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SimHealth 2012 Innovation - Education - Research Making Teams Work The Annual Conference of the Australian Society for Simulation in Healthcare Monday 10 September - Thursday 13 September 2012 Sydney Hilton Hotel, Sydney Australia

Abstracts

Download the Call For Abstracts.

Research Awards

The objective of the Research Awards is to encourage scientific excellence in the areas listed in the conference sub-themes.

University of Technology Sydney, Research Awards Sponsor

Since 2011, the University of Technology Sydney has sponsored the Research Awards. A prize to the value of $250 will be awarded for each of:

  1. Overall best abstract
  2. Best technical abstract
  3. Best abstract
  4. Best research abstract
  5. Best poster (voted by delegates at the conference)

See photos of the Awards presentations at SimHealth 2011 and SimHealth 2010!

Sub-Themes of Making Teams Work

Education, Training and Assessment

For example:

  • Inter-professional learning
  • Curriculum development and evaluation
  • Teaching methods including debriefing methodologies
  • Educational outcomes

Policy, Operational and Resource Issues

For example:

  • Workforce
  • Impact of simulation on length of training
  • Cost of simulation and simulation resources
  • Distributed simulation
  • Simulation centre operations
  • Accreditation, certification and credentialing

Patient Safety

For example:

  • Human factors and patient safety research in simulated environments
  • Usability testing (new clinical equipment or new hospital design) in simulated environments
  • Simulated case re-enactment and review 
  • Workplace culture and teamwork
  • Implementation of safety initiatives using simulation

Innovation and New Technologies

For example:

  • Hybrid or mixed methodology simulation
  • Computer modelling of health delivery processes
  • Quality improvement methodology
  • Innovation in simulation planning and delivery
  • New ways, new techniques for facilitating simulation
  • Safe systems design
  • Telemedicine
  • Robotics
  • Gaming
  • Virtual reality

Formats

1. Posters

One of the aspects of SimHealth that has traditionally been strong is the scientific program. The number of abstracts has increased every year and consequently this year there will be a change in emphasis of presentation of these papers. Selected papers will still be invited as oral presentations; however the majority of authors will be invited to present in a poster format. Presenters will give a short (3 - 5 minute) explanation of the posters during special poster rounds moderated by a keynote speaker or simulation expert.

Posters should be no more than 84cm (wide) x 119cm (high) in dimension. Authors must attend their posters during the allocated time to answer questions. The poster should include author and co-authors' names, a short title and the name of the institution where the work was carried out. Posters may include completed research or works in progress.

Electronic material or limited practical demonstrations at the poster rounds are encouraged although because of the timing these will need to be brief to fit within the 5 minute presentation time slot.

See photos of the Posters from SimHealth 2011!

2. Oral Presentations

The number of oral presentations at the conference will be limited this year. Authors wishing to present results of original research or report on educational or other projects are invited to submit in this section.

Successful research abstracts will present clear outcomes data. Reports on educational or other projects should include data beyond participant satisfaction. Incomplete abstracts will not be considered.

Fifteen minutes will be allocated for oral presentations with five  minutes for questions. A Conflict of Interest statement must be included in each presentation.

3. Workshops

Workshops are short, focused, interactive sessions. A limited number of 90-minute sessions, and in exceptional circumstances 180-minute sessions, are available for presenters who wish to present small group educational sessions or conduct in-conference workshops.

4. Ask the experts: research I am trying to do

The aim of this session is to assist researchers wishing to conduct research in one aspect of simulation. Members of the audience should benefit from shared ideas. Participants are invited to submit abstracts under this category to present work in progress for discussion among the audience and expert facilitators. The standard submission template should be used; including aims, background and proposed methods, but it is not expected that results or conclusions will be included.

5. Ask the experts: training I am trying to develop

The aim of this session is to develop training solutions for identified training needs for specific groups. Participants are invited to submit abstracts under this category to present work in progress for discussion among the audience and expert facilitators. The standard submission template should be used; including aims, background and proposed methods, but it is not expected that results or conclusions will be included.

Registration

All presenting authors must register and pay for their attendance at the conference.

Abstracts Presented

Note: "Results" and "Conclusions" for Abstracts will be available on the web-site 6 months after SimHealth.

Session 1 – Free Papers 1 – Teamwork courses
Tuesday 1330–1500 – Level 3 – Grand Ballroom A

Chair: Ella Scott

Title
To wheeze or not to wheeze – ‘all the world's a stage’: in-situ simulation in a paediatric hospital
Authors
Ms Karen Bond 1, Ms Coralie Gower 1, Ms Rebecca King 1, Ms Lynn MacRitchie 1, Ms Carolyn Smith 1, Ms Ella Scott 1, Ms Sandra Wales 1
1 Sydney Children's Hospitals Network, Randwick, NSW, Australia
Abstract
Aims: This paper will describe a work in progress in developing, implementing and evaluation of an in-situ simulation based teaching curriculum. The most recent evidence based practice for the care of infants requiring hospital admission for bronchiolitis will be addressed.

Background: During the winter months in Australia, many infants become unwell with viruses causing bronchiolitis. Whilst the illness is usually self limiting a small percentage of infants require hospital admission for supportive treatment in order to maintain their hydration and oxygenation (New South Wales Department of Health, 2003, Fitzgerald & Kilham 2004). In 2010 New South Wales (NSW) Ministry of Health implemented Clinical Practice Guidelines (CPG) to assist clinicians standardisation of evidence based care.

Ensuring the success of implementing CPG's at a local level necessitates developing policies and procedures, effective communication, staff engagement and empowerment to support change, and continual evaluation (Canadian Health Services Research Foundation Report, 2011). The use of in-situ simulation is recognised as an effective method of increasing clinical expertise, through providing the opportunity for staff to learn and manage changes in a controlled setting.

Implementing all these elements can be challenging in the ongoing dynamic health care environment. Even though bronchiolitis is a common presentation, evidence has changed regarding best practice. This involves administration of oxygen therapy, the increased use of humidification of oxygen and the implementation of a notification system called Between the Flags to identify the deteriorating patient (NSW Ministry of Health). Increasing nurse' s knowledge and reducing the variance in the management of bronchiolitis will ensure standardised care, patient safety and improved patient outcomes.

Methods: Nurses from the emergency and medical wards were engaged in the development of the curriculum and introduced to the in-situ simulation environment. This process was supported the PaNSTAR (paediatric and neonatal simulation training across the regions project). The target learners from each ward were identified and participated in the program, prior to the winter. Evaluation includes; participants learning and the resultant patient outcomes measured in accordance with adherence the guideline.

References:

  1. Birkhoff S and Donner C (2010). Enhancing paediatric clinical competency with high fidelity simulation. The Journal of Continuing Education in Nursing. 41 (9). pp 418-423
  2. Canadian Health Services Research Foundation;(2011) Understanding whole systems in Healthcare: The case of Emerging Evidence-informed Nursing Service Delivery Models. www.chrsf.ca.
  3. Clinical Excellence Commission – Between the Flags, www.cec.health.nsw.gov.au/programs/ between-the-flags
  4. Fitzgerald, D., & Kilham, H. Bronchiolitis: Assessment and evidence-based management. Medical Journal of Australia. 2004. 180 (8) pp.399-404.
  5. NSW Health Clinical Practice Guidelines – Infants and children: Acute management of Bronchiolitis-second edition. www.health.nsw.gov.au

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Title
Making teams work: TeamSTEPPS® in simulation
Authors
Ms Tina Holmes, Dr Barbara Parker
University of South Australia
Abstract

Aims: This project was developed to integrate the teaching strategies and tools of TeamSTEPPS® with simulation into a nursing curriculum within a University setting. This presentation will focus on the identified training needs and lessons learned in the implementation of TeamSTEPPS® within a university based setting using standardised simulated patients to prepare nursing students prior to clinical placement with the knowledge, skills and strategies to enhance communication and teamwork.

Background: The transfer of information from one health care professional to another is an essential part of patient care and is undertaken in the context of a multitude of multifaceted settings. Failure to provide effective transfer of communication has been linked to adverse patient events. TeamSTEPPS® evolved in the United States (US ) led by the US Department of Defense (DoD) Patient Safety Program in collaboration with a number of expert partners. United States (US ) health organizations have reported positive outcomes in implementing teamwork initiatives to improve interdisciplinary communication and have observed a notably decline in the incidence of clinical error (30.9%to 4.4%). TeamSTEPPS® was introduced in South Australia (SA) in 2008 with a range of initiatives, for example; the implementation of the IS BAR tool to improve communication during handover. The curriculum of TeamSTEPPS® has now been widely implemented across SA metropolitan and rural health services, in light of this, it is not unwise to consider the assimilation of the TeamSTEPPS® curriculum into a nursing curriculum within a University setting. A project was undertaken in North Carolina at the Dukes University to implement TeamSTEPPS® into the School of Medicine. Up until now TeamSTEPPS® has not been implemented in a University setting in Australia.

Method: The project was undertaken across three interrelated stages including:

  1. Identifying the need
  2. Planning, training, and implementation
  3. Sustainment

Stage 1: This stage consisted of assessing the need and identifying potential barriers to implementing change within the University setting. The Practice Based Laboratories were identified as the setting to successfully support the initiative. A team training needs analysis was undertaken and student learning objectives identified.

Stage 2: This stage involved working closely with the ‘change team’ to develop a modified plan to meet the academic teaching team and student learning needs within a University setting. TeamSTEPPS® tools and strategies were defined, plan for evaluation was developed, specific groups to train were identified, and time and resources were allocated. A timeline was developed and communicated to all staff about the initiative. The knowledge and skills learned were applied to the Practice Based Laboratories creating an environment that supported communication and teamwork through simulation education to nursing students.

Stage 3: This stage is aimed at ensuring that improvements in teamwork performance of students are sustained and transferable to the clinical setting. The teaching team will provide continual support and reinforcement of the TeamSTEPPS® principals within the student learning experience. Evaluation is aimed at effectiveness of the tools and strategies implemented within the Practice Based Laboratories, changes in processes and student outcomes.

References:

  1. Australian Commission on Safety and Quality in Health Care (2010). The OSSIE Guide to Clinical Handover Improvement. Sydney, ACSQHC.
  2. TeamSTEPPS® Multimedia Resource Kit. [TeamSTEPPS®: Team Strategies & Tools to Enhance Performance and Patient Safety; developed by the Department of Defense and published by the Agency for Healthcare Research and Quality.] AHRQ Publication No. 06-0020-3. Rockville (MD): Agency for Healthcare Research and Quality; September 2006.

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Title
Evaluation of a critical care simulation series for undergraduate nursing students
Authors
Jon Mould, Haidee White and Robyn Gallagher
Abstract
Aim: Simulation is increasingly being used to prepare and supplement clinical practice in critical care areas for undergraduate Bachelor of Nursing (BN) students, with some success. However, the effects of multiple, medium-high fidelity simulations for this purpose have not been previously assessed. The purpose of this study was to assess self-reported confidence and competence using a series of scenario-based simulations.

Background & Method: A pre-test /post-test design was used to evaluate a series of simulations conducted over a 9 week semester. There were twenty seven scenarios in total, with each individual scenario lasting approximately five to seven minutes and incorporating programmed mannequins, moulage and actors. The scenarios were embedded in a team-based process involving preparation and video-recordings used to debrief. Third year BN Students (n = 219) reported their confidence and competence before and after the simulation series and made comments on their perception of the experience.

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Title
Teamwork during patient handover
Authors
Dr Tanja Manser, University of Fribourg
Abstract
Introduction: Handover research and improvement efforts have mostly focused on the information transfer function of patient handover. However, the specific mechanisms between handover communication processes among teams of transferring and receiving clinicians and handover quality are poorly understood. Based on observational research using a taxonomy for handover behaviors as a team activity this presentation will outline:
  1. patterns of handover communication in different clinical settings and across handover roles,
  2. handover behaviors related to higher ratings of handover quality and
  3. compensatory functions of receiving clinicians handover activities.

Findings will be discussed with regard to implications for the design of simulation-based research and for training / work design interventions.

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Session 7 – Free Papers 2 – Evaluating and developing simulation programs
Tuesday 1530–1700 – Level 3 – Grand Ballroom A

Chair: KT Waxman

Title
The Satisfaction with Simulation Experience Scale (SSES): A replication study
Authors
Dr Brett Williams, Monash University
Abstract

Background: Simulated learning environments are a vital component in paramedic education. Therefore having instruments such as the Satisfaction with Simulation Experience Scale (SSES) with strong measurement properties to use in educational research studies is important. Only one study has reported on the psychometric properties of the SSES previously1.

Objectives: To investigate the factor structure of the SSES when completed by a group of undergraduate paramedic students from a large Australian university.

Methods: A cross-sectional study using a paper-based version of the SSES was administered to second and third year students from an undergraduate paramedic course during the final weeks of semester two 2011. Data from the SSES were analysed with Principle Components Analysis (PCA) with Varimax rotation.

References:

  1. Levett-Jones T, McCoy M, Lapkin S, Noble D, Hoffman K, Dempsey J, et al. The development and psychometric testing of the Satisfaction with Simulation Experience Scale. Nurse Educ Today. 2011;31(7):705-10.

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Title
Evolution of evaluations – lessons learnt in a large simulation centre
Authors
Dr Peter Thomas, Mr Matthew Shuker, Clinical Skills Development Service, Queensland Health
Abstract

Aim: To provide an overview of methods used to conduct course evaluations, generated from the experiences of a large simulation centre.

Background: The collation of course evaluations is an essential component to the development and review of curriculum offered by any educational group. Various methods may be utilised including manual or electronic data capture methods and interviews regarding the pros and cons of various methods, including paper-based with manual or partially automated data entry, electronic survey tools and follow-up interviews. Feedback and consultation from the centre's faculty and staff has contributed to the evaluation of course evaluation methods.

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Title
Acute to chronic: Using clinical simulation in interprofessional training to prepare pregraduate students for the workplace
Authors
Ms Marie Heydon 1, Ms Grainne O'Loughlin 1, Ms Alex Pile 1, Dr Kumud Dhital 1
1 St Vincent's Hospital
Abstract
Aim: To use simulation as part of a multimodal 1 week education program for medical, nursing and allied health pre-graduates including simulation of emergency clinical scenarios and simulated case conference of a chronic and complex clinical scenario. Evaluation of benefit in the context of attainment of interprofessional competencies.

Background: Interprofessional education is acknowledged as a fundamental means for equipping health students and professionals for multidisciplinary team work in the health environment and consequently to be better prepared to respond to local health needs (World Health Organisation, 2010). A one week interprofessional program was funded via a grant to design and implement a course to develop further understanding of the roles of other professions, and team based skills to enhance collaborative care practice and planning. The program included interdisciplinary learning across a range of simulated environments covering common emergency clinical scenarios to the management of challenging/ complex cases.

Methods: 52 students (19 Medical, 21 Nursing and 12 Allied Health) participated in a one week interprofessional program in their last semester of study. A variety of educational strategies were employed during the week, and a range of quantitative and qualitative evaluation tools assessing the whole program were used. These included the WSEIS, ISVS, and two other tools – one locally developed and the other an adaptation of a self assessment tool produced by the Canadian Interprofessional Health Collaborative, which were used pre and post program, the RIPLS (used pre program), a content evaluation tool and specific simulation centre evaluation sheets.

The program included two key simulation methods:

  • All students had the opportunity to either participate in or observe simulation scenarios covering advanced life support and the deteriorating patient in a dedicated Simulation Centre. Debriefing and qualitative evaluation of these sessions was conducted.
  • Team based clinical scenarios covering complex/chronic situations using team case discussion and case conference roles plays and debriefing.

References:

  1. CIHC National Interprofessional Competency Framework Source: Canadian Interprofessional Health Collaborative, College of Health Disciplines, University of British Columbia, Vancouver BC V6T 1Z3, Canada. www.cihc.ca
  2. World Health Organisation. (2010). Framework for Action on Interprofessional Education and Collaborative Practice. Cited January 2012: http://whqlibdoc.who.int/hq/2010/WHO_HRH_ HPN_10.3_eng.pdf

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Title
Scenario development: The California model
Authors
Dr KT Waxman 1,2
1 University of San Francisco, 2 California Institute for Nursing and Health Care
Abstract
Scenario development is integral to a successful simulation. Scenarios should be written with specific learning objectives which are the tool that guides the simulation. The California Simulation Alliance created a scenario template, validation and testing tool for their 60 scenarios which were written by their academic and service partners. All scenarios are evidence-based, validated by peers, and tested prior to making them available to subscribers. The template is has been adopted by the Victorian Simulation Alliance and will be shared with the participants during the session.

References:

  1. Waxman, KT. (2010). Development of education-based clinical simulation scenarios: Guidelines for nurse educators. Journal of Nursing Education. 49 (1).

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Session 13 – Free Papers 3 – Teamwork in procedural settings
Wednesday 1100–1230 – Level 3 – Grand Ballroom A

Chair: Tanja Manser

Title
Team stress profiles during obstetric emergencies
Authors
Dr Pamela Andreatta, Dr David Marzano, University of Michigan Department of Obstetrics and Gynecology
Abstract

Background: Stress affects human performance and decision-making, and the degree of stress experienced by physicians and nurses during emergency situations has the potential to limit their effectiveness as both clinicians and team leaders. [1-10]

Aims: The purpose of this study was to assess the stress levels of clinical team members (leaders and non-leaders) during the management of simulated Obstetric Emergencies.

Methods: A sample of 68 physicians, residents and nurses from Obstetrics, Emergency Medicine, Anesthesia and Neonatology participated in simulationbased drills to manage Obstetric Emergency cases as interdisciplinary teams. A total of 58 cases were included in the drills, each with low, moderate or high difficulty ratings depending on the clinical and psychosocial factors associated with the case. Cases were randomly selected and team members participated in up to four cases each, with no more than two cases per drill. Baseline, peak and mean heart rates were captured during the cases for each team member using wristworn non-invasive heart rate monitors. Individual stress levels were calculated using baseline-peak heart rate differentials to characterize peak stress, and baseline-mean heart rate differentials for sustained stress during each case. Case difficulty and team-leader status were considered in the analysis of variance. Direct measurement of clinical performance related to stress level was not measured for this study because we could not predict when stress responses would be in effect due to the dynamic nature of each team's case management.

References:

  1. Easterbrook JA. The effect of emotion on cue utilization and the organization of behavior. Psychol Rev. May 1959;66(3):183-201.
  2. Humara M. The relationship between anxiety and performance: a cognitive behavioral perspective. Athletic Insight. 1999;1(2):1-14.
  3. Mandler G. Thought processes, consciousness, and stress In: Human Stress and Cognition: An information Processing Approach. New York: John Wiley & Sons; 1979. 
  4. Van Gemmert AW, Van Galen GP. Stress, neuromotor noise, and human performance: a theoretical perspective. J Exp Psychol Hum Percept Perform. Oct 1997;23(5):1299-1313.
  5. Rutledge T, Stucky E, Dollarhide A, et al. A real-time assessment of work stress in physicians and nurses. Health Psychol. Mar 2009;28(2):194-200.
  6. Hunt EA, Shilkofski NA, Stavroudis TA, Nelson KL. Simulation: translation to improved team performance. Anesthesiol Clin. Jun 2007;25(2):301-319.
  7. Andreatta PB, Bullough AS , Marzano D. Simulation and team training. Clin Obstet Gynecol. 2010 Sep;53(3):532-44. PMID: 20661038
  8. Müller MP HM, Fichtner A, Hardt F, Weber S, Kirschbaum C, Rüder S, Walcher f, Koch T, Eich C. Excellence in performance and stress reduction during two different full scale simulator training courses: A pilot study. Resuscitation. 2009;80:919-924.
  9. Stucky ER , Dresselhaus TR , Dollarhide A, et al. Intern to attending: assessing stress among physicians. Acad Med. Feb 2009;84(2):251-257.
  10. Abell N. The index of clinical stress: A brief measure of subjective stress for practice and research. Social Work Research and Abstracts. 1991;27:12-15.
  11. Lepnurm R, Lockhart WS, Keegan D. A measure of daily distress in practising medicine. Can J Psychiatry. Mar 2009;54(3):170-180.
  12. Inzana CM, Driskell JE, Salas E, Johnston JH. Effects of preparatory information on enhancing performance under stress. J Appl Psychol. Aug 1996;81(4):429-435.
  13. Smith R, Nye S. Comparison of induced affect and covert rehearsal in the acquisition of stress management coping skills. Journal of Counseling Psychology. 1989;36(1):17-23.
  14. Robbins I. The psychological impact of working in emergencies and the role of debriefing. J Clin Nurs. May 1999;8(3):263-268.
  15. Saunders T, Driskell JE, Johnston JH, Salas E. The effect of stress inoculation training on anxiety and performance. J Occup Health Psychol. Apr 1996;1(2):170-186. 
  16. McCue JD, Sachs CL. A stress management workshop improves residents' coping skills. Arch Intern Med. Nov 1991;151(11):2273-2277.

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Title
Whole-team OR simulations – what are the educational needs?
Authors
Dr Matt Gers, Dr David Cumin, Associate Professor Jennifer Weller CMHSE, University of Auckland
Abstract

Aim: To determine content needs for a teamwork-focused multi-disciplinary operating room (OR) simulation course.

Background: Observational research of Operating Room (OR) teams supports the proposition that failures in teamwork and communication are common and lead directly to compromised patient care and reduced productivity1. The need for inter-professional collaboration and skills in effective teamwork is widely acknowledged2-9. Simulation is now a popular choice for training purposes10. The most successful and valid simulations are those that are based on real cases. We believe that the non-technical challenges in simulations should also be grounded in real teamwork failures, ideally those that are context-specific. However, one issue that has not been explored with respect to whole-team OR simulation training, is which teamwork issues are seen as important and of practical relevance to practicing OR staff. Such views, once known, can guide realistic simulation course development.

Methods: We conducted focus groups separately with surgeons, anaesthetists, anaesthetic technicians and OR nurses at two metropolitan hospitals. Using a semi-structured question guide based on a leading model of teamwork11, we enquired about the obstacles to good teamwork in the OR. We took notes and also audio recorded the sessions. After all sessions were conducted we reviewed the audio files to ensure that the notes taken were an accurate and exhaustive summary of the discussions. The notes were then coded using NVivo (QSR, v9) by two researchers specifically looking for educational needs and examples of good and poor teamwork. A second round of coding was performed manually to group the sub-themes into thematic categories. From the responses, the coders also compiled a list of actual situations which could be used in simulations

References:

  1. Lingard L, Espin S, Whyte S, Regehr G, Baker GR, Reznick R, et al. Communication failures in the operating room: an observational classification of recurrent types and effects. Quality and Safety in Health Care 2004;13:330-34.

  2. Institute of Medicine. To Err Is Human: Building a Safer Health System. Washington DC: National Academy Press, 2000.

  3. Lin R, Chaboyer W, Wallis M. A literature review of organisational, individual and teamwork factors contributing to the ICU discharge process. Australian Critical Care 2009;22:29-43.

  4. Kilner E, Sheppard LA. The role of teamwork and communication in the emergency department – a systematic review. International Emergency Nursing 2010;18:127-37.

  5. Hammick M, Freeth D, Koppel I, Reeves S, Barr H. A best evidence systematic review of interprofessional education: BEME Guide no 9. Medical Teacher 2007;29:735-51.

  6. Freeth D, Ayida G, Berridge EJ, Mackintosh N, Norris B, Sadler C, et al. Multidisciplinary obstetric simulated emergency scenarios (MOSES ) – promoting patient safety in obstetrics with teamwork-focussed interprofessional simulations. Journal of Continuing Education in the Health Professions 2009;29:98-104.

  7. Haynes AB, Weiser TG, Berry WR, Lipsitz SR, Breizat AS, Dellinger EP, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. New England Journal of Medicine 2009;360:491-99.

  8. Leonard M, Graham S, Bonacum D. The human factor – the critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care 2004;13:i85-i90.

  9. Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al. Health professionals for a new century – transforming education to strengthen health systems in an interdependent world. Lancet 2010;376:1923-58.

  10. Eppich W, Howard V, Vozenilex j, Curran I. Simulation-based team training in healthcare. Simulation in Healthcare 2011;6:S14-S19.

  11. Salas E, Sims DE, Burke CS. Is there a “Big Five” in teamwork? Small Group Research 2005;36:555-99.

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Title
Training in Professional Skills (TIPS): Outcomes of a Non Technical Skills (NTS) course for Surgical Education and Training (SET) trainees
Authors
Dr Robert O'Brien 1, Mr Adrian Anthony 2, Mr David Birks 2, Mr Phil Moreau 2, Associate Professor Phil Truskett 2, Mr Julian van Dijk 1, Mr John Cartmill 2
1 St Vincent's Hospital, 2 Royal Australasian College of Surgeons
Abstract
Aims: Utilise a range of education methods, including simulation, to provide opportunities for SET trainees to increase their understanding of the importance of Non Technical Skills (NTS) in contributing to patient safety and good professional practice.

Background: There has been a changing landscape in patient safety as clinicians and social and organisation scientists have begun to collaborate in systematically analysing the observed behaviours of surgeons in the operating theatre 1. Behavioural failures rather than technical skills are becoming the most common reason for errors in surgery 2,3. Through the recognition of the importance that the role NTS play in improving patient safety and contributing to better outcomes there have been a number of tools developed for teams within the operating theatre to identify the associated NTS behaviours 4,5. Although there are several behaviour marker tools and courses about utilising these tools, programs based around teaching to identify and improve NTS are rare. This course was developed to close the gap in NTS training in line with the competencies outlined by the Royal Australasian College of Surgeons and originally funded through the Department of Health and Aging and ASSH as part of the NTS in Synthetic Learning Environments project in 2008/09.

Methods: A generic two day course was developed for SET trainees who have undertaken at least two to three years of their training (SET 2 or SET 3) was developed. This course focuses on issues within a clinical setting and challenges the participant's skills particularly in communication, teamwork, crisis resource management and leadership.

A range of interactive lectures, facilitated discussions, small group activities, and simulation scenarios involving simulated patients are used to build on the knowledge and skills throughout the course. Faculty are from a range of backgrounds including consultant surgeons, physicians and medical educators at a ratio of 2:1 participants to instructors. Evaluation data is collected to ascertain how well the objectives have been met and further inform development of the course. TI PS was conducted as a pilot on four occasions before being launched and is currently conducted four times per year with 12 participants per course.

References:

  1. Flin R, Mitchell L, (Eds): Safer Surgery. Analysing Behaviour in the Operating Theatre, Aldershot: Ashgate, 2009.
  2. Bogner M. (ed) Human error in Medicine. LEA: Hillsdale, NJ, 1994.
  3. Bogner M.(ed) Misadventures in Health Care. LEA : Mahwah, NJ, 2004
  4. Yule S, Flin R. Maran N, Rowley D, Youngson G, Paterson-Brown S. Surgeon's Non-technical Skills in the Operating Room: Reliability Testing of the NOTSS Behaviour Rating System, World Journal of Surgery (2008) 32: 548 -556
  5. Mishra A, Catchpole K, McCulloch P. The Oxford NOTECHS System: reliability and validity of a tool for measuring teamwork behaviour in the operating theatre. Quality and Safety in Healthcare (2009): 18: 104-108.

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Title
Reliability of an instrument for self-assessment of teamwork in critical care
Authors
Associate Professor Jennifer Weller, Dr Boaz Shulruf, Dr Jane Torrie, Dr Robert Frengley, Ms Kaylene Henderson
Abstract
Background and Goal of study: Teamwork is recognized as a key factor in patient safety, with an established relationship between poor teamwork and medical error. A validated instrument to assist health professionals to assess the performance of their team would help to identify gaps in performance and identify areas for improvement. However, the literature on self-assessment suggests doctors are not good at assessing their own performance. We have previously reported on the validity and reliability of a structured teamwork rating instrument used by trained external assessors in a simulated learning environment1. However, while external feedback on team performance is very valuable, there are limited opportunities for external assessors to observe clinical teams at work, in particular, in the context of a crisis. We therefore aimed to determine the reliability of teamwork rating instrument used by critical care teams, to assess their own team performance.

Material and methods: We used a previously validated teamwork rating instrument consisting of 21 items each describing an observable marker of team performance (1). Forty critical care teams comprising one doctor and three nurses participated in four highly realistic simulated emergency scenarios, and each participant independently rated their team's performance at the end of each scenario. In addition, all scenarios were videotaped, randomised and then rated by three trained expert assessors blinded to scenario order.

The properties of the instrument when used for self-assessment were evaluated using Exploratory Factor Analysis (maximum likelihood, oblimin rotation), and Cronbach's α for internal consistency. Results were then compared with those generated by external assessors.

Reference:

  1. Weller J, Frengley R, Torrie J, Shulruf B, Jolly B, Hopley L, et al. Evaluation of an instrument to measure teamwork in multidisciplinary critical care teams BMJ Qual Saf 2011;20:216-22.

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Session 16 – Free Papers 4 – Simulation Devices
Wednesday 1100–1230 – Level 4 – Room 1

Chair: Peter Hill

Title
Capabilities and limitations of the METI human patient simulator in demonstrating Guedel's stages of anaesthesia
Authors
Dr Osman Ozturk 1, Dr Stuart Marshall 2
1 Hutt Hospital, 2 Monash Medical Centre
Abstract
Aims: To assess capabilities and limitations of a high-fidelity anaesthetic training mannequin – the Medical Education Technologies Incorporated Human Patient Simulator (METI – HPS, Sarasota, Florida) – in aiding participants to identify key Guedel Stages during simulated gaseous anaesthesia. We hypothesized that participants would more accurately identify Guedel's Stages if conditions with additional cues were provided over and above existing pharmacodynamic modelling.

Background: Arthur Guedel devised a system to aid assessment of anaesthetic depth, based on changes in respiratory pattern, rate, and changes in the size and position of the patient's pupils. It was divided into four key stages: Guedel's Stages of Anaesthesia. Before the advent of modalities to aid the assessment of anaesthetic depth, knowledge and utilization of Guedel's Stages was common. Guedel's Stages are still utilized in paediatric anaesthesia and in remote-location anaesthesia when agent monitoring is not available however they are difficult to teach without access to healthy patient volunteers consenting to an inhalational induction technique.

Methods: Following formal ethics approval, six anaesthesia residents and six anaesthesia consultants/fellows were randomly selected to participate based on availability to briefly leave clinical duties. METI -HPS mannequin was intubated and spontaneously breathing, with audible pulse oximetry being the sole monitoring available to the participants. Guedel's Stages 2, 3 and 4 (G2, G3, G4 respectively) were assessed upon due to their clinical relevance and standardized written information outlining the features of these stages was available to participants.

For each of G2, G3 and G4, three conditions were devised: ‘Model-Driven’ (MD) using solely the mannequin's pharmacodynamics modelling; Manual Override (OR) of respiratory rate/pattern and pulse rate, and Manual Override of respiratory rate/ pattern and pulse rate plus a visual representation line drawing of pupillary signs (OR +V).

Once each condition was set, participants were asked to identify the relevant Guedel's stage and write brief comments as to which signs they utilized to reach their conclusion. Each participant entered the simulation room a total of nine times according to the computer-generated random sequence, to which they were blinded.

Data were analysed using a chi-square test to examine correct identification of each of the depths of anaesthesia using each of the three conditions. Comparisons of each participant's correct responses were made between each of the conditions using a paired t-test. Effects of experience were analysed using a Mann-Whitney U test.

References:

  1. Bewes P. Anaesthesia in Children Using the EMO System. Update in Anaesthesia, 1998 (8), Article 6, 1-7
  2. Calmes SH. Arthur Guedel, M.D., and the Eye Signs of Anesthesia. American Society of Anaesthesiologists Newsletter September 2002, 66 (9)
  3. Cole DJ, Domino KB. Depth of anesthesia. Current Opinion in Anaesthesiology; 2009, 22 (6): 782-787
  4. Guedel AE. Anesthesia: A teaching outline. Anesthetic Depths, Surgical Reflexes, Stages and Various Operations. Anesthesia and Analgesia May-June 1936: 120-127
  5. Hall JE, Ebert TJ, Harmer M. Induction characteristics with 3% and 8% sevoflurane in adults: an evaluation of the second stage of anaesthesia and its haemodynamic consequences. Anaesthesia, 2000, 55: 545-550

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Title
Using low cost devices to provide metrics for motor skills training
Authors
Dr Timothy Coles 1, Dr Cedric Dumas 1, Dr David Fielding 2, Dr Andrew Hill 3,4, Dr Marcus Watson 3,4,5
1 The Australian e-Health Research Centre, CSIRO ICT Centre, 2 Department of Thoracic Medicine, Royal Brisbane and Women's Hospital, 3 Queensland Health Clinical Skills Development Service, 4 UQ School of Psychology, 5 UQ School of Medicine
Abstract
Aim: This abstract aims to report on the development of a new part task simulation platform for study and assessment of the medical motor skills of trainees and experts. A case study for bronchoscope manipulation is proposed.

Background: Flexible bronchoscopy is a diagnostic intervention involving the insertion of a light and camera into the bronchial tree to perform visual inspection for suspicious lesions and to perform biopsies for analysis. Bronchoscope navigation, typically learnt in vivo through the apprentice model, where a trainee observes a procedure, practises it under supervision and, when proficient, becomes a mentor themselves. It is a challenging intervention to master in part due to the anatomical variability of the tree structures, where competency requires training in a set of complex theoretical and practical skills. Although alternatives such as mannequin and virtual reality based procedural training exist, fine manipulation control and navigation is only learnt through experience, as a lack of posture knowledge limits the ability to train in these areas. The difficulty to verbalise and/or to assess posture, haptics and fine motor control compounds this training problem because accurate information is difficult to concisely describe.

Methods: To capture additional information during observations of real and simulated bronchoscopies within the Royal Brisbane and Women's Hospital's thoracic medicine department, a platform for capturing body posture and bronchoscope manipulation during simulated procedures is proposed. The platform is based on low cost devices that can be easily replicated and deployed. Figure 1 depicts the proposed setup.

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Title
Development of a novel, low-cost, laparoscopic simulator for the performance of pelvic lymphadenectomy in cancer surgery
Authors
Dr R Kevin Reynolds, Dr Pamela Andreatta
University of Michigan
Abstract
Aims: Learning advanced laparoscopy for surgical treatment of cancer requires the novice surgeon to develop several key skills including recognition of surgical planes, awareness of anatomic structures including potentially dangerous or fragile areas, and mastery of dissection by applying appropriate force to tissues without causing injury. An instructor must allow the learner to carry out the steps of a lymphadenectomy when the skills of the learner are subjectively deemed to be adequate to the task without placing the patient at undue risk. The premise of surgical simulation is that practice of related skills on a simulator will improve surgical skill necessary to safely carry out pelvic lymph node resection prior to operating on human subjects. The primary aim of this project was to develop a novel, low-cost laparoscopic simulator capable of replicating tissues for which coordinated surgical skills must be utilized in the performance of lymph node resection.

Background: Laparoscopic lymph node resection is both prognostic and therapeutic for treating a number of cancers including endometrial cancer. The pelvic nodes are attached to critical vascular and neural structures that are easily damaged. Boundaries of the pelvic node dissection include the bifurcation of the common ileac artery superiorly, the psoas muscle laterally, the inguinal ligament inferiorly, the anterior division of the hypogastric artery medially, and the obturator nerve posteriorly. The nodes are soft, easily fractured, and bleed easily. There is no simulator that currently replicates the anatomy and the technique of lymph node dissection for cancer treatment surgery.

Methods: A pelvic sidewall model was created with clay upon which various materials were tested to replicate the appearance, integrity and fragility of normal arteries, veins, nerves, and lymph nodes. A die was produced for the arterial and venous systems with which vessels were cast using several polymer combinations in addition to silicone rubber. Nerves were constructed using rubber bands, and nodes were replicated with soft materials including foam rubber, clay, Silly Putty™, polystyrene foam; and Floam™, a soft, moldable child's toy. Adhesives including silicone adhesive, Super Glue™, and rubber cement were tested for attachment of nodes to vessels with realistic adhesion to replicate the surgical procedure.

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Title
Should cognitive aids be treated as medical devices?
Authors
Dr Stuart Marshall, Southern Health
Abstract
Cognitive aids are displayed prompts designed to help users complete a task or series of tasks (1). If seen as tools to help users' performance, they could reasonably be conceptualised as medical devices. The development of medical devices their design processes and testing are expected to conform to the international standards for medical devices (2). A literature review was undertaken to discover the extent to which cognitive aids for anaesthetic emergencies conform to medical devices standards in terms of the content to achieve their intended goals, their design and training in their use (3). The majority of papers describing a cognitive aid show that great care is taken to ensure current best practices are adhered to. Unfortunately, little attention seems to be paid to the design or training in the cognitive aid. Usability specifications are often ill defined and testing in real world or simulated naturalistic settings are uncommon. Specifically, the devices are rarely tested in the team-based situations that most will be used in, with no evidence that cognitive aids improve team performance in simulated crises. Cognitive aids should be considered as medical devices. Processes of cognitive aid development should adhere to existing usability engineering principles related to medical devices. By treating cognitive aids in this way, it can reasonably assured that they are fit for the purpose for which they were intended.

References:

  1. Reason J. Cognitive aids in process environments: prostheses or tools? International Journal of Man-Machine Studies. 1987;27:463-70.
  2. IE C. 62366, Ed.1: Medical devices – Application of usability engineering to medical devices. USA: International Electrotechnical Commission; 2007.
  3. Marshall S.D. Use of Cognitive Aids During Emergencies in Anesthesia: A Review of the Literature (Under Review)

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Session 19 – Free Papers 5 – Surgical Skills Training
Wednesday 1330–1500 – Level 3 – Grand Ballroom A

Chair: Wendy Babidge

Title
Four-day, simulation-based suturing & knot tying workshop equates 1st year residents with the performance of senior residents in Honduras
Authors
Dr Pamela Andreatta 1, Dr Tara Lang 2, Dr Brian Brost 2
1 University of Michigan, 2 Mayo Clinic
Abstract
Aims: Evaluate a 4-day, proficiency-targeted, simulation-based knot tying and suturing workshop for first year Obstetric & Gynecology residents in Honduras.

Background: Knot-tying and suturing are fundamental surgical skills for open procedures. Mastery of these skills is emphasized during medical school and residency programs [1, 2]. Training programs incorporating proficiency targets with simulation-based practice have demonstrated adept acquisition of these skills within a 4-week training interval. [3] The benefits of a focused 4-day simulation based workshop tied to proficiency targets in knot-tying and suturing for open surgical procedures has not been evaluated, however potential benefits for outreach training in global health are significant.

Methods: Eighteen (1st year = 9, 2nd/3rd year = 9) Obstetrics & Gynecology residents from Honduras participated in a 4-day workshop focusing on two-handed knot tying and suturing skills required for repairing Obstetric related lacerations. Other procedural skills related to the management of Obstetric emergencies were also taught during the workshop. Pre- and post-training performance assessments were implemented for knot tying, suturing a 2-layer incision using a running stitch, and suturing a 1-layer incision using a running locked stitch. Proficiency targets for sutures included: correct stitch, layers closed correctly, 10 cm incision offset, 10 cm spacing between sutures. Proficiency targets for knot-tying included: correct knot, placement and tension.

References:

  1. Sanders CW, Edwards JC, Burdenski TK. A survey of basic technical skills of medical students. Acad Med 2004;79:873.
  2. McMahon DJ, Chen S, Maclellan DG. Formal teaching of basic surgical skills. Aust NZ J Surg 1995;65:607.
  3. Scott DJ, Goova MT, Tesfay ST. A cost-effective proficiency-based knot-tying and suturing curriculum for residency programs. Journal of Surgical Research 2007;141:7-15. doi:10.1016/j.jss.2007.02.043

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Title
Does high-fidelity simulation training improve self-confidence of junior physiotherapists performing ICU clinical skills?
Authors
Mr Daniel Seller 1,2, Ms Lindsay Beavers 1, Dr Robert O'Brien 2, Dr Kim Brock 1
1 Physiotherapy Department, St Vincent's Hospital, 2 Medical Education Unit, St Vincent's Hospital
Abstract
Aims: To assess the effect of a module-based high-fidelity simulation training program on the self confidence of junior physiotherapy staff performing Intensive Care Unit (ICU) clinical skills.

Background: Our hospital began utilising simulation technology for ICU clinical skills training of junior physiotherapists in 2010. The format for each module of the original training program was approximately 50% tutorial, 50% bedside practical session with a high-fidelity mannequin. The program has evolved to practical clinical vignettes based around each topic (e.g. Tracheostomy Management), followed by structured debriefing. Existing literature investigating simulation in physiotherapy training is scarce – although one study1 reported improved confidence in physical therapy students when simulation was incorporated into their pre-clinical curriculum.

Methods: Prior to the simulation program, all thirteen (13) participants completed an online survey investigating confidence, experience, and self-rated competence across different aspects of ICU physiotherapy, including assessment and treatment techniques, equipment, and different clinical presentations. Confidence questions used a 5-point Likert scale, and comprised multiple components – such as multiple different physiotherapy techniques within the “Treatment” question. Responses for each component were added to provide an aggregate score for each question. The initial survey also collected demographic data including previous physiotherapy and simulation experience. Participants completed 1-4 simulation sessions – depending on previous simulation experience and staff availability – covering the following topics: Introduction to Simulation / General Assessment of ICU Patients; Assessment of Haemodynamically Unstable ICU Patients; Tracheostomy Management; and Acute Respiratory Failure. Each session involved two teams of 2-3 participants: one team participated in a vignette-based scenario with the other observing. The teams then switched and a new scenario was run based on the same topic. Learning objectives for the session were outlined prior to commencing each scenario, and on completion a structured debrief using a plus/delta model was conducted to consolidate the learning objectives. At the completion of the entire program, all participants were re-surveyed.

References:

  1. Shoemaker MJ, Riemersma L, and Perkins R, Use of high fidelity human simulation to teach physical therapist decision-making skills for the intensive care setting. Cardiopulm Phys Ther J, 2009. 20(1): p. 13-18.

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Title
Prediction of aptitude for colonoscope tip control
Authors
Dr Hans De Visser 1, Ms Nancy Yu 1, Dr Norm Good 1, Dr Andrew Hill 2,3, Associate Professor Marcus Watson 2,3,4 
1 The Australian e-Health Research Centre, CSIRO, 2 Queensland Health Clinical Skills Development Service, 3 School of Psychology, The University of Queensland, 4 School of Medicine, The University of Queensland
Abstract
Aim: This paper aims to determine whether a significant relationship exists between the ability to efficiently steer a virtual endoscope model using a computer keyboard and the ability to efficiently steer the endoscope model using the control knobs on a (modified) real endoscope.

Background: In colonoscopy, the gastroenterologist is required to manoeuvre a flexible endoscope through the highly deformable colon by using the steerable tip of the endoscope. Poor natural motor skills and spatial awareness could inhibit a gastroenterologist from ever becoming as efficient as their peers. Endoscopy training programs could benefit significantly from a cost efficient test to identify early on in the training process those individuals that are highly suitable to become gastroenterologists and those that are not likely to succeed because of poor aptitude.

Methods: Fifteen volunteers with non-medical backgrounds were asked to perform a number of path-following tasks within the virtual environment of the CSIRO Colonoscopy Simulator. For each task, participants were required to use either a computer keyboard or a modified endoscope to control the movement of a virtual endoscope tip to follow a path on the (virtual) endoscope monitor. The experiments consisted of six sessions that were evenly spread over three weeks. Each session consisted of two sets of tasks, one with each controller type: keyboard or endoscope. Which controller was used first at the first session alternated between participants, and also alternated for each participant between sessions. Each set consisted of the same six tasks randomly ordered. Participants were assessed on the time it took them to finish each task.

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Title
Surgeon versus non-surgeon training
Authors
Associate Professor Wendy Babidge, Nicholas Marlow, Meryl Altree, John Field, Peter Hewett, Tan Swee Chin, Guy Maddern, FRACS
Abstract
Aims: This study compared surgeon and non-surgeon trainers to determine whether experience backgrounds have any influence on the outcomes of participants learning the basic tasks of laparoscopic surgery on surgical simulators.

Method: Attempt data was drawn from three hundred and ninety eight participants from Queensland, New South Wales, Victoria, South Australia and Western Australia. The number of attempts taken to reach proficiency for both surgeon and non-surgeon trained cohorts were compared.

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Session 20 – Free Papers 6 – Utilizing our Resources
Wednesday 1330–1500 – Level 4 – Room 3

Chair: Tess Vawser

Title
Establishing a Clinical Simulation Support Unit (CSSU) in Western Australia: How we achieved it and why it promotes successful outcomes
Authors
Dr Claire Langdon, Mr Richard Clark
Clinical Simulation Support Unit
Abstract
Aims: This paper will discuss how the Clinical Simulation Support Unit has brought a strategic and cohesive approach to the delivery of Simulation Training in Western Australia. We will discuss how it was achieved, and lessons learned from our experience.

Background: WA Health historically:

  • Provided approximately 1,250 simulation training courses annually. Eighty percent of these were medium to low fidelity courses focusing on life support and emergency medical treatment. These courses accounted for approximately 60% of training expenditure, and were mostly half- or one-day courses.
  • Had insufficient dedicated staffing to provide or support simulation training without enough staff to make full use of available equipment.
  • Had no formal communication networks in place for simulation training, with no state-wide coordination of simulation training for the various health professions.
  • Had a central budget as well as Area Health Service (AHS) monies. This resulted in independent development of simulation training at various sites and increased the likelihood of
    • duplicating effort unnecessarily,
    • failing to detect gaps in functionality,
    • uncoordinated maintenance, and
    • delivering less than adequate staff and course development.
  • Had an ongoing need to develop strategies to manage efficient, cost-effective and safe training for undergraduate students from all health disciplines.

In 2012 the Clinical Simulation Support Unit was established as part of the Health Simulation Training Strategy for Western Australia. This paper will discuss how the CSSU has successfully brought together stakeholders from Public, Private, NGO and Education to plan and deliver cohesive simulation training in WA.

Methods: The Immersive and Simulation Based Learning (ISL) Committee was formed in 2008 and brought together stakeholders from different jurisdictions to work collaboratively in planning how delivery of simulation training in WA could be achieved. Responding to a need for increased capacity for simulation training, Health Workforce Australia made funding available for distribution for capital works and programs. The CSSU has followed the blueprint developed by the Committee to successfully deliver the most cohesive and cross-sectoral program of capital and recurrent projects.

Reference:

  1. WA Health Simulation Training Strategy (HSTS ) Medical Workforce Branch, Department of Health Western Australia 2010.

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Title
Space matters: Creating effective learning spaces
Authors
Dr Joanne Gray, Ms Michelle Kelly, Ms Jane Raymond, Ms Rosemarie Hogan
Faculty of Nursing, Midwifery and Health. University of Technology, Sydney
Abstract
Aims: The aims of this project were to gain an insight into students' perception of their preferred simulation laboratory learning environment, and to identify those learning space design concepts that encourage the active engagement of the student.

Background: Evidence suggests that today's students tend to place great value on connecting with others and want their learning experiences to replicate these values (Van Note Chism, 2006). These students therefore favour active, participatory, experiential learning, much the same learning style they exhibit in their personal lives (Baird & Fisher, 2005). Space can have a significant impact on teaching and learning. The influence of “built pedagogy”, or the ability of space to define how students are taught, is very powerful (Oblinger, 2006). The ways in which a space is designed therefore shapes the learning that happens in that space. Strange and Banning (2002) suggest that although the essential features of the learning environment might theoretically support various possibilities, the layout, location, and arrangement of space and facilities make some behaviours more (or less) likely than others.

Methods: The project had several data collection phases with students participating in a workshop where they viewed trigger photos of a range of different simulation laboratory spaces; working in groups to redesign the simulation laboratory space; using video and photography to capture the design concepts, and then participating in focus group discussions. In addition, a survey of all undergraduate nursing and midwifery students was conducted to gain their views of these learning spaces.

References:

  1. Baird, D.E., & Fisher, M. (2005). Social media, gen Y and digital learning styles. Journal of Educational Technology Systems, 34 (1), 205-6
  2. Oblinger, D.G. (2006). Space as a change agent. In D.G. Oblinger, (Ed), Learning Spaces. EDU CAUSE (Ebook). Accessed 6.12.2010 http://www.educause.edu/LearningSpaces
  3. Strange, C., & Banning J.H. (2002). Educating by Design: Creating Campus Learning Environments That Work. San Francisco: Jossey-Bass
  4. Van Note Chism, N. (2006). Challenging traditional assumptions and rethinking learning spaces, In D.G. Oblinger, (Ed), Learning Spaces. EDU CAUSE (Ebook). Accessed 6.12.2010 http://www. educause.edu/LearningSpaces

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Title
State wide accreditation for simulation sites
Authors
Mr Matthew Shuker, Mr Dylan Campher, Miss Jodie Litherland, Mr Lucas Tomczak, Dr Peter Thomas, Miss Lisa McCoy 
Clinical Skills Development Service, Queensland Health
Abstract
Aim: To develop accreditation standards, framework, and implementation tools to raise and monitor the quality of simulation based education throughout the state.

Background: A distributed delivery model for simulation based education is used throughout the state that establishes and supports various sized simulation centres in local hospitals and community centres. The quality of the centres varies greatly across the state due to a number of factors. It was identified that greater support was needed to provide a quality framework for local sites. The only current accreditation available in the simulation industry is not specific to Australian needs, and can be expensive and impractical for smaller centres.

Methods: A range of accreditation tools and quality frameworks where reviewed, and it was determined that a similar model to the Australian Qualifications and Training Framework (AQTF) would be developed and tailored to meet local needs. The initial standards framework and criteria was developed, and then consultation was conducted state wide through a simulation delivery project to refine the criteria and requirements for achieving accreditation. Once these standards and criteria were finalised a number of possible solutions to auditing and accrediting the sites were proposed. The proposed implementation strategies were also sent out for stakeholder consultation.

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Title
The Victorian Simulation Alliance – a model for collaboration, professional development and resource sharing
Authors
Ms Leone English Holmesglen Institute
Abstract
Introduction: Effective collaboration is integral to the ongoing development and implementation of sustainable simulation-based health professional education. This presentation outlines the genesis of the Victorian Simulation Alliance (VSA), a state-wide multidisciplinary ‘community of practice’ established in 2010. The VSA connects and supports health professional educators from across universities, vocational education and public and private health. The VSA has contributed actively to setting the strategic direction of simulation in Victoria.

The presentation will outline the VSA model and its implementation with a view to informing and encouraging the establishment of further alliances in other Australian states. Challenges will be highlighted and strategies used in overcoming these will be discussed.

Background: The dynamic nature of health care delivery, and advances in technology, have driven rapid growth in simulation-based health professional education over the last decade. This is not only evident at the undergraduate level but is also an important component of ongoing professional development as contemporary clinical practice requires the health professional to participate in ongoing training and assessment to continually refine and update their clinical practice (Gaba, 2004).

The VSA was established in response to a perceived need within Victoria to support health professional educators in the developing area of simulation-based education and has been modelled on the successful Bay Area Simulation Collaborative (BAS C) and Californian Simulation Alliance (CSA), established through the California Institute for Nursing and Health (CINH) in San Francisco. CINH has provided continued advice and support during the establishment of the VSA.

The mission of the VSA is aimed at “creating an environment that fosters collegiality, collaboration, networking and sharing among those engaged in health professional simulation-based education and research.” The VSA model provides a platform for: creating a cohesive voice & a common language; facilitating ongoing professional development; information dissemination; best practice identification; scenario development & sharing; fostering collaboration & partnerships; facilitating inter-organisational research; informing standard & policy setting; identifying opportunities & lobbying for funding and forming global links.

VSA Progress: In 2011 the Alliance established its web platform; conducted a training needs analysis; implemented a tailored training program; established a Research Committee and applied successfully for Health Workforce Australia (HWA) funding. Members of the VSA Steering Committee have also been actively involved at a state and regional level in informing the strategic direction of simulation activities.

This year, with the assistance of the HWA funding, the Alliance is setting up a Simulation Facilitator Pool which will enable education providers to access appropriately qualified Simulation Facilitators on a short-term needs basis. This will provide the ability to flex training up and down, providing an efficient and cost-effective use of limited resources. 

The VSA is committed to providing quality teaching and learning resources for its members and is currently working on the development of a range of validated simulation scenarios. Working cooperatively will assist in ensuring the sustainability of simulation-based education, helping to mitigate the relatively high costs associated with this form of training through the sharing of resources and expertise.

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Session 25 – Free Papers 7 – Simulation for new audiences
Thursday 1100–1230 – Level 4 – Grand Ballroom B

Chair: Gwendolen Jull

Title
Building confidence and skills in tracheostomy management for speech pathologists: Trial of a workforce training program using human mannequin simulation
Authors
Professor Elizabeth Ward 1,2, Ms Sonia Baker 3, Ms Brooke Duggan 4, Ms Laurelie Wall 2, Ms Keli Hancock 4, Ms Lynell Bassett 3, Mr Trent Hyde 5
1 Centre for Functioning and Health Research, Queensland Health, 2 School of Health and Rehabilitation Sciences, The University of Queensland, 3 Speech Pathology Department, Royal Brisbane & Women's Hospital, Queensland Health, 4 Speech Pathology Department, Princess Alexandra Hospital, Queensland Health, Australia, 5 Clinical Skills Development Service, Queensland Health
Abstract
Aims: To
  1. Appraise clinicians' perceptions of a simulated learning environment for acquiring tracheostomy management skills, and
  2. Evaluate the development of clinicians' tracheostomy management skills and confidence achieved through attending the one-day simulation training workshop.

Background: There are currently insufficient training opportunities to prepare speech pathologists to work with patients with a tracheostomy and 25% of clinicians who manage this caseload do not feel confident in their skills.1,2 Opportunities for workplace tracheostomy training is also inconsistent across services.1,2 Current workplace training models are dependent on available and appropriate patients, and clinical training may take place sporadically over months. Hence, the challenge is to find a way to provide a consistent learning environment and deliver this clinical training in a time efficient manner. Of the various types of simulations, mannequin-based simulations offer the unique opportunity to mimic the physical and physiological responses of a patient, allow clinicians to practice the performance of procedures, and provide real time physiological responses within a very realistic physical setting. This modality may provide a solution for preparing speech pathologists for managing tracheostomy patients in a safe, realistic and time efficient manner.

Methods: Participants: Forty-seven speech pathologists were recruited to attend (in groups of 8 participants) one of six, one day “Tracheostomy and Speech Pathology Simulation (TAS P)” workshops. They were recruited from adult health settings state-wide via an expression of interest (EOI ) process, with strategic sampling employed to ensure diversity. Only those speech pathologists who were identified by their departmental managers as needing basic skills training with tracheostomy management population were invited to attend. Procedure: Prior to attending, each participant read the state-wide guidelines for tracheostomy management and completed an online quiz to ensure all had equivalent theoretical knowledge prior to attending. Clinicians then attended the TAS P workshop which involved practice of speech and swallowing management across 8 clinical scenarios using human simulation mannequins set within a simulated critical care ward environment. To evaluate skill learning, participants' performance of key clinical skills tasks (eg., cuff deflation, finger occlusion) during scenarios were rated as “successful or unsuccessful”. Clinicians also completed questionnaires regarding their perceived levels of confidence and their perceptions of the workshop pre-, post- and at four months post-training.

References:

  1. Ward, E., Agius, E., Solley, M., Cornwell, P., & Jones, C. (2008). Preparation, clinical support and confidence of speech-language pathologists managing client with a tracheostomy in Australia. American Journal of Speech-Language Pathology, 17(3), 265-276.
  2. Ward, E., Morgan, T., McGowan, S., Spurgin, A., & Solley, M. (in press). Preparation, clinical support and confidence of speech-language therapists managing clients with a tracheostomy in the UK. International Journal of Language and Communication Disorders.

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Title
Design functions required for physiotherapy in simulation
Authors
Felicity Blackstock 1, Kate Watson 2
1 Department of Physiotherapy, School of Allied Health, La Trobe University, Bundoora, VIC 3086, Australia
2 Division of Physiotherapy, School of Health and Rehabilitation Science, The University of Queensland, St Lucia, QLD,4072 Australia
Abstract
Aims: Design and implement appropriate SLE scenarios for use in entry-level physiotherapy training as an integrated learning experience with traditional clinical experience. 

Background: The success of a simulated learning environment (SLE) relies on the engagement of students in the learning process. The fidelity of the scenario is a large component of this engagement. Physiotherapy assessment and intervention is based around analysis of movement patterns that are abnormal and/or painful. The fidelity of the simulated experience relies heavily on scenario design and accurate portrayal by the simulated patients (SPs).

Methods: In a series of national RCTs, two SLE models successfully replaced in part, traditional clinical time in both cardiorespiratory (Blackstock et al.,) and musculoskeletal physiotherapy fields (Watson et al. 2012). The design process for each simulated scenario centered on matching course curriculum objectives to the Australian Standards of Physiotherapy Practice. Real interactions between a physiotherapist and patient were filmed. A total of 18 simulated patient scenarios based on these cases were then scripted. Actors were recruited and matched according to case demographics and physical requirements. Training of the actors involved learning the script and studying the DVD film demonstrating the real case. SPs role played the script with a physiotherapist, who provided them with feedback on the accuracy of the psychological and physical portrayal of the case. At the conclusion of the SLE all students were invited to complete a study designed questionnaire about the quality of the SLE experience. Within the questionnaire students were asked to rate the realism of the SLE on a five point Likert scale from (1) strongly agree to (5) strongly disagree and provide open ended comment on their perception of the experience.

References:

  1. Blackstock, F., Watson, K., Morris, N., Jones, A., Wright, A., McMeeken, J., Rivett, D., O'Connor, V., Peterson, R., Haines, T., Watson, G. & Jull, G. (under review). Simulation can contribute part of cardiorespiratory physiotherapy clinical education: two randomised trials. Simulation in Healthcare.
  2. Watson, K., Wright, A., Morris, N., McMeeken, J., Rivett, D., Blackstock, F., Jones, A., Haines, T., O'Connor, V., Watson, G., Peterson, R. & Jull, G. (2012). Can simulation replace part of clinical time? Two parallel randomised controlled trials. Medical Education, 46(7), 657-667.

Disclosure: All authors have disclosed no relevant financial relationships.

Acknowledgements: The authors would like to acknowledge Professor Gwendolen Jull (Lead), Professor Anthony Wright, Professor Norman Morris, Professor Joan McMeeken, Professor Darren Rivett, Dr Anne Jones, Ass Prof Terry Haines, Ass Prof Vivienne O'Connor, Geoffrey Watson, & Ass Prof Raymond Peterson as investigators on the RCT Innovations in Physiotherapy Education.

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Title
Using simulation to facilitate health workforce recruitment
Authors
Nicholas Ralph 1, Associate Professor Melanie Birks 1
1 School of Nursing and Midwifery, CQ University
Abstract
The positive effects of simulation on user engagement are well established. Recently, research on user engagement has centred on the experiences of the student or clinician participating in the simulation. At present, Australia is faced with significant health workforce issues, particularly in the area of recruitment. This presentation will showcase an innovative concept that uses simulation as a key component of a regionally targeted recruitment strategy. The development and implementation of the concept will be addressed in addition to projected recruitment rates associated with simulation.

Session 31 – Free Papers 8 – Simulation for patient safety
Thursday 1330–1500 – Level 4 – Room 1

Chair: Walter Eppich

Title
‘Stemi-sim’ – a ‘process of care’ simulation can help improve door to balloon times for patients with ST elevation myocardial infarction
Authors
Dr Victoria Brazil, Dr Mark Baldwin, Dr Mark Dooris, Ms Helen Muller, Dr Louise Cullen
Royal Brisbane and Women's Hospital
Abstract
Aims: To improve ‘door to balloon’ times for patients with ST elevation myocardial infarction (STEMI), through in situ simulation of patient journeys.

Background: Timely care for patients with STEMI has been shown to improve morbidity and mortality. Reperfusion of ischaemic myocardium is best achieved by percutaneous coronary intervention (PCI) as soon as possible after arrival at hospital – the ‘door-to-balloon’ time. Door-to-balloon time is influenced by the process of care and by the interactions and performance of key teams in the care of STEMI patients.

Methods: Pre-hospital providers and multi-disciplinary teams from Emergency (medical, nursing, patient support) and Cardiology (medical, nursing, imaging) participated in a series of in situ simulations of the STEMI patient journey.

Simulated (manikins and monitor emulators) and standardised patients (actors trained to perform as patients with STEMI ) were used. ‘Patients’ arrived in the emergency department with a paramedic. Participants were required to identify possible candidates for PCI, provide immediate assessment and management, communicate effectively between teams and coordinate physical transfer and urgent intervention in the cardiac catheter suite. After each patient care episode, teams participated in a facilitated debrief to discuss process, teamwork and communication issues, with a focus on areas for improvement.

Data was collected on the performance against time-based targets and quality of care Key Performance Indicators in the simulations. Door-to-balloon times for real STEMI patients presenting to the facility before and after the intervention were collected and analysed using Mann-Whitney tests.

Participants were surveyed up to 1 week after simulation exercises. Data was collected on participant perceptions of the experience, including the simulation and the debrief, and their reflections of how the STEMI patient journey could be improved.

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Title
Utility of combining post-graduate with undergraduate students across professional groups in a high-fidelity simulation
Authors
Mr Matt Johnson, Ms Chantal Parera, Mr Jenni Jennings, Ms Gabrielle Koutoukidis, Mr Jeff Allen, Ms Leone English
Abstract
Aim: This pilot study sought to determine if participants from different professions and education levels can act as confederates in a simulation to increase clinical realism and learning? It also sought to determine if an inter-professional clinical simulation can be used to teach participants about other profession's skill sets. Background: Managing patients requires different health care professions to communicate and collaborate effectively. Despite this, research indicates that cross-discipline communication and collaboration is often problematic.

Studies have shown that effective management can be compromised by a lack of understanding of the skills and responsibilities of other professions, and an inability to manage the discrepancies. IPL is often compromised by a lack of large-scale fidelity that allows for multiple professions to interact as they would in the real world. There are also commonly problems with the depth of available skills and knowledge within the student groups that do not allow the participants to fully participate in the activity.

Method: This program utilized a multi-level simulation centre to create a scenario where nursing students manage a ward of patients, one of whom suddenly deteriorates. Qualified doctors interact with the nurses to manage the patient until it is decided the patient must be transferred to another facility by ambulance. Paramedics undergoing undergraduate training respond to the call in vehicles and are backed up by paramedics completing intensive care training. The paramedic crews are required to take over management of the patient before loading and delivering the patient to a simulated Emergency Department where another group of undergraduate nurses are required to triage and manage the patient. This program is not only unique in that it involves three levels of qualification (qualified doctors, post-graduate paramedics, undergraduate paramedics and undergraduate nurses) but that it uses a team of inter-professional observers to create inter-professional debriefing teams. Qualitative results on the student's perceptions of both the activity and the fidelity of the simulation were collated. Quantitative data regarding the awareness of inter-professional skill sets was also collected.

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Title
Comprehensive clinical care orientation using simulated patients informs quality and safety mechanisms prior to moving to new hospital facilities
Authors
Dr Pamela Andreatta, Dr David Marzano, Dr Roger Smith
University of Michigan Department of Obstetrics and Gynecology
Abstract
Aims: To qualitatively evaluate system-level challenges associated with new hospital facilities using concurrent, comprehensive simulation-based patient care, and to provide recommendations for averting adverse impact on patient care.

Background: Our institution's Ob/Gyn Department moved its entire operations from a 25 bed, centrally oriented facility to a tangential location, fourfold increased footprint, 63 patient suites and 4 operating theatres arranged in logistically and physically distinct pods. Concerns over patient safety and quality of care led us to design an immersive orientation in the new facilities using simulated patients, prior to transferring the clinical care of actual patients. We sought to identify and remedy areas of concern about quality and safety.

Methods: Ob/Gyn clinicians (N=180) participated in simulated patient care necessitating the use of resources required for patient triage, low and high risk antepartum care, normal and urgent intra-partum care, and normal and emergent postpartum care, including surgical interventions. In addition to patient care in the new facilities, participants were paged to consult at each of two institutional emergency departments (ED); pediatric and adult. We asked participants to identify areas of concern, causes for delays, and issues they felt could adversely impact patient care. We analyzed these data using qualitative methods (theme generation, frequency distributions), identified two significant and unanimous care quality challenges, and derived recommendations for systems-level process improvements.

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Title
Research using simulation: cognitive aid design in local anaesthesia toxicity
Authors
Dr David Donnelly, Dr Cate McIntosh
FAN ZCA, Hunter New England Skills & Simulation Centre, Newcastle, Australia
Abstract
The use of cognitive aids in anaesthetic crises has been recommended to improve patient safety. However, simulation- based studies have shown that inadvertent misuse may lead to incorrect or delayed treatment being given. This study aimed to investigate how design can affect the utility and function of a cognitive aid for the specific situation of local anaesthetic (LA) toxicity management.

Twenty doctor-nurse pairs of volunteers were recruited to participate in a simulated case in which a patient developed cardiac arrest due to systemic LA uptake. The first 10 participants were randomised to receive one of three currently available aids to treat LA toxicity. After the scenario, participants completed a written questionnaire and were interviewed regarding the aid's utility, ease of use, design, and their overall satisfaction with the aid. Using this data the aid was re-designed and re-evaluated in an iterative process. An additional 6 doctor-nurse pairs were recruited from a separate health service to test the final iteration of the cognitive aid.

Posters Presented

Note: "Results" and "Conclusions" for Posters will be available on the web-site 6 months after SimHealth.

Session 2 – Professorial Posters 1 – Interprofessional
Tuesday 1330–1500 – Level 3 – Trade Exhibition Area

Chairs: Cyle Sprick and Stephanie O'Regan

Title
(P1) Promoting team health – an exploration of the value of a simulated interprofessional learning program for rural health students
Authors
Associate Professor Penny Paliadelis 1, Professor Ieva Stupans 2, Ms Anthea Fagan 3, Ms Jackie Lea 4, Associate Professor Linda Turner 5, Dr Maree Puxty 6
1 School of Health, University of New England, 2 School of Science & Technology, University of New England, 3 School of Health, University of New England, 4 School of Health, University of New England, 5 School of Health, University of New England, 6 School of Rural Medicine, University of New England
Abstract
Synopsis: This paper reports on the innovative design and outcomes of a short learning program undertaken by a range of rurally based undergraduate health students. The medical, nursing, pharmacy and social work students worked through two case scenarios via high and low fidelity simulations, using actors, and supported by an online learning site. The program was designed to enhance effective interprofessional teamwork and communication skills prior to graduation. The attitudes and experiences of students who completed the program were explored via pre and post program questionnaires, audience response software and qualitative feedback.

Purpose: The international literature clearly identifies the needs for greater integration of interprofessional education into the curricula of entry-level health professions to enhance mutual respect, effective team-work and patient-centred care across all practice settings. This paper will report on the design and outcomes of an interprofessional learning program that involved undergraduate students of medicine, nursing, pharmacy and social work learning together via a range of simulations and panel sessions to enhance their teamwork and communication skills.

Methods: The learning program was developed by a team of academic and clinical health professionals around the care of two clients with chronic conditions and a range of social problems, within a rural health context. An evaluation methodology was chosen to explore the students' attitudes and experiences of participating in this program. Data consisting of pre and post program surveys, audience response data and qualitative comments, which was analysed to determine the effectiveness of the program in using simulations to promote interprofessional learning.

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Title
(P2) Whole-team or simulations – why aren't there more courses?
Authors
Dr David Cumin, Dr Matt Gers, Associate Professor Jennifer Weller
CMHSE, University of Auckland
Abstract

Aims: This work presents a systematic review of simulators in courses for teaching interdisciplinary teamwork skills in an operating room (OR ) environment.

Background: Observational research of OR teams supports the proposition that failures in teamwork and communication are common and lead directly to compromised patient care and reduced productivity1. The need for interprofessional collaboration and skills in effective teamwork is now widely acknowledged throughout the health care literature2-6. However, few health care providers receive specific training in teamwork2,7.

Simulation is now a popular choice for training purposes and for research into teamwork and communication8. What is striking about existing simulation-based teamwork initiatives, however, is that they tend to focus on one discipline at a time and do little to overcome the inter-professional boundaries between surgeons, anaesthetists, nurses and other members of the healthcare team. This is despite the US Institute of Medicine's directive that teams who work together should be trained together2 and evidence that it is these inter-professional interactions that could currently most benefit from teamwork training9. One barrier to whole OR team simulations may be the lack of meaningfully engaging general surgical models. This review was conducted to identify simulators used by other groups. 

Methods: We searched PubMed, EM BASE, and the Cochrane Library for “simulat* AND (team* OR *discipline) AND “medical” with limits on English results. These publications were used as a primary source from which other publications were identified. We eliminated all papers which did not include specific reference to simulated human patients in a medical environment and those that used actors instead of participants. Studies were also excluded if the simulations did not involve a team of medical personnel relevant to an operating room team.

References:

  1. Lingard L, Espin S, Whyte S, Regehr G, Baker GR, Reznick R, Bohnen J, Orser B, Doran D, and Grober E: Communication failures in the operating room: an observational classification of recurrent types and effects. Quality and Safety in Health Care 2004. 13: 330-334
  2. Kohn LT, Corrigan JM, Donaldson MS, and (Institute of Medicine): To Err is Human: Building a Safer Health System. ed. Washington, D.C., National Academy Press, 2000. pp
  3. Kilner E and Sheppard LA: The role of teamwork and communication in the emergency department – a systematic review. International Emergency Nursing 2010. 18: 127-137
  4. Hammick M, Freeth D, Koppel I, Reeves S, and Barr H: A best evidence systematic review of interprofessional education: BEME Guide no 9. Medical Teacher 2007. 29: 735-751
  5. Freeth D, Ayida G, Berridge EJ, Mackintosh N, Norris B, Sadler C, and Strachan A: Multidisciplinary obstetric simulated emergency scenarios (MOSES ) – promoting patient safety in obstetrics with teamwork-focussed interprofessional simulations. Journal of Continuing Education in the Health Professions 2009. 29: 98-104
  6. Leonard M, Graham S, and Bonacum D: The human factor – the critical importance of effective teamwork and communication in providing safe care. Qual Saf Health Care 2004. 13: i85-i90
  7. Greiner A and Knebel E: Health professional education: a bridge to quality. ed. Washington DC, National Academic Press, 2003. pp
  8. Eppich W, Howard V, Vozenilex j, and Curran I: Simulation-based team training in healthcare. Simulation in Healthcare 2011. 6: S14-S19
  9. Sexton JB, Thomas EJ, and Helmreich RL: Error, stress, and teamwork in medicine and aviation: cross sectional surveys. British Medical Journal 2000. 320: 745-749
  10. Cumin D and Merry AF: Simulators for use in anaesthesia. Anaesthesia 2007. 62: 151-162
  11. McIntosh C, Macario A, Flannagan B, and Gaba DM: Simulation: What does it really cost? Simulation in Healthcare 2006. 1: 109 Abstract #1473
  12. Ziv A, Wolpe PR, Small SD, and Glick S: Simulation-based medical education: An ethical imperative. Academic Medicine 2003. 78: 783-788
  13. Moorthy K, Munz Y, Adams S, Pandey V, and Darzi A: A human factors analysis of technical and team skills among surgical trainees during procedural simulations in a simulated operating theatre. Annals of surgery 2005. 242: 631-9

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Title
(P3) Undergraduate interprofessional learning through simulation crisis team training
Authors
Dr Sok Ying Liaw 1, Dr Chiang Siau 2, Dr Gerald Chua 3, Dr Piyanee Yobas 1, Ms WenTao Zhou 1
1 Alice Lee Centre for Nursing Studies, National University of Singapore
2 National University of Singapore, 3 Jurong General Hospital
Abstract
Aims: The study aimed to make preliminary evaluations of the perceptions of medical and nursing undergraduates regarding the use of a simulation-based approach to interprofessional learning.

Background: Interprofessional learning has been identified as an essential means of ensuring safe and effective patient care. Interprofessional learning, through simulation in a controlled environment, can help individuals from different healthcare professions understand each other better, potentially overcoming attitudinal differences to work together more effectively and improve patient care and outcome.1 This ability to communicate, mutually support and work as a team is especially important when healthcare personnel face the stress of managing a clinical crisis under time-pressure, in a dynamic environment.2

Methods: The program took place in a simulation laboratory using a patient simulator. The session began with a review of TeamSTEPPS (Strategies and Tools to Enhance Performance and Patient Safety) principles. Participants were then assigned to rotating groups of 8 to 10 learners. During a 3-hour session, each group undertook 4 simulation crisis scenarios, with each group subdivided into 2 teams consisting both nursing and medical undergraduates in each team. While one team managed the crisis, the other team observed the scenario through live audio and video-feed. Each scenario lasted 20 minutes and was followed immediately by a debriefing session, facilitated by a nursing and a medical facilitator. A pretest-posttest design was conducted to evaluate the outcome of the program. Fifty final year medical (n=32) and nursing students (n=18) at the National University of Singapore (NUS) volunteered to participate the study. The study was approved by a University Institutional Review Board. A questionnaire on perception of simulation-based interprofessional learning was completed anonymously by the undergraduates before and immediately after the simulation session. Each questionnaire consisted of 8 statements using 5-point Likert rating scales and 3 open-ended questions. A paired t-test was used to evaluate changes between pre-test and post-test scores. Open-ended comments were transcribed, coded and analyzed for recurring themes.

References:

  1. Hammick H, Freeth D, Koppel I, Reeves S , Barr H. A best evidence systematic review of interprofessional education: BEME Guide no. 9. Medical Teach 2007; 29(8): 735-51.
  2. Rall M, Gaba DM: Human performance and patient safety. In: Miller RD, ed. Miller's Anesthesia 6th ed. Philadelphia: Churchill Living stone, pp 3021-71.

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Title
(P4) The Randwick Interprofessional Educators (RIPE) Program: Ward simulation for interprofessional education
Authors
Mrs Robyn Endre, Mrs Joanne Rimington, Mr Ross Proctor
Abstract
Aims: The aims were:
  1. Develop innovative interprofessional learning opportunities
  2. Build faculty capacity in interprofessional teaching
  3. Address issues of effective teamwor
  4. Increase understanding of simulation
  5. Improve the knowledge base and debriefing skills of our group.

Through all of this we sought to link these attributes and skills to the patient as the centre of all care. In order to achieve these aims, we designed a program that would enable final year undergraduate students to experience working in a collaborative culture as an Interprofessional (IP) team member in a carefully constructed simulated healthcare environment and supported situation. Our first interprofessional team included medicine, nursing, pharmacy, social work and physiotherapy/exercise physiology. In building capacity, we aimed to foster an improved mutual understanding of our respective roles.

Background: A 2010 survey on patient's perspectives of NS W public hospitals reported that staff teamwork was the single factor most likely to influence whether patients viewed their care as excellent or poor 1. Enhancing interprofessional client-centred collaborative practice is needed to provide more effective and efficient care, along with improving client engagement and participation. Similarly, in 2010, a World Health Organisation (WHO) report emphasised the need for increased collaborative healthcare practice to strengthen health systems and health outcomes and linked the development of ‘collaborative-practice-ready health care professionals’ directly to the development and implementation of effective interprofessional education. 2

Methods: A simulation was conducted in one day with a two-phase scenario repeated three times and involving six groups of five final year students. Participants were self-selected (medicine) or allocated by supervisors from the other healthcare professions. Three patients and a family member were professional actors. An experienced senior nurse educator was the Nurse unit Manager. Patient and visitor scripts and roles were developed by our interprofessional group and based on scenarios developed from actual patient events. Relevant clinical paperwork normally available on the ward was present. Access was made available to a realistic range of equipment and drugs. A pre-briefing was conducted for each group to outline the objectives and process of the simulation. It was emphasised, that the focus was interprofessional communication and teamwork not clinical skills. We designed our own pre- and post-questionnaires to evaluate interprofessional awareness based on Likert scales; these were not student assessment tools.

References:

  1. Chief Executives Newsletter, South East Sydney Local Health District, The NE WS, 18th April 2012. NS W Health Patient Survey, see: http://www.health.nsw.gov.au/hospitals/patient_survey/index.asp
  2. World Health Organisation (2010). Health Professions Network Nursing and Midwifery Office within the Department of Human Resources for Health. Framework for action on interprofessional education & collaborative practice. Geneva: World Health Organisation.

 

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Title
(P6) Ward rounds: Developing a collaborative best practice model of interdisciplinary teaching for multidisciplinary practice
Authors
Associate Professor Patrea Andersen 1, Professor Noel Tait 2, Professor Kenneth Walsh 3, Ms Pauline Gaetani 4, Professor Alison Jones 5, Associate Professor Angela Brown 6
1 University of Wollongong
2 University of Wollongong
3 University of Wollongong
4 IS HD Wollongong Hospital
5 University of Wollongong
6 University of Wollongong
Abstract
Ward rounds are an everyday occurrence in clinical practice. They provide the means for assessing patient care needs and communicating these within a multidisciplinary team. The literature demonstrates poor ward round practice contributes to poor patient care outcomes (O'Hare, 2008). Garling (2008) identifies that there is a need to change current practise and facilitate more effective interdisciplinary communication.

This presentation reports collaborative research between The Illawarra Shoalhaven Local Health District (ISL HD) and The University of Wollongong. Using a Practice Development methodology, the aim of the research is to develop and test a best practice model for conducting ward rounds and develop interdisciplinary communication and team work. The model and accompanying teaching resources arising from the project will be incorporate into undergraduate Medicine and Nursing curricula and later extended to New Graduate Nursing, Pre-Vocational JMO and Junior Allied Health staff induction programmes. Immersive simulation and debriefing supported by facilitated workshops and online resources which focus on developing communication and teamwork, provide the medium to bring students from differing health disciplines together and support interdisciplinary teaching.

Details regarding the best practice model, the interdisciplinary simulation structure, teaching package, supporting learning objects including the results of pre and post intervention testing to date will be presented. This presentation will be of particular interest to people involved in health professional education who are interested in developing interdisciplinary partnerships and teaching resources utilising simulation to facilitate the development of interdisciplinary communication and team work, and enhance the work readiness of graduates of health programmes – making teams work!

References:

  1. Garling, P. (2008). Special commission of enquiry acute care services in NS W public hospitals. Final Report, NSW Government: Sydney.
  2. O'Hare, J. (2008). Review Article: Anatomy of the ward round. European Journal Internal Medicine, 19, 309-146.

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Session 8 – Professorial Posters 2 – Surgical/procedural & technology-based simulation
Tuesday 1530–1700 – Level 3 – Trade Exhibition Area

Chair: Jennifer Weller

Title
(P8) Simulation workshop for paediatric bronchoscopic removal of inhaled foreign bodies
Authors
Dr John Curotta 1, Ms Sue Trapani 1, Dr Matija Daniel 1, Dr Marlene Soma 4, Dr Sally Wharton 2, Dr Justin Skowno 2, Ms Ella Scott 3
1 The Children's Hospital at Westmead, Dept ENT Surgery, 2 The Children's Hospital at Westmead, Dept Anaesthetics, 3 The Children's Hospital at Westmead, Kim Oates Paediatric Simulation Centre, 4 Sydney Children's Hospital, Dept ENT Surgery
Abstract
Background: Inhalation of foreign bodies by children is uncommon and can be immediately life-threatening or produce an unstable clinical situation. The patient is typically a 2-3 year old child. Management requires complex equipment, high skill levels and cognitive input from anaesthetic, nursing and surgical teams.

Method: Our workshop focuses on familiarising participants with the clinical background, the equipment and its assembly and cooperation between teams and highlighting indicators of the deteriorating patient and responses. The duration of the workshop is a 3 hour half day conducted in the Kim Oates Australian Paediatric Simulation Centre at The Children's Hospital, Westmead. The format involves skills stations followed by scenarios and debriefing (conducted in the operating room type environment). This workshop is targeted at Specialists in Advanced Training (Anaesthetic and ENT) and operating theatre nurses with an aim to focus on the procedural skills required and coordination between the team. The Laerdal SimBaby is used along with appropriate paediatric bronchoscopes and tower? to mimic the complexities of foreign body inhalation. 

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Title
(P9) Assessment of medical expertise using computer-based simulation
Authors
Dr Marino Festa 1,3, Mr Thomas Loveday 2, Dr David Schell 3, Associate Professor Mark Wiggins 2
1 Kim Oates Australasian Paediatric Simulation Centre, 2 School of Psychology, Macquarie University, 3 Department of Paediatric Intensive Care, Children's Hospital at Westmead
Abstract
Aim: This study describes the use of an interactive computer-based series of simulations to measure and assess expert performance amongst a large and diverse group of intensive care practitioners of variable experience and expertise.

Background: Immersive simulation allows the learner to practice and reflect on high-level decision-making and patient management skills in a safe and supportive environment. However, learners differ in their levels of prior skill and ability and this may impact learning outcomes. Some of these differences are attributable to previous exposure and experience in relevant clinical situations (Grabner et al., 2007). While time in post in a position of responsibility correlates with expertise, the rate of acquisition of expertise is not necessarily uniform across individuals, even with the similar levels of exposure (Taatgen, 2002). There is evidence to suggest that as individuals progress towards expertise, there is a qualitative change in the way in which they process task-related information (Wiggins et al., 2002). This qualitative shift in performance appears to reflect an increased reliance on the perception and utilisation of key task-related cues (Lipshitz et al., 2001). It is proposed that a greater understanding of the relationship between expertise and simulation-based lesson design is fundamental to the efficient and successful use of immersive simulation for training in healthcare.

Methods: Fifty participants with experience as clinicians in paediatric intensive care were recruited whilst attending the 6th World Congress in Pediatric Critical Care Medicine in Sydney in 2011. Participants undertook a series of PC-based interactive simulated scenarios (EXPERTise) that were designed to measure performance using static and dynamic cues on four different assessment tasks. Participant behaviour and speed of performance were analysed to allow the differentiation of expert and non-expert performance. The validity of this differentiation was examined in a subsequent diagnostic task incorporating static and dynamic simulated cues.

References:

  1. Grabner, R.H., Stern, E., & Neubauer, A.C. (2007). Individual differences in chess expertise: A psychometric investigation. Acta Psychologica, 124, 398-420.
  2. Taatgen, N.A. (2002). A model of individual differences in skill acquisition in the Kanfer-Ackerman air traffic control task. Cognitive Systems Research, 3, 103-112
  3. Wiggins, M., Stevens, C., Howard, A., Henley, I., and O'Hare, D. (2002). Expert, intermediate and novice performance during simulated pre-flight decision-making. Australian Journal of Psychology, 54, 162-167.
  4. Lipshitz, R., Klein, G., Orasanu, J., & Salas, E. (2001). Focus article: Taking stock

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Title
(P10) Evaluation of using telemedicine in unexpected disasters (earthquake) in city of Tehran, Iran
Authors
Ms Dina Ziadlou1, Mr Pier Hossein Kolivand2, Mr Nasrohalh Nasrabadi3
1 MS, Information Technology Engineering, Shahid Beheshti University of Medica, 2 MS,Business Administartor, Industrial management organization, 3 PhD Candidate of medical informatic, Tehran University
Abstract
The subject of decrease in effects of a disaster is a complex process because all measures leading to decrease in damages of a disaster should be considered which itself requires considering many matters like engineering, management and medicine. One of the most important needs of developing countries is offering health and treatment services in disasters and emergency situations. Human disputes, droughts, natural disasters (floods, earthquakes and storms) can rapidly cause death or a big catastrophe. Meanwhile crisis management with an appropriate planning can set the society for prevention, preparation, aid and reconstruction.

Considering that the country of Iran geo-technologically is situated on earthquake belt, it is subject to devastating earthquakes and using new technologies like Telemedicine can have a great effect in the structure of crisis management of Iran.

In this research proposed for the first time in Iran, structure of crisis management, Telemedicine devices and telecommunication systems have been verified and by assessing needs in time of unexpected disasters- earthquake in Tehran metropolis; I have reached to a proposed plan for adding Telemedicine unit in structure of crisis management plan in e-government. In a crisis maneuver, performed in a hospital for evaluation of using Telemedicine in crisis, using present telecommunication connections and Telemedicine systems in one group included that twenty persons and not using Telemedicine systems in other group with the same number, the status of both were verified and their weak and strong points were evaluated.

Key words: Telemedicine, Crisis management, Earthquake

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Title
(P11) Extending possibilities – developments in virtual worlds as clinical simulation platforms
Authors
Mr David Holloway, Dr Linda Dawson, Dr Patrea Andersen
University of Wollongong
Abstract
Aims:
  • Discuss the utility of virtual worlds as an effective education tool
  • Provide insight into the current state of virtual worlds as a clinical simulation platform, with emphasis on broader immersive scenarios
  • Highlight the evidence supporting virtual worlds as a platform to increase practitioner competence and confidence
  • Emphasise how virtual worlds can make multidisciplinary simulation more achievable
  • Identify key areas for future development in the field

Background: Over the past five years, there has been a significant increase in interest in the use of virtual worlds like Second Life and OpenSim as educational tools. Although virtual reality training has been part of surgical training for decades, a body of evidence is being developed within the health professions that demonstrates the effectiveness of 3D virtual environments across nursing, midwifery and the allied health professions. More specifically, the need for improved communication between the disciplines is well identified and virtual world platforms provide a cost-effective opportunity to create immersive multidisciplinary scenarios.

Methods: A review of published research since 2007 was conducted, with an emphasis on virtual world simulations looking beyond a particular clinical procedure, to broader immersive scenarios. The virtual environments themselves were limited to ones that have potential for widespread application due to their relatively low setup costs and ability for sharing of data between educators. In light of the trends from the literature, key areas for future development were identified.

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Title
(P12) To cure, to kill, or to test? Decision-making tendencies in a medical paradigm, the role of individual differences in feelings of confidence
Authors
Mr Simon Jackson, Dr Sabina Kleitman
University of Sydney
Abstract
Aims: The present study focused on how judgement (diagnostic) confidence, and its accuracy (calibration and discrimination), guides subsequent decision (treatment) behaviour. The first aim was to investigate whether stable individual differences in Confidence, Calibration, and Discrimination emerged across cognitive and decision-making domains. Further aims were to establish whether these differences could predict stable differences in decision-making tendencies acquired utilizing a novel paradigm: The Medical Decision-Making Test (MDMT).

Background: Improving clinician diagnostic and treatment accuracy is of the utmost importance. To reliably test and develop optimal clinician performance, it is necessary to identify the underlying psychological processes involved. Furthermore, developing valid and reliable simulation based tests are required to conduct a thorough analysis of group and individual differences in performance for a variety of reasons.

Method: 193 undergraduate psychology students completed the MDMT and three cognitive ability tests (accompanied by confidence ratings after each question), a personality questionnaire, and the Need for Closure questionnaire.

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Title
(P13) Integrated virtual patient and standardized patient training course
Authors
Dr Che-Wei Lin
Taipei Medical University Wan Fang Hospital Clinical Skill Center
Abstract
Aim: We hereby presented our preliminary experience on a novel clinical assessment/training model iOS CE.

Background: We utilized both standardized patients (SP) and a virtual patientsimulation software. To achieve a comprehensive and formative assessment of our students' clinical competencies, this assessment model is designed as a short OS CE (using one specific scenario for a series of test sessions) that contains 5 integrated components (stations).

Methodology: After providing a brief orientation to the examinees, they would go through the following stations to receive assessment of specific clinical skills. Station 1 is planned to assess the competencies of history taking and physical examination by using a SP; Station 2 is designed for assess the ability of differential diagnosis from the information gotten from previous station by virtual patient system differential diagnosis page; Station 3 is aimed to assess of the ability of laboratory and imaging tests decision making and interpretation by virtual patient; Station 4 is intended to assess the ability of diagnosis and clinical reasoning by using virtual patient; and Station 5 is a session for giving feedback to the examinees by the tutor.

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Session 14 – Professorial Posters 3 – Centre/program based
Wednesday 1100–1230 – Level 3 – Trade Exhibition Area

Chairs: Peter Brooks and Margaret Bearman

Title
(P14) Participant perspectives of a national training program for simulation educators and technicians – The AusSETT program
Authors
Ms Kristy Freeman 3, Professor Jennene Greenhill 6, Professor Brian Jolly 1, Professor Debra Nestel 1, Professor Harry Owen 6, Ms Leanne Rogers 6, Professor Cobie Rudd 5, Dr Cyle Sprick 6, Ms Beverly Sutton 1, Associate Professor Marcus Watson 3, 4, Dr Margaret Bearman 1, Professor Peter Brooks 2, Mr Dylan Campher 3
1 Monash University, 2 University of Melbourne, 3 Queensland Health, 4 University of Queensland, 5 Edith Cowan University, 6 Flinders University
Abstract
Aim: The aim of this presentation is to share evaluation data from participants of the only national simulation educator and technician training program in Australia.

Background: The drivers for simulation-based education (SBE) in the health professions are well documented. SBE has seen a dramatic uptake in the last decade offering learning and assessment opportunities that are difficult to access by other educational methods. Competent faculty is seen as key to high quality SBE.

Five Australian universities were commissioned by Health Workforce Australia (HWA) to develop a national training program for simulation educators and technicians/coordinators – the AusSETT program. HWA is responding to a significant national health workforce issue – the need to facilitate the quality of SBE.

Methods: AusSETT is an intensive train-the-trainer program, which offers a 12-week program with two to three intensive days of 4-6 modules, underpinned by an electronic portfolio permitting peer assessment of skills. Each module is designed to take between four and eight hours, and includes online resources. AusSETT is being offered across all health professions in all jurisdictions. Topics include: core foundations for training-the-trainer; a basic introduction to SBE; manikin based SBE; simulated patient methodology; virtual patient methodology and audiovisual training. The AusSETT program employs a range of evaluation methods. In this presentation we will report on participants' perspectives of the program from baseline and follow-up questionnaires, module evaluations and module submissions. All participants are invited to complete evaluations. Descriptive statistics will be used to compute numerical data while free text is analyzed thematically.

Disclosure: The universities of the authors have received funds for work associated with the AusSETT Program

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Title
(P15) Developing a national program for simulation educators and technician trainers: Evaluation of a community of practice
Authors
Dr Margaret Bearman 1, Mr Dylan Campher 3, Ms Kirsty Freeman 5, Professor Jennene Greenhill 6, Professor Brian Jolly 1, Professor Debra Nestel 1, Professor Harry Owen 6, Ms Leanne Rogers 6, Professor Cobie Rudd 5, Dr Cyle Sprick 6, Ms Beverly Sutton 1, Associate Professor Marcus Watson 3 & 4, Professor Peter Brooks 2
1 Monash University, 2 University of Melbourne, 3 Queensland Health, 4 University of Queensland, 5 Edith Cowan University, 6 Flinders University
Abstract
Aims: This presentation aims to share experiences of the group funded to develop a national training program. The presentation will use the notion of “communities of practice” to view the process of the development, implementation and evaluation of the AusSETT Program.

Background: A group of Australian universities was formed to tender for the development of a Health Workforce Australia-funded national training program for simulation educators and technicians/coordinators – the AusSETT Program. This process represents national investment in the health professional educator workforce with respect to simulation-based education (SBE). It also facilitates the development of a shared understanding of the competencies of an SBE workforce. The work of the group can be understood through the theoretical lens of a ‘community of practice’ framework.

Methods: The group of universities had existing, divergent and potentially competing programs that focused on developing faculty for SBE in healthcare. The development processes of transforming these disparate materials into a new program are evaluated against Wenger's1 ‘community of practice’ model.

Reference:

  1. E Wenger, Communities of Practice, 1998: Cambridge, Cambridge University Press

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Title
(P16) Identifying and training key skills in simulation instructors: The Coordinated Approach to Simulation-based Training (CAST)
Authors
Ms Jennifer Hogan 1, Ms Susan Ballinger-Doran 1, Ms Tracey Nichols 1, Dr Stuart Marshall 1,2,3
1 Southern Health Simulation Centre, 2 Monash University, Health PEER, 3 University of Queensland, School of Psychology
Abstract
Introduction: Simulation education is not a ‘walk-up’ start. The journey to producing effective simulation learning sessions includes planning and preparation of material along with deliberate practice and reflection on key skills of facilitation. We set out to identify the fundamental skills of expert simulation educators prior to the development of a comprehensive train-the-trainer course.

Methods: Over a decade of instructor experience and participant feedback from train-the-trainer sessions at our centre were reviewed to identify the key skills obtained by expert simulation facilitators. Further evidence was drawn from video review of the facilitation behaviours of seven instructors1, and the self-assessment feedback of students' emotional stress during simulation sessions2 from two previous studies. These ideal behaviours along with relevant educational theories were identified. Four senior simulation instructors constructed an inventory of key skills relating to educational theory and current pedagogies of simulation. Finally a comprehensive train-the-trainer course was created from the required skill set.

References:

  1. Hogan, J., Flanagan, B., Marshall S. What facilitation skills and behaviours optimise students' learning when using a simulator in the ‘pause and discuss’ mode? Focus on Health Professional Education: A Multi-Disciplinary Journal 2008 10 (2);36-37
  2. Ballinger Doran, S. Preparation (familiarisation) of learners into the simulation-based learning environment. Masters' of Education Thesis, 2011 Monash University.
  3. Flin et al (2003) Development of the NOTE CHS system for assessing pilots' CRM skills. Human Factors and Aerospace Safety, 3, 95-117.

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Title
(P17) Development of a state wide curriculum sharing database
Authors
Mr Matthew Shuker, Mr Dylan Campher, Mr Shane Convine, Dr Peter Thomas
Clinical Skills Development Service, Queensland Health
Abstract
Aim: To build an online database that would allow curriculum and other related resources to be shared throughout the state to provide simulation educators with access to standardised materials. Background: A distributed delivery model for simulation based education is used throughout the state and provides support to various sized centres in training of simulation coordinators and faculty, and supply and maintenance of simulation and audio visual equipment. The need was identified by stakeholders across the state to provide access to standardised course materials, providing further support to time poor educators and coordinators that hold clinical and educator positions.

Methods: Consultation was conducted state wide through a simulation delivery project to scope the requirements for the online database. Database developers and other IT specialists were included in the process to ensure the proposed database was feasible. Proposed designs and scoping documents were circulated to the stakeholder group on a regular basis until consensus was reached on how the database would be built.

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Title
(P18) Health Workforce Australia: Planning a national program for simulation educators and technicians
Authors
Ms Rachel Riordan 3, Ms Juleen Browning 3, Ms Katie Walker 1,2
1 New York City Health & Hospitals Corporation, 2 Society for Simulation in Healthcare, 3 Health Workforce Australia
Abstract
Aim: The purpose of the Training Program is to increase simulation educator and technician training capacity and quality.

Background/Introduction: Health Workforce Australia (HWA) is a government funded agency with a mandate to reform the healthcare workforce in Australia. A key program of HWA is the $94M Simulated Learning Environments (SLE) Program which seeks to train healthcare professionals more efficiently and effectively through the adoption of simulation techniques1.

The main objectives of the SLE Program are to:

  • Increase the use of simulated learning modalities in clinical training for entry level health professionals;
  • Optimise clinical training experiences through the use of simulation techniques to develop clinical skills and competencies required by health professionals;
  • Increase access to simulated learning techniques for students in regional, rural and remote settings; and
  • Improve quality and consistency of clinical training.

In order to achieve these objectives, HWA is undertaking a number of projects. Work was initially undertaken in an initial twelve health professions to identify aspects of curricula most effectively delivered through learning using simulation techniques. A report 2 that summarised the findings of this work included common recommendations across the professions. One of these recommendations was to invest in human resources including training of educators and technicians. This abstract describes the commissioning of a national Training Program for simulation educators and technicians.

Method: The Training Program will:

  • include all curricula and learning materials for delivery of the Training Program
  • include an e-learning component
  • include face to face sessions
  • use a train the trainer model
  • increase capacity of simulation educators and technicians within the Australian healthcare context
  • be delivered by multiple simulation education providers in each state and territory
  • encompass a learning package that skills educators for teaching using a variety of simulation modalities
  • ensure a quality standard for simulator educators and technicians.

The Training Program will have the capacity to apply generically across professions and across all levels of training in health professional education.

References:

  1. http://www.hwa.gov.au/programs/clinical-training/simulated-learning-environments-sles
  2. http://www.hwa.gov.au/sites/uploads/simulated-learning-environments-2010-12.pdf

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Title
(P12) To cure, to kill, or to test? Decision-making tendencies in a medical paradigm, the role of individual differences in feelings of confidence
Authors
Mr Simon Jackson, Dr Sabina Kleitman
University of Sydney
Abstract
Aims: The present study focused on how judgement (diagnostic) confidence, and its accuracy (calibration and discrimination), guides subsequent decision (treatment) behaviour. The first aim was to investigate whether stable individual differences in Confidence, Calibration, and Discrimination emerged across cognitive and decision-making domains. Further aims were to establish whether these differences could predict stable differences in decision-making tendencies acquired utilizing a novel paradigm: The Medical Decision-Making Test (MDMT).

Background: Improving clinician diagnostic and treatment accuracy is of the utmost importance. To reliably test and develop optimal clinician performance, it is necessary to identify the underlying psychological processes involved. Furthermore, developing valid and reliable simulation based tests are required to conduct a thorough analysis of group and individual differences in performance for a variety of reasons.

Method: 193 undergraduate psychology students completed the MDMT and three cognitive ability tests (accompanied by confidence ratings after each question), a personality questionnaire, and the Need for Closure questionnaire.

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Session 26 – Professorial Posters 4 – Nursing
Thursday 1100–1230 – Level 3 – Trade Exhibition Area

Chairs: Debra Kiegaldie and Leanne Rogers

Title
(P20) Three month evaluation of nurses' clinical emergency response training using immersive high-fidelity simulation
Authors
Dr Christopher Gordon, Dr Thomas Buckley
Sydney Nursing School, The University of Sydney
Abstract
Aim: To determine the effect of an intensive high-fidelity immersive simulation program on graduate nurses perceptions of emergency skill competency in the workplace. Background: The early detection and management of patients with deteriorating conditions is currently a major focus of clinical research and practice development. Almost in parallel, the adoption of simulation into nursing curricula has received widespread support.

Methods: Seventy graduate RN s undertook a clinical emergency response training program. The 4 day program included: lectures, resuscitation workshops using Resusci Anne simulator®, team building exercises and repeated clinical emergency scenarios in an immersive high-fidelity environment utilising Sim-man®. Scenarios focussed on airway and breathing difficulties, cardiac arrhythmia recognition, chest pain, electrolyte disturbances, hypotension and cardiac arrest. We evaluated participants (n=52) self-ratings of technical and non-technical skill competency when dealing with actual clinical emergencies and the types of emergencies experienced 3 month after training. Student t-tests were used to compare responses at 3-months compared to immediately following the training and Spearman's rank-order correlation to evaluate associations at 3 months.

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Title
(P23) Simulation training of a new undergraduate nursing programme in Hong Kong
Authors
Mr Alan Yat Kwan Tsang, Ms Suet Lai Wong, Ms Baljit Kaur, Ms Cora Ka Yee Lo, Ms Cathy Nga Yan Lee
The Open University of Hong Kong
Abstract
Aims: To develop a strategic plan to establish a new simulation training centre and incorporating simulation training in the curriculum of a new five-year undergraduate nursing programme.

Background: Simulation training is incorporated in the curriculum of the fouryear undergraduate nursing programme of the Open University of Hong Kong since 2007. With the introduction of 3-3-4 education system in Hong Kong, the four-year programme will transform to a five-year programme in 2012. A simulation training team is set up to plan a new simulation training centre to meet the projected increase in number of nursing students and formulate the simulation training pedagogy to pace their learning of clinical nursing skills and develop their critical thinking and problem solving abilities.

Methods: SWOT (Strengths, Weaknesses, Opportunities, and Threats) was used as a framework to guide the strategic planning of the new simulation training centre and simulation training pedagogy of the new nursing curriculum.

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Title
(P24) Competency of fundamental clinical assessment of novice undergraduate nursing students: A pilot study
Authors
Ms Suet Lai Wong, Mr Alan Yat Kwan Tsang, Ms Baljit Kaur, Ms Cora Ka Yee Lo, Ms Cathy Nga Yan Lee
The Open University of Hong Kong
Abstract
Aims: The purpose of this study is to evaluate the competency of year-one undergraduate nursing students on fundamental clinical assessment and documentation of findings.

Background: Nursing faculties are challenged to implement teaching strategies that ensure competency of year-one undergraduate nursing students to perform basic clinical assessment and documentation before their first clinical placement. Human simulators training as pedagogy of fundamental clinical assessment skills allows nursing students to practice skills in a mimic environment before working in a real setting.

Methods: Each year-one undergraduate nursing student received a total of six hours simulation training and practice after the theoretic input. The contents of the simulation training included features of human simulators, hand-on skills of fundamental clinical assessment with essential equipments, and the proper patient documentation. They learned how to measure the blood pressure manually, to palpate pulses, to listen to breath sounds by using a stethoscope, and to document findings. After the completion of simulation training, each nursing student was assessed on the competency of fundamental clinical assessment and documentation by randomly on one of nine scenarios within a 10-minute period. The process of each nursing student's 10-minute assessment period was video recorded. By reviewing the video records, one checklist was used to evaluate whether nursing students had achieved the required steps of fundamental clinical assessment. Another checklist with a maximum score 25 was used to evaluate the accuracy and correctness of the documentation.

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Title
(P25) A collaborative initiative supporting the development and implementation of SLE teaching and learning in nursing curricula
Authors
Associate Professor Patrea Andersen 1, Professor Patrick Crookes 2, Mr Roy Brown 3, Professor Tracey Levette-Jones 4, Mr Stephen Guinea 5, Professor Margaret McAllister 6, Associate Professor Kerry Reid-Searl 7, Associate Professor Christopher McCafferty 8
1 University of Wollongong, 2 University of Wollongong, 3 University of Wollongong, 4 University of Newcastle, 5 Australian Catholic University (Victoria), 6 University of the Sunshine Coast, 7 Central Queensland University, 8 Edith Cowan University
Abstract
This presentation reports a collaborative initiative lead by the University of Wollongong School of Nursing Midwifery and Indigenous Health to support increasing clinical training capacity initiatives and the implementation of SLE teaching and learning in nursing curricula. The pooled expertise of recognised nursing academics working in the field of simulation representing six Australian universities are engaged in developing a curriculum resource that comprise of fifty-six hours of clinical simulation scenarios. The resource utilises a range of simulation modalities which allow the user to tailor teaching to their facilities and curricula. Professional competencies (ANM C, 2008) and critical practice components identified by Crookes et al., (2010), Levett-Jones et al., (2010) and Rudd, et al (2010) provided the foundation for the resource development. Simulation scenarios are designed to enhance develop of clinical competence in medication and IV administration, clinical reasoning, patient assessment, monitoring and management of the deteriorating patient and associated clinical interventions, communication and interdisciplinary team work.

The Predict, Prevent, Manage and Promote (PPMP) model (Alfaro-LeFevre, 2009) provides a structure within scenarios to enhance outcomes and address quality and safety. Information and resources regarding debriefing methodologies are included. While providing a structured teaching resource that support faculty implement SLE teaching and learning activity, this resource may also provide nursing programmes that have in excess of 800 hrs, the capacity to supplement 40hrs (1 wk) of clinical placement. Using a simulation resource such as this to replicate clinical situations may provide more flexibility in programme delivery. This may result in decreasing demand on placements, whilst at the same time providing a means for supporting the increase of student intakes to meet workforce demands.

This presentation will provide information about the SLE package, including a sample of materials and how these can be used. This presentation will be of particular interest to people involved in nursing education who are seeking resources to support the planning and implementation of SLE teaching and learning in curricula, and who seek to enhance student competence and readiness for practice.

References:

  1. Alfaro-LeFevre, R. (2009). Critical Thinking and Clinical Judgment: A Practical Approach to Outcome-focused Thinking, 4th Ed. Philadelphia: Elsevier – Saunders
  2. Australian Nursing & Midwifery Council. (2008). National Competency Standards for the Registered Nurse. Canberra: Australian Nursing & Midwifery Council
  3. Crookes, P., Brown, R., Dignam, D., Edwards, H. & McCutcheon, H. (2010). ‘The development of a pre-registration nursing competencies assessment tool for use across Australian universities’, ALT C.
  4. Levett-Jones, T., Hoffman, K., Dempsey, J., Jeong, S., Noble, D., Norton, C A., Roche, J. & Hickey, N. (2010). ‘The ‘five rights’ of clinical reasoning: an educational model to enhance nursing students' ability to identify and manage clinically ‘at risk’ patients’, Nurse Education Today, vol. 30, pp. 515-520.
  5. Rudd, K., Freeman, K., Swift, A. & Smith, P. (2010). ‘Use of simulated learning environments in nursing curricula’, Health Work Force Australia.

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Session 32 – Professorial Posters 5 – Paediatrics & emergency medicine
Thursday 1330–1500 – Level 3 – Trade Exhibition Area

Chairs: Harry Owen and Brett Williams

Title
(P26) Identifying incidents of suboptimal care during paediatric emergencies – An observational study utilising insitu and simulation centre scenarios
Authors
Dr Fenton O'Leary 1,2, Dr Andrea Christoff 1, Ms Jennifer Major 1, Ms Ingrid Wolfsberger 1, Dr Francis Lockie 1, Dr Sally Wharton 3
1 Emergency Department, The Children's Hospital at Westmead, 2 Sydney Medical School, University of Sydney, 3 Anaesthetic Department, The Children's Hospital at Westmead
Abstract
Aims: The aim of this paper was to identify sub optimal care during standardised scenarios and to identify the potential causation factors.

Background: Life threatening paediatric emergencies are relatively uncommon events, however, when they do occur staff caring for these children must have the ability to recognise the deterioration, evaluate, immediately treat and obtain help for these patients. Standardised simulations in the working environment, such as the emergency department or operating theatre, or within a simulation centre enable these situations to be recreated realistically, on demand, without any risk to a patient or the participants. 

Methods: Participants were emergency department and operating theatre staff and students from a tertiary paediatric hospital. Ethical review board approval was obtained prior to commencement of the study. Participants either participated in or observed standardised scenarios as part of the emergency department and operating theatre interdisciplinary education program, insitu or in a simulation centre. Scenarios reflected real cases where possible. Incidents of sub optimal care were identified during scenarios and were analysed by thematic qualitative assessment methods. Potential causation factors were elicited during scenarios and during facilitated debriefs immediately after. Senior clinicians identified the sub optimal incidents and were trained in debriefing to elicit causation factors. Causation factors were attributed to any of seven pre-defined categories, with multiple causation factors allowed for each incident.

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Title
(P27) Design and delivery of a PICU in-situ simulation training program
Authors
Dr Andrea Christoff 1, Ms Lynette Kirby 1, Dr Marino Festa 1,2
1 Department of Paediatric Intensive Care, The Children's Hospital at Westmead, 2 Kim Oates Australasian Paediatric Simulation Centre
Abstract
Aim: To design a training program for junior doctors and nurses in the paediatric intensive care unit (PICU), to be delivered using multi-disciplinary in-situ simulation based training.

Background: The ability to simulate real-life clinical situations in the medical environment is becoming increasingly important. In-situ simulation is used to help re-create realistic clinical scenarios in a team environment (1). In-situ simulation benefits the learners involved because it simulates real clinical situations in a familiar environment and can be used to augment established curriculum. Evidence suggests the use of simulation-based methods for clinical and team training provides an opportunity for medical and nursing staff to practice skills needed to effectively manage patients in real clinical situations (2).

Methods: An in-situ simulation training program designed to incorporate specific learning objectives derived from established nursing and medical staff intensive care training curricula is described. Program content (topics) was chosen after collaboration and consultation with nurse educators and senior medical staff and review of adverse events in the PICU. Wherever possible, teaching scenarios for each topic were designed utilizing factors from real clinical events in PICU, with a focus on nursing and medical staff training needs. Each scenario was designed to deliver specific learning objectives relevant to the topic.

References:

  1. Kneebone, RL, Scott, W, et al. (2004) Simulation and Clinical Practice: Strengthening the Relationship. Medical Education, 38, 1095-1102.
  2. Andreatta, PB, Bullough, AS, et al. (2010) Simulation and Team training. Clinical Obstetrics and Gynecology, 53, 532-544.

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Title
(P29) Realism in resuscitation training – Does time matter?
Authors
Dr Kristian Krogh 1, Professor Berit Eika 1, Dr Christian Bjerre Høyer 2
1 Centre for Medical Education, Aarhus University, 2 Institute of Forensic Medicine, Aarhus University
Abstract
Aims: This study explores the impact of realism in time during resuscitation training in simulation-based education (SBE).

Background: Resuscitation is an essential clinical skill for medical professionals. Simulation-based courses are a prominent educational modality for teaching and assessing cardiopulmonary resuscitation (CPR)[1, 2]. It is important to optimize the outcome of courses to secure the best treatment for people suffering from cardiac arrest[3, 4]. It is observed that young doctors are not able to keep track of time and rush CPR during resuscitation in real live resuscitation attempts as well as in simulation. This may lead to impaired resuscitation. The reason for this neglect of time during resuscitation is unknown. One factor could be the impairment of time control during simulation-based training[5, 6]. Instructors often compress time, in the sense that the 120 seconds CPR between heart rhythm controls/defibrillation is compressed to 30-60 seconds during training. To explorer the impact of realism in time during SBE it is questioned who novices' resuscitation performance is affected by real time compared to compressed time during SBE?

Method: Participants were voluntary recruited during their 4th year of medical school at Aarhus University, Denmark. Out of 131 invited 52 completed the course. All were novices with no prior education in advanced resuscitation. The course was a one day course in resuscitation based on the European Resuscitation Council's (ERC) Advanced Life Support (ALS ) – Guidelines 2010[7-11] divided equally between lectures and simulation training.

  • Group 1 (Intervention): Participants used 120 seconds of CPR between rhythm controls/defibrillation.
  • Group 2 (Control): Participants used compressed “120 seconds” of CPR (30-45 seconds) between rhythm controls/defibrillation.

Participants were assessed using the validated ER C CAST est[12], developed to the ER C ALS provider course in a post-test only design.

References:

  1. Domuracki KJ et al: Learning on a simulator does transfer to clinical practice. Resuscitation 2009, 80(3):346-349.
  2. Gaba DM: The future vision of simulation in healthcare. Simul Healthc 2007, 2(2):126-135.
  3. Andersen PO et al: Development of a formative assessment tool for measurement of performance in multi-professional resuscitation teams. Resuscitation 2010, 81(6):703-711.
  4. Andersen PO et al: Critical incidents related to cardiac arrests reported to the Danish Patient Safety Database. Resuscitation 2010, 81(3):312-316.
  5. Soar J et al: European Resuscitation Council Guidelines for Resuscitation 2010 Section 9. Principles of education in resuscitation. Resuscitation 2010, 81(10):1434-1444.
  6. Wulf G et al: Motor skill learning and performance: a review of influential factors. Med Educ 2010, 44(1):75-84.
  7. Nolan JP et al: European Resuscitation Council Guidelines for Resuscitation 2010 Section 1. Executive summary. Resuscitation 2010, 81(10):1219-1276.
  8. Deakin CD et al: European Resuscitation Council Guidelines for Resuscitation 2010 Section 4. Adult advanced life support. Resuscitation 2010, 81(10):1305-1352.
  9. Nolan JP et al: Part 1: Executive summary: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Resuscitation 2010, 81 Suppl 1:e1-25.
  10. Nadkarni VM et al: Part 2: International collaboration in resuscitation science: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2010, 122(16 Suppl 2):S276-282.
  11. Deakin CD et al: Part 8: Advanced life support: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2010, 81 Suppl 1:e93-e174.
  12. Ringsted C et al: Assessment of Advanced Life Support competence when combining different test methods-reliability and validity. Resuscitation 2007, 75(1):153-160.

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Title
(P30) Factors affecting year 3 medical students' mastery of clinical skills in the complex ward based environments
Authors
Ms Evelyn Dalton 1, Ms Helen Wozniak 2, Ms Sue Ralston `
1 Sydney Nursing School, University of Sydney, 2 Flinders University, Northern Terriotory, 3 St John Ambulance, Burwood
Abstract
Aim: Currently, the University of Sydney Graduate Medical Program (USydGMP) students are taught clinical skills such as vital signs, advanced life support in the safe, regulated learning environment of a clinical simulation laboratory, within a hospital setting. The ability of students to transfer these skills to the patients varies considerably, as does the students' confidence in their ability to perform the skill. This project aimed to examine and identify a clinical skill, which the students' learnt in the clinical simulation laboratory and then transferred to their practical work environment, the ward. Blood pressure measurement was used as a trigger to examine the relationship between learning, confidence and performance of the clinical skill. We then sought to identify which learning contexts and what learning strategies enable students to achieve clinical skills mastery in the workplace such as the hospital ward.

Background: Studies have revealed a lack of correlation between a student's clinical experience, level of confidence and performance of clinical skills (1-3). It is also known that medical students are poor self-assessors of their clinical skills (4).

Methods: This research adopts a responsive approach by collecting both quantitative and qualitative data to provide a richer picture of clinical skills learning.

In the first stage 44 USydGMP Year 3 students, at two metropolitan clinical schools in Sydney, were asked to complete a questionnaire about self perceived confidence and experience of learning blood pressure measurement. During stage 2 they were observed performing this skill in the hospital ward. In the third stage, students attended one of the four focus groups (n=28) where they reflected on this experience and discussed factors that affect mastery of clinical skills in the workplace.

References:

  1. Barnsley L, Lyon P, Ralston SJ, Hibbert EJ, Cunningham I, & Gordon FC. Clinical skills in junior medical officers: a comparison of self-reported confidence and observed competence. Med. Educ., 2004. 38: p. 358-67.
  2. Krupat E, Pelletier SR, & Chernicky DW. The Third Year in the first person: Medical students report on their principal clinical year. Acad. Med., 2011. 86: p. 90-96.
  3. Widyandana D, Majoor G, & Scherpbier A. Transfer of Medical Students' clinical skills learned in a clinical laboratory to the care of real patients in the clinical setting: The challenges and suggestions of students in a developing country. Educ. for Health, 2010. 23. p. 6.
  4. Sargeant J, Eva K, Armson H, Chesluk B, Dornan T, Holmboe E, Lockyer J, Loney E, Mann K, & van der Vleuten C. Features of assessment learners use to make informed self-assessments of clinical performance. Med. Educ., 2011. 45: p.12.

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Title
(P31) High fidelity simulation: New curriculum for fourth year undergraduate medical students doing emergency medicine rotation
Authors
Dr Chia Yih Chong Michael, Tan Tock Seng Hospital
Abstract
Aim: We aimed to find out:
  1. the usefulness of incorporating high fidelity simulation for fourth year undergraduate medical students doing emergency medicine rotation;
  2. students' perception of using simulation as a teaching tool.

Background: Numerous conditions in emergency medicine lend themselves particularly useful to training using high fidelity simulation. Recently, with the acquisition of high fidelity mannequins, we revamped our undergraduate medical student curriculum undergoing emergency medicine rotation. Our medical students, in their fourth year of training, spent a total of four weeks in the emergency department. Our new structured teaching program comprises of classroom-styled lectures, bedside procedures and shop floor rotations to mimic shift working life. Continual assessments take the form of mini-CEX. They also underwent basic cardiac lift support training. At the fourth week of their rotation, a session of high fidelity simulation is planned for them.

Methods: A self-administered questionnaire was used. A series of questions were asked to explore the students' perception on the usefulness of simulation.

During simulation training, in addition to teamwork and communications, two main medical conditions were emphasized: 

  1. management of cardiac arrhythmias; and
  2. hemodynamic instability.

We adopted a slightly different approach to simulation training for the undergraduates. For every scenario, they resuscitated the mannequin for fifteen minutes, a debriefing session for thirty minutes followed by a short lecture for another fifteen minutes. This was to cater to different training needs as medical students are generally still in the formative years of building their knowledge base; the short fifteen minutes of classroom-styled lecture enable them to consolidate their knowledge on that particular aspect of management.

In order to encourage self-learning, increase awareness and cultivate interest in simulation, a group of three students were told to come up with one scenario to teach their fellow classmates. They were told to re-enact one patient they had co-managed together on the shopfloor. Under guidance from their clinical tutor and simulation technologist, they proceeded to design and program the scenario. During simulation training, they played the scenario on their fellow classmates, while they themselves took on the role of facilitators.

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Posters Displayed

Note: "Results" and "Conclusions" for Posters will be available on the web-site 6 months after SimHealth.

Posters Wednesday Morning Tea – What's happening in healthcare simulation?
Wednesday 1030–1100 – Level 3 – Trade Exhibition Area

Title
(P32) Including a simulation programme into year one nursing practice. How effective in terms of student learning?
Authors
Mrs Nancy McNamara, Waikato Institute of Technology (Wintec)
Abstract
Aims: The aim of this research is to evaluate student learning from the newly introduced simulation programme.

Background: Educating undergraduate nurses in the 21st century provides some very realistic challenges. As nursing and faculty shortages collide they create what Hinshaw (2008) calls the “perfect storm” a unique moment in nursing history. This coupled with decreased government health budgets, increased student numbers and higher patient acuities has resulted in a reduction in the availability and quality of clinical placements. Simulated nursing practice is an innervative strategy designed to address these concerns (Kahdong-Edgren, 2011). A simulation programme was designed for Semester 2 undergraduate nursing students as there were no available clinical placements.

Methods: Second semester nursing students each take part in a 40 hour simulation programme which consists of: a four hour clinical workshop followed by a two hour clinical duty and a two hour debrief. Students' work in groups of three, each have an opportunity over the 4 week period to assume the role of primary nurse, observer nurse and patient. Day one each of the students (approximately 84), will be asked to self -assess and rate their knowledge, clinical skills, clinical decision making and critical thinking. They will reassess and rate using by responding to the same questions at the completion of the four week rotation. Results will be analysed on a question to question basis comparing the pre and post ratings.

References:

  1. Hinshaw, A.S. (2008). Navigating the perfect storm: Balancing a culture with workforce challenges. Nursing Research, 57(1S), S4-S10. ns.2010.03.074
  2. Kahdong-Edgren, S. (2011). Report on the 2nd Swiss Conference on Simulated Patients and Simulation. International Nursing Association for Clinical Simulation and Learning. Elsevier Inc. doi 10.1016/j.ecns.2010.10.001
  3. Quint, S., & Kahdong-Edgren, S. (2011). Quint Clinical Judgement in Simulation

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Title
(P33) Assessment of PGY1 doctors clinical performance and teamwork during Emergency Medicine (EM) rotation using high fidelity simulation
Authors
Dr Chia Yih Chong Michael, Tan Tock Seng Hospital
Abstract
Aims: Using high fidelity simulation, this study aims to assess PGY1 doctors' ability to recognize and manage common acute conditions and teamwork during resuscitation.

Background: Before 2010, Singapore Medical Council did not accredit Emergency Department (ED) to train postgraduate year 1 (PGY1) doctors. This was changed in 2010. ED received its first cohort of PGY1 in January 2011. All had 8 months of inpatient ward work experience prior to rotation to ED.

Methods: A group of 7 PGY1 was put through a series of simulated scenarios of acute medical and trauma scenarios. This assessment was performed using a high fidelity mannequin at the end of first week and the last week of their EM rotation. In the week prior to the assessment, they had completed their pre-reading materials and a classroom quiz covering all the key resuscitation principles and common emergency conditions. They were assessed on two major components, namely clinical performance and teamwork. Under clinical performance, examples of components assessed were:

  1. ability to take a targeted history;
  2. ability to perform physical exam;
  3. ability to order appropriate investigations; and
  4. ability to institute acute management based on ABCDE principle.

For teamwork, examples were 1) leader's ability to lead, delegate, facilitate; 2) team's ability to communicate clearly; and 3) overall ability to work as a team effectively. Independent assessors, including peers graded the PGY1. The rating used was a 5-point scale, whereby 1=poor, 3=average and 5=excellent.

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Title
(P34) Development of an instructional model for enhancing self-development competency and productive creativity for social development of Thai nursing students
Authors
Mrs Nongnaphat Rungnoei, Mrs Nittaya Thongma, Mrs Prapaiphis Singhasem, Mrs Thunyaporn Cheunklin, Mrs Mukda Phadungyam, Mrs Angsinee Kansukcharearn
Prachomklao College of Nursing, Praboromarajchanok Institute Institute
Abstract
Aim: This study was to develop an instructional model for enhancing self-development competency and productive creativity for social development.

Background: General education for human development is an important subject for imbuing students' recognition of the importance of self-development, desirable characteristics of graduates, intelligence, wonder as well as self- and social responsibility. This research, aiming to enable the instructions to enhance the values for the society, was based on the concepts of instructional model development1, knowledge creation and creative and productive education2. It also put an emphasis on the learner's possession of desirable characteristics or a person having the perfection in generating the creative ideas and creating the new things for the society as well as 4 characteristics of young generation – Critical mind, Creative mind, Productive mind and Responsible mind (CCPR).

References:

  1. Joyce, B.R., Weil, M. & Calhoun, E. Model of Teaching. 8th ed. London: Allyn & Bacon, 2008.
  2. Sinlarat, P. CCPR: The New Conceptual Framework for Education. Bangkok: Chulalongkorn University Printing House, 2011.

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Title
(P35) Exploration and evaluation of simulation debriefing techniques utilised in undergraduate interprofessional simulation based healthcare education
Authors
Mrs Shanaz Pasha 1, Mrs Gerri Nevin 1, Dr Hora Ejtehadi 1, Professor Ruth Endacott 2 & 3
1 Birmingham City University, 2 Plymouth University, 3 Monash University
Abstract
Aim: To identify and evaluate the effectiveness of debriefing techniques used in undergraduate interprofessional simulation based healthcare education.

Background: Effective team work between healthcare professionals is a fundamental element in the provision of safe and good quality patient care. Research evidence demonstrates that there is poor collaboration between professionals1. Increasing number of interprofessional simulation based education programmes are being developed to improve interprofessional collaboration. Debriefing is described as the most important component of simulated learning2,3. It is recognised that most of the learning of simulation based education takes place during the debriefing, however if the debriefing is poorly conducted it can have a negative impact on learners2,3. A review of the literature reveals that despite its recognised crucial importance there is a paucity of research on simulation debriefing4,5,6. Facilitation of debriefing by competent instructors is important in utilising learning opportunities presented in simulation sessions4. Structure and specific techniques are also deemed to be essential for enhancing learning during debriefing4,7. There is an increasing availability of simulation training courses, however research indicates that there is significant variation in the perceived ideal roles of facilitators and what is implemented in debriefing practice8. It is suggested that debriefing practices vary considerably between facilitators9. It has not been possible to identify research evidence to advocate, what constitutes as best practice in terms of simulation debriefing with undergraduate interprofessional learners. Despite the increase in inter-professional education and training initiatives there are no recommendations on optimal debriefing with learners from a variety of health care professional backgrounds. It is therefore vital and timely to explore the technique or techniques used for debriefing interprofessional learners. Assessment of the efficacy of the debriefing techniques in use is crucial.

Methods: Qualitative and Quantitative methods (multiple methods) will be employed to address the proposed research area. Observation of debriefing sessions, DASH10 tool (student version), questionnaires and semi-structured interviews will be used to gain an understanding of debriefing techniques and evaluation of their effectiveness in achieving the learning objectives. Debriefing facilitators and trainee health care professionals will be invited to participate in the study. Interprofessional learners will consist of medical students, nurses, physiotherapists, operating department practitioners and radiographers.

References:

  1. Reeves, S., Zwarenstein, M., Goldman, J., Barr, H., Freeth, D., Hammick, M., Koppel, I. Interprofessional education: effects on professional practice and health care outcomes (Review). The Cochrane Collaboration; 2009(4):1-21
  2. Rall, M., Manser, T., Howard S. Key elements of debriefing for simulator training. Eur J Anaesthesiol; 2000(17):516-517.
  3. Fanning, R.M., Gaba D.M. (2007) the role of debriefing in simulation-based learning. Simul Healthc; 2007(2):115-125
  4. Raemer, D., Anderson, M., Cheng A., Fanning, R., Nadkarni, V., Savoldelli, G. Research Regarding Debriefing as Part of the Learning Process. Simulation in Healthcare; 2011(6): 52-57
  5. Issenberg, S.B., Ringstead, C., Ostergaard, G., Dieckman, P. Setting a Research Agenda for Simulation-Based Healthcare Education. Sim Health; 2011(6): 155-167
  6. Zigmont, J.J., Kappus, L.J., Sudikoff, S.N. (2011) The 3D Model of Debriefing: Defusing, Discovering and Deepening. Seminars in Perinatology; 2011(35):47-51
  7. Dismukes, R.K., Gaba, D.M., Howard, S.K. So many roads: facilitated debriefing in healthcare. Simul Healthc; 2006(1):23-25
  8. Deikmann, P. Molin Friss, S., Lippert, A., Ostegaard D. The art and science of debriefing in simulation: ideal and practice. Med Teach; 2009 (31):e287-e294
  9. Dreifuerst, K.T. The Essentials of Debriefing in Simulation Learning: A Concept Analysis. Nursing Education Perspectives;2009; 30 (2):109-114
  10. Simon, R., Rudolph, J.W., Raemer, D.B. (2009) Debriefing Assessment for Simulation in Healthcare. Center for Medical Simulation. Cambridge, MA

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Title
(P36) The promotion of student psychological safety during nursing simulation
Authors
Ms Renee Brighton, Associate Professor Patrea Andersen, Ms Leeanne Heaton
University of Wollongong
Abstract
Aims: The use of simulation in nursing education is typically associated with patient safety, but what about the safety of the learner? The aims of this presentation are to examine strategies to help reduce levels of stress and performance anxiety experienced by nursing students undertaking simulation.

Background: When an assessable, simulated exercise was offered for third year, potential graduating nursing students, the assessors noted high levels of student stress and performance anxiety. This was despite the fact the majority of students agreed that they had been suitably prepared to undertake the simulation. Stress and performance anxiety experienced by nursing students during simulation has been modestly discussed in the literature (Ganley & Linnard-Palmer 2010; Gandt 2008), although strategies to help ensure student psychological safety during simulation remains an under-researched area.

Methods: A review of the literature on stress and performance anxiety experienced by nursing students during simulation has been completed. Workshops facilitated by mental health nursing academics for all staff involved in simulation that explore current methods utilised in managing anxiety and performance issues will better assist students cope psychologically.

References:

  1. Gandt, LT 2011, ‘The effect of preparation on student anxiety and performance in summative situations’, Clinical Simulation in Nursing, pp. e1-e9.
  2. Ganley, BJ & Linnard-Palmer, L 2010, ‘Academic safety during nursing simulation: perceptions of nursing students and faculty’, Clinical Simulation in Nursing, pp. e1-e9.

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Title
(P37) Using learning objects to provide context in simulation
Authors
Associate Professor Patrea Andersen, Ms Kay Crookes, Associate Professor Victoria Traynor, Ms Siobhan Wragg
University of Wollongong,
Abstract
Incorporating simulation in curricula is a strategy that provides innovative opportunities to address the challenges of preparing learners for the complexities of clinical practice (Jefferies, 2007). However, where students have had limited exposure to clinical practice their understanding of the context of this may impact on the quality of the learning experience. This is especially so when students are expected to engage in simulation activities that include role play. Using learning objects as a teaching tool and embedding these within the structure of simulation can enhance the quality of the learning experience through facilitating an understanding of the practice context, including how patients present (Windle, McCormick, Dandrea & Wharrad 2011).

This presentation outlines the development and use of a DVD that depicted a series of scenarios related to the assessment and care of a patient with delirium, and how this was incorporated within the structure of simulation in the Challenges of Ageing subject in the Bachelor of Nursing at The University of Wollongong. The results of an initial evaluation of the usefulness of using the DVD as a learning object in simulation, including student and staff perspectives will be presented. Incorporating learning objects in simulation has transferability to other health professions and will be of interest to academics and practitioners interested in teaching methods that prepare students for simulation and enhance the quality of the learning experience.

References:

  1. Jeffries, P. (Ed.). (2007). Simulation in Nursing Education: From Conceptualization to Evaluation. New York: National League for Nursing.
  2. Windle R J, Wharrad H, McCormick D, Dandrea J & Wharrad, H 2011, ‘The characteristics of reusable learning objects that enhance learning: A case study in health-science education’ British Journal of Educational Technology Vol. 42, no. 5, pp. 811-823

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Title
(P38) Clinical skills laboratory or clinical simulation: Does language matter?
Authors
Ms Leeanne Heaton, Associate Professor Patrea Andersen, Professor Patrick Crookes , Associate Professor Margaret Wallace
University of Wollongong
Abstract
Aim: The literature available describing simulation and fidelity often leads to confusion with differing accounts, descriptions and terms used inconsistently. There is growing interest in utilising simulation in undergraduate health care education programs, but it is difficult to develop simulation pedagogy into a curriculum when terms used in the literature are unclear. Churchouse & McCafferty (2011) and Thomas (2011) agree that terms used in simulation are often inconsistent and commonly ‘misused’ and that there is a need for agreement about terms associated with simulation and how they are used. There is concern that simulation in health care education is being developed too hastily with little thought about how the integration of simulation occurs in the curricula. The inconsistent use of terminology will impact on the development of simulation as pedagogy in health care education.

Background: Terminology about simulation can be quite different with some instances depicting the term as a pedagogical approach consistent with behaviourist training methods designed to learn a skill. In others, simulation is an immersive methodology that requires existing knowledge and skills and requires participants to respond to complex situations. The significance of inconsistent terminology has recently been highlighted by The International Nursing Association for Simulation and Learning (INAS CL) (2011) publishing a glossary of terms about simulation. This glossary however, does not necessarily reflect the language people are using about simulation on an international level. To facilitate understanding, terminology needs to have consistent meanings understandable to all involved. It is important to understand definitions and also whether the technique used has had clear benefits to the learning experience of the participant.

Methods: A qualitative design with data collected from individual interviews from a purposive sampling group of people who are actively engaged in clinical simulation and/or clinical skills laboratories related to healthcare. This project draws on the knowledge of educators and their use of terminology in simulation.

References:

  1. Churchouse, C. & McCafferty, C. (2011). Standardized patients versus simulated patients: Is there a difference? Clinical Simulation in Nursing, Article in Press.
  2. The International Nursing Association for Clinical Simulation and Learning (INAS CL) Board of Directors (2011, August). Standard I: Terminology. Clinical Simulation in Nursing, 7(4S), s3-s7.
  3. Thomas, M. J. W. (2011). Dimensions of fidelity. What really is important in training and research? SimHealth Innovation Education Research Conference, Sydney Australia.

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Posters Displayed

Note: "Results" and "Conclusions" for Posters will be available on the web-site 6 months after SimHealth.

Posters Thursday Morning Tea – What's happening in healthcare simulation?
Thursday 1030–1100 – Level 3 – Trade Exhibition Area

Title
(P39) 4 Cornerstones of an efficiently run simulation center
Authors
Mrs Hilaneh Vandia, The Ohio State University College of Nursing
Abstract
Our University has been educating nurses since the early 1900's and with the continuing growth of our very dynamic program the need for education through simulation has also expanded to reflect the changing face of the nursing profession. At present our Simulation Lab/Center currently conducts over 500 patient simulations annually for our nearly 1000 undergraduate and graduate nursing students, as well as nursing interns and other health science students not only separately but also collaboratively. In addition we conduct skills labs for all undergraduate and most graduate students.

In this presentation we will share what we feel are the four “C's” or “Cornerstones” to maximize efficiency, productivity and excellence in our simulation center. The first “C” is what we call the Cast of Players and in it we will share how we maintain faculty/staff as well as the various roles within the lab. We will also discuss our pre-simulation meetings and how we coordinate and cooperate through team work with clinical faculty to enhance the overall simulation experience. The second “C” we call Controlling the Chaos and in this we will share how we purchase, maintain, store and organize the 800,000 health care items utilized by the students in our lab as well as our use of a database to keep current. The third “C” we will discuss is our Collaboration with other colleges within the university such as medicine, respiratory, physical therapy, pharmacy, business and also theatre, art and architecture and also our collaboration with the community at large. We will discuss how we interact with each college and reach into the community to augment the simulation process. The final “C” will center on Cost Effectiveness and various strategies we use in simulation and skills training within the lab to maximize the results for our students through effective and creative use of the monies and resources available to us at the university.

Disclosure: The authors have disclosed no relevant financial relationships and no conflict of interest.

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Title
(P40) The clock is ticking: an exploration of time critical decision making in undergraduate nursing students
Authors
Mr Mark Zasadny, Mrs Angela McKay, Ms Carey Mather, Ms Deb Carnes, Ms Andrea Miller
University of Tasmania (Utas)
Abstract
Aim: The aim of this presentation is to outline the development of a team nursing simulation program at a regional multi-campus university and how this impacts on teaching and learning objectives within the undergraduate nursing curriculum. It focuses on providing students with opportunities to develop knowledge, skills and behaviour that contribute to patient safety within development of the curriculum while using appropriate simulation modalities.

Background: Time management in nursing is a skill that is often covertly developed through trial and error while undertaking work integrated learning or simulation opportunities. For many undergraduate nursing students the administration of medications is an area that students struggle to complete confidently in a timely manner. Lecturers, facilitators and preceptors assist students in expeditious medication management, however, various other factors may overshadow the need for students to grasp the concept of time management as an attribute that is highly desirable in the workplace. The challenge is to incorporate time management into a structured nursing curriculum that allows for students and teaching staff to develop and enhance these skills.

Method: A nursing ward simulation program has been developed to assist students in teams to manage medication administration and identify challenges to safe administration. The focus is on placing students in a simulated learning environment with time pressures that requires critical decisions to be made with integrated dilemmas that need to be addressed. This medication management simulation activity addresses the National Agenda related to medication safety and facilitates a learning opportunity for undergraduate nurses to participate in an initial safety and quality education process as part of their professional development.

The simulation requires students in teams to rotate through a series of scenarios organised as patient medication rounds that require the teams to assess, administer and document medications within a given time frame before moving on to the next patient. The medication team consists of two to three students while one other student acts as the standardised patient for the simulation.

Students are required to deal with emerging dilemmas, and while not critical or harmful to the patient, decisions need to be made as to the most appropriate intervention. Lecturers act as a resource and decision support that can be consulted by students to discuss best course of action.

After completion of the activities, students are involved in a group debrief and have an opportunity to discuss the challenges faced. Students involved in role-playing the standardised patients are also involved in the debrief and offer feedback to the participants on their performance as a ‘nurse’ within the simulation and their perceptions of human interactions, communication and care.

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Title
(P41) Putting the stress back into simulation: A cost effective approach to simulating the environmental stressors of aeromedical and road retrievals
Authors
Justin Willmore, Andrew Heasley, Mater Children's Hospital
Abstract
Aim: Develop a cost effective way to simulate the environmental challenges facing paediatric retrieval teams in both aeromedical and road based transportation. This will improve and familiarise staff to the extrinsic environmental factors common to transportation such as noise, temperature, communications, cabin restrictions and the limited resources which can potentially impact upon the provision of care to critically ill patients.

Background: The Mater Childrens Hospital retrieval team consists of approximately 30 members from both Nursing and Medical backgrounds, and conducts 370 retrievals p/a. It retrieves critically ill children with a variety of illnesses, and utilizes all modes of transport including road, rotary and fixed wing transportation. Access to vehicles/aircraft for the purposes of retrieval training is limited, and does not allow retrieval team members to become familiar with the environmental stressors of transportation.

Method: We will purchase and use partition walls that can be configured to match the dimensions of all vehicles in addition to two dimensional pictures that will recreate a visually realistic simulation environment. We will also attempt to recreate environmental factors by focusing on seating arrangements, personal restraints and harnesses, access to oxygen and suction outlets, use of inboard communication systems and background noise. Retrieval based simulations will then be conducted within this environment.

Results/Conclusion: Work in progress

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Title
(P42) Ensuring an interprofessional approach to simulation training in Western Australia
Authors
Mr Richard Clark, Dr Claire Langdon, Clinical Simulation Support Unit
Abstract
Aims: This paper will discuss how we established a program to deliver Interprofessional Simulation Training across a range of health service providers.

Background: Interprofessional Education occurs when two or more professions learn with, from and about each other to improve collaboration and the quality of care1. The significant increase in numbers of students who are undertaking undergraduate and postgraduate entry training in health care means that the workforce needs to find creative solutions to supply these emerging clinicans with the skills, knowledge and ability they require in order to safely graduate and enter the workforce.

Methods: Using funds provided by Health Workforce Australia, we developed a program that allocated FTE to the public health system for metropolitan and rural hospital sites and to Non Government organisations. The program allocated equal funding to Allied Health and Nursing professions. We allocated a program officer, logistic support officer and clerical support to enable a range of programs targeting IPE simulation training at the sites.

Reference:

  1. UK, Centre for the Advancement of Interprofessional Education, 2002

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Title
(P43) The development of an online problem-solving framework for students to explore case studies
Authors
Mr Roy Brown, Associate Professor Angela Brown, Mr Rob Wright, Ms Joanne McLoughlin, University of Wollongong
Abstract
Aims: The project aims to:
  1. Provide a framework for the student to practise essential workplace skills such as thinking critically, analysing, making predictions and creating plans based on best available data in a simulated situation developed using authentic patient information and the knowledge of experienced practitioners.
  2. Enrich the student's online learning environment with a flexible, self-paced mechanism to explore key curriculum concepts and procedures.

Background: Simulated learning includes many modalities (Decker et al 2008). It is important to actively develop methods of providing engaging and meaningful learning experiences that assist the student towards success (Kolb 1984). This project has been undertaken to take online environments beyond rudimentary access to documents towards more student-centred activity in exploring key curriculum concepts and skills. Focusing on an authentic (real) case study; using a problem-solving approach an online resource has been developed that includes comprehensive patient assessment, an essential skill for graduates of Nursing. The student follows a patient journey through the acute care sector (hospital) and is exposed to “situations”. This patient's journey includes the emergency department/ ward/ theatre/recovery and discharge. The resource enables the nurse to visit each area and be involved in ‘care’. This project utilized the expertise of academics, a learning designer and an expert clinician.

Methods: The core team selected a case and identified operational parameters. The brief was to identify, not only the decision points, but also critical thinking and reasoning and to consider possible options and appropriate responses in real time. The educational design included opportunity within the scenario for the student to revisit evidence and other reference materials (including additional client data). Initially feedback from the academic and clinical team members was used to revise the structure and some content; student feedback initially was through open discussion with actual field testing to come in the near future. An evaluation framework will be incorporated with the universities evaluation cycles of the subject in which this resource is placed. It is intended to assess / evaluate on a number of levels.

References:

  1. Decker S, Sportsman S, Puetz L, Billings L. (2008). The evolution of simulation and its contribution to competency.
  2. J Contin Educ Nurs. Feb; 39(2):74-80. Kolb, D. (1984). Experiential learning: Experience as the source of learning and development. Englewood Cliffs, NJ: Prentice-Hall.

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Title
(P44) Simulated cultural competence: Innovative teaching strategies from a rural Australian university
Authors
Mrs Anthea Fagan, Mrs Pauline Gillan, University of New England, Australia
Abstract
Aims:
  • provide undergraduate nursing students with culturally challenging experiences within a safe and non-threatening environment
  • promote culturally competent nursing practice to undergraduate nursing students
  • promote reflection on culturally challenging issues

Background: Due the increasingly multicultural nature of Australian society and an increasing awareness of the centrality of culture to the provision of effective health care (Daly & Jackson 2003), nursing today provides a culturally challenging prospect for many undergraduate nursing students. Integration of simulated scenarios using a range of culturally challenging situations can provide an exciting, interactive and engaging method of allowing students to practice clinical and culturally appropriate skills. The purpose of this presentation is to showcase a rural university's innovative delivery of cultural competence and clinical based content through simulation to ensure the application of culturally competent care to nursing practice.

Methods: A collaborative teaching team decision was made to use a problem based learning approach. The overall aim of the project was to develop and apply the knowledge and skills of the first year student nurse. A case study approach with elements addressing cultural competence while practising basic clinical skills was simulated in the clinical laboratory teaching at a rural university. The case studies addressed confronting cultural issues, this allowed the students to explore and reflect on their own values and beliefs in a simulated clinical setting. Specific cultural issues explored during simulations included race, religion, socio-economic and sexuality issues.

References:

  1. Daly, J. & Jackson, D. (2003), ‘Transcultural health care: Issues and challenges for nursing’, Contemporary Nurse, Vol 15, Issue 3, pp.8-9.
  2. Grossman, S., Mager, D., Opheim, H. M. & Torbjornsen, A. (2011), ‘A Bi-national Simulation Study to Improve Cultural Awareness in Nursing Students’, Clinical Simulation in Nursing, e1-e6.
  3. Koskinen, L., Abdelhamid, P. & LicPhil, H. L. (2008), ‘The simulation method for learning cultural awareness in nursing’, Diversity in Health and Social Care, 5, pp. 55-63. 
  4. Rutledge, C., Barham, P., Wiles, L. & Benjamin, R. S. (2008), ‘Integrative simulation: A novel approach to educating culturally competent nurses’, Contemporary Nurse, Vol 28, Issue 1-2, pp. 119-128.

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Title
(P45) Using simulation to facilitate engagement and integration of interprofessional learning
Authors
Mrs Melanie Barlow
Abstract
Aim: Simulation is becoming a recognised method of learning within health care that promotes critical thinking, teamwork and an awareness of roles across a range of clinical scenarios (Elliott et al. 2011 & Fox-Robichaud and Nimmo, 2007). The challenge for the organisation, which consists of six hospitals on site both public and private and one regional hospital, was to redirect existing processes for clinical simulated education toward an integrated model. A Simulation Interest Group was developed with the goal of bringing together and engaging education providers across the professions and organisation to improve collaboration and ultimately grow and embed interprofessional learning.

Background: It was found that although some clinical units were successfully demonstrating inter-professional learning in isolation, the multi-hospital campus lacked both coordination and collaboration across the inter-hospital and interprofessional boundaries. Fortunately the findings coincided with the planning for a new purpose built central simulation centre and an interest group was formed that was to be the nucleus of inter-professional learning across the organisation.

Method: Once director level clinical stakeholder engagement in the simulation interest group was established, the group was used to develop and validate simulation education tools, which were made available campus-wide and housed within a web-based central resource library. Validation ensures that the tools and scenarios are clinically accurate, educationally sound and inclusive of organisational policies and initiatives, e.g. clinical handover and risk of the deteriorating patient. A SharePoint collaboration portal was the initial vehicle for communication and housing of resources for the simulation group, which unfortunately was poorly utilised by selective disciplines.

References:

  1. Elliott, S., Murrell, K., Harper, P., Stephens, T & Pellowe, C. (2011). ‘A comprehensive systematic review of the use of simulation in the continuing education and training of qualified medical, nursing and midwifery staff’.
  2. JBI Library of Systematic Reviews 9(17) 538-587 Fox-Robichaud, A. & Nimmo, G. (2007). ‘Education and simulation techniques for improving reliability of care’. Critical Care 13. 737 -741.

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Title
(P46) Professional Development (PD) in remote Australia – a pilot project using High Fidelity Patient Simulation (HFPS): Outcomes and lessons learnt
Authors
Mr Irwyn Shepherd 1, Dr Michael Wilson 1, Dr Tamsin Cockayne 1, Prof Debra Nestel 2
1 NT GPE, 2 NT GPE, 3 NT GPE, 4 Monash University
Abstract
Aim: To educationally prepare General Practitioners (GPs) as Clinical Supervisors, and GP Registrars in the use of HFPS in remote Australia. Background: The Northern Territory (NT ) is the largest of Australia's eight states and territories measuring 1,349,129 square kilometres (520,902 square miles) with a distributed population of 229,675. This creates particular challenges in the provision of professional development (PD). These challenges include professional and social isolation, a mobile workforce, recruitment issues, limited clinical placements, few Clinical Supervisors, lack of exposure to complex, acute clinical presentations and the tyranny of time and distance in an often inhospitable land. This pilot program was designed to support General Practitioners (GPs) in their PD as Clinical Supervisors and for GP Registrars (qualified doctors training to become GP's). The program – Enhancing Vertical Integration in General Practice Training (EV GPT) used HFPS to address some of the challenges associated with delivering simulation-based education to GPs in rural and remote environments. There are few reported studies on the use of HFPS in these environments.

Method: The Program EVI GPT is based on a perceived need identified by NT GPE. The program consists of HFPS-based training that will prepare GPs to enhance their clinical supervisory capabilities. The program is designed to ensure that both the GPR and GP Supervisors are comfortable with the method and techniques needed to deliver high quality HFS. During the program they are familiarised with the set-up of the manikin, how to develop scenarios and best practice in using scenarios in teaching. The educational theories underpinning EV GPT are socio-cultural [1], experiential [2] and expertise development [3]. Program objectives: After completing their program, GP Supervisors and GP Registrars will be expected to be able to:

  • Use new teaching, learning, assessment and evaluation skills relevant to HFPS as an educational method
  • Develop HFS scenarios relevant to the NT Primary Care setting
  • Demonstrate how to create a safe learning environment using HFPS to explore complex clinical and professional issues
  • Reflect on professional support for future GP registrars.

References:

  1. Wenger, E., Communities of Practice: Learning, Meaning and Identity 1998, Cambridge: Cambridge University Press.
  2. Kolb, D. and R. Fry, Toward an applied theory of experiential learning, in Theories of Group Process, C. Cooper, Editor 1975, John Wiley: London.
  3. Ericsson, K., Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains. Academic Medicine, 2004. 79 (10): p. S70.

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Title
(P47) The effects of mild fatigue on laparoscopic skills
Authors
Associate Professor Wendy Babidge, Jurstine Daruwalla, John Field, Meryl Altree, Nicholas Marlow, Peter Hewett, Guy Maddern
Abstract
Aims: This research study examined the impact of fatigue on the ability to maintain basic laparoscopic skills.

Methods: Seventy three Victorian Surgical Trainees, Registered Medical Officers, Interns and Medical Students were enrolled, randomised and trained to proficiency on either a low fidelity FLS box trainer or a high fidelity virtual reality LapSim trainer and then assessed to ascertain a base-line score. Participants were reassessed after working a 10-hour shift.

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