find it challenging to offer anything more removed than direct supervision due to difficulties accessing the clinical environment in emergencies. These constraints drove us to find alternative methods of providing this practical experience.

Aim:

The aim of the study was to create a trust-wide high-fidelity simulation course for novice anaesthetists, focussing on confidence building and preparation for on-calls, together with clinical and non-technical management of specific anaesthetic complications.

Methods/design:

A pre-course questionnaire aided a learning needs analysis and informed the learning objectives. Poor confidence due to lack of training was a common theme. Issues identified included limited case numbers, exposure to common emergencies and difficulty progressing to more distant supervision. Using a standardized scenario authoring platform (IRIS) we collaborated with a multi-professional faculty group to design a 1-day simulation course. To ensure an authentic learner experience, scenarios were designed for delivery in a high-fidelity simulation suite using Laerdal SimMan3G with LEAP software. Familiar clinical equipment, such as a Datex Ohmeda anaesthetic machine, was used and access to typical cognitive aids provided to mirror a real theatre environment.

Implementation outline:

Initially, participants prepared for an anaesthetic induction following standard operating procedures, including performing the World Health Organisation Surgical Safety Checklist. They then carried out this uncomplicated induction with the assistance of a trained Operating Department Practitioner. This aided in embedding good clinical practice and promoted patient safety. A second scenario followed, during which an emergency unfolded. The group observed each scenario through a video link and contributed to a consultant-led debrief. To assess course impact participants completed post-course questionnaires. Confidence universally improved after the course. Every attendee found the course useful and was highly likely to recommend it to a colleague. For several participants, this provided their first experience carrying out an emergency anaesthetic induction without direct supervision. In this setting, simulation has been used as a valuable tool to supplement clinical exposure where there were significant barriers to traditional training methods. We intend to further develop this course to become an integral part of novice anaesthetic training within our trust. ]]>
<![CDATA[45 Simulation XR: An Extended Reality Learning Experience]]> https://www.ijohs.com/article/doi/10.54531/BQWV4810 Background:Simulation has always been employed to cover a wide-ranging aspect of the learning objectives in the Emergency Department (ED) curriculum at post-graduate and undergraduate level [1]. In a busy environment like our Emergency Department where bedside teaching is not always possible, the learning objectives can be met through the Simulation Extended Reality (XR). XR is particularly useful during the COVID-19 pandemic when real patients, standardized patients and relatives could not be reached due to the risk of contracting a deadly disease. However, Inter-professional education [2] must continue. We can now have our nurses, trainees, health support workers in a large room all connected to one device in a virtual world and be able to deliver teaching to them.

Aim:

The aim of the study was to introduce new healthcare students to the clinical environment through the use of mixed reality devices to ensure familiarity before contact with the real environment and to provide alternative simulation education and ‘bedside’ teaching during disruptive periods like the COVID-19 pandemic.

Method/design:

XR is a term that covers augmented reality (AR)/mixed reality (MR), which refers to a set of mobile digital technologies that allow a three-dimensional computer-generated model in the form of a hologram to be overlaid on a real environment [1]. This technology can be used to ‘create’ simulated patients for the purpose of learning in an immersive learning environment (ILE). Our learners can have the opportunity to interact with the Holo-patient in proximity thereby bypassing the restrictions of the real clinical environment with all the risk involved, particularly during the COVID-19 outbreak.

Implementation outline:

With the use of a headset such as Google Glasses or the Microsoft HoloLens that projects a hologram into the users’ physical environment, our learners can interact with the mixed reality (XR) world and have clinical encounters with simulated/standard Holo-patients (SHP). With the headset on, the learner can see the patient, hear real sounds from the patient and see objective data/vital signs that can aid clinical reasoning and make the simulated scenario more immersive. A new healthcare worker (student nurse, clinical support worker, doctor on first rotation) will have an immersive experience that bridges virtual and real-world, supplements reality, and has the potential to build confidence and aid learning prior to encountering the real world. ]]>
<![CDATA[60 Talking Under Cover: A Virtual Workshop to Improve Communication in PPE]]> https://www.ijohs.com/article/doi/10.54531/WCZD9238 Background:Since 15 June 2020, all hospital staff were mandated by the government to wear a facemask in hospital and it looks like they will remain a permanent feature in healthcare for the foreseeable future. There is a significant body of research about the plethora of adverse effects that wearing masks can have on verbal communication [1] and we have evidence that effective communication is a common root cause of clinical error that affects patient safety [2]. However, despite the mounting evidence about the detrimental effects, there is little out there in the way of solutions to these problems.

Aim:

The aim of the study was to develop an interactive virtual workshop aims to improve the verbal communication of healthcare staff whilst wearing Personal Protective Equipment (PPE).

Method/design:

We delivered 14 workshops from March 2021 to May 2021 to 80 participants. First, we discussed the barriers that healthcare workers are up against when they are working in Personal Protective Equipment (PPE) and then speak about vocal anatomy and how speech is created. The workshop then focusses on how to make speech clearer whilst also advising healthcare staff on how to look after their voice. To ensure the workshop is interactive, there are a number of exercises that the participants perform and videos of COVID cardiac arrest simulations are used to discuss the potential speech and communication errors in PPE which could affect patient safety in an emergency. Finally, we also incorporated a patient’s perspective in designing this course. They offered very helpful suggestions regarding verbal and non-verbal communication when communicating with patients in PPE, which are often overlooked by healthcare professionals but immensely valuable to improve patients’ and staff experience.

Implementation outline:

We invited hospital departments to book on to the virtual training and collected electronic feedback from participants. As a result of this feedback, we hope to be able to provide face-to-face training in the future and incorporate simulation in the workshops so that participants can practice what they have learnt with higher fidelity and we are better able to understand how the added burden of cognitive bandwidth will influence people’s communication. ]]>
<![CDATA[48 Use of Simulation to Introduce Delivery Room Cuddles as Standard Practice in a Neonatal Intensive Care Unit]]> https://www.ijohs.com/article/doi/10.54531/NRWC9112 Background:Kangaroo Mother Care (KMC) was introduced in the 1970s to keep premature babies warm after birth. There has been growing evidence of multiple benefits including physiological autoregulation, reduced stress, positive attachment, enhanced neurocognitive development, breastfeeding and psychological well-being. Delivery Room Cuddles (DRC) was introduced 15 years ago in Norfolk and Norwich University Hospitals as an extension of KMC. Other units have since reported the successful introduction of the process [1]. Anecdotally in our Neonatal Intensive Care Unit (NICU) parents were not routinely offered skin-to-skin contact with their infant early in their neonatal journey.

Aim:

The aim of the study was to safely introduce DRC as standard practice in our NICU.

Method/design:

We obtained feedback on parental and staff experience with DRC. A Failure Mode and Effects Analysis (Figure 1) was then carried out to break down the DRC process into steps, highlight potential risks and mitigation strategies. Information was synthesized into a standard operating procedure (SOP) and checklist. The use of a transport incubator to mobilize premature infants was not common practice in our NICU at the start of the project; therefore, a parallel SOP was developed for this. Staff training was then carried out using a video simulation and workshops. DRC was formally introduced in April 2021 (Figure 1).
FMEA
Figure 1:
FMEA

Implementation outline:

Before implementation, 54 medical and nursing staff completed the survey, rating statements on confidence from 1 ‘strongly disagree’ to 5 ‘strongly agree’. Confidence was higher in non-intubated infants 32–34 weeks’ gestation (33/54 rated 5) and lowest in intubated infants <27 weeks’ gestation (10/54 rated 5). Staff reported anxieties around equipment failure, delaying care and adverse events. Thirty-nine parents completed the questionnaire. Thirty-four babies were born locally. Only five babies had DRC, of which four had no respiratory support. Time to first skin-to-skin contact ranged from 2 hours to 17 days (mean of 5 days). DRC is becoming routine practice in our NICU with no adverse events to date. Anecdotally staff and parents report great satisfaction with DRC, although formal outcome assessment is outstanding. Introducing DRC is feasible with adequate process planning and staff training using video simulation and workshops. DRC is cherished by families, rewarding for staff and sets infants up for a positive start in the neonatal journey. With examples of successful DRC practice and emerging safety outcome data, DRC is likely to become routine practice. Using this model of process design and training, other units will also be able to safely introduce DRC. ]]>
<![CDATA[95 Striving to Thrive: Developing an Innovative Region-Wide Medical Registrar Preparation Simulation-Based Course]]> https://www.ijohs.com/article/doi/10.54531/XBOS2145 Background: The COVID-19 pandemic has led to disruption and missed educational opportunities for Internal Medicine (IM) Year 2 trainees who shall progress to the second stage of their training in August 2021, stepping up to the medical registrar role. It had become apparent that some of these trainees may not be currently performing at the level expected for this stage of their training and may encounter some difficulties during this transition period.

Aims:

We were tasked by Health Education England (West Midlands) to design and implement an innovative region-wide medical registrar preparation course, utilizing simulation-based education. The courses required standardized content that could be delivered by either face-to-face or virtual modalities across multiple centres in the region.

Method/design:

Two separate high-fidelity simulation courses were designed to deliver key aspects of the IM training curriculum with a clear focus on the behaviours, attitudes and skills required to perform as a junior medical registrar: ‘Thrive’. A 1-day course designed for trainees who are expected to be able to progress to IM year 3 without any concern. These courses were planned to be run by other regional centres to their local trainees using either a face-to-face or virtual format. ‘Strive’. A 2-day course designed for those trainees who have been identified as needing extra support to be able to progress to IM year 3. These courses were planned to be run via a face-to-face format at our SimWard to trainees from across the region. Course content included a mix of high-fidelity simulation scenarios as well as workshops focussing on key areas for medical registrar preparation as identified by IM trainees: Leading cardiac arrests Debriefing Breaking bad news Prioritization and delegation Giving advice Escalating care

Implementation outline:

All content was designed and produced in house to then be provided electronically to region-wide centres facilitating standardized delivery, including pre-recorded simulation scenarios to allow virtual delivery. A webinar was held to aid roll out and provide training on course delivery and content to participating centres. Courses were delivered during the spring and summer of 2021. Initial feedback has shown an increase in perceived trainee confidence in dealing with all topic areas at the registrar level and has illustrated that learning has already been utilized in clinical practice. Courses are ongoing until the end of July 2021, after which a full analysis of region-wide impact can be made. ]]>
<![CDATA[168 A Novel Approach to Interactive, Online History-Taking in Medical Education During the COVID-19 Pandemic]]> https://www.ijohs.com/article/doi/10.54531/WNXE8869 Background:The COVID-19 pandemic resulted in an unprecedented shift from face-to-face to online teaching with a subsequent deleterious impact on the quality of teaching delivery within medical education [1]. Human interactions such as history-taking are challenging to recreate without the nuances of face-to-face teaching. We present the first instance of a gamified online interactive history-taking simulation, in this case specifically designed for secondary school students interested in a career in medicine. Effective history-taking is a fundamental determinant of patient care and by developing this simulation we are focussing on the proximal determinants of patient care. We believe that this unique approach is translatable to undergraduate and post-graduate medical education, resulting in wider and longer-lasting beneficial impacts on both education and clinical care.

Aim:

Our aim was to demonstrate the feasibility of utilizing a novel approach to interactive, online simulated history-taking.

Method/design:

The session was designed for students attending a virtual work-experience programme and is founded upon gamification principles. History-taking is a humanistic social process requiring effective communication skills and recognition of verbal and non-verbal cues. The session enabled students to directly instruct a passive clinician to take a history from a simulated patient actor, incorporating both verbal and non-verbal actions. This novel teaching method is analogous to Freire’s work, highlighting the importance of the learner being an active participant, thus enabling experiential learning [2].

Implementation:

This interactive approach required a simulated patient actor, a passive clinician and a verbal instructor to be present. Students were presented with a case scenario and viewed the interaction between the simulated patient actor and passive clinician online via a video conferencing service (in this case, Zoom). Students provided instructions to the passive clinician using the typed chat function. These typed instructions were relayed by the verbal instructor to the passive clinician via an earpiece and the passive clinician would then embody these instructions. This allowed students to work as a group to directly elicit a history and witness their instructions being actioned. Examples of instructions included questions to verbalize, adjustments to body language and alteration of the tone of voice. Following good student instruction, the passive clinician gradually grew in competence and confidence throughout the scenario, thus allowing real-time, interactive feedback of their history-taking approach. The session concluded with a reflection of the communication traits that helped to gain an effective history from the patient using a debrief model. ]]>
<![CDATA[61 Exercise Martian Attack!: Using VR Feedback as a Reflective Tool for Paramedic Science Students]]> https://www.ijohs.com/article/doi/10.54531/KJAL3798 Background:Paramedic students have had to overcome the restrictions COVID-19 with many of their clinical skills moving online, limiting opportunities to engage with clinical practice partners, a key requirement of their professional programme. Social distancing has been challenging to overcome and the paramedic teaching team’s solution was to offer the University underground carpark to stage a simulated Casualty Clearing Point for a Major Incident Martian Attack!

Aim:

The aim of the session was to reconceptualize our simulation practice at the university level and to Engage our students with an authentic, reflective, and clinical skills-based assessment experience To draw upon lessons learned to improve our processes and guidelines for stakeholders involve in clinical skills assessments To enhance the student learning with early familiarization and ‘hands on’ practice with the equipment utilized in the field of paramedic science

Design:

The paramedic teaching team created ‘Martian Attack!’ a short video to set the scene for the tasks the first-year students teams need to accomplish. The students were divided into pairs where they were tasked to triage at ‘stations’ treating mannequins with simulated injuries under time constraints. This was followed by demonstrating immobilization techniques and extracting a weighted mannequin from an enclosed space using a Saviour Technical Stretcher (STS). All these skills require a combined improvised approach towards casualty evacuation. Students were observed by critical care professionals and offered feedback. ‘There is only so much simulation that can be done in a room so I thought it was great to be able to get out and experience a “Real Life” event where we could put the skills and knowledge from the previous weeks into practice in a supported environment’. Student J.

Implementation outline:

Three-hundred-and-sixty-degree film clips captured these simulated scenarios and debriefs and were added on a virtual platform hosted by Panopto so that students could reflect on the scenarios in their own time to aid their learning and reflection. The film clips made accessible by a range of technologies, from google cardboards to OCULUS Quest, added the high-fidelity aspect of realism to the student’s learning experience. The next steps will be to consult with our practice partners to streamline and identify further areas of practice that will enhance the skill mix of students on placement. ]]>
<![CDATA[66 An Evaluation of ‘Remote Consultations’: A Simulation-Based Education Intervention]]> https://www.ijohs.com/article/doi/10.54531/ILZF1394 Background:The COVID-19 pandemic necessitated an increase in virtual consultations with a disruption to the management of long-term conditions. Ongoing virtual consultations are required to assist with demand, patient experience and environmental impact. In both primary and secondary care, there has been no formal education provided to the workforce on how to conduct virtual consultations. Anecdotally this is affecting staff experience and well-being, patient experience and, could impact on the effectiveness of the consultation in aiding self-management. There is also an inherent risk of missed or incorrect diagnosis in virtual consultations, which could be mitigated with adequate training of the workforce.

Aim:

The training aimed to promote the development of clinical practitioners in a safe environment and to expose these participants to the key aspects of remote consultations. Additionally, the course aimed to encourage independent reflection of participant knowledge, skills, behaviour, attitudes and service quality provision in relation to simulated remote consultation scenarios.

Simulation activity outline:

We provided a combination of didactic and simulation-based education (SBE) on virtual consultations. We provided educational recordings of virtual model consultations for reference. Trainees were provided with the videos to complete a self-paced didactic educational session. Subsequently, a group session was held virtually in groups of six involving simulated clinical scenarios with a faculty-led debrief. Avatars were used to simulate patients and patient medical records were simulated in the ‘chat’ function. These simulation sessions allowed the transfer of knowledge into practice whilst using SBE methods to debrief on human factors skills, specifically focussing on human factors in a virtual world.

Method/design:

The purposely developed ‘Remote Consultation Self-Assessment Tool’ was completed immediately prior to and after the training. This tool provided Likert responses to 10 statements relating to the course content and consequent quantitative analysis was based on the percentage change in participant self-assessment. The General Self Efficacy Scale (GSE) was also used to gather information from participants prior to and after the training. The GSE measures participant self-efficacy via a 5-point Likert scale.

Implementation outline:

A total of 29 participants attended the course. There was a high failure to attend rate of 40%, with covering the COVID-19 vaccine clinics a commonly stated reason for failure to attend. Primary care workers made up 60% (n = 18) of participants, 26% (n = 9) worked in secondary care and 6% (n = 2) worked in other settings. Most participants (85%) were naive to SBE. There was a significant improvement in both the remote consultation self-assessment tool (mean difference 12.08 [95% CI 5.31 to 18.83] p = 0.001) and the GSE (mean difference 3.54 [95% CI 1.81 to 5.27] p < 0.0001). This model of delivering SBE has improved access for staff working in primary care and other areas who have not been able to access SBE previously. The use of avatars is a feasible method of delivering SBE. Consideration to improving attendance rates at courses should be a priority for those delivering SBE. ]]>
<![CDATA[49 The Effective Management of Resources in a Busy Sim Centre]]> https://www.ijohs.com/article/doi/10.54531/TJLC8913 Background:The efficient working of a busy, multi-faceted Healthcare Simulation Centre that caters to many different stakeholders requires a repertoire of protocols and procedures. Standard Operating Procedures (SOPs) ensure all resources are managed as effectively as they can be so that teaching can be continuously delivered at the optimum level.

Aim:

The aim of this wide-ranging project was to devise a collection of SOPs and accompanying files that regulate the efficient management of resources in a Sim Centre.

Method/design:

A template for SOPs was created, with entries for background, purpose, scope, procedures etc. ensuring each SOP would meet a universal standard for the department. They also must be approved by the Simulation Manager and reviewed annually. Accompanying documents, spreadsheets and online forms to facilitate that the processes outlined in the SOPs would also have to be created.

Implementation outline:

The SOPs include maintenance and servicing of equipment, loaning of equipment, booking of equipment for teaching and self-directed practise, inventory, management of Simulation spaces and storage areas, stock-taking and ordering of consumables. A suite of instructional documents, data management spreadsheets and online forms have been prepared and are updated regularly in accordance with the procedures outlined in the SOPs. Much of what simulation staff do is learned on the job and losing that institutional knowledge can be devastating for a program. To combat this the SOPs capture the essential steps to efficiently run our centre. The SOPs are useful tools to communicate the correct way of carrying out an activity and are used to orientate and train new technical staff in our centre. Importantly, the SOPs are an integral part of our quality enhancement process, updated regularly, and used to communicate innovations and improvements amongst the wider centre user community. These SOPs and associated resources will be made available to the simulation community upon request. ]]>
<![CDATA[94 Phygital Simulation for a Large Group of Learners in a Regional Teaching]]> https://www.ijohs.com/article/doi/10.54531/QUEU5150 Background:Over the years, knowledge-based simulation has been a valuable way of delivering certain content of the syllabus in medical education. There have been challenges to undertake any form of educational activities during the COVID-19 pandemic due to a global shutdown [1], let alone face-to-face teaching. Digital education has endeavoured to fill this gap via the increased use of different online platforms to prevent the spread of COVID-19. Nonetheless, one facet of educational strategy that has remained challenging to provide online is teaching and learning with simulation. Currently, a phygital [2] method of teaching is being utilized; some learners are with the instructor in the classroom (physical presence) and others are online (digital presence.) The inclusiveness and participation from the online audience have been seen to be poor.

Aim:

The aims of the study were to deliver an inclusive and effective simulation session to a large cohort of trainees in emergency medicine and to provide an immersive learning environment to learners by enhancing their feeling of being present in the simulation hub.

Method/design:

We delivered a phygital simulation with the aid of digital technology in a way that encouraged participation from all attendees. We sought to overcome known challenges of simulation teaching during the peak period of COVID-19 and identified newer challenges unique to the situation and suggestions for future improvements or simulation.

Implementation outline:

During the simulation, we utilized a standardized patient (SP) (who did not require further training for our method) and various equipment/components of the room including cameras for the different views required. The room had a limit of five persons (as per COVID-19 restrictions) so we designed a teaching method that enabled us to cater efficiently for the remaining 33 participants of the scheduled regional teaching session. A volunteer candidate was chosen from the online audience to lead in the simulation. Prior to selection, all candidates were shown the brief which explained the expectation of leading and the different camera views available to aid their performance. They viewed the whole room with separate focuses on the SP, the device required to perform a procedure, and their appointed physical presence (PP) who they will instruct to perform the procedure. We identified advantages, challenges and areas of future development and believe that this type of teaching can be applied to a wide range of simulations that required demonstration. ]]>
<![CDATA[170 Demonstrating Innovation Through the Skills Hub Initiative]]> https://www.ijohs.com/article/doi/10.54531/JBQQ6667 Background: In April 2020, Birmingham City University played a key role in the local response to the coronavirus pandemic by providing essential skills training to student nurses, existing National Health Service (NHS) staff who were returning to practice and staff being redeployed to critical care areas. The University’s action saw the rapid development, and delivery of a logistical plan involving staff mobilization, collaboration, skills mapping and prioritization of clinical service needs. Over 2,000 clinicians, including our own students, received a far-reaching training programme covering eight key skills needed to take on frontline NHS roles in the fight against COVID-19. The programme was innovative, sustainable and all risks to patients were eliminated, as the learning took place within the University’s state-of-the-art simulation facilities.

Aims:

Our aim was to design and deliver a rapid skills development centre that could train a core mass of staff facing redeployment to the standard required to work, competently and confidently, within the teams on the frontline NHS.

Method:

The rapid development was a huge challenge, involving identifying an essential cohort of staff from the Faculty of Health who were willing and able to deliver such a wide range of clinical skills. Each skill was risk assessed and a COVID-19 lead was identified within the team. We ensured all essential personal protective equipment (PPE) was available and that social distancing could be assured, including reducing the number of students in a room at any one time. This was particularly challenging as it increased the teaching time required exponentially.

Implementation outline:

This was a difficult time globally, and the University’s action led to the demonstration of outstanding courage and commitment to care towards the community we serve. While the public was being urged to stay at home, our staff were constructing a Skills Hub to deliver in-person with personal risk. The Estates and Facilities team worked to create a one-way system throughout the complex building. The University worked closely with the skills teams in local NHS Trusts, especially University Hospitals Birmingham, to ensure the skills taught were in line with Trust requirements, and that the training would have the biggest impact in supporting patient care. The Skills Hub team worked tirelessly and in collaboration to ensure the efficacy of development and the safe delivery of the programme. The Skills Hub continues to operate as a huge success, proving sustainability, whilst continuing to provide an integral part of curriculum achievement for all healthcare students. ]]>
<![CDATA[127 Caution and Context: COVID-19 as the Educational Focus for Inter-Professional Learning]]> https://www.ijohs.com/article/doi/10.54531/EHBK4388 Background:Traditionally our university-affiliated Office of IPE delivers a 3-phase (exposure, immersion, competence) inter-professional education (IPE) curriculum which is a graduation requirement for students. On 13 March 2020, on-site classes were suspended due to the first confirmed case of COVID-19 in the state. Faculty rapidly implemented alternative methods of instruction to complete coursework for the spring semester utilizing COVID-19 as the educational focus and hosting these learning events on the virtual platform.

Aim:

The aim of the study was to lean into the educational opportunities provided by the global pandemic to continue to provide high-quality IP education including simulation, crafting these educational events to meet the pandemic needs of our community.

Method/design:

During the COVID-19 pandemic, healthcare students and faculty stepped forward with a desire to serve during this health crisis. Several public health support programmes were provided by the academic health centre and IP educational activities were crafted around these. Such programmes included: a 1–800 COVID-19 hotline providing rapid access to health screening to assist the community in understanding when and where they should access the healthcare system for testing or care; a Contact Tracing Call Center to identify those with exposure and risk and counsel next steps; and provision of public health information regarding the virus and the vaccine. IP Faculty developed a series of IP simulations to provide students with the knowledge and skills necessary to serve in these public health support areas. These simulations were all structured utilizing an initial brief (detailing Interprofessional Education Collaborative (IPEC) domains and Patient- and Family-Centered Care principles), followed by scenario-specific education such as IP team review of screening algorithm and decision tree for hotline and call centre work, with subsequent standardized patient (SP) interaction, and finally IP debriefing. Five simulations involving 190 students occurred. Evaluation metrics collected included pre-/post-Interprofessional Collaborative Competencies Attainment Survey (ICCAS), evaluation of learning objectives, SP interaction and simulation methodology via Likert scale, and identification of themes from qualitative response items.

Implementation outline:

Inter-professional simulation training activity via an online platform supported student learning for COVID-19 disease information, screening algorithm and decision tree tools and telemedicine delivery. The rapidly implemented virtual training prepares students to graduate whilst also supporting the state during this public health crisis. This work provides a template by which curricula can pivot to meet the needs of all key stakeholders during a time of global crisis. ]]>
<![CDATA[158 The Introduction of Virtual Simulation into a Pre-Registration Nursing Course During the COVID-19 Pandemic]]> https://www.ijohs.com/article/doi/10.54531/BTYS4786 Background:The COVID-19 Pandemic changed the way teaching and learning could be delivered at Sheffield Hallam University; the use of virtual simulation was explored to enhance the student experience and prepare students for placement.

Aim:

The aim of the study was to evaluate the application of virtual simulation for pre-registration nursing students.

Method/design:

Oxford Medical Simulation (OMS) is an immersive, interactive, virtual healthcare simulation platform that allows participants to engage in a wide range of clinical scenarios. The environment, patient and other team members are fully interactive, with conversation and physiology adapting to students’ actions and treatment. The educational focus is on decision-making, clinical reasoning and critical thinking to improve patient care.

Implementation outline:

A programme was developed to allow students to take part in lecturer-led sessions where OMS was used to practise the assessment and management of an unwell patient. Virtual scenarios lasting 15–20 minutes were managed by the lecturer, with students offering their contributions to determine the steps they wanted to take to manage the patient. Screen sharing of the virtual simulation via Zoom allowed students to take part in the scenarios from home. Learning outcomes predominantly focussed on A to E assessment, encouraging students who had never encountered a ‘real’ patient before in a clinical setting to begin to develop a structured approach. Evaluation of introduction of OMS to Nursing Course. This evaluation describes the benefits realized between the launch of OMS in November 2020 and 1 January 2021. The data presented include qualitative and quantitative data collated and analysed from student online survey responses. Data from 188 purposively sampled student participants were collated and analysed. The qualitative data demonstrated improvements in the student experience, under the following themes: (a) preparing students for placement, helping to apply knowledge to practice and improve decision-making; (b) developing confidence, providing a safe learning space – able to make mistakes without patients coming to harm. Students were also asked to rate their level of satisfaction on a 5-point scale (where 5 was most satisfied). The median rating for the 55.9% (n = 105) student responses was 5.0 with no statistical difference between identifiable fields of nursing (X2 (2)=1.882; p = 0.390). As Ingrassia et al. [1] point out, ‘there is great uncertainty about how COVID-19 will impact future training in simulation facilities’ (p = 0.2), and moving forward, in the altered climate in which we find ourselves, OMS might be considered an important complement to the future teaching and learning experience. ]]>
<![CDATA[18 SP Training for Transgender Healthcare Stations: What SPS and Program Directors Need to Know]]> https://www.ijohs.com/article/doi/10.54531/KIAH2695 Background:Recent interest in the United States addressing Lesbian, Gay, Bisexual, Transgender (LGBT) healthcare issues, particularly obstacles faced by transgender individuals, has resulted in newly developed programming addressing these concerns. Training students and faculty on nuances of LGBT patients, with a specific focus on transgender patients, is critical if outcomes for this population are to improve. Data show 23% of survey respondents avoided seeing a doctor when needed, fearing mistreatment as a transgender person [1]. This programming also addresses the anxiety of healthcare practitioners when interacting with members of a marginalized community which frequently stems from inadequate training and infrequent direct experience with patients from that community.

Aim:

The aims of the study were to increase empathy and awareness of LGBT healthcare needs and to improve communication and patient/practitioner relationships through experiential learning with live transgender standardized patients.

Method/design:

The programmes developed address fundamentals for healthcare professionals about serving LGBT patients: inclusivity, rapport, effective communication without creating anxiety or offense, language to avoid, and other practical knowledge including various surgeries and gender-affirming care available to transgender individuals. Initial panel discussions with members of the LGBT community have proved very effective in covering realities faced by transgender patients. Implementation of Teaching OSCEs (Objective Structured Clinical Exams) utilizing transgender individuals applies gained knowledge from lectures and discussions. It is critical for learners to experience working with an actual transgender standardized patient to effectively simulate encounters. Only a person from a marginalized community can accurately portray unique experiences affecting that particular community. Advanced medical training has also been developed including training for forensic examiners.

Implementation outline:

These programmes include an LGBT didactic presentation, followed by a moderated panel (conducted virtually or in-person) of transgender individuals from varied backgrounds to share personal experiences receiving healthcare. Trainees are encouraged to ask panellists questions regarding concerns on proper communication, inquire about experiences in receiving gender-affirming care and discuss how to improve healthcare for transgender patients. Subsequently, trainees have the opportunity to participate in scenarios scripted and led by transgender standardized patients (SPs) or Trans Teaching Associates (TTAs). These scenarios can be conducted virtually, focussing on interview/history taking and communication skills, which makes global reach possible. In-person hands-on OSCEs can further assist trainees by providing opportunities to visualize trans anatomy. Learner feedback on improved understanding and empathy has been overwhelmingly positive, proving the necessity of providing training for learners in the care and treatment of transgender patients. ]]>
<![CDATA[46 ‘Born Too Soon’ Virtual Simulation for Ambulance Services On Premature Babies Born Unexpectedly in the Community]]> https://www.ijohs.com/article/doi/10.54531/SBGL9631 Background:Premature infants are at risk of death or neurodevelopmental impairment unless prompt effective care is delivered [1]. When born unexpectedly in the community, this risk increases due to limited resources and expertise. In 2020, West Midlands Ambulance Service (WMAS) attended 3594 unplanned births, yet paramedics do not receive specific training for the management of premature infants. Simple and timely measures can significantly improve the outcome of these infants [2].

Aim:

The aim of the study was to introduce a recurring virtual simulation workshop for WMAS on optimizing the initial care for vulnerable premature infants born unexpectedly in the community.

Method/design:

Our local WMAS lead identified a training need through informal feedback from paramedics about the lack of training and confidence in dealing with premature births. Our workshop, designed to address this need, begins with an overview of prematurity. A simulation session follows, demonstrating basic Neonatal Life Support skills using equipment available to pre-hospital teams, focussing on thermoregulation. It concludes with a question-and-answer session. To enhance pre-hospital thermal care, we also put forward a successful business case for heated gel mattresses to be introduced across the WMAS and incorporated training for its use in the workshop.

Implementation outline:

Two virtual training workshops have been delivered so far. In 2020, seven paramedics attended, and two completed the feedback and found the session valuable. After advertising, a second workshop was delivered in March 2021. Over 330 WMAS personnel registered, 219 attended and 132 gave feedback. There were representatives of various grades from 16 hubs across the region. Before the session, 12.2% of participants reported feeling somewhat confident/confident attending unplanned premature births of infants <32 weeks’ gestation. Following the session, this improved to 66.7% of participants. Attendees commented on how ‘useful’, ‘fabulous’ and ‘fantastic’ they found the session. The sharp rise in interest in this virtual workshop confirms the training need whilst the positive feedback highlights the effectiveness of the virtual simulation workshop. With enhanced technical support, we will improve the learning experience of participants in the future. This project also led to the successful introduction of heated gel mattresses which are now carried on every WMAS ambulance. We expect that with increased staff training and confidence, the incidence of babies admitted with hypothermia following an unexpected birth in the community will improve with time. Our vision is to expand this project to other regions to empower pre-hospital staff to support premature infants born unexpectedly in the community and improve outcomes. ]]>
<![CDATA[161 Absent in Body But Present in Spirit: Battling on When Both Learners and Faculty are Remote from the Simulation Centre]]> https://www.ijohs.com/article/doi/10.54531/LBGD6694 Background:Over the last year, COVID-19 has constrained the capacity of education centres to deliver face-to-face simulation-based education (SBE). Restrictions on travel between NHS trusts necessitated development of remote simulation to allow learners to participate in training safely. The challenge to maintain training provision was increased due to the imposition of shielding requirements on a member of the education faculty requiring them to isolate at home over a 2-month period (February–April 2021).

Aim:

The aim of the study was to allow educators isolating at home to continue to support SBE, despite their physical absence from the training centre, by: Simulating the patient role remotely. Facilitating debrief from home. Observing SBE within the simulation suite and supporting subsequent discussions using video conferencing platforms. Supporting delivery of human factors teaching sessions to Trust staff remotely.

Method/design:

To deliver SBE remotely for learners with remote faculty rested on three key requirements: Collaborative and iterative development of scenarios that could be delivered effectively for learners remotely utilizing expertise from the simulation centres education and technical teams. The creation of scenarios optimized for remote delivery. Effective communication and observation between remote faculty, centre-based staff and remote participants over Microsoft Teams (MST) to allow remote facilitation of debrief Controlling and voicing the patient simulator from isolation at home via a desktop PC linked with simulation centre systems via a virtual private network (VPN) and utilizing the Zoom platform.

Implementation outline:

Faculty member shielding requirements lasted for approximately 8 weeks and during that period they were able to support a range of SBE courses; Foundation years doctors (supported 14 courses) Final-year medical students (supported 6 courses) Surgical nurses (supported 1 course) Burns speciality (supported 1 course) Acute care skills: Nurse OSCE provision (supported 4 courses) Human Factors teaching to trust staff (delivered 5 lectures) Key equipment: PC with dual screens to allow MST and Zoom software to be managed simultaneously to allow response to participant communication and interactions in real time. Headset-Microphone to support effective fidelity within audio exchanges. The facility to contribute to educational provision was mutually advantageous to all members of the educational faculty: Off-loading some of the burden of training from those within the centre. A positive influence on the mental health for the isolated. Making remote simulation work possible was through whole team collaborative working. ]]>
<![CDATA[177 Going Upstream: Key Considerations When Moving a Face-to-Face Simulation Module and Assessment to Virtual Delivery]]> https://www.ijohs.com/article/doi/10.54531/LCIB3983 Background: ‘Preparing for on-call’ is a level 6 physiotherapy module delivered face-to-face to enable synthesis of respiratory knowledge and application to real ‘on-call scenarios’, preparing students for the transition into clinical practice. Due to lockdown, we could not deliver this module face-to-face and changed it to a ‘virtual delivery’ for teaching and assessment.

Aims:

The aim of the study was to deliver a face-to-face SBE module and assessment virtually.

Methods/design:

We used the principles of SBE design [1] pre-brief, virtual simulation and debrief. We involved simulated patients (SPs) (in their own homes, with blurred background, thereby simulating a hospital environment). They were delivered appropriate props: hospital gown, range of oxygen masks, BP cuff and saturation probe. The SPs were trained online in how to portray respiratory deterioration, a nurse facilitator was trained to give appropriate information about the patient and a physiotherapy clinical educator supported the students with their A-E assessment and management of the patient. Although normal ‘hands-on’ could not be achieved, we ensured that the students demonstrated their clinical reasoning using the ‘think aloud’ technique [2].

Implementation:

We achieved a ‘virtual on-call experience’ by involving SPs, confederate nurse facilitators and physiotherapy clinical educators working synchronously with students via Microsoft Teams. With teaching groups of eight, we kept to the principles of SBE by pre-briefing, running a realistic scenario with clear learning outcomes, followed by a debrief facilitated by the nurse and physiotherapy educator. Students were able to rehearse their clinical reasoning by ‘thinking out-loud’; these preparatory ‘virtual on-call scenarios’ enabled them to become familiar with ‘performing’ on Teams. This ‘process-familiarity’ led to a preparedness, professionally and psychologically for their subsequent ‘virtual on-call assessments’. Four on-call scenarios were delivered in this module, enabling the learning outcomes to be achieved via this method of delivery. The virtual on-call assessment was run in three virtual rooms on Teams, with an SP, a clinical educator as an examiner, a confederate nurse, and one student in each room. The assessment scenario ran for 30 minutes replicating the normal examination time, giving students the opportunity to rehearse the skills they had learnt in the module. Additional supportive information was given to the students by sharing a ‘patient monitor’ (screenshots from the ALS Laerdal manikin monitors). In total, 28 assessments were achieved in 1 day, with two taken separately for extenuating circumstances. Student feedback has been positive with all students passing, enabling graduation this summer. ]]>
<![CDATA[96 A Virtual Mock Trial for Inter-Professional Learning]]> https://www.ijohs.com/article/doi/10.54531/LOVW1916 Background:As a healthcare professional, participating in a medical negligence trial is an intimidating and stressful prospect, exacerbated by the fact that many have never been in a courtroom. To meet this learning need, our institution runs a Mock Trial inter-professional learning event (IPE) designed to give law students and medical, nursing, pharmacy, public health and other healthcare professions students exposure to a medical negligence trial and the opportunity to learn about, from and with each other as they collaborate as a jury to reach a verdict. To continue to deliver high-quality inter-professional education during the COVID-19 pandemic, transition to the virtual platform was required. Important lessons learnt from this process can be applied to the effective planning of similar virtual events.

Aim:

The aim of the study was to effectively transition a large-scale in-person inter-professional Mock Trial simulation to the virtual platform to increase the accessibility of simulation education during social distancing and beyond.

Methods/design:

Subject matter experts from the local law school and a university-affiliated Office of Inter-Professional education (IPE) jointly developed content for the Mock Trial. Students enrolled in the virtual Mock Trial were given pre-course jury instructions, IPE objectives and technical connection information 2 weeks before the trial. Law students, the judge and simulated witnesses received script materials 1 month prior to preparing. Facilitators participated in a virtual ‘crash course’ training 1 week before and a 15-minute pre-huddle just prior. Jurors (the students) watched the trial via Zoom and then were put into inter-professional breakouts with a facilitator to deliberate. All returned to the main room and verdicts were delivered followed by a debriefing session. Facilitators also debriefed after the event conclusion. Pre- and post-assessments were completed by students.

Implementation outline:

The in-person Mock Trial event was conducted in 2018 and 2019, but was cancelled in 2020 due to the pandemic. In the 2021 learning event, 11 individuals were in person in the courtroom with the remaining students (143) participating via zoom. These 11 individuals comprised: one judge, four law students (two defense, two prosecution), five witnesses and one administrator. Social distancing/masking rules were obeyed. One witness participated via Zoom. Student and facilitator evaluation data, including assessment of IPEC competencies, were comparable to previous in-person events. This effective translation of a large-scale simulation event to the virtual platform demonstrates the utility and increased access to learners of this modality and will form a useful part of our simulation education toolkit post-pandemic. ]]>
<![CDATA[187 A Virtually Perfect Debrief? The Undergraduate COVID-19 Simulation Challenge]]> https://www.ijohs.com/article/doi/10.54531/LBEN7828 Background:Feedback from undergraduate medical students recognizes high-fidelity immersive simulation-based education (SBE) as an opportunity to put clinical reasoning and behavioural skills into practice whilst guaranteeing patient safety. The tool used in SBE to bridge event experiences with meaningful reflection is the debrief. Debriefing is a facilitated reflection to guide learners through a process of detecting performance issues and exploring rationales for behaviours [1]. A systematic review of high-fidelity simulation literature identified feedback, including debriefing, as the most important feature of SBE [2]. During the COVID-19 pandemic, all simulation training was temporarily halted for undergraduate students. Some students collaborated with the simulation team to create an alternative delivery method, maintaining social distancing and minimizing mixing of different student cohorts, whilst preserving the educational yield created through debriefs.

Aim:

The aim of the study was to create pre-recorded high-fidelity simulation scenarios with the involvement of course participants, final-year medical students. Use the recorded scenarios to observe simulation, create meaningful discussion and explore both clinical and human factors.

Method/design:

Three partially scripted scenarios were recorded involving medical, surgical and COVID-19-specific cases. This included intentionally scripted learning points, as well as unintended developments which generated additional learning. These videos were designed to be shown in a virtual setting or limited number group, therefore allowing for continued simulation training during the height of the pandemic. The virtual simulation session involved a moment-by-moment analysis of each scenario facilitated by a faculty member. This allowed for an observer-led debrief and more in-depth reflection.

Implementation outline:

Most participants gave positive feedback on the perceived quality of this training modality, recognizing its potential to create an engaging environment for learning. There was recognition of its limitations; it cannot replace immersive simulation, however involving service users in the design and implementation enhanced the learning opportunities. The videos created a springboard for discussion encouraging the formation of emergent objectives, including reflecting on behaviours and attitudes. Faculty noted that students were more confident to identify and critique errors as well as challenge poor behaviours when they were not observing a peer. The participants represent a unique cohort of students whose training has been disproportionately affected by the pandemic. We hope that this course has gone some way to address this shortfall. ]]>
<![CDATA[169 Managing The Acutely Unwell Patient: An Interactive and Gamified Approach to Online Simulation During The COVID-19 Pandemic]]> https://www.ijohs.com/article/doi/10.54531/LYWY7128 Background: The COVID-19 pandemic has necessitated a transition from traditional face-to-face teaching to virtual equivalents, sometimes at the expense of teaching quality and student engagement [1]. Knowledge and a practical understanding of the management of an acutely unwell patient are essential for safe and effective clinical practice. This involves problem-solving, situational awareness and the ability to deal with uncertainty. To demonstrate these skills virtually, we developed an online, gamified interactive video simulation exemplifying the management of an acutely unwell patient. The simulation was tailored to prospective medical students in secondary school during a virtual work-experience programme. We propose that this approach is potentially translatable across the healthcare profession at both undergraduate and post-graduate levels, thus allowing for teaching to be more engaging, participant-led, and accessible.

Aims:

Our aim was to demonstrate the feasibility of a novel gamified online simulation approach to teaching the management of acutely unwell patients.

Method/design:

Using elements of gamification and interactive film, this virtual session was designed to teach prospective medical students the ‘A to E’ approach of managing an acutely unwell patient. The management of an acutely unwell patient is an iterative and dynamic process that requires one to manage uncertainty and constantly re-evaluate the clinical situation. The session was designed using interactive film, with students given the ability to influence a clinician’s actions and subsequent changes of clinical scenario dictated by student live-vote. This interactive and engaging approach allowed students to reflect-in-action and be active learners, in line with an experiential pedagogy [2].

Implementation:

Students attended a live session using a video conferencing service (Zoom) and their responses to clinical scenarios were recorded using an online voting tool (Mentimeter). Students were provided with a case history of an unwell patient and presented with an opening video. The session required video options to be pre-recorded to reflect the numerous potential avenues within the scenario as dictated by the students’ chosen actions. Depending on overall student voting consensus, pre-recorded videos of the clinician’s actions and changes to the clinical scenario were subsequently shown. For example, if the appropriate clinical action was selected, students would progress through the A-E approach. Students effectively guided the clinician to manage the unwell patient, with iterative and real-time feedback provided throughout the scenario. The session was concluded with a debrief, explanation of the case and key learning points. ]]>
<![CDATA[87 Maxsim, A Novel Simulation-Based Education Course for Oral and Maxillofacial Surgical Emergencies]]> https://www.ijohs.com/article/doi/10.54531/YPDM2333 Background:For Oral and Maxillofacial Surgery (OMFS) Senior House Officers (SHOs), with no formal medical training, the first exposure to inpatient medical or OMFS emergencies will be the first time they are having to manage them, usually alone.

Aim:

Simulation-based education has been demonstrated to increase experience and confidence when used in medical education; therefore, an OMFS simulation-based education (SBE) course was created to facilitate this learning in a safe environment.

Method/design:

The course included implementation of training on SBAR, A to E Assessment, stations on medical emergencies such as sepsis, and OMFS emergencies centred around scenarios that necessitate rapid response including retrobulbar haemorrhage and carotid artery blowout. Pre- and post-course questionnaires were given to all delegates to assess their change in confidence when managing the scenarios. Each was asked to score their confidence in managing the scenarios numerically from 1 to 10.

Implementation outline:

Delegate numbers were limited due to the COVID-19 pandemic with all 10 completing both questionnaires. There was an even distribution between first- and second-year SHOs. Two had received simulation training before, however very limited. In all 10 simulation stations, every delegate felt an increase in confidence on average by 45% (range: 38–56%, p < 0.05) on the 10-point scale. Positive feedback was received, with all delegates finding the day useful, it achieving what they hoped and stating they would recommend the course to a colleague. Both the SBAR and A to E tools were unknown to all of the SHO’s, highlighting their lack of medical training as they are well-known tools within the medical community. SBE was demonstrated to increase the experience and confidence of SHO’s managing and escalating common OMFS situations. This will increase the quality of patient care of these specific scenarios but the translatable skills will also enable more comprehensive care and handover in all aspects of the delegates roles. Simulation-based education is an invaluable method of training for clinical scenarios and needs to become more common place in Oral and Maxillofacial Surgery. Furthermore, Health Education England has commissioned the course to run on 3 days annually, providing simulation-based education for 40 SHOs in the Southwest Deanery undertaking a rotation within OMFS. ]]>
<![CDATA[166 Sequential Simulation as Replacement for Standard 4-Week Practice-Based Learning (PBL) for First-Year Undergraduate Physiotherapy Students]]> https://www.ijohs.com/article/doi/10.54531/WOSY5813 Background: Practice-based learning (PBL) via clinical placement is a core part of a physiotherapy degree with the Chartered Society of Physiotherapy (CSP) requiring completion of 1000 placement hours. The COVID-19 pandemic resulted in cancellation of placements on top of an already saturated geographical placement provision in certain regions with many Higher Education Institutes (HEI) reporting a backlog of placements. Inability to meet requisite placement hours impacts on student progression, reducing the flow of physiotherapists into the workforce at a time when Allied Heath Professions (AHP) growth has been planned. The CSP and Health and Care Professions Council (HCPC) have both encouraged HEIs to be innovative in placement provision in response. Simulation is widely utilized in healthcare training but remains an emerging concept in terms of placement replacement [1]. Previous examples have demonstrated simulation being used to enhance placement delivery [2] but a dearth of examples exist within the UK for fully simulated placements.

Aims:

The aim was to develop a fully simulated placement that replicated the learning objectives achievable through standard PBL.

Method/design:

Development of a novel placement model to deliver a fully simulated placement as replacement for a standard 4-week clinical placement scheduled for 15 (20% cohort) first-year physiotherapy students.

Implementation outline:

The placement was split across clinical specialities within cardiorespiratory and musculoskeletal physiotherapy. Key objectives were set weekly: week 1, focussing on communication/patient-centred care (scaffolded across subsequent 4 weeks); week 2, focussing on assessment, patient management and clinical reasoning; week 3, consolidation of clinical reasoning; week 4, case presentation. Sequential simulation was utilized to best replicate clinical practice, following simulated patients from pre-admission/injury, through to admission, deterioration, rehabilitation and long-term management. This approach enabled learners to experience a full patient journey, unachievable through standard placement timelines. Simulation using a mixed approach to facilitation and PEARLS debrief, handover tasks, multi-disciplinary team meetings, discharge planning and smaller vignette scenarios to develop specific clinical skills were simulated utilizing actor role players, high-fidelity manikins and peer enhanced e-learning. The placement modelled a CLiP (collaborative learning in practice) delivery, an approach promoted across standard placements by HEE, with students autonomously setting objectives, utilizing across level learning, recording of daily learning logs, reflections and peer assessments. Pre- and post-placement data have been gathered exploring the students’ experiences, expectations, and attitudes towards simulated placement, competence and confidence in both communication and clinical skills using focus group interviews and questionnaires. ]]>
<![CDATA[200 Paramedic Online Simulation: A Novel Approach]]> https://www.ijohs.com/article/doi/10.54531/CQWQ8045 Background:In response to an initial lack of opportunity for frontline ambulance placements during the early stages of the COVID-19 pandemic, a university lecturing team developed a novel, interactive online simulation format for student paramedic education.

Aim:

The technique aimed to provide the students with the opportunity to continue to practice and refine their questioning and clinical decision-making abilities, even without having a physical patient present.

Method/design:

The subsequently developed format was designed to help ensure continuing development of newly acquired clinical assessment principles. Case-based scenarios took the students through key stages of a pre-hospital patient encounter. These were carefully created to resemble the real-life setting as closely as possible.

Implementation outline:

The Blackboard Collaborate teaching platform was utilized in conjunction with pre-designed slides on Microsoft PowerPoint to facilitate the learning activity. Open access images of specific scenes, hazards, people and medication were selected to create visual cues and context for the initial stages of the call, with pre-recorded sounds enhancing this experience. Students were encouraged to use microphones and the chat functionality of Blackboard to interact with their simulated patient, who was played by a lecturer, and responded in real time. Simulated monitors and pre-recorded heart and lung sounds were utilized to provide students with clinical information in a similar timeframe and format to real-life clinical encounters. On the basis of the information gathered, students then devised clinical treatment plans and delivered virtual ‘handovers’ verbally. Debriefing immediately followed the scenario, with self-reflection from participating candidates actively encouraged and supported. Spectating students were then invited to provide their observations on the scenario itself, including facilitation of peer review. All scenario debriefs further contained specific learning points for discussion and exploration, helping to ensure learning was meaningful, with a strong relationship to contemporary issues in paramedic practice. Students reported a high level of satisfaction with this technique, repeatedly describing it anecdotally as both engaging and useful to their clinical development. Facilitator learning has included refinement of techniques and strategies, along with widening participation with other professions. Subsequently, the format has been employed in teaching a range of different healthcare professions, along with being used for online inter-professional learning events between student paramedics, nurses, and midwives, and registered pre-hospital clinicians alike. ]]>
<![CDATA[178 Upstream Immersion: Preparing Allied Health Students with Foundational Placement Skills through a Multi-Disciplinary Simulation Week]]> https://www.ijohs.com/article/doi/10.54531/QAVZ1602 Background:The COVID-19 pandemic has led to an increased demand for clinical placements for Allied Health Professional (AHP) students. Consequently, we have needed to be creative to explore other ways to ensure students complete their 1,000 hours of clinical experience across the programme. A potential option is to use simulation to replace a portion of clinical hours. Evidence confirms that up to 25% of authentic physical practice with standardized simulated patients results in comparable student competency as assessed by an educator and that a 1-week period of simulation is effective in building students’ confidence before continuing with a placement in the clinical setting [1,2].

Aim:

Our aim was to design, develop, implement and evaluate a multi-disciplinary simulation programme to prepare students with foundational placement skills. We sought to therefore reduce the burden on NHS staff. We also sought to determine the effect of the programme on student readiness for placement, student confidence, investigate stakeholder perceptions of the programme and determine the suitability of simulation in contributing to clinical hours.

Method/design:

Simulation-based educational (SBE) pedagogy and principles guided the programme design and included: pre-brief, simulation with regular time outs to enable rehearsal of an activity and debriefing for reflection. We employed actor role players to act as the patient, relative or carer and clinical educators to guide the students as they would on a traditional placement. We developed three generic patient case studies designed specifically to focus on the development of the key programme learning outcomes: developing patient-centred communication skills and professional behaviours. We adopted a mixed-methods approach in our research design, collecting quantitative data from student self-report pre–post questionnaires, clinical educator questionnaires and qualitative data from focus groups to address our research questions and aims.

Implementation outline:

A total of 29 Allied Health Professional students (from physiotherapy, occupational therapy and podiatry) completed a 5-day intensive simulation programme. The programme included an inter-professional ‘fishbowl simulation’ followed by 3 days of profession-specific clinical scenarios with profession-specific learning outcomes ending on the final day in six simulated multi-disciplinary team meetings. The sessions were interactive with simulated patients and their relative/carers giving authentic patient feedback from a patient perspective. We observed rich transformational learning observing students improve their communication skills and becoming more patient-centred in their approach. Preliminary student feedback indicates that they found the simulation programme challenging but extremely rewarding. Formal data analysis is continuing. ]]>
<![CDATA[1 Prison Simulation: Creating Accessible Xr Content for Hybrid Tel Classrooms in He]]> https://www.ijohs.com/article/doi/10.54531/JSXW3687 Background:An Inter-professional Education (IPE) simulated learning prison was created in Microsoft Teams (MS Teams) for health and social care HE students using a #ReStartSim template [1], and advice from individuals with experience of working and being in prison.

Aim:

The aim was to deliver a simulated learning IPE event with additional features accessible across the XR spectrum (extended reality) for technology-enhanced learning (TEL) accessible to students and staff within and external to the university in preparation for the hybrid (and hyflex) HE classrooms of autumn 2021.

Method/design:

This simulation was co-created with colleagues across organizations thanks to the #DigiLearnSector, and based upon developments from a simulated learning event run in 2020 [1]. MS Teams was used as the base of the simulation, with digital resources embedded throughout. A ThingLink (www.thinglink.com) of a prison was donated by colleagues via. the #DigiLearn Sector. The Thinglink (360-degree interactive image of the prison) was edited to include IPE resources and links to MS Teams meetings which were the ‘rooms’ in the prison. These rooms included profession-specific huddles, prisoner assessment rooms and presentation rooms for externals to present. As this was an IPE learning event, we involved students and colleagues from Allied Health Practice (AHP), medical and prison backgrounds to focus on ‘improving patient safety’ through practicing accurate assessment and communication in a safe environment [2]. Meeting rooms were created in MS Teams and then added as active links to the ThingLink for 360 view access into an MS Teams meeting. ‘Staff rooms’ were created as channels for participants to split into smaller groups and connect over the lunch break. This simulation used gamification and presented the initial concept of the day as a game, so the simulation was in effect wrapped around a mini-IPE conference on what students might need to know if they went on placement or to work in a prison for the first time.

Implementation outline:

This simulation used both shared and profession-specific learning outcomes, and ran in September 2021 with second-year students who were used to navigating MS Teams resources. Digital skills were recorded in LinkedIn. ]]>
<![CDATA[123 Tint: Training in Trauma Simulation Programme]]> https://www.ijohs.com/article/doi/10.54531/WJGW8538 Background:Major trauma is one of the leading contributors to death for several age groups globally making it a public health concern. There are approximately 20,000 cases of major trauma per year in England and over 25% of these result in deaths [1]. In an urban trauma unit, since January 2021 there have been 94 major trauma calls with 17 (18.0%) transferred to a major trauma centre. Human factors such as effective communication, leadership, teamwork, situational awareness and understanding of systems are crucial in the assessment and management of trauma patients.

Aim:

This Emergency Medicine (EM) course was designed for Specialty and Associate Specialist Grade (SASG) doctors to develop leadership skills and to demonstrate technical and non-technical skills as a trauma team leader (TTL) when assessing severely injured patients. This course has a strong focus on the understanding of hospital systems and processes for the timely assessment and treatment of complex trauma patients.

Method/design:

After a successful HEE funding bid, a simulation training course was devised to cover the main principles of trauma management and the non-technical skills required to manage a trauma patient and help up-skill the 14 SASG doctors at an urban trauma unit. Five scenarios were designed based on real patients seen in urban trauma units in London. On designing the scenarios, an understanding of the functioning of hospital systems such as requesting and administering blood products and transferring patients both within the hospital and within the trauma network, were crucial learning objectives.

Implementation outline:

This course was delivered weekly from January to June 2021. Sessions involved the EM SASG doctor, two EM nurses and the members of the wider MDT expected at each trauma call, to recreate the resuscitation room environment. Each SASG doctor underwent all five trauma simulation scenarios individually as the TTL. Each scenario was followed by a focussed debrief by two EM consultants, with discussion around human factors, technical and academic aspects of trauma management. All 14 SASG doctors completed the five trauma scenarios. As a result of this training, there has been an improvement in the management of patients with higher injury severity scores in the ED based on both clinical supervision and feedback from the candidates. Given the impact on practice that this training has had, this course will be delivered to the wider trauma teams within the trust, with the EM SASG doctors continuing as TTLs. ]]>
<![CDATA[58 Neonatal Critical Care Communication Training Through Simulation: A Novel Regional Course for Neonatal Trainees]]> https://www.ijohs.com/article/doi/10.54531/LVPE1931 Background: Challenging conversations occur frequently within neonatology [1]. Effective communication enhances outcomes, satisfaction, incidence of complaints, adverse events and conflict resolution [2]. We identified that within our region there was no formal programme of neonatal communication skills training.

Aims:

The aim of the study was to design a communication skill simulation course for neonatal trainees.

Method/design:

We collected feedback from 10 neonatal trainees and 15 consultants regionally. 53% of consultants and no trainees had received formal communication skills training. Lack of confidence was the highest discussing end of life, post-mortem consent, breaking bad news and conflict resolution. Further feedback from 21 parents and 45 staff locally highlighted lack of privacy, sensitivity, clarity, consistency and empathy as areas to develop. We first trialled a virtual simulation workshop on antenatal counselling during the COVID-19 pandemic. A pre-recorded scenario was played and debriefed live. Two candidates then took part in a scenario, in break-out rooms, followed by a smaller group debrief. A face-to-face course was then developed. The day, designed for eight candidates, began with an introduction session focussed on psychological safety followed by ‘trauma-informed communication’ by a clinical psychologist. The candidates were then split into two groups for scenarios. Each had the opportunity to lead a scenario. Faculty utilized role play with a standardized faculty ‘parent’ and block simulation with an actor. The Diamond Model was used for debrief. A workshop on ‘post-mortem consent’ and a talk from a parent about their neonatal journey were also included.

Implementation outline:

Ten trainees attended the virtual workshop. Nine strongly agreed that the pre-recorded and 10 that the live sessions were useful. All strongly agreed/agreed that the virtual learning environment worked well, was safe and comfortable, the debriefs were structured and educational, and that attendees’ confidence in antenatal counselling had improved. Seven candidates attended the face-to-face course. All strongly agreed/agreed that the sessions were relevant to their practice and skills learnt were transferrable. Self-rated confidence improved in all communication themes. All candidates strongly agreed that the learning environment was safe and supportive. Candidates found both methods of simulation valuable, four preferred block simulation. All would recommend the course to their colleagues. We addressed a training gap by developing this course. Despite using different styles of teaching and adapting to virtual training during the COVID-19 pandemic, feedback was consistently positive suggesting that flexibility enhances learning. A similar course could be developed in other regions to continue to strengthen communication skills training. ]]>
<![CDATA[198 A Novel ‘Virtual Simulation’ for The Advanced Life Support Group, Making a Dream a Reality: A Beginner’s Guide]]> https://www.ijohs.com/article/doi/10.54531/FCPL7280 Background:In the UK, it is a requirement for staff involved in paediatric critical care to remain up to date with advanced paediatric life support (APLS). To do so there is an expectation to participate in face-to-face courses on a four-yearly basis. The Advanced Life Support Group (ALSG), an organization dedicated to supporting professional education, sought to add to their resources in line with advances in online capabilities. With stakeholder input, the goal emerged to develop an engaging, interactive and entirely novel educational product. Here we present the pilot stages of our project.

Aim:

The aim of this project was to produce an educationally effective and novel product that learners of APLS would engage with and enjoy.

Method/design:

Stage 1 involved determining clearly defined learning objectives mapped to the APLS curriculum. At a round table with stakeholders, educationalists, and a technologist an outline of the project was formed and the scenario of a sick baby with bronchiolitis chosen for a pilot. Informed by literature on serious game design, a branching narrative was created. Stage 2 involved collating resources. A photoshoot at Leicester Royal Infirmary A&E (Accident and Emergency) created a set of images. A video shoot at the Royal London Hospital A&E generated a series of videos. These were then edited and used to create a Microsoft PowerPoint slide set. Voiceovers to text, sound effects to add a hospital atmosphere and questions were then added. Stage 3 involved taking this draft and translating it into an interactive final product utilizing Articulate Software. This enabled its usage across smartphone, desktop, and laptop devices. Testing followed with anonymous online feedback informed by the 7Is framework [1]. (Domains include; interaction, interface, instruction, ideation, integration, implementation, and improvement.)

Implementation outline:

We launched the pilot version at the RCPCH (Royal College of Paediatrics and Child Health) Conference 2021. Feedback was collected from delegates and continues to be collected via online participants. It is hoped that ongoing quality improvement cycles will assist in assuring a finished fully functional online virtual advanced paediatric life support simulation for release in 2022. Further stakeholder review is pending. Thus far it has been met with universal approval, i.e. all learners questioned expressed that they would like to utilize this novel style of education again. The average duration to complete the virtual simulation was 15 minutes. All learners rated their knowledge and skills in APLS to be either unchanged/revised or improved. Finally, interactivity online was felt to need improvement by most participants. Interactivity is key if high levels of engagement are to be achieved. Future testing will determine whether any educational impact is maintained across time. The current pilot version can be accessed at the following webpage https://2020courses.alsg.org/course/view.php?id=1869. ]]>
<![CDATA[44 A 3-Week Virtual Observational Clinical Placement for Pre-Registration Physiotherapy Students Using Simulation Teaching and Learning Principles]]> https://www.ijohs.com/article/doi/10.54531/VMXE8374 Background:Clinical placement capacity was highly affected by the COVID-19 pandemic. Key issues in January 2021 included: international travel restrictions, high infection rates, reduced clinical educational capacity and the requirement for many individuals to self-isolate for 10 days. A contingency plan was necessary to maintain student progression, enabling them to join the workforce without delay. It was important to ensure that any placement contingency met the required module learning outcomes and standards, centring around non-discriminatory practice and confidentiality, professional and personal behaviours, communication, policies and legislation, health and safety, reflection, evidence of learning, critical incident review and personal development. Given the pressures of lockdown during the pandemic, student experience and well-being was an important consideration.

Aim:

The aim of the study was to investigate whether the learning outcomes of a clinical placement experience can be met through a virtual observational placement model adopting simulation principles.

Method/design:

The virtual placement experience was led and facilitated by academic faculty staff from Oxford Brookes University who were trained in simulation delivery. It was delivered in partnership with clinicians from Oxford Health NHSFT, Healthshare Oxfordshire, Great Western NHSFT, Warwick Physio & Rehab, the Bosworth Clinic, Oxford University and Oxford University Hospitals NHSFT. The placement lasted 3 weeks, with a week in three core areas (Cardiorespiratory, Musculoskeletal and Neurology).

Implementation outline:

Eight pre-registration MSc physiotherapy students attended the placement from the outset, increasing to 15 students over the placement period due to student self-isolation requirements. A variety of simulated and real observational opportunities were provided, including live-streamed in-/outpatient face-to-face patient assessments/treatment appointments, community virtual follow-up appointments, pre-recorded assessments/treatment interventions and community-based virtual rehabilitation classes, and patient record keeping. Clinical reasoning discussions were delivered following each observational opportunity, using an advocacy-inquiry debriefing approach by the academic faculty [1,2]. Student assessment was equivalent to a face-to-face observational placement, including a presentation discussing the skills they had observed and developed (Figure 1). Qualitative and quantitative student and faculty feedback were collected pre- and post-placement. Identified opportunities included: (i) exposure to a variety of observational areas of practice enhances the curriculum; (ii) enhanced learning due to additional time for peer, clinician and academic facilitated debrief; (iii) enhanced student experience particularly for international students or those having to self-isolate. This clinical placement experience was highly rated by students with potential for wider implementation. The use of advocacy-inquiry debriefing and additional support provided by the academic faculty warrants further investigation to maximize student learning opportunities on clinical placement.
Figure 1:
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<![CDATA[2 Play to Prepare with Technology-Enhanced Simulation]]> https://www.ijohs.com/article/doi/10.54531/CBJJ3408 Background:Traditional simulation training within medical education has been well established for several decades and involves playing out emergency situations in a role-play format. This type of simulation training is typically located at hospitals and medical centres and requires considerable organization, costs, in-person attendance and allocated time away from clinical commitments. Technological transformation within healthcare education is growing and, in particular, there has been an increase in mobile applications (apps) to aid medical education. Coupling the two together has allowed ‘gamification’ to emerge and grow in popularity as a powerful tool to enhance learning retention.

Aim:

The aim of this innovation project was to create a technology-enhanced simulation app for mobile devices to train in Advanced Life Support (ALS) for cardiopulmonary arrest, using game mechanics.

Method/design:

A technology-enhanced simulation mobile app called ‘SimPL’ has been created to facilitate technology-enhanced learning on mobile devices. It allows the user to run physiological observations on a simulated patient. This has gained popularity on the Apple and Google Play Store amongst healthcare professionals. We now want to build on this and start by simulating ALS for cardiopulmonary arrest. A minimum viable demo that healthcare professionals can use to run an ALS scenario is being developed. The aim is to allow healthcare professionals to run through an interactive ALS scenario and give the user flexibility to make any decision they want regarding intervention and see how the patient responds to it. It provides real-time, haptic and constructive performance feedback to the intervention being carried out.

Implementation outline:

The use of technology-enhanced simulation for healthcare education is a novel area and with the fast acceleration of game mechanics development, there is scope for medical education to be delivered in this way. The technology-enhanced simulation app will be launched on the Apple and Google Play Store to all healthcare professionals around the world. Feedback will be gathered from users to allow further developments of the product. The overall outcome is to produce a network of mobile apps to deliver medical education in an interactive, engaging and easily accessible way to help clinicians prepare for emergency medical situations anytime, anywhere. ]]>
<![CDATA[65 Putting it into Practice: A Simulation-Based Education Programme for Parents]]> https://www.ijohs.com/article/doi/10.54531/XZNW3865 Background:The Paediatric Long-Term Ventilation (LTV) team are increasingly discharging children home with LTV via a tracheostomy. As a result, more parents are being asked to play the role of a nurse. They receive training, prior to discharge, in highly skilled tasks to enable them to care for their child’s long-term health needs at home. Whilst Simulation-based Education (SBE) is widely used in the education of health professionals, it is not currently part of the educational programme for these parents/caregivers.

Aim:

The aim of the study was to undertake a quality improvement project to produce an SBE programme for parents/caregivers of children being discharged home on LTV via a tracheostomy. The main objective was to improve the safety of patients through improving the confidence of parents/caregivers in managing and escalating emergencies prior to their discharge.

Method/design:

Through a focus group including parents/caregivers of children receiving LTV via a tracheostomy, who are already at home, we aim to co-produce this project, with the patient voice and experiences at its core. We plan to undertake the SBE with one or more parents/caregivers in a location separate from the clinical setting, that is designed to replicate their home environment as best as possible [1]; present will be one facilitator from Simulation Services (SS) and one clinical expert from the LTV team. We have written a bank of scenarios, including accidental decannulation, ventilator failure and respiratory arrest requiring cardio pulmonary resuscitation and phoning of the emergency services. However, scenarios will be chosen and individualized to suit each family’s needs. We will debrief in a separate room and this will be led by the SS facilitator, with the expert from the LTV team invited in to support with their clinical knowledge.

Implementation outline:

Over the next 4 months, baseline data will be collected with a Likert scale of confidence ratings for each of the planned scenarios, prior to the SBE. We will collect these data again immediately after the SBE, and then again at 3 months. We will also ask, at both of these time points, if there is anything additional that the parents/caregivers would have wanted from the SBE and how it can be improved. These data will allow us to evaluate and develop the programme for future families through a plan-do-study-act cycle approach. To understand where SBE fits within the wider education provided to parents/caregivers, we will ask them which elements of their education they have found most useful, and why. ]]>
<![CDATA[3 The Implementation of Simulated Placements in Undergraduate Healthcare Courses During the Covid-19 Pandemic]]> https://www.ijohs.com/article/doi/10.54531/WGFR7996 Background:In 2020 many healthcare students lost placement hours due to COVID-19. In response to this crisis, simulated placements were implemented to ensure students were able to achieve their practice hours. A pilot project was undertaken in November 2020. This was then developed at pace into a simulated placement module that could accommodate around 3,500 students by the start of January 2021. Nursing and Midwifery Council guidance was updated in February 2021 [1] to suggest all nursing students in the UK may access 300 hours of simulated learning and this could include face to face, online live and online self-directed simulated learning.

Aim:

The study aimed to enable nursing students to maintain their hours as required by the NMC, and provide evidence to demonstrate achievement of their competencies. It also aimed to ensure patients and service users from all fields were represented within the activities.

Method/design:

A module blackboard site was developed online to house the materials. Each activity was mapped to the cohort-specific proficiencies which needed to be achieved for that particular level of study (BSc and MSc). A wide range of activities were included such as Oxford Medical Simulation, detailed case studies and scenarios including ‘talking head’ style videos and patient documentation, service user interviews, analysing Care Opinion patient feedback, and 360-degree tours of a patient’s home to undertake a risk assessment.

Implementation outline:

Students were able to access the simulated placements if waiting for a clinical placement due to lack of availability, if course completion was delayed due to ‘opting out’, or if the student was self-isolating or shielding. Students received comprehensive guidance as well as regular YouTube updates to walk them through the process. A mixture of live online sessions and self-directed activities were included and engagement was logged on a placement timesheet. There were also activities and live sessions focussing on student well-being and preparation for placements. It was also important to include activities focussing on other fields of nursing such as mother and baby or learning disabilities. A reflection was then uploaded to the digital placement assessment document so that it could be accessed virtually by the practice assessor and academic assessor. The simulated placements have since expanded into the Allied Health Professional courses within the university and it has been valuable to undertake interprofessional resource sharing to further enhance the simulated placements experience. ]]>