Board 127 - Program Innovations Abstract A Coast to Coast Collaboration

Introduction/Background Privileging is the process by which an institution grants permission to a provider to perform patient care activities. When a hospital grants privileges, it “explicitly endows a [provider] with the right to perform that procedure within its physical and administrative confines”.2 The use of simulation-based assessment (SBA) allows providers to practice and be assessed on a predetermined set of procedures in a controlled and standardized setting until acceptable performance is reached.23 As privileging programs shift toward competency-based assessment, simulation is being utilized to both gain and maintain privileges.25 However, the scope of existing privileging programs that utilize SBA and exactly how SBA is incorporated remains unclear. The objective of this study was to survey simulation centers regarding existing and planned privileging programs that incorporate SBA. Methods Ninety two simulation centers were included in the survey. For feasibility, only simulation centers that were accredited by either the American College of Surgeons (ACS) or from the Society for Simulation in Healthcare (SSiH) were included. The survey took approximately 20-30 minutes to complete and was addressed to directors of simulation centers. Survey data was collected from March through April 2013. Results Twenty seven simulation centers responded (29%). The majority of centers were associated with public hospitals (62%); 33% of centers were associated with private hospitals. All were associated with teaching hospitals. A majority of centers had approximately 5,000-10,000 square feet. Regarding the number of full time employees (FTE’s), this ranged widely from 1 – 52. Nineteen procedures were included in the survey; these were determined based on a review of the literature.33 The procedures that were most often selected as having existing SBA privileging programs included central venous catheterization, sedation, laparoscopic surgery and robotic surgery. The procedures that were most often selected for SBA privileging programs in development included GI endoscopy and bronchoscopy procedures. All of the nineteen procedures surveyed had at least one center with either a current or future SBA program in development. Additional procedures centers reported SBA privileging programs included vein graft harvesting and airway management. Reasons for beginning such programs included desire to develop standards, risk management, patient safety, response or cost reduction related to adverse events, targeting of procedures that occur less frequently and cost reduction related to training. The majority of centers required all providers who performed the given procedure to participate in the program (57%). Centers collaborated with human resources (17%), risk management/legal (33%), quality improvement/quality assurance (42%), medical staff office (58%), continuing medical education (42%), and patient safety (25%). A majority of centers utilized their programs for initial privileging of new providers (57%). Top barriers included institutional political support, provider resistance to participate, litigation from providers (i.e. provider sues hospital if denied privileges), and simulation center staffing and equipment. Methods to develop content for SBA privileging programs included internal expert opinion (69%), literature review (54%), and multi-department (46%) or interprofessional (38%) committees. One center reported that they worked with a credentialing committee; no other Methods of choosing criteria were reported. Methods of delivering the SBA privileging program included testing performance on simulation models (77%) and the use of performance-based checklists (62%). None of the centers reported a method for assessing procedural competency. Conclusion It is clear from the Results that simulation centers are developing SBA privileging programs. However, the process is fragmented as centers are developing programs as single institutions. Further research, publication and guidance is needed so that simulation centers can learn from each other regarding best practices when delivering SBA privileging programs.

BackgroundSimulation forms an integral part of medical training, but the modality is rarely accessed by nursing staff in our Trust. This abstract describes the development of a simulation course targeted...

Bridging medical simulation with computer science and engineering: A growing field of study

ObjectivesTraining effectiveness indicates how good a program has met pre-set training objectives or organizational goals for the best benefit of healthcare professionals and service users in the community. The study aimed to evaluate training effectiveness following implementation of new training curriculum of emergency surgical airway procedures (Cricothyroidotomy) organized by the Queen Elizabeth Hospital. DesignThis training evaluation relied on observational descriptive study design. Timed task on Cricothyroidotomy procedures and standardized post-training questionnaire were applied to assess the first 3 levels of Kirkpatrick's model: (Level-1) Reaction by training satisfaction; (Level-2) Learning by acquisition of knowledge and skills assessment passing rate; (Level-3) Behavior by personal strengths. SettingThis program was operated in the Multi-Disciplinary Simulation and Skills Centre, a hospital-based high-fidelity simulation training center accredited by the Society for Simulation in Healthcare. ParticipantsThe study recruited 80 trauma service providers, including 35 general surgeons, 15 emergency physicians, 10 anesthesiologists or intensivists, 6 neurosurgeons, 4 orthopedic surgeons, and 10 emergency nurses from five trauma centers under the Hospital Authority. All underwent the Advanced Trauma Life Support training in advance. ResultsCompared with reference score from previous training sessions, the result of program using new training curriculum and simulator demonstrated significant training satisfaction of participants (Level-1), and high level of assertiveness, mental preparedness, self-efficacy, and internal locus of control and responsibility (p < .01, for all in Level-3). All participants (N = 80) completed entire Cricothyroidotomy procedure in 2 min without technical errors (Assessment passing rate = 100%) (Level-2). ConclusionsUnder Kirkpatrick model, simulation training in Cricothyroidotomy procedure using new curriculum and simulators has been proven to be useful for healthcare professionals involved in trauma service management. The result suggests that application of a state-of-the-art training tools to advanced surgical skills training could improve training satisfaction, knowledge and skills acquisition, and personal strengths transferable to clinical practice. ACGME competenciesPractice Based Learning and Improvement.

Resuscitation from cardiac arrhythmia, requiring cardioversion/defibrillation is a common simulation training scenario. Use of live defibrillation enhances simulation fidelity but is not without risk. This survey was conducted to describe the prevalence of live defibrillation use during training scenarios in healthcare simulation centers, and when used, if safety training was required before using live defibrillation. A convenience sample of attendees at the 7th annual International Meeting on Simulation in Healthcare (January 2007) was surveyed using a closed-ended 23-item survey instrument. Survey domains included responder and simulation center demographics, simulation center defibrillation safety policies, and attitudes toward defibrillation practices in simulation training environments. Fifty-seven individuals representing 39 simulation centers returned surveys, 29 of which were in the United States. Live defibrillation was used in 35 of the 39 centers (90%). A defibrillation safety training policy was in effect at 14 of 39 centers (36%). Formal training before using live defibrillation was considered necessary by 48 of 55 responders (87%). Forty-eight of 54 responders (89%) strongly agreed or agreed with the statement, "I feel using live defibrillation plays an important role in simulation-based education." Although most responders consider use of live defibrillation important and believe formal defibrillator safety training should be conducted before use, only about one third of the centers had a training policy in effect. It remains to be determined whether safety training before the use of live defibrillation during simulation-based education increases user safety.

Simulation-based education (SBE) is increasingly used as an education tool to improve learning for healthcare providers. In newborn care practice, SBE is used in the Neonatal Resuscitation Program (NRP) and training in procedural skills. The NRP is a mandatory course in Malaysia for all house officers (interns) and medical officers (residents) during their pediatric rotation. Almost 30,000 of NRP providers have been trained over the last 5 years. The recent establishment of the Allied Healthcare Center of Excellence (AHCoE), an organization dedicated to promoting SBE, and Malaysian Society for Simulation in Healthcare (MaSSH) aims to enhance the integration of SBE into the healthcare training curriculum and set up a local healthcare simulation educator training program. Our experience in implementing SBE necessitated that we made several important choices. As there was no strong evidence to favor high-fidelity over low-fidelity simulation, and because simulation centers can be very costly to set up with limited resources, we chose SBE mainly in the form of low-fidelity and in situ simulation. We also identified an important developmental goal to train Malaysian instructors on structured debriefing, a critical activity for learning in SBE. Currently, debriefing is often carried out in our centers at an ad hoc basis because of time limitation and the lack of personnel trained. Finally, we aim to implement SBE further in Malaysia, with two axes: (1) the credentialing and recertification of physicians and nurses, and (2) the education of lay caregivers of high-risk infants before discharge from the neonatal intensive care unit.

Background/Aims/ContextThe Debriefing Assessment for Simulation in Healthcare Student Version (DASH-SV) is a 6 element questionnaire, with each element scored on a 7 point effectiveness scale, designed for completion by simulation...

Faculty development in medical simulation is a growing need, given the increased use of simulation-based learning in healthcare. Training of trainers is demanding and resource-consuming; therefore, there is a need for accessible, practical, and resource-saving solutions enabling efficient faculty development. For that purpose, we investigated whether a massive open online course (MOOC) could meet these challenges. This manuscript presents a MOOC, its pedagogical strategies, and its impacts on faculty development. The University of Liège Medical Simulation Center developed a MOOC with five learning units focused on the foundations of simulation training. Each unit ends with a set of theoretical and practical exercises. Our results showed knowledge and skills acquisition (objective exercise score data) among participants with a success rate of 67%, as well as high levels of engagement and confidence in learning (self-reported data). We demonstrate that a MOOC for faculty development in healthcare simulation is effective, has the potential to be an accessibility enabler, and offers an additional tool for trainer training. We recommend designing it with various asynchronous online modalities and multiplying social interactions with peers and trainers to favor trainees’ engagement and subsequent learning. Further perspectives should study blended learning strategies in faculty development and define the optimum ratio between face to face and online synchronous and asynchronous modalities.Graphical Characteristics and advantages of MOOCs as an asynchronous online teaching tool for faculty development in healthcare simulation.

Despite its evidenced effectiveness in clinical education,1 simulation training is an underused resource in foundation doctor education at Milton Keynes University Hospital (MKUH). In addition, human factors (HF) training is a black hole in the foundation programme curriculum, despite its widespread use to promote safe and efficient working in other high-reliability organisations. A number of high profile cases have highlighted the importance of human factors training for healthcare professionals.2 We aimed to fill both of these training voids with a human factors simulation programme aimed directly at FY1s at MKUH. After identifying key concepts and learning needs, we delivered an introductory lecture on the practical applications of HF theory. This included: communication skills, handover, bandwidth, leadership, raising concerns and situational awareness. Following this, a 12 week programme of weekly simulations training was delivered. This was based around common clinical scenarios often encountered by FY1s. All scenarios had been encountered by ourselves as FY1s. The main emphasis of the simulations was the real-time application of HF theory in a clinically relevant context. We designed 4 separate clinical scenarios pairing each with a key HF concept. We selected escalation to seniors, communication, situational awareness and bandwidth as the key learning points. We chose these as they were deemed the most applicable to everyday life as a junior doctor. These were conducted in a simulation suite with a 3G simulation manikin and trained simulation technicians. Senior ICM clinicians were present to observe and debrief on both clinical and HF components of each scenario. Session feedback was gathered via a questionnaire assessing; content, structure, presentation and environment, with each domain scored 1–5. In addition, the Debriefing Assessment for Simulation in Healthcare (DASH) tool was used by FY1s to assess the debriefing process. Although ongoing at the time of submission, feedback has been universally positive. Average score for session content was 9.7/10, whilst session structure averaged 14.2/15. A consolidation lecture has been arranged after which we will attempt to quantify FY1 confidence in the HF domains simulated, and how this has impacted on clinical practice. An understanding of human factors is essential for healthcare professionals to work safely and effectively; currently this plays a limited role in our foundation programme curriculum. We believe that this novel programme helps address these unmet educational and professional needs. We intend to expand and develop this programme to include multidisciplinary cohorts, across several local health trusts. References Bullock A, Webb K. Technology in postgraduate medical education: A dynamic influence on learning?Postgraduate Medical Journal2015;91:646–50. doi:10.1136/postgradmedj-2014-132809 Bromiley M. The husband’s story: From tragedy to learning and action. BMJ Qual Saf2015;24:425–7. doi:10.1136/bmjqs-2015-004129

You've Got to Have the Right Stuff

Footnote: Further copies of this guideline together with annotated references can be obtained from Director, Bureau of Communicable Disease Epidemiology, Laboratory Centre for Disease Control, Health Protection Branch, Department of National Health and Welfare, Ottawa, Ontario K1A 0L2. Also available are copies of other guidelines in the Infection Control series including: Guidelines for 1. Prevention of Intervascular Infections 2. Prevention of Surgical Wound Infections 3. Prevention of Nosocomial Pneumonia, 4. Prevention of Urinary Tract Infections, 5. Hospital Environmental Control (1988), Isolation and Precaution Techniques (1990), Long Term Care Facilities (1986), Occupational Health in Health Care Facilities (1986, under revision). Organization of Hospital Infection Control Programs (1985, under revision), Perinatal Care (1988). Guidelines for Infection Control Within a Correctional Environment have also been developed and have been published by the Correctional Service of Canada.

As Accessible as a Book on a Library Shelf: The Imperative of Routine Simulation in Modern Health Care

Clinical simulation is a teaching strategy that replicates medical situations in controlled environments. The COVID-19 pandemic created disruptions for healthcare simulation centers. As a response, the Universidad Anáhuac designed online clinical simulation practices and assessments. The pre-intervention survey showed skeptical medical students (59.15%) to continue this learning format. The intervention included neurology, cardiology, and gynecology topics supported by five faculty members and staff. Instruments were examination checklists to evaluate the clinical competence based on a 100 score and the Debriefing Assessment for Simulation in Healthcare (DASH) with a 1 (extremely ineffective) to 7 (extremely effective) score. Students received individual training by Zoom, including simulation practices, debriefing, and assessment. Even though it seemed impossible to address clinical skills by distance, simulation practices continued with online resources. Collaborative participation between faculty, students, and staff facilitated learning during the COVID-19 conditions.

Integrating medical simulation programs into the Turkish undergraduate medical curriculum Dilek Kitapçıog˘lu, Mehmet Emin Aksoy Medical Education Department, Faculty of Medicine, Acibadem University, CASE - Center of Advanced Simulation and Education, Istanbul, TurkeyThe letter by Ah-kee and Khan1 arguing that a mandatory year for studying leadership management within an already overcrowded undergraduate curriculum is not realistic and feasible drew our attention. We strongly support this idea because of the difficulties we met during integration of simulation programs into the undergraduate curriculum in Turkey.View the original paper by Ah-kee and Khan.

Evidence shows the use of interventions to prevent falls are costly to healthcare facilities. Using a sample of older adult patients who fell at least once during the intervention year of a three-year cohort study in one long term care nursing facility, at a continuing care community providing skilled nursing and assisted living, we provide detailed evidence of the number and costs of durable medical equipment and number and type of non- durable medical nursing care interventions utilized to prevent subsequent falls. This level of description can aid healthcare facilities and administrators in their plans to reduce recurrent falls among older adults.