2012.07.02 The Development of a National Simulation Training Programme
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Dr. Crina Burlacu, College of Anaesthetists in Ireland, presented The Development of a National Simulation Training Programme at Simulation in Irish Medical Education: Where Are We, and Where Are We Going? held at NUI Galway on the 2nd July 2012.
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2012.07.02 The Development of a National Simulation Training Programme
- 1. The Development of the National Simulation Training Programme in Anaesthesia Dr. CRINA L. BURLACU MD, MSc, FCARCSI, DEAA Consultant Anaesthetist Director of Simulation for Training College of Anaesthetists in Ireland
- 4. Outline â« Simulation strategy & logistics â« CAST - From vision to action â« Take home message
- 5. Simulation Strategy & Logistics
- 6. Simulation - logistics Strategy Institutional Buy-in Funding Operational Manpower Curriculum & Courses âą Curriculum planning âą Case library âą Educators âą Training the Trainer Quality Assurance âą Mission Statement âą Business plan âą Centre design âą Equipment âą Politics âą Networking âą Strategic frameworks âą Budget âą Sources of revenue âą Marketing âą Medical Director âą Admin Manager âą Admin Assistant âą Simulation Specialists âą Audit âą Research âą Collaboration
- 7. Business plan â« Objectives & training rationale â« Target markets (users, motivation, financial status) â« Competition & feasibility study â« Strengths & weaknesses â« Resources & costing â« Marketing mechanisms â« Timescale
- 8. Mission Statement Our philosophy is to provide systematic training to trainees and continuing medical education and development to practitioners in anaesthesia through experiential learning and directed self-reflection in a clinical skills and simulation environment.
- 9. Scope and Objectives â« Education â« Assessment â« Research
- 10. Education â«Systematic approach to the management of medical emergencies â«essential knowledge â«technical skills â«strategies for problem avoidance and problem solving â«principles of crisis management â«Applying principles of adult learning
- 11. Assessment ïFormative vs. summative assessment ïProblems with reliability and validity ïResources ïTTE = Train the Examiners ïLimited international experience of using simulation for assessment ïSimulation for accreditation: Israel, ABA US ïCAI â simulation at the Primary OSCE & SDR
- 12. Research The impact of simulation on Training Outcomes Technical skills Non-technical skills Easy in the Simulation Lab Patient Outcomes Difficult to show translation in practice Design and ethical issues
- 13. Target Audience Trainees in Anaesthesia Practitioners in Anaesthesia Other healthcare professionals Acute care specialties
- 14. Institutional buy-in â« Strategic Framework National Curriculum and Guidelines: HSE-METR; CAI International Recommendations Postgraduate Training in Anaesthesiology, Resuscitation and Intensive care: New Revised Guidelines and Syllabus 2011; www.eba-uems.eu/pubs â« Evidence Koetsier E, et al. : Complaints and incidents related to anaesthesia services are foremost attributed to non-technical skills. EJA 2011; 28: 29-33 â« Politics â« Networking & opportunities for funding
- 15. UEMS/EBA GUIDELINES Postgraduate Training Program From The Standing Committee On Education And Training Of The Section And Board Of Anaesthesiology Domain 1.8: Anaesthesia Non-Technical Skills (ANTS) During the course of their training, residents must acquire non-technical abilities to master interpersonal and organizational tasks during the perioperative care of patients. These include the following competences: a. Develops and maintains an overall dynamic awareness of the situation based on perceiving the elements of the operating room environment (patient, team, time, monitoring and equipment) and understands what they mean and anticipates what could happen in the near future C b. Makes decisions to reach a judgment or diagnosis about a situation, or to select a course of action, based on experience or new information under both normal conditions and in time- pressured crisis situations D c. Manages resources and organizes tasks to achieve goals, be they individual case plans or longer term scheduling issues C d. Communicates effectively and works with others in a team context, in any role, to ensure effective joint task completion and team satisfaction D
- 16. Centre Design & Equipment â« Understand the educational needs before you built or buy â« Technical vs. non-technical skills vs. both â« Individual vs. team training â« Single specialty vs. multiple specialties â« Single discipline vs. multiple disciplines
- 17. Simulation Centre Design â« Building and space planning â« Room usage Mock OT/ITU/Ward Control room Debriefing room(s) Other: communication rooms, lecture theatre, E-learning stations, external training area, breakout spaces â« Audio-visual system â« Others: acoustic, lighting, air-handling, security
- 18. Centre Design
- 21. Equipment â« Part-task trainers â« Medium & high fidelity mannequin patient simulators â« Computer-based simulators â« Equipment for added realism â« Equipment for specialized courses
- 22. Centre Operation & Administration â« Calendar & booking system â« Course material update/props â« Simulator maintenance â« Manuals â« Data organization â« Policies â« Marketing/Website â« Insurance â« Real-life emergencies
- 23. CAST- From vision to action College of Anaesthetists Simulation Training
- 24. Strategic framework â«Under- and postgraduate teaching and training reform in Ireland (2006) â«HSE & HEA - 6.5 mil capital investment â«HSE-METR set-up â« Two pilot Multidisciplinary Regional Clinical Skills Centres â«COAI Education Centre & Simulation Laboratory â« Other existing facilities
- 25. Other driving forces â« COA updating the existing competence-based curriculum â« Change in trainees working hours â« EWTD â« Economic condense â« Decreased number of training posts â« Change in allocation of funding for training
- 26. CAST Programme College of Anaesthetists Simulation Training OR Collaborative Anaesthesia Simulation Training Several participating institutions: Education Centre â COAI Dublin ASSET Centre UCC Cork Regional Clinical Skills Centre SJH Dublin RCSI Clinical Skills Laboratory Beaumont Hospital Dublin Department of Anaesthesia UH Galway
- 28. CAST - Principles â«Careful mapping to the current competence-based training curriculum in anaesthesia â«National coverage â«Uniform educational content â«Homogenous training of educators â«Continuous quality management programmes
- 29. CAST- Terms of Reference COAI â«Simulation curriculum â«COAI â approved courses â«Guidelines, forms, templates â«Inspection, evaluation and accreditation â«Centralized training for trainers â«CME for participants and faculty â«Collaboration with Medical Council/other Training Bodies â«Collaboration with ASPiH & SESAM RCSSC â«Delivery of COAI-approved core courses â«Local faculty recruitment and accreditation â«Audit and research â«Revenue reinvested in simulation equipment â«Local management, administrative and technical operations
- 30. College of Anaesthetists Simulation Training From vision to action â«Search for expertise â«Search for models â«Development of curriculum & course material â«Faculty recruitment and training â«Piloting â«Marketing â«Networking & communication strategy â«Construction & refurbishing work â«Technical training â«Targeted Procurement Strategy
- 33. Curriculum & course material development â«Careful dissection of the existing competence-based training curriculum â«Identification of areas amenable for simulation training â«Fusion in several core courses â«Clear learning objectives â«Course material (scenarios, script) â«Peer review â«Approval sought from CAST Committee â«Input from specialists for OA/PA/ITU etc. courses
- 34. CAST- governance and quality assurance â«CAI provides governance Gives legitimacy and encourage participation Consistency of training Maintains standards Regular review of programme Accreditation of RCSSC â«CAI provides continuous evaluation Participant evaluations = quality improvement tool Regular audit â«CAI is training the trainers Generates pool of teachers/facilitators Maintain teaching standards Certifies trainers after training
- 35. â«Initial centre visitation and evaluation â«Initial pooling of resources â«Quantitative and qualitative guidelines for Simulation Centres â«Planned accreditation process â«Application for accreditation â«Inspection and accreditation â«Re-accreditation CAST - Accreditation
- 36. CAST - Faculty â«Good will â«Special interest in education & simulation â«Structured teaching commitments â«Continuous recruitment: consultants, senior SpRs, MSc â«Watch for participants with potential to become instructors â«Nominated Course Lead Consultants â«In-house instructors training and accreditation
- 37. Faculty Training
- 38. Piloting â« Workshops â« Course piloting
- 39. Advertising campaign COAI website www. anaesthesia.ie
- 40. CAST - Timescale Phase I (2010-2012) Anaesthetic Emergencies I Anaesthetic Emergencies II or ARREST course Obstetric Anaesthesia & Emergencies or COAST Paediatric Anaesthesia & Emergencies (RTPs, SpRs 1-3) Beginners in Anaesthesia Course ( BSTs first 6 months) Phase II (2012-2015) Intensive Care Clinical Decision Making MASCOT Multidisciplinary anaesthesia-obstetrics
- 41. Two years on⊠â«July 2010 - June 2012 â«More than 650 trainees went through more than 60 courses delivered in 4 centres â«Each trainee participates in 1 simulation course/6 months â«5 courses ( BIA, AE, ARREST, COAST & PA) mandatory for certain training grades â«Other courses have already been piloted: Clinical Decision Making, MASCOT â«The programme has been extended to doctors in non-training positions (PDP) and other specialities â«3 TTT courses
- 42. CAST- Evaluations COAST course; 8 courses, 83 participants; 95% response rate; 2010-2011 Post- course evaluation statements Median Range S1 The course met the stated educational objectives 5 [3,5] S2 The course matched my own training needs 5 [4,5] S3 I found the course relevant to my stage of training 5 [1,5] S4 I found the course relevant to my current clinical practice 5 [2,5] S5 The methods of delivery were adequate to the course stated objectives 5 [4,5] S6 The pace of the course was adequate 4.5 [3,5] S7 I am overall satisfied with the course 5 [4,5] S8 The course will change my future practice 5 [2,5] AE & ARREST 180 participants; 165 evaluations; 91 % response rate; 2010
- 44. OthersâŠ
- 45. Lessons learnt & take home message
- 46. Take home message â«Before you buy simulation equipment â«Assess your clinical & educational needs â«Identify your target users â«Search for best suited technology â«Now you are ready to select and integrate the right technologies! â«Seek help from other centres & simulation groups â«Demand support from your institution â«Help your community understand the benefits â«You are not done ! â«Train your simulation educators â«Continuously monitor your clinical needs to ensure relevant training â«Aim for recurrent training â«Seek new applications of simulation â«Generate audit & research
- 47. Take home message â«Have a clear vision and strategy all along â«Start small and then evolve â«It hurts when simulation equipment remains in a box or the skills lab remains empty â«Donât accept it from your institution, partners, managers or Faculty â«Ask for help, demand support, request assistance â«Publicise your results
- 48. Thank you ! cburlacu@coa.ie www.anaesthesia.ie