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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.

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

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  1. 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

  2. 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

  3. Iqaluit Vancouver Montreal Ottawa Toronto

  4. 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!

  5. 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)

  6. Methods Funding: • Health Canada • RBC Foundation • Royal College • Needs assessment • Context • Priority needs • Learners • Modify course

  7. 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

  8. SimuCase Virtual Patient Operator Facilitator Learners

  9. 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.”

  10. Results: Questionnaire Relevant Videoconference effective Technical skills improved Confidence increased Will not change practice SimuCase allowed practice SimuCase feedback useful

  11. Results: Quiz • 28% improvement • Paired t-test (n=10): p=.016 • Cronbach’s alpha: 0.67

  12. 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

  13. Results: High-fidelity simulations

  14. 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

  15. 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

  16. Thank you • Questions? • twillett@royalcollege.ca

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