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NHS Lothian Clinical Skills Mastery Programme

NHS Lothian Clinical Skills Mastery Programme. James Tiernan June 2014. Implementing safe and effective clinical performance. Postgraduate Clinical Procedural Skills. Is there a problem?. Learning and teaching skills is a challenge. One Approach: The skills carousel.

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NHS Lothian Clinical Skills Mastery Programme

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  1. NHS Lothian Clinical Skills Mastery Programme James Tiernan June 2014 Implementing safe and effective clinical performance

  2. Postgraduate Clinical Procedural Skills Is there a problem?

  3. Learning and teaching skills is a challenge

  4. One Approach:The skills carousel

  5. An alternative approach:Lothian Clinical Skills Mastery Programme Why?Many trainees are not achieving procedural competencies How?A skilled team to facilitate learning via safe, simulated practice. What? The Mastery Programme

  6. KnowledgeSkills DrillsPerformance Safety

  7. Intended Learning Outcomes Trainees After participation in the mastery programme, the doctor in training will have the skills required to achieve competency in mandatory and desired procedural skills to the level of safe clinical performance under supervision. Tutors After participation in the mastery programme, the faculty clinicians will be able to teach clinical procedural skills to doctors in training in an effective and structured fashion, receiving appropriate recognition for their contributions.

  8. NHS Lothian Clinical Skills Mastery Programme Unskilled Doctor Faculty Development + Accreditation Knowledge + Video Packs (On line) Task Trainer Lab Sessions Co-ordination via Online Booking System + Sessional Checklist Skills Assessment Task Trainer In-Situ Sessions Supervised + Video Supervised + Video Ongoing Clinical Practice Supervised Competent Doctor

  9. Education Packs Reading and Video Online New MED Website Checklists Formative assessment

  10. TUtorial Booking System“TUBS” https://tutorialbooking.com Advertise a session Sign up to sessions Automatic feedback generated Teaching Log generated for ARCP All of SE Scotland

  11. Skills Lab Session 1 Trainee + 1 tutor Discussion of experience and concerns Lab environment Demonstration Practise Feedback Trouble shooting and discussion Establish motor skills + clinical decision making

  12. Clinical Session (In situ) 30mins - 1hr 1 Trainee + 1 tutor PAA / ARU / PAA Full Asepsis + Drapes Entire procedure under supervision Feedback Trouble shooting and discussion Establish simulated safety and competence

  13. Faculty Induction and Developmentvia The Clinical Educator Programme

  14. FacultyRight Person – Right Skill – Right Way – Right Place – Right Time Consultant / Registrar / Specialty Doctors facilitators ST3+ Anaesthetics / ITU / Medical specialties / A&E Skill-specific Induction process Introductory session Observation Facilitation (supervised) Facilitation (unsupervised) Accreditation via Clinical Educator Programme Recognised for ARCP / CPD

  15. How can we effectively teach procedural skills?

  16. The Challenge: TRANSFER Learning for Quality and Safety

  17. Johari Window

  18. Development Learning for Quality and Safety

  19. Break it Down Bite Size Chunks

  20. Procedural Phases Preparation, Assistance and Positioning Non technical skills + clinical decision making  Asepsis + Anaesthetic Procedural Pause 3 Point Check Insertion Anchoring + Dressing Completion Documentation / Communication / Trouble shooting

  21. Non- Technical Skills These allow effective and timely Escalation of care Mellanby et al. 2013

  22. Evidence Base

  23. Evidence Base - Outcomes • T1 - Lab measurements • Thoracocentesis / LP / Paracentesis • T2 - Patient care practices • CVC / Laparoscopy • T3 - Patient outcomes • Bacteraemia, ITU admissions, LOS • T4 – Collateral effects • Cost savings, Other trainees McGaghie et al. 2014, Medical Education

  24. Mastery Programme LP StudyAims – To demonstrate: • Improved performance of LP via Mastery methodology • Safety • Sterility • Success • Impact of environment on simulated performance • Added value of in-situ training

  25. Mastery Programme LP Study Reading and Video Learning Phase 1 Lab Skills Session Group A Group B Lab Skills Session In Situ Skills Session Phase 2 Assessment In Situ Phase 3 Follow Up Questionnaire / Interview

  26. Progress • Sessions • Faculty • Feedback • Study outcomes TBA

  27. Next Steps Expansion into other trainee groups Inclusion of other skills Faculty expansion Multi-professional tutors Enhancing faculty + time protection Evaluation of Clinical Outcomes Mastery Model Mandating simulated competency prior to real life Straight forward Challenging Culture change

  28. NHS Lothian Clinical Skills Mastery Programme Unskilled Doctor Faculty Development + Accreditation Knowledge + Video Packs (On line) Task Trainer Lab Sessions Co-ordination via Online Booking System + Sessional Checklist Skills Assessment Task Trainer In-Situ Sessions Supervised + Video Supervised + Video Ongoing Clinical Practice Supervised Competent Doctor

  29. Safety, Sterility and Success Thank you james.tiernan@nhs.net

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