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A case for Funding Large Scale Simulations in Australian Healthcare Marcus Watson PhD Senior Director Queensland Health Skills Development Centre School of Medicine, The University of Queensland Does size matter? Does size matter? QH SDC Cairns Townsville Mackay Rockhampton Bundaberg

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a case for funding large scale simulations in australian healthcare

A case for Funding Large Scale Simulations in Australian Healthcare

Marcus Watson PhD

Senior Director Queensland Health Skills Development Centre

School of Medicine, The University of Queensland

slide4

QH SDC

Cairns

Townsville

Mackay

Rockhampton

Bundaberg

Hervey Bay

Roma

Toowoomba (not an official centre)

slide7

Courses Delivered by the SDC

Faculty Training

Emergency and Rural

  • Advanced Life Support – Interns
  • Advanced Cardiac Life Support
  • Clinical Rural Skills Enhancement
  • Emergency Events Management
  • Emergency Crisis Resource Management
  • Emergency Technical Skills Course for Doctors
  • Acute and Critical Medical Emergencies
  • Pre-Hospital Trauma Life Support
  • Paediatric Emergency Crisis Resource Management

Simulation With Integrated Mannequins

Crisis Resource Management Train the Trainer

Difficult Debriefing Training

Grad Dip Health Simulations

Communication Skills

  • Frontline Communications
  • Friday Night in the ER

Intensive Care and Anaesthetics

Surgical and Psychomotor Skills

  • Intensive Care Crisis Event Management
  • Anaesthetic Crisis Resource Management
  • Anaesthetic Crisis Resource Management for GPs
  • Paediatric Anaesthetic Crisis Resource Management
  • Recovery Room Crisis Resource Management
  • Basic Assessment & Support in Intensive Care
  • Effective Management of Anaesthetic Crises
  • Advanced Paediatric Intensive Care Critical Skills
  • Physiotherapy and Critical Care Management
  • Introduction to Physiotherapy CardiorespiratoryManagement
  • Fundamentals of Laparoscopic Surgery
  • Minimally Invasive Surgical Techniques
  • Introduction to Laparoscopic Surgery
  • National Endoscopic Training Initiative
  • Operative Laparoscopy Workshop for O&Gs
  • Perioperative Advanced Laparoscopic Skills

Disaster Medicine

  • Emergo Train

Medical Radiations

Maternity and Newborn

  • Introduction to Vascular Ultrasound
  • Basic Skills in O&G Ultrasound
  • Practitioner Initiated X-ray
  • Maternity Crisis Resource Management
  • Newborn Crisis Recourse Management
changing the face of healthcare
Changing the face of healthcare

What healthcare needs is clinical training on an industrial scale with simulation efficiently integrated into clinical practice along with other educational methods.

identifying the critical motivation
Identifying the Critical Motivation

Training

Systems

Interdisciplinary learning

Technology integration

Human Factors

Non-Technical skills

Safety

Performance assessment

Competency assessment

Quality

Workload assessment

Specialty skills

Quantity

Organisations design

Workplace orientation

Technical skills

Efficiency

Equipment design

Process design

Pre-employment skills

identifying the critical motivation10
Identifying the Critical Motivation

Training

Systems

Interdisciplinary learning

Technology integration

Human Factors

Non-Technical skills

Safety

Performance assessment

Competency assessment

Quality

Workload assessment

Specialty skills

Quantity

Organisations design

Workplace orientation

Technical skills

Efficiency

Equipment design

Process design

Pre-employment skills

identifying the critical motivation11
Identifying the Critical Motivation

Training

Safety

Quality

Quantity

Efficiency

quantity of quality argument
Quantity of Quality argument
  • We have a clinical skills shortage
  • Increasing the number of students increase the burden on already overs stretched clinical mentor
  • We can provide more simulation experience but we cannot guarantee more experience on clinical placements
  • We can control the quality of simulations experience
quantity of quality argument13
Quantity of Quality argument
  • The opportunity for clinicians to develop clinical skills is often haphazard and there are examples of clinicians graduating without having been assessed or in some cases performing crucial clinical skills.

Wall, Bolshaw, & Carolan, 2006, Medical Teacher

Fox, Ingham Clark, Scotland, & Dacre, 2000, Medical Education

Remmen, et. al., 2001, Medical Education

  • In the 1960s medical students received 75% of their teaching at the bedside, in the late 1970s this dropped to 16% and since then it has decreased further.

Ahmed, & El Bagir, 2002, Medical Education

  • The acquisition of basic clinical skills suffered when there is limited supervised hands-on experience, skill levels in health are likely to drop unless alternate training methods are used.

Remmen, et. al., 2004, Medical Education

Seabrook, 2004, Medical Education

safety and efficiency argument
Safety and Efficiency argument
  • Patient error is estimated to have a direct cost in Australia of $2 billion a year
  • Patient are treated by ‘teams’ of clinicians not by a clinician
  • Patient safety reports indicated that non-technical skills are involved in the majority of adverse events reported that cause harm

Wilson, Runiman, Gibberd, Harrison, Newby, & Hamilton, (1995) Medical Journal of Australia

  • Other industries have become safer by a combination of standards, regulations and appropriate preventative
  • Healthcare needs to provide the right training
team training crisis resource management
Team training Crisis Resource Management

Tertiary Hospital 2007

    • Births ~ 4,800
  • Annual mandatory fire drills
    • Fires = 0
  • Annual mandatory basic life support
    • Cardiac emergencies = 0
  • Maternity emergencies that occurred in 2007
    • Cord prolapse = 22
    • Placental abruptions = 41
    • Shoulder dystocia = 71
  • Maternity Crisis Resource Management MaCRM
    • 2 day multidisciplinary workshop including scenarios and structured debriefing
training when where and how
Training – when, where and how
  • Multidisciplinary training in healthcare is starting to occur in hospital systems with varied levels of success. Most issues arrive when clinicians undergo concurrent training rather than training as a team.

El Ansari, Russell & Willsc (2003) Public Health

  • Australia has simulation centres that provide excellent immersive learning for technical and non-technical skills.
    • The training capacity of most centres is not limited by the number of simulators or rooms but rather by the number of instructors and the support staff available to deliver training
    • An analogy is cottage industries that provide high quality products to a small proportion of the population.
training when where and how21
Tertiary Skills Development Centres

Inter-disciplinary training

Specialty training

Technical hub

Supports University training

Conducts major research

Staff 10-50 FTE,

100-200 PT instructors

Affiliated Skills Development Centres

Inter-disciplinary training

Supports University training

Conducts major research

Staff 3-9 FTE, 10-50 PT instructors

Portable Simulations

Inter-disciplinary training

Specialty training

Opportunistic training

Supports University training

Staff 2-3 FTE, 2-100 PT instructors

Departmental ‘Pocket’ Simulations

Department training

Inter-disciplinary training

Opportunistic training

Rehearsals

Research

1-2 FTE, 3-20 PT instructors

Training – when, where and how
how quickly can we grow
How quickly can we grow?

Based on 2007

Queensland Health

clinical population

- Actual training

Days required will

increase

six critical training issues
Six Critical Training Issues
  • The right blended learning environments,
  • Emphasis on the knowledge and skills likely to prevent harm,
  • Standardisation of curriculum and reliable assessment,
  • Training as teams not just as individuals,
  • The use of skilled instructors,
  • Dedicated support staff to provide efficient and accountable education.
questions
Questions

We can do things in simulation we cannot or should not do with ‘real’ patients

We can apply simulation systematically and opportunistically to develop a leaner and safer healthcare system

We can develop more simulation-based training but we cannot rely on more quality clinical training opportunities