Traditional Poster Round
Context: : Rigid training systems and increasing clinical service pressures limit educational opportunities, attainment of clinical skills, and acquisition of personal qualities including leadership and team working. This is a particular challenge in high pressure, fast turnover specialties such as Paediatric Emergency Medicine (PEM). We therefore introduced a multi-disciplinary, high fidelity in-situ simulation programme to improve experience and competency relevant to PEM. The programme is fully integrated in the clinical service, occurs in real time, and includes systems testing and multi-professional team working in the Emergency Department and across other hospital specialties. Uniquely, it’s novel approach maintains satisfaction and engagement with the programme. The multidisciplinary make-up of the leadership team ensures engagement from a range of disciplines.
Description: : Our programme syllabus covers 22 core PEM competencies, compiled with a focus on patient safety; these include common, or uncommon but important, events. Programme development included benchmarking from national sources including the PEM curriculum and Major Trauma guidance, staff feedback, nursing competences, and review of governance and patient safety incidents. Simulations focus on clinical skills, protocols, and leadership, and are delivered once to twice weekly, either as “Mini Sim” (15 minutes) or “Big Sim” (one hour); debriefs occur after, and are structured and bespoke for participants, to include clinical and human factors learning. Simulations occur in the department involving staff on clinical shifts, in real time, with real equipment/drugs and contain a formal assessment for the medical and nursing staffs revalidation portfolios. Other specialty teams are included to ensure systems integration and whole-hospital learning, with learning outcomes disseminated via newsletter.
Observation/Evaluation: : In the 21 months the programme has been running for we have trained 121 doctors and 84 nurses through “Mini Sim” and 96 doctors and 154 nurses through “Big Sim”, and have delivered these 90% and 100% of the time respectively. We have dynamic feedback about our programme using a bespoke online Paediatric Point of Care Simulation feedback tool, collected assessments of participants’ confidence prior and post simulations and have evidenced from external hospital teams regarding how our simulation programme has directly improved clinical management. More than 234 work place based assessments have been completed for doctors’ portfolios in the last 21 months. Training of nursing assistants in resuscitation scribing has directly transposed to better clinical notes in actual resuscitation situations. Simulation of 22 core Paediatric Emergency competencies has demonstrated successful acquisition of skills and learning.
Discussion: : This integrated, in-situ programme with a focus on team working, ensuring clinical competency, leadership skill development and patient safety is novel. Our evaluation of the programme reveals that it is embedded, sustainable and goes ahead over 92% of the time. The design of this programme is readily transferrable to other healthcare settings and proves that simulation in healthcare is vital in breaking barriers to clinical skill acquisition, team working and learning receptive leadership training.