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The use of distance learning technologies to bring simulation based critical care training to a remote community in nort

The use of distance learning technologies to bring simulation-based critical care training to a remote community in northern Canada

Timothy Willett, RCPSC; Susan Brien, RCPSC; Pierre Cardinal, RCPSC & uOttawa; Rick Hodder, uOttawa; John Kim, uOttawa; Dave Neilipovitz, uOttawa; Shahin Shirzad, UBC.

2011 MedBiq Conference, 11 May 2011


Critical care

Critical care

  • Patients with an imminently life-threatening condition

  • Time is tissue

  • Community:

    • Critical illness can happen anywhere

    • Community practitioners  recognition & early intervention

  • Training:

    • Simulation-based

    • ABCs, crisis resource management


The use of distance learning technologies to bring simulation based critical care training to a remote community in nort

Iqaluit

Vancouver

Montreal

Ottawa

Toronto


Iqaluit formerly frobisher bay

Iqaluit (formerly Frobisher Bay)

  • ~3000 km from tertiary care

  • Population 6,200

  • Only hospital in Nunavut (population 30,000)

  • Nunavut > 2,100,000 sq km  15th in world!


Challenges

Challenges

  • Health human resources

  • Transport

  • Access to CPD

  • Cost (either way)

  • Goal: Test a distance-learning model of a simulation-based critical care course (ACES)


Methods

Methods

Funding:

  • Health Canada

  • RBC Foundation

  • Royal College

  • Needs assessment

    • Context

    • Priority needs

    • Learners

  • Modify course


  • Methods1

    Methods

    • Delivery

      • Web modules

      • Lectures

      • Case discussions

      • Task training

      • Simulation

    • Evaluation

      • Questionnaires

      • Pre- and post-course quiz

      • Post-course simulation (on-site)

      • Delayed interviews

    TeleMedicine


    Simucase virtual patient

    SimuCase Virtual Patient

    Operator

    Facilitator

    Learners


    Results sessions

    Results: Sessions

    • 4 web modules

      • poorly used

      • access issues

      • well-liked

    • TeleMedicine: 8 sessions

      • 4 hrs lecture & cases

      • 3.5 hrs task training

      • 4 hrs SimuCase VP

    “In terms of the [TeleMedicine], the mannequins, that kind of thing and doing this all kind of on a long distance basis, I think it was effective.”


    Results questionnaire

    Results: Questionnaire

    Relevant

    Videoconference effective

    Technical skills improved

    Confidence increased

    Will not change practice

    SimuCase allowed practice

    SimuCase feedback useful


    Results quiz

    Results: Quiz

    • 28% improvement

    • Paired t-test (n=10): p=.016

    • Cronbach’s alpha: 0.67


    Results high fidelity simulations

    Results: High-fidelity simulations

    • 2 cases

    • 10 physician candidates: 1 leader, 1 assistant

    • RN actor

    • 2 facilitators from Ottawa

    • Videotaped

    • Checklist: Custom, Delphi process

    • GRS: “Ottawa GRS”

    • Standard: Modified Angoff


    Results high fidelity simulations1

    Results: High-fidelity simulations


    Results delayed interview prevalent themes

    Results: Delayed interview (prevalent themes)

    • Positive experience, appreciative

    • Well qualified instructors

    • Technical problems not significant

    • Changes in:

      • Approach to critically ill patient / priorities

      • Vasoactive medications

      • Assessment / monitoring

      • Confidence

      • Communication

    • Delivery strategy was effective; liked the on-site simulations

    • SimuCase was effective; enhanced skills applicable to high-fidelity simulation


    Lessons learned

    Lessons learned

    • Support from decision-makers

    • Community-based coordinator

    • TeleMedicine tech support

    • Web modules: disc backups

    • Virtual patient works

    • Outcomes positive

    • Limitations:

      • Pilot study, small n, limited rigour


    Thank you

    Thank you

    • Questions?

    • [email protected]


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