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slide1

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
slide3

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 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?
  • twillett@royalcollege.ca
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