Improvement In Confidence Levels Research Articles

Harvard Medical School Global Mental Health: Trauma and Recovery Course: What is the Global Impact? Three Year’s Results

Purpose: This paper describes and documents an innovative blended learning Global Mental Health: Trauma and Recovery certificate training course. This course combines a two-week face-to-face training in Orvieto, Italy with a five-month follow-up online virtual training as a learning experience for global health care practitioners. Continuing medical education (CME) accreditation is offered upon completion. This course utilized an innovative blended learning model with a community of practice approach, a combination of lectures and discussions, and online in-depth group case study discussions. Methodology: Data was collected by self-reported anonymous evaluation by participants of three continuous years of the CME Global Mental Health: Trauma and Recovery certificate training course sponsored by Harvard Medical School. One hundred fifty-five participants (n= 39 in 2011; n = 57 in 2012; n=59 in 2013) underwent a pre- and post-course evaluation to determine sustained confidence in performing medical and psychiatric care to traumatized patients and communities, as well as to determine their learning of the Global Mental Health Action Plan (GMHAP). Results: Over the course of three independent years, a total of 155 participants were evaluated. There was evidence for significant improvement in their confidence levels in all clinical areas (diagnosis; treatment of trauma; use of psychotropic medication) when comparing baseline to completion of the six-month course. All ten dimensions of the GMHAP and nine medical and psychiatric aspects of treatment revealed significant improvement in confidence levels. Regression analysis also indicated similar results after the adjustment of demographic covariates. Physicians and participants with mental health and social work background had significantly higher confidence. Participants who were MD’s or psychiatrists had higher confidence in most of the categories of confidence except for self-care, understanding culture, collaboration, and policy and financing. The model showed no difference in learning based upon gender and level of development of country of origin. Conclusion: The evaluation of this blended learning CME program provides evidence of significant enhancement of clinical practice and planning skills in health care practitioners working with highly traumatized patients and communities worldwide. This successful training over the past 18 years has gone far to achieve the health and mental health capacity building as requested by the Ministers of Health from post-conflict societies in the historic Rome meeting in 2004.

Multidisciplinary Obstetric Simulation Training: Experience at KK Women's and Children's Hospital (KKH), Singapore, a Tertiary Referral Centre.

Background Multidisciplinary simulation training in the management of acute obstetric emergencies has the potential to reduce both maternal and perinatal morbidity. It is a valuable tool that can be adapted for targeted audiences of different specialities at all experience levels from medical students to senior consultants. Methods In this study, pre- and post-course questionnaires of learners with varying levels of clinical experience from Obstetrics and Gynaecology (O&G), Anaesthesia, Neonatology, Emergency Medicine, midwifery, and nursing who undertook two simulation courses (namely the Combined Obstetrics Resuscitation Training course, CORE, and the CORE Lite), which comprised lectures and simulation drills with manikins and standardized patients, between 2015 and 2023 were compared. This also included a period when training was affected by the coronavirus disease 2019 (COVID-19) pandemic. Results The results showed that both simulation courses increased confidence levels amongall learners in the management of obstetric emergencies. Pre-course, participants were most confident in the management of neonatal resuscitationand severe pre-eclampsia, followed by postpartum haemorrhage.They were least confident in the management of vaginal breech delivery, uterine inversion, and twin delivery. Post-course, participants were most confident in the management of neonatal resuscitation and shoulder dystocia, followed by postpartum haemorrhage. They were least confident in the management of uterine inversion and maternal sepsis, followed by vaginal breech delivery and twin delivery. Whilst we saw a huge improvement in confidence levels for all obstetric emergencies, the greatest improvement in confidence levels was noted in vaginal breech delivery,twin delivery,and uterine inversion. Conclusion The simulation courses were effective in improving the confidence in the management of obstetric emergencies. While it may be difficult to measure the improvement in clinical outcomes as a result of simulation courses alone, the increase in confidence levels of clinicians can be used as a surrogate in measuring their preparedness in facing these emergency scenarios.

1234 IMPROVING HEART FAILURE MANAGEMENT WITHIN HOSPITAL AT HOME

Abstract Introduction Heart failure (HF) is a common problem managed in our West Lothian multi-disciplinary hospital at home (HaH) service, however significant variation in practice was noted with considerable resource implications. We aimed to standardise and improve this by developing a dedicated protocol. Methods We developed a protocol to guide the assessment and management of HF within HaH. We collected baseline (n=25) and follow-up data (n=10) after protocol introduction from patients referred to HaH with heart failure. Outcomes reviewed included anticipatory care planning (ACP) decisions, length of stay (LOS) and treatment strategy. We held staff education sessions and surveyed staff confidence regarding HF management. Results ACP discussion rates improved after protocol introduction, with decision rates improving for both escalation of care (28% to 80%) and resuscitation (44% to 60%). LOS reduced after protocol introduction (mean 6.3 days to 5.9 days). Titration of oral diuretics alone (71%) was associated with a shorter LOS (mean 5.4 days) compared to IV (29%, mean 8.1 days), with no difference in 28 day outcome. In those with HF with reduced ejection fraction, the rates of beta-blocker prescription increased (57% to 80%) however ACE-inhibitor prescription decreased (29% to 20%). Use of add-on therapy (e.g. thiazide diuretics) increased (12% to 30%) with a decrease in complication rates (12% to 0%). All staff found the protocol helpful with an improvement in confidence levels. Conclusions Through introducing a standardised protocol, we observed an improvement in anticipatory care discussion rates and a trend towards shorter LOS. Oral diuretic titration was less resource intensive without an adverse impact on outcome. Future plans include ongoing education and data collection, trialling a joint multi-disciplinary meeting with cardiology for discussion of complex patients and embedding a treatment strategy of oral diuretic titration with a ‘discharge with planned review' approach in appropriate patients.

Building resilience through improving groundwater management for sustainable agricultural intensification in African Sahel

BackgroundThis paper examines the role of improved groundwater access and management in providing opportunities for sustainable agricultural intensification and building the resilience of community farmers in Southern Burkina Faso. The findings contribute to current debates about pathways of commercialisation and adaptation in the African Sahel, especially those seeking to find responses to managing the impacts of climate change and delivering on the Sustainable Development Goals.MethodsThis paper presents data that has been thematically analysed based on the Framework for Sustainable Intensification developed by Pretty and Bharucha (Ann Bot 114:1571–1596, 2014). The data used includes 144 Vulnerability Baseline Assessments which were conducted at the start of the project with the four target Burkinabe communities (Kado, Poa, Tomo, and Zhilivele), and 33 monitoring interviews and vulnerability assessments from the Burkinabe communities of Poa and Tomo to track progress and behaviour change resulting from the BRAVE project interventions.ResultsThe data analysis showed that Burkinabe communities are already making some use of groundwater to support their agricultural livelihoods; most do this through accessing groundwater from shallow wells. It was also shown that there were improvements in the four main themes Identified by the Sustainable Intensification Framework. These included improved information sharing through increased peer-to-peer learning and improvements in confidence levels; improved social cohesion through reduction in community conflict over water resource management; asset improvements shown by tangible improvement of yields; and increased awareness exemplified by behaviour change.ConclusionsThrough using the Sustainable Intensification framework, this paper argues that such an approach improves essential aspects of resilience building such as information sharing, improved local governance and increased social capital and income. We argue that such changes provide essential pathways to reducing vulnerability and increasing resilience of at-risk communities in the Sahel, but that national policy alignment and investment is essential for long term change and sustainability.

Global virtual strabismus surgery teaching for ophthalmology residents during COVID-19

In response to the COVID-19 pandemic, the World Society of Pediatric Ophthalmology and Strabismus (WSPOS) piloted strabismus surgery simulation webinars providing real-time surgical instruction using an accessible model eye. The purpose of this study was to demonstrate improvement in confidence level with strabismus surgery among ophthalmology residents who participated in the webinar.

Point-of-Care Ultrasound Curriculum for Internal Medicine Residents During the COVID-19 Era: A Pilot Study.

Introduction: The use of point-of-care ultrasound (POCUS) by internal medicine physicians and residents is increasing. We present the results of a pilot study to implement a POCUS curriculum that was interrupted by the Coronavirus Disease 2019 (COVID-19) pandemic at an internal medicine residency program at a community hospital. The purpose of this study is to inquire about the attitude and interest of our medical residents in POCUS. Additionally, we also plan to examine whether a curriculum that lacks some practical aspects due to COVID-19 restrictions can still improve the residents’ confidence in recognizing common POCUS applications and improve image interpretation skills.Methods: We conducted a prospective, pre-, and post-curriculum pilot study to examine the POCUS skills of categorical internal medicine residents in Post-Graduate Years (PGY) 1 through 3 at a community hospital. The two POCUS-related skills examined were self-reported confidence level in recognizing certain POCUS examination findings and POCUS image interpretation skills. Due to social distancing guidelines, we were unable to host hands-on sessions as originally planned, but residents did receive lectures via Zoom regarding POCUS training and also organ-specific diagnoses. Three primary outcomes were measured: (1) baseline difference in confidence level between interns (PGY-1) and senior residents (PGY-2 and 3) at the beginning of the curriculum, (2) improvement in POCUS confidence level before and after the curriculum considering interns and senior residents all together and also separately, and (3) improvement in image interpretation skills before and after the curriculum.Results: Of 41 residents, 23 participants completed the pre- and post-curriculum test. Of the 23 participants, 12 participants were interns, and 11 were senior residents. Overall, interns showed a statistically significant improvement in the confidence level in almost all diagnoses except pulmonary embolism (p = 0.084). For image interpretation tests, significant improvement was found only in recognizing the two signs of pneumothorax: pleural line absent sliding (X2 = 4.00, p < 0.05) and the barcode sign (X2 = 6.13, p < 0.05). The pre-curriculum confidence level questionnaire included a question about residents’ interest in learning POCUS during residency. It showed that the vast majority of residents (21 residents [91%]) are either extremely or mostly interested in POCUS. Most of our residents (18 [78%]) did not have formal exposure to POCUS during medical school.Conclusion: A POCUS curriculum that lacks hands-on workshops and longitudinal image saving and reviewing due to the COVID-19 pandemic restrictions did not improve the residents’ image interpretation skills, although the confidence levels of the interns statistically improved. After the pandemic, we plan to implement the full curriculum and examine whether it will improve the residents' image acquisition and interpretation skills.

SPT and SPTA tandem learning in a pro bono environment: a model for intraprofessional learning

Objective: Clinical education and collaboration are critical components of developing student physical therapists (SPTs) into safe and competent clinicians. While students may find themselves in various settings upon entering the workforce, working alongside a physical therapist assistant (PTA) is highly likely. With the rise in demand for therapy services, realistic and comprehensive training in SPT-SPTA (student PTA) collaboration is needed to support quality health care. Model: A student-run pro bono clinic hosted within a Midwestern DPT Program uses a peer-to-peer model that provides the space for collaborative learning between SPTs and SPTAs. Serving as a clinical rotation site for 4 weeks, the pro bono clinic schedules an SPTA alongside a pair of SPTs. Discussion: SPTs gain early experience in decision-making related to delegating tasks to SPTAs with various skill levels, engaging in intraprofessional communication and reporting improvements in confidence levels. Qualitative reporting from the SPTAs and their host institution’s faculty indicate that the team approach to learning has become a preference among their students. Furthermore, students feel more comfortable learning and working with fellow young professionals, showing more significant interactions with clients and more opportunities for clinical growth. Clinical relevance: This model combines two previously described beneficial approaches to learning: a program attached pro bono clinic and a PT/PTA team learning environment. Integrating these concepts may catalyze intraprofessional education of SPTs and SPTAs.

120 Improving Delirium Recognition and Management Through In-Situ Simulation

Abstract Introduction Delirium is a common condition that is often associated with increased morbidity and mortality, longer hospital admission, and discharge to a residential or nursing home. By improving our ability to recognise and manage these patients we can intervene early to help reduce the likelihood of these outcomes. Method We organised several in-situ simulation scenarios with junior staff working on the Elderly Care Unit. The research team designed a scenario to re-create a typical delirious patient on the ward. Participants had to recognise the patient was delirious and instigate a management plan. Participants completed a pre and post-intervention questionnaire to ascertain whether they felt the simulation had improved their confidence. Additionally we performed an audit to investigate whether our intervention led to an improvement in the recognition and management of delirium in patients on the ward. Results The questionnaires showed an increase in participants’ confidence and knowledge when managing a delirious patient on the ward. From reviewing patient notes pre-intervention we identified that 24 patients were delirious during admission,14 of which were accurately diagnosed with delirium. The remaining 10 patients were diagnosed with “Acute Confusion”. On reviewing these 10 patients’ notes, they were all likely to have a diagnosis of delirium. Post-intervention there were 14 patients identified as delirious during their admission. All these patients were correctly documented as having delirium with no inaccurate use of terminology. The data also showed increasing use of tools such as AMTS and 4AT to diagnose delirium. Conclusions From the data gathered, we can see participants are better at recognising and diagnosing delirium. However, our sample sizes are too small to test statistical significance between data points. To improve the project we would include a larger sample size to determine whether the simulation produces a statistically significant improvement in confidence levels.

Assessing domain based teaching skills of postgraduates after a workshop on effective lesson plan

Introduction: Despite having to spend a substantial amount of time in teaching undergraduates, postgraduate students do not receive any formal instructions on teaching skills. We undertook a project which aimed at imparting basic teaching skills to postgraduates in the form of formulating a good lesson plan and a study to see whether there was an increase in their confidence levels. Three assessors independently assessed the postgraduates’ use of the domains of a lesson plan as a means of data triangulation. Objectives: Train postgraduate students in constructing a good lesson plan. Evaluate the outcomes of this educational program. Material and Methods: The change in confidence levels of postgraduates was assessed through a retro-pre questionnaire and a check list was used by three independent faculty to assess the use of the domains of a lesson plan and to judge the overall effectivity of teaching. Kappa statistics was used to determine the agreement between the three assessors. Results: A significant improvement in confidence levels of the postgraduates in use of the domains of the lesson plan was observed. The assessors found 70-100% use of the domains of a lesson plan which resulted in effective teaching. The assessors also identified some domains which had not been addressed adequately by the postgraduates. Conclusion: Our study demonstrated an improvement in confidence levels of the postgraduates and assessor evaluation confirmed the improvement in their teaching skills .The road ahead would involve retraining the participants in concepts that they found difficult to emulate, include more postgraduates into the program and obtain student perspective on the teaching skills of postgraduates. Keywords: Postgraduates, Teaching skills, Lesson plan.

A low cost surrogate eye model for corneal foreign body removal

BackgroundPatients commonly present to the Emergency Department with a corneal foreign body (FB). There is currently a lack of adequate training for junior doctors in the management of this condition. Our self-made surrogate eye model aims to address this void in our junior doctors’ knowledge.MethodsParticipants were guided through a hands-on session with a slit-lamp using our eye model, which is made of a hemispherical agar embedded with pencil lead fragments simulating as FBs. Using a 7-point Likert scale, all participants completed a questionnaire both before and after training, for: (1) knowledge in corneal FB removal, (2) confidence in corneal FB removal, and (3) effectiveness of the model.ResultsOut of 73 participants, 82.2% (60/73) had no prior experience in corneal FBs removal. After the training session, their knowledge improved from a median score of 2 (interquartile range [IQR] 1 to 3) to 5 (IQR 5 to 6), with improvement in confidence levels from 2 (IQR 1 to 2) to 5 (IQR 4 to 6). The effectiveness of our eye model scored a median of 6 (IQR 5 to 7).ConclusionsOur surrogate eye model is low-cost, quick and easy to reproduce. After use, our learners expressed greater confidence in managing the removal of corneal FBs and use of slit lamp. With a recent focus in patient safety and quality, teaching this procedure via simulation is a safe way of bridging the gap between traditional didactic teaching and the clinical environment.

Computer access of morning report/ Harrison Club PowerPoint presentations to the medicine residents has improved their confidence in management and in preparation for the monthly exams and for the American Board of Internal Medicine: an innovative education quality improvement project at Harlem Hospital center

ABSTRACT Background Morning report is an important conventional teaching activity of residency programs worldwide. Objectives We aimed at creating a shared digital folder of the morning report/Harrison Club presentations for the training year of 2018–2019. Our primary objective was to assess the residents’ satisfaction regarding its accessibility, as well as to estimate the percentage of residents who felt improvement in confidence levels in their management skills and their preparation for the monthly exams and for the American Board of Internal Medicine (ABIM). Methods This study is a cross-sectional study comparing the three different Post-Graduate Year residents. An anonymous questionnaire was distributed to 44 participating residents, and a multivariate analysis test was conducted. Results Most of the residents thought the morning report/Harrison Club folder was easily accessible. 86.7%, 82.4% and 83.3% found it valuable to improve their confidence in management; 80%, 70.6% and 83.3% found it valuable to improve their confidence in preparation for the monthly exams; and 86.7%, 82.4% and 83.3% found it valuable to improve their confidence in preparing for the ABIM among the PGY1, PGY2, and PGY3 residents, respectively. Conclusion Almost all the residents agreed that they would recommend adoption of a similar digital tool in other residency programs.

Addressing Educational Needs in Managing Complex Pain in Cancer Populations: Evaluation of APAM: An Online Educational Intervention for Nurses.

Cancer-related pain is associated with significant suffering and is one of the most challenging symptoms to manage. Studies indicate that front-line clinicians often lack the knowledge on best practices in cancer pain management. The current project, a quality improvement (QI) initiative, evaluated the outcome of an online educational intervention for nurses on complex cancer pain management. An online 7-module educational intervention, Advanced Pain Assessment and Management, was offered from 2012 to 2017. Pre-post course evaluations included self-reported knowledge and confidence across cancer pain management domains. In-course competency assessments included knowledge examination, online discussion forum participation, opioid dosage calculation assignment, and small-group-based case study. A mixed-model statistical analysis was used to assess pre-post course change in pain management confidence level. In all, 306 nurses from 89 hospitals in Ontario, Canada, were enrolled in the course; 81.4% returned the precourse survey and 71.9% successfully completed the course. The average confidence level on pain management was low at baseline (57.5%) but improved significantly post-course. In-course competency assessments ranged from 81% to 89%. Mixed-model results showed post-course improvements in confidence levels, independent of sociodemographic background, clinical role, and professional educational level. Nurses with longer years of practice and more cancer cases reported greater confidence. A facilitator-led online educational intervention focusing on complex cancer pain management can significantly improve nurses' knowledge, confidence, and skills. Low baseline knowledge among nurses highlights the pressing need for health-care organizations to implement cancer pain management training as an integral part of health-care QI initiative.

Improvement in Confidence Levels for the Management of Paediatric Cardiac Arrests in Medical Students Following a Training Course.

BackgroundNewly qualified doctors lack competency in handling a cardiopulmonary resuscitation. The ability to recall CPR fundamentals have been shown to be inadequate. Of greater concern is that medical students over - estimate their ability to deliver such aid in a real - world setting. As most medical students are only taught adult BLS they are often unskilled and/or unhelpful in managing paediatric specific emergencies. This fact is supported by the poor outcomes demonstrated in delivering successful Paediatric Basic Life Support (PBLS).ObjectivesOur aim was to evaluate the baseline confidence levels of medical students in dealing with a paediatric cardiac arrest (PCA) and the improvement seen following a PBLS training course.MethodsA prospective study was conducted on 51 medical students who attended an established one - day PBLS and first aid course at one UK medical school. Participants were requested to complete a questionnaire directly prior to and after the course.ResultsFollowing the delivery of the training, the cohort reported a statistically significant (P < 0.05) increase in mean confidence with PCA from 2.2/10 (2.2 out of 10) to 7.5/10. A pre - training mean confidence score of 2.6/10 was observed for Year 4 and 5 students who are close to graduating.ConclusionsOur findings clearly demonstrate very poor confidence among medical students with PCA at all stages of their training. We would strongly advocate the inclusion of a PBLS component in medical school curriculums so that future doctors are adequately prepared to deliver PBLS with confidence.

Using simulators to teach pediatric airway procedures in an international setting

IntroductionThere has been a growing shift towards endoscopic management of laryngeal procedures in pediatric otolaryngology. There still appears to be a shortage of pediatric otolaryngology programs and children's hospitals worldwide where physicians can learn and practice these skills. Laryngeal simulation models have the potential to be part of the educational training of physicians who lack exposure to relatively uncommon pediatric otolaryngologic pathology. ObjectivesThe objective of this study was to assess the utility of pediatric laryngeal models to teach laryngeal pathology to physicians at an international meeting. MethodsPediatric laryngeal models were assessed by participants at an international pediatric otolaryngology meeting. Participants provided demographic information and previous experience with pediatric airways. Participants then performed simulated surgery on these models and evaluated them using both a previously validated Tissue Likeness Scale and a pre-simulation to post-simulation confidence scale. ResultsParticipants reported significant subjective improvement in confidence level after use of the simulation models (p < 0.05). Participants reported realistic representations of human anatomy and pathology. The models' tissue mechanics were adequate to practice operative technique including the ability to incise, suture, and suspend models. ConclusionThe pediatric laryngeal models demonstrate high quality anatomy, which is easy manipulated with surgical instruments. These models allow both trainees and surgeons to practice time-sensitive airway surgeries in a safe and controlled environment.

Teaching Spinal Cord Neuroanatomy through Drawing: An Interactive, Step-Wise Module.

This interactive, case-based module was created to provide medical students with self-guided practice to improve their confidence with, and understanding of, neuroanatomy. The module was created to supplement neuroanatomy instruction. It is based on the idea that pictures and drawings are effective tools for teaching clinical neuroanatomy, especially when paired with a step-wise approach to solving clinical cases. The learning module focuses on the basics of spinal cord anatomy and lesion localization, topics fundamental to neuroanatomy. Students who have had a basic introduction to these topics in their neuroanatomy course will find this module a useful educational supplement. A full version of the module, which includes a self-drawing component for additional reinforcement, can be completed in approximately an hour. A shorter version without the self-drawing component, can be completed in less time. The materials associated with the module include an answer packet to use as a guide through the module cases, and both pre- and postmodule practice questions for self-evaluation. Both modules were tested at our institution by separate groups of second-year medical students in the early portion of their neuroanatomy course. Both module versions showed significant improvement in confidence levels when describing spinal cord anatomy and lesion localization. Furthermore, students were highly satisfied with the material and reported they were likely to reuse it for additional studying. The use of this module by medical students during their neuroanatomy course provides a step-wise, case-based approach that simplifies the learning of learning neuroanatomy, and improves their confidence through pictures and drawings.

Evaluating the Effectiveness of the General Surgery Intern Boot Camp

The aim of our study is to evaluate the effectiveness of newly implemented general surgery intern boot camp. A 2-day didactic and skills-based intern boot camp was implemented before the start of clinical duties. Participants who did not attend all boot camp activities and had prior postgraduate training were excluded. A survey utilizing a 5-point Likert scale scoring system was used to assess the participants' confidence to perform intern-level tasks before and after the boot camp. Subgroup analyses were performed comparing changes in confidence among graduates from home institution versus others and general surgery versus other subspecialties. In the analysis, 21 participants over two years were included. Among them, 7 were graduates from home institution (4 general surgery, 3 subspecialty) and 14 were from other institutions (6 general surgery and 8 subspecialty). There were significant increases in overall confidence levels (pre = 2.79 vs post = 3.43, P < 0.001) after the boot camp. Additionally, there were improvements for all subcategories including medical knowledge (2.65 vs 3.36, P < 0.001), technical skill (3.02 vs 3.51, P < 0.001), interpersonal skills and communication (3.04 vs 3.53, P = 0.001), and practice-based learning (2.65 vs 3.41, P = 0.001). There was an improvement in confidence level for both home institution graduates (2.89 vs 3.53, P = 0.022) and other graduates (2.74 vs 3.34, P < 0.001). Similarly, participants from general surgery (2.78 vs 3.46, P = 0.001) and other specialties (2.74 vs 3.34, P < 0.001) reported significant improvement in confidence. General surgery intern boot camp before the start of official rotation is effective in improving confidence level in performing level-appropriate tasks of the incoming new interns.

Simulation-based otolaryngology - head and neck surgery boot camp: 'how I do it'.

In otolaryngology, surgical emergencies can occur at any time. An annual surgical training camp (or 'boot camp') offers junior residents from across North America the opportunity to learn and practice these skills in a safe environment. The goals of this study were to describe the set-up and execution of a simulation-based otolaryngology boot camp and to determine participants' confidence in performing routine and emergency on-call procedures in stressful situations before and after the boot camp. There were three main components of the boot camp: task trainers, simulations and an interactive panel discussion. Surveys were given to participants before and after the boot camp, and their confidence in performing the different tasks was assessed via multiple t-tests. Participants comprised 22 residents from 12 different universities; 10 of these completed both boot camp surveys. Of the nine tasks, the residents reported a significant improvement in confidence levels for six, including surgical airway and orbital haematoma management. An otolaryngology boot camp gives residents the chance to learn and practice emergency skills before encountering the emergencies in everyday practice. Their confidence in multiple skillsets was significantly improved after the boot camp. Given the shift towards competency-based learning in medical training, this study has implications for all surgical and procedural specialties.

Geomechanical modelling of CO 2 geological storage with the use of site specific rock mechanics laboratory data

Many diverse challenges – political, economic, legal and technical – face the continued development and deployment of geological storage of anthropogenic CO 2 . Among the technical challenges will be the satisfactory proof of storage site security and efficacy. Evidence from many past geotechnical projects has shown the investigations and analyses that are required to demonstrate safe and satisfactory performance will be site specific. This will hold for the geomechanical assessment of saline aquifer storage site integrity where, compared to depleted hydrocarbon fields, there will be no previous pressure response history or rock property characterization data available. The work presented was carried out as part of a project investigating the improvement in levels of confidence in all aspects of saline aquifer site selection and characterization that could be expected with increasing data availability and in-depth analysis. Attention focused on the geomechanical modelling and the rock mechanics data used to populate models of two storage sites in geological settings analogous to those where CO 2 storage might be considered. Coupled geomechanical models were developed from reservoir simulation models initially incorporating generic rock mechanical properties and then laboratory-derived site-specific properties. The models were run in various configurations to investigate the effect of changing the rock mechanical properties on the geomechanical response of the storage systems. Modelling results showed that the pressure response at one site due to low injectivity caused significant potential for fault reactivation. Increasing the number of injection wells, thereby reducing the individual rates needed to deliver the target capacity, reduced the injection pressures and ameliorated, but did not eliminate, this adverse response.

Improving asthma care in rural primary care practices: a performance improvement project.

Rural areas are often underserviced health areas, lack specialty care services, and experience higher levels of asthma-related burden. A primary care, asthma-focused, performance improvement program was provided to a 6-county, rural-frontier region in Colorado to determine whether asthma care practices could be enhanced to become concordant with evidence-based asthma care guidelines. A pre-post, quasi-experimental design was used. A complex, multifaceted intervention was provided to multidisciplinary primary care teams in practices serving children and adults with asthma. Intervention elements included face-to-face trainings, clinical support tools, patient education materials, a website, and clinic visits. Performance improvement and behavior change indicators were collected through chart audits and surveys from the entire health care team. Participants included three health care organizations and their staff in 13 primary care practices. Overall, all team members reported statistically significant improvements in confidence levels for providing quality asthma care. Chart reviews of asthma patient encounters completed before and after the program demonstrated statistically significant improvements in asthma care practices for asthma control assessment (1% vs 20%), provision of asthma action plans (2% vs 29%), controller prescription (39% vs 71%), inhaler technique assessment (1% vs 18%), and arrangement of follow-up appointment (20% vs 37%). The asthma care-focused, multifaceted, complex, performance improvement intervention provided to rural primary health care teams lead to significant improvements in all indicators of quality asthma care provision to adults and children with asthma. However, significant barriers exist for rural practices to adopt evidence-based asthma care practices.

Board 216 - Program Innovations AbstractYorkshire Immersive Paediatric Simulation

Introduction/Background Junior doctor training in the United Kingdom (UK) has undergone significant changes recently. There has also been a significant increase in the integration and commitment to simulation based learning in the last decade.1 In 2012, a fully immersive simulation training programme was developed and piloted in paediatric simulation within Yorkshire. Lead by two senior Paediatric Simulation Fellows, this has now been fully established. A full year’s cohort of 36 trainees (ST3s) attended the course, aimed at easing the transition to Registrar (Level 2 training) status. We believe that this is one of the first courses of its kind in Paediatrics and helped bridge an important gap in the training programme to prepare junior trainees for the Registrar role. Methods A fully immersive course was established with six scenarios each lasting 30 minutes followed by 40 minutes of video assisted debrief. The scenarios all mapped to the educational curricula for training paediatric doctors. All scenarios are run in a simulated ward and obstetric theatre and use high fidelity simulators and are watched on live video link by other participants. Faculty include two senior grade simulation fellows, a paediatric nurse and a Paediatric Consultant. All trainees completed a Pre and Post course questionnaire, detailing their confidence in scenarios and rating the debriefing sessions. Results: Conclusion All 36 trainees (100%) stated that the course would help them become a better registrar and free text feedback was very positive, with the most cited comment asking to have yearly simulation courses incorporated into the Paediatric training programme in Yorkshire. The feedback from the mandatory course was overwhelmingly positive. There was significant improvement in confidence levels of our trainees’ ability to lead an acute resuscitation, lead a ward round and deliver bad news to parents. Free text also praised the preparation the scenarios gave to performing at a more senior level. Following this year’s review, the course will continue to be mandatory for all ST3 trainees in Yorkshire. There have also been plans made to make the course truly interprofessional using student nurses concurrently as participants in the future.